Question: Are skin tightening procedures an effective alternative to the neck lift? How do you know when you really just need surgery instead?

Answer: Overall, skin tightening procedures really are not an effective alternative to a neck lift but Ultherapy, which is used to treat the layer of the face deep to the skin, can be very effective at improving a neck.  Ultherapy uses microfocused ultrasound to create small thermal injury zones 3 and 4.5 mm below the skin surface and the new transducer can provide these zone at 1.5 mm under the skin.  A combination of these treatments across the neck and face all create new collagen, which tightens and lifts.  It is actually the only nonsurgical device ever to be given a lift indication by the FDA.  It is, however, most effective in patients with very early signs of aging as it is not going to be able to lift nearly as effectively as a surgical procedure.  If you can lift several centimeters on each side of the jaw then you would be much better off with surgery, but if you can only lift a few millimeters on each side of the jaw and this improves your concern then you may be a candidate for Ultherapy.