Ageing of the neck is multifactorial and often more challenging to treat than facial ageing. The dermis of the neck is thinner, containing less collagen and elastin, leading to reduced structural integrity and elasticity. Fewer sebaceous glands result in dry, more fragile skin.
Constant movement and lifestyle factors such as ‘tech neck’ contribute to early crease formation. The neck is also exposed to environmental damage yet often receives less photoprotection and care than the face. With time, platysmal banding, subcutaneous fat atrophy and mandibular bone resorption reduce support and contour, accentuating laxity [1].
Treatment options range from surgery to minimally invasive methods such as energy-based devices, injectables and biostimulators. One approach is the synergistic use of botulinum toxin type A and hyaluronic acid boosters. Hyaluronic acid boosters improve hydration, elasticity, and surface smoothness, while botulinum toxin relaxes superficial platysmal fibres, reducing fine lines and wrinkles. Together, they offer a minimally invasive yet effective method of neck rejuvenation [2].
Letybo® (letibotulinumtoxin A, Huons Global, South Korea) has been used off-license, including with administration as microdroplets (microtoxin) in combination with non-cross-linked hyaluronic acid — the ‘Korean Glass Facial’ technique [3].
Croma revitalis® skin booster (Croma Pharma, Austria) is a non-cross-linked hyaluronic acid injectable containing 1.8% HA and 2.1% glycerol to enhance hydration. It is indicated for improving skin firmness, tone and elasticity, and for photo-ageing of the face, neck, décolleté and hands. By replenishing the extracellular matrix and stimulating fibroblast activity, it enhances dermal quality and hydration [4].
The combined use of Letybo microtoxin and Croma revitalis® skin booster provides both neuromodulatory and bio-revitalising effects, addressing dynamic and structural elements of neck ageing.
Case report
A female patient in her late 40s presented seeking improvement in horizontal neck lines and mild skin laxity. She was dissatisfied with visible transverse lines and fine wrinkles. The patient was not naïve to aesthetic treatments and followed a consistent skincare regimen. She was aware of the combined botulinum toxin and skin booster protocol and wished to try it to reduce the horizontal lines.
Clinical assessment showed fine to moderate transverse cervical rhytides. On the IBSA Neck Laxity Scale [5], she scored Grade 3, indicating moderate tissue laxity. This treatment approach was considered reasonable and appropriate for her presentation.
Treatment
One treatment session was performed to address horizontal neck lines and improve signs of ageing of the neck. The following treatment protocol was used: 1ml of Croma revitalis® and 50 units of Letybo, diluted in 2.5m of normal saline were mixed using a Luer-lock-to-Luer-lock connector.
The solution was administered using an intradermal microdroplet technique to the neck area, including directly into the transverse cervical rhytides.
Results
Pre-treatment images were taken on 3 June 2025 and post-treatment on 21 August 2025. Visible improvement was noted in horizontal neck lines, fine wrinkles, and overall texture. The skin appeared smoother and more hydrated, with softening of transverse rhytides. The patient expressed high satisfaction. Maintenance included daily broad-spectrum SPF and a retinol-based night moisturiser. Results were explained to be temporary, with repeat sessions every three months recommended for sustained improvement.
References
1. Engerer N, Frank K, Moellhoff N, et al. Aging of the neck decoded: new insights for minimally invasive treatments. Aesthetic Plast Surg 2022;46(4):1698–705.
2. Noormohammadpour P, Ehsani A, Mahmoudi H, et al. Botulinum toxin injection as a single or combined treatment with non-cross-linked high molecular weight and low molecular weight hyaluronic acid gel for neck rejuvenation: A randomized clinical trial. Dermatol Ther 2022;35(10):e15673.
3. Chan B. Korean Glass Facial treatment protocol: combined microtoxin and microhyaluronic acid for facial and neck rejuvenation. Aesthetics and Skin Institute, Melbourne, Australia; 2021.
4. https://www.cromapharma.com/int/
products/skin-booster/
[Link last accessed November 2025]
5. Tateo A, Siquier-Dameto G, Artzi O, et al. Development and validation of IBSA photographic scale for the assessment of neck laxity. Clin Cosmet Investig Dermatol 2021;14:349–54.
Declaration of competing interests: None declared.
