Horizontal neck lines are creases that have set into thin, slackening skin. The neck folds every time you look down, and over the years those folds etch in as rings; hours a day on a phone deepens them, hence ‘tech neck’. Neck skin is thinner than the face, has fewer oil glands and usually gets less sunscreen, so its collagen thins sooner. Some people have faint rings from childhood that deepen with age. Where the tissue under the chin has also folded forward, the slack skin drapes over it and the rings look deeper still. Dr Nish works out which of these your neck has at your assessment.

Yes, in almost every case they can. Rings and a crinkled, papery texture are a skin-quality problem, and skin quality responds to Sofwave™. It is FDA-cleared to lift lax neck tissue: one visit, nothing to recover from. Rings etched into very thin skin are smoothed with Profhilo over 2 visits. If the under-chin has folded forward as well, 720 PDO neck threads reposition it first. The exception is a neck with significant skin excess: there, non-surgical treatment may not achieve what surgery can. Dr Nish tells you that at the assessment rather than after a treatment.

Most lined necks need Sofwave™ alone, and the assessment tells you whether yours is one of them. Rings and crinkle with the under-chin still in place are a firming job, and Sofwave™ does it in one visit. Rings still etched into paper-thin skin after firming are a surface job, and Profhilo rebuilds that surface over 2 visits. A fold under the chin with slack skin draped over it is a repositioning job, and neck threads come first. Where two apply, Dr Nish stages them, where clinically appropriate and in line with manufacturer guidance, and sets the sequence at your assessment.

Sofwave™ softens neck lines by firming and thickening the skin they are creased into; it does not fill a ring one by one. The ultrasound warms the collagen layer about 1.5 mm below the surface. Over 12 weeks the skin rebuilds collagen, so the papery crinkle smooths out and the rings become shallower. In the pivotal study 88% of patients had improved at 12 weeks after a single session, and results keep building to 6 months. A ring etched into very thin skin may need Profhilo afterwards. Results are individual and may vary.

Sofwave™ for the face and neck, which includes the under-chin, is £1,800 as a single session at Medisha Clinic, Mayfair. Profhilo for the neck is £350 a session, or £700 for the 2-session course. A 720 PDO neck thread lift is £750, and the staged Neck Lift Plan of neck threads followed by Sofwave™ is sequenced by Dr Nish and quoted after consultation. Sofwave™ for the décolletage is £1,150. Review appointments are included. Your assessment with Dr Nish is £50 and is redeemable in full against treatment. Medisha Clinic is at 58 South Molton Street, Mayfair, London W1K 5SL, a short walk from Bond Street station.

Neck creams and exercises do not remove rings that have already set in, because the rings are creases in thinned skin rather than dryness or weak muscle. SPF every day slows further thinning and is worth doing; a retinoid may soften surface texture a little over months. Exercises work the muscle under the skin and leave the skin itself unchanged. What changes an established ring is rebuilding collagen where it sits, with Sofwave™, rebuilding the surface with Profhilo, or repositioning a fold with threads. Dr Nish tells you which at the assessment.

The right time is when the rings start to bother you, which for most people is the mid-30s to mid-40s. Firming thin skin at that stage keeps the creases from etching deeper and may spare you a lift later. Sofwave™ at that age means one visit, nothing to recover from, and firming that builds for 6 months. There is no upper age limit. What matters is how much the skin has slackened and whether anything has folded, not your age.

Sofwave™: little to see at 6 weeks, a visibly smoother and firmer neck by 12 weeks, and the firmest point around 6 months. After that, one session a year keeps it. Profhilo: smoother, more hydrated skin about a month after the second visit, holding for 6–9 months before a repeat. Neck threads: the under-chin repositioned on the day, holding 12 to 18 months while the threads dissolve over 6–9 months and leave collagen behind. You are reviewed at four and 12 weeks, and the maintenance plan is set then.

Neck treatment at Medisha is mildly uncomfortable at most, and for Sofwave™ there is nothing to recover from. Numbing cream goes on first; the ultrasound then feels like short pulses of deep warmth, and make-up and a collar go straight back on. Profhilo is a handful of small injections with little bumps at each point for a day. Neck threads are placed under local anaesthetic; expect mild swelling and tenderness for about 2 days, sometimes a bruise, and a fortnight with no heavy exercise, massage or wide mouth-opening. Written aftercare and Dr Nish’s own number go home with you.

Yes, the chest is treated in the same visit as the neck. The crinkle on the décolletage is the same thin skin, and sun is usually its main driver. Dr Nish maps the neck and chest together and passes the Sofwave™ applicator over both. Profhilo can be placed across the chest in the same pattern where rings are etched in. Daily SPF afterwards protects the result on both.

Then Dr Nish tells you at the assessment and refers you to a surgeon for an opinion. Sofwave™ firms, Profhilo smooths and threads reposition, but none of them removes skin. A neck with significant skin excess, where the slack drapes rather than crinkles, may not get from these what a neck lift operation can give. You are told that before anything is booked, not after a treatment that did not do enough.

Because the neck is unforgiving of the wrong tool, and all three tools are here in one pair of hands. Dr Nish Shah MD performs Sofwave™, Profhilo and 720 PDO neck threads himself, so what you are offered follows your neck rather than the clinic’s equipment. He is Senior International Clinical Trainer at Derma Medical, one of the UK’s largest aesthetics training academies, where he teaches neck threads to other doctors. He is also Official UK Trainer for Sunekos, Brand Ambassador and Key Opinion Leader for PDO threads and dermal fillers, and Medisha is an official certified Sofwave™ partner. With over 30,000 non-surgical treatments he is one of the most experienced aesthetic doctors in the UK and London. The clinic has rated 5.0 on Google from 128 reviews, and he will say if surgery is the right answer for your neck.