A neck that wrinkles and puddles is one of the biggest humiliations of aging. When the late Nora Ephron wrote, “I Feel Bad about My Neck,” the title alone was enough to get the attention of baby boomers. For so many, a sagging neck signals old age.

Not only is a sagging neck difficult to camouflage with makeup, but it is also more resistant to improvement with diet, exercise and sun avoidance. Neck skin seems to age more rapidly than facial skin. Philly.com interviewed plastic surgeons and patients about different approaches to improving the neck.

Sixty-four year old Walter Dowgiallo owns a company that creates the labels and packaging for companies like Victoria’s Secret, Liz Claiborne and Bath & Body Works. Dowgiallo, very concerned with his image because of his business, was bothered by “this little thing under my chin. Six years ago, a Cambridge, Massachusetts plastic surgeon “lifted” his neck and ever since then Dowgiallo has felt “spectacular.”

There was a time when if you wanted a tight neck, you underwent a full face lift. Twenty years ago, the Cambridge surgeon who operated on Dowgiallo published the results of his work on “corset platysmaplasty,” a procedure that, through a small incision tucked under the chin, could tighten the muscles of the neck and reshape the jaw line.

Today, more and more surgeons use that procedure or a variation to improve the neck only. There are patients who are reluctant to have a facelift even though they have been unhappy with their necks for years. One such patient was hoping a nonsurgical skin-tightening treatment might do the trick but her Philadelphia plastic surgeon told her that she would not be satisfied with the results and to consider surgery. After undergoing neck and eyelid surgery, her 14-year-old granddaughter declared “I have a teenage grandmother.”

Of note, the American Society for Aesthetic Plastic Surgery (ASAPS), which issues annual statistics on prevalence of plastic surgery procedures, has no current category to track the neck lift. A neck lift has traditionally been part and parcel of a face lift and some plastic surgeons believe it should remain so. According to a Philadelphia plastic surgeon, “Anatomically, the muscles of the neck are connected to muscles of the face, so if you try to tighten just the neck muscles, you will not do the face a service.” He thinks that even if your chief complaint is your neck, you will get better results with a face lift.

A renowned New York surgeon feels that skin elasticity should be the determining factor. “One procedure does not fit all.” All these practitioners would agree that the best procedure for you can only be determined by exploring options with a board-certified plastic surgeon.