Of all the body parts that go to hell in middle age, I’d say the neck is the worst. Actually, make that the sagging neck and jaw.
Fortunately, it’s only in certain mirrors that you see what’s going on below the chin. Unfortunately, that makes multiple mirrors in shop changing rooms a horrible revelation. Not long ago I looked, appalled, at my profile. Where once my neck went up in a nice straight-ish line to meet my jaw, it seemed now to have taken a short cut midway up, and set out at a 45-degree angle to meet my chin. The chiselled neck was gone. As for the jaw itself, I can only say it was undefined.
I can’t say I’m particularly bothered about the state of my face — the compensation for a plumper face is that you have less obvious wrinkles — but from the chin down . . . dear God. And that is sadly the case with lots of women in their 50s — even, it seems, if you are a supermodel.
It’s all too rarely that I have anything in common with Linda Evangelista, 56, the woman who famously said that supermodels don’t wake up for less than $10,000 a day. But five years ago she resorted to a treatment, CoolSculpting, to reduce fat around the jaw area. Alas, the treatment, which works by freezing fat cells, backfired, and she feels that she is now ‘permanently deformed’.
Linda Evangelista, 56, claims she was left ‘permanently deformed’ after having CoolSculpting treatment to reduce fat around her jaw area. Pictured: Linda after ‘CoolSculpting’ treatment, in 2017
At the famous Prager Clinic in London’s Knightsbridge, they admit they had doubts about CoolSculpting and decided to cease using it.
‘I stopped offering the procedure because I believe I can get similar and even better results with injectables, with far less risk and at much better value for money,’ says Dr Michael Prager.
Instead, his is one of the first clinics in the country to offer a potentially game-changing fat-dissolving injectable, Belkyra.
Dr Prager is synonymous with cutting-edge aesthetic treatments that actually work — but come at a price. In this case, Belkyra is a new formulation where the practitioner injects a substance that dissolves fat cells in the neck and chin.
Does that sound too good to be true? The substance, I am told, makes the fat cells swell and eventually burst. The contents of the cells are then dispersed through the body’s own internal cleaning mechanism, the lymphatic system.
Over the course of two to four weeks, it is claimed, the fat deposits reduce and you should see a difference in the fatty areas of the neck and chin. Results vary among patients depending, usually, on whether you are overweight or not, but a fat reduction of between 10 per cent and 20 per cent is normal.
No, it’s not an entirely new concept — the Prager Clinic has been injecting lipo (fat)-dissolving substances for a while now. But what is different is the injectable fat solution used and how it is administered — on a grid to identify injection points.
The grid makes the application of the product more precise. And Belkyra is an improved version of a previous injectable, which is more effective. It has been available in the U.S. for a few years but has only just arrived here.
The famous Prager Clinic in London’s Knightsbridge, admit they had doubts about CoolSculpting and decided to cease using it. Pictured: Linda Evangelista, in 2015
This new injectable is sought- after because, unlike invasive treatments such as liposuction and CoolSculpting, which work by freezing fat cells, it is extremely safe (although the clinic did warn me about potential side-effects, including tenderness and swelling).
Some patients see results after a single session; others need up to four treatments. And because you need up to four, or even six, weeks’ recovery time between sessions, you are looking at quite a long time for the whole course — perhaps as much as four to six months. I had four treatments over five months, with six or more weeks between them.
The practitioner for the first three sessions was Dr Lizzie Tuckey, who is a qualified medical practitioner and an NHS doctor who works on reconstructive treatments for cancer patients, including women who have undergone mastectomy. In other words, she is a very good and competent doctor, not just an aesthetician, which is a fancy word for someone who makes you beautiful.
It hurt like billy-o and my neck swelled up like a toad in mating season. But a few weeks later there’s less pudginess around my jaw
Like me, she is appalled by the unnecessary facial treatments young women are having to make them more like an Instagram version of themselves — or, worse, like reality TV stars. She is also really nice, with an air of calm competence that probably does wonders for nervous clients.
In my case, I wasn’t nervous so much as curious. But all the same I’m not a masochist, so I was grateful that the treatment began with a local anaesthetic, lidocaine, which acts instantly and makes you feel numb.
Next Dr Lizzie placed the grid over my neck and identified the injection points. She then grasped the flesh in the area firmly and made an injection. She paused to see how I was taking it, then moved on to the next area.
Reader, it hurt. Even with an anaesthetic, it really hurt. I did my best to be a brave little soldier but I can’t imagine anyone actually enjoying it. It is in the nature of the thing to be painful, which is quite different from the kind of non-invasive treatments I’m used to.
Melanie McDonagh had four Belkyra treatments over five months, with six or more weeks between them. Pictured: Dr Lizzie injects writer Melanie with Belkyra
My ideal facial is manual lymphatic drainage, where a therapist gently manipulates your jaw, neck and face with her fingers. Injections are a different matter altogether.
At the end of the session, my neck and jaw felt both numb and very tender — and rather abused. Dr Lizzie advised that I probably shouldn’t arrange any important engagements for the week after each treatment.
This would not be the time for a crucial job interview or for throwing a party. It would have been ideal just before lockdown. If you like polo necks, now is the time to wear them. In my case, what I needed after my treatment was a large gin.
It was just as well Dr Lizzie warned me what to expect, because the after-effects were dramatic. My neck swelled up like a goitre. I looked like a toad in mating season. It was appalling.
But forewarned is forearmed, and I simply went ahead with normal life, feeling self-conscious rather than going into hibernation. But I was alarmed at the extent of the reaction and got in touch with Dr Lizzie to see whether it was normal.
After the session, my neck and jaw felt both numb and very tender — and rather abused
She assured me that it was, and promised the swelling would subside after about a week.
We extended the time before my next session, however, so it was about a month before I went for the next one.
The initial swelling took a little longer than a week to subside, and at the end of it I couldn’t see any obvious reduction in fatty areas. But that is normal, too. Some people see an immediate improvement, but they are probably a bit less like a dumpling than me.
The swelling, in fact, is a good thing. Dr Lizzie observed that: ‘The inflammation is what causes the fat cells to be absorbed by the body. It produces fibroblasts, [the kind of cells] that make collagen and stimulate elastogenesis [the formation of elastic fibre], which ensures that any fat loss is matched with skin-tightening, so you don’t end up with a saggy chin.’
So the bullfrog look suggests the treatment is working.
Melanie said she had big black bruises on her neck where the needle had gone after the third session. Pictured left: Melanie before, right: the subtle results
The next session was in one way better because I knew what to expect. But it still hurt like billy-o. Again I swelled up afterwards. After the third session, what I noticed more was bruising on the neck where the needle had gone in: big black bruises. That wasn’t a good look either, giving the impression that I had been self-harming in some way.
After the second session, Dr Lizzie sent me for an excellent radio-frequency facial treatment to improve my skin tone.
She also gave me a useful set of facial exercises to do at home (confession: I wasn’t very good about doing those).
Dr Prager briskly pinched the skin on my neck and declared ‘we can do more here’
In addition, she gave me a set of Prager skin products to try, which are very good, including an antioxidant serum with vitamin C that stimulates collagen (skin fibre) production and helps deal with the inflammation. That worked on the look and feel of the skin. I’d use them any time.
And she recommended that I should have tests for my thyroid function, because this can have an effect on fatty tissue.
We agreed that the condition of my neck and jaw wasn’t just to do with fatty deposits. Muscle tone, which responds to facial exercise and electronic treatments, is important, too.
But what about the fat reduction that is the point of the treatment? What about the chiselled neck I wanted back?
Dr Lizzie Tuckey (pictured) and Melanie agreed the treatment achieved a subtle improvement after three sessions
Dr Lizzie and I examined the photographs after the third session and we both thought there was an improvement, but not a dramatic one.
My profile was a little changed in that the neck had tightened a little, but not so much that you would notice particularly. In other words, the treatment was not transformative. Yet.
For my fourth treatment, I was given the injection by Dr Prager himself, who is German and exudes expertise. He briskly pinched the skin on my neck, declared ‘we can do more here’ and straight away gave me three or four injections.
He didn’t bother with an anaesthetic. He is manifestly expert and no-nonsense. It did hurt, but because there were fewer injections, no more than before.
That was just over a week ago. I did swell up again and the skin looked bruised and a bit yellow. But perhaps for me, unlike poor Linda Evangelista, the swelling has subsided somewhat. I reckon recovery in my case takes between ten days and two weeks.
But the great thing is, the treatment continues to have an effect long after the injections are over. Dr Prager tells me that ‘it works on the fat cells quickly but the real benefit of the procedure, the skin-tightening effect, takes much longer’.
Melanie (pictured) said the treatment has given more definition to her neck, offering an improvement rather than a transformation
He adds: ‘I would say that the skin-tightening is actually the main feature of the procedure. The dying fat cells cause the skin disposal cells, called macrophages, to lay down a lot of new collagen. And this process, like any form of skin resurfacing, takes time.’
Body treatments, apparently, work much quicker. You can have Belkyra in several areas, including the stomach, thighs, underarms and chin. The chin, stomach and thighs are the most popular target areas — potentially the bum, too — during the summer months.
I have seen a difference from the treatment. Not drastic, quite subtle. There is less pudginess around the jaw, a bit more definition in the neck — so an improvement rather than a transformation. And there is still further to go.
But I should say that other women have had really good results from the treatment even after one session; it varies with the individual, as these things often do. Meanwhile, I’m going back for one of Dr Lizzie’s excellent pain-free facials. That I really am looking forward to.
Belkyra costs £495-£595 per session, depending on the amount of product used (drmichaelprager.com)