This morning it is 52 degrees and moist on the hilltop. I’m preparing for my trip back east on Monday and being sure to pack some beachwear for my sailboat ride on the Chesapeake and Rehoboth Beach combing when I visit my son, Roger. Something seems off with this picture. This May Gray day is not so atypical for this time of year in San Diego, but it never feels entirely right either. As part of my restocking of my wardrobe this year (I am now breaking more new territory into the 260s on my weight) I have tried to be a bit smarter than I normally am about buying some end-of-season long-sleeve layers that are on sale. I view these as less fashion whims than wardrobe staples. One of the strange adjustments I have to make these days is figuring out what works and doesn’t work with my new body form. Even though my weight varied by a fairly wide range over the last sixty years, the common theme was that I was fat and that meant that certainly clothing approaches were always in play. The obvious one was preferring larger rather than smaller. The place whee that worked least well was in my neck. While my neck size has always been between 17-18 inches, that is sort of a regular XL size and when you go up to 3-4XL the designers make the neck equally bigger, which then looked very sloppy on me. My tailored shirts were all custom-made (both for work and leisure), so that’s how no avoided that problem. But now that I’m off-the-rack, the XL-2XL sizing I’m buying to better fit me in the body is working better in the neck. Nevertheless, my Zepbound Journey has been working against me it seems.
As Kim lost weight with Ozempic (she is now on Manjauro and is at her all-time low, just like me), I used to tell her that she was getting Ozempic-face. That was my way of saying that her face was getting noticeably leaner with her cheekbones more prominent. She still looks great (prettiest woman in the world to me), but like me, she lived her life with a full and healthy-looking face that no one would ever say needed Botox anywhere. Now, as she has leaned-out she has started wondering if she needs filler here or there. I hope she doesn’t do that, since I think she looks perfect, but women view their looks differently than men do…or so I thought. What I have started to see in the bathroom mirror these days is a leaner face, probably akin to the Ozempic Face that I saw on her, perhaps a little less noticeable due to the beard, but there are definitely more cheekbones involved. I have also added another signature feature, which I am calling Zepbound Neck.
The neck is one of the most revealing sites of aging in the human body and what happens there reflects various distinct biological processes occurring simultaneously. The seven cervical vertebrae and their intervertebral discs undergo progressive changes beginning earlier than most people realize often starting in the 30s and 40s even if symptoms don’t appear until later. Disc degeneration is the central process with intervertebral discs losing water content (they are roughly 80% water in youth and progressively dehydrate with age). As discs thin the space between vertebrae narrows and the disc’s outer ring (annulus fibrosus) develops small tears and weakens. In fact, this might have something to do with my hand neuropathy (TBD when I see the neurologist in a few weeks). As discs thin and joints are stressed differently the body responds by laying down extra bone at the vertebral edges creating osteophytes or bone spurs. These are the body’s attempt to stabilize a changing structure but can encroach on nerve roots and the spinal canal. By age 60 more than 85% of people show radiographic evidence of cervical degeneration even though many have no immediate symptoms. It is essentially universal aging of the cervical spine. In more advanced cases the spinal canal itself narrows (cervical stenosis), potentially compressing the spinal cord itself (myelopathy) producing symptoms in the hands, arms, and eventually legs. The neck musculature also undergoes general age-related loss of muscle mass and strength affecting the whole body. This causes a forward head posture, the head migrating forward of its ideal position over the spine. For every inch the head moves forward of its ideal position over the spine the effective weight the neck must support increases dramatically. A head that weighs 10-12 pounds in neutral position effectively weighs 30-40 pounds when carried two inches forward. Modern screen use has accelerated this process across all age groups but aging makes it harder to correct. This is one of the reasons I like going to Gyrotronics, which Kim and I did yesterday, since the focus is on opening up the spine and neck and combating this sort of neck degeneration. If you’re like me and lived a life of bad posture, its all the more important to address this when you are both aging and losing weight.
Then there are those very noticeable neck ligaments, which provide passive stability to the spine. They go through a loss of elasticity, increased stiffness, and in some cases, even calcification. And as you lose weight you’ve got less subcutaneous fat under your skin, but the same amount of skin (at least for a while). This is where aging becomes most visually apparent… the neck is often one of the first places where aging shows clearly, sometimes before the face. The loss of skin elasticity is part of the problem. The neck skin contains collagen and elastin fibers that provide structure and recoil. With age, collagen production decreases (roughly 1% per year after age 20), elastin degrades, causing the snap-back quality of skin to diminish, and the skin becomes thinner overall… less subcutaneous fat, thinner dermis.
This has several specific neck effects. Taken in the order that I most notice it on my new Zepbound Neck begins with what is called platysmal banding. The platysma is a thin sheet of muscle running from the lower face down across the neck to the chest. With age it loses tone and its edges become visible as vertical cords or bands running down the front of the neck. It is one of the most characteristic signs of neck aging, and it gets more complicated when you’ve carried around a few extra chins that are suddenly deflated and have nowhere else to go but hang out with the platysma gang under your chin. Then there’s the cervicomental angle, the angle between the underside of the chin and the front of the neck. In a perfect world that would ideally be around 90 degrees like it is when you’re a kid, but it becomes less defined with age due to loss of skin elasticity, accumulation of submental fat (the proper name for those extra chins under your real chin), the descent of facial soft tissues (this is sounding like a bad horror movie) and the general weakening of our old friend the platysma. For some people (I’m guessing less so for us historic chubs), there are also horizontal neck lines that crease across the neck, which become deeper and more permanent as skin loses the ability to recover from repeated folding. All of these horrible things produce the characteristic jowling and softening of the jawline that merges with neck aging and make us all look more and more like old turtles.
Beyond the structural issues, there are also skin texture changes, which certainly differ a great deal depending on how much care you give your skin. Kim has skin care products that number in the dozens and she takes this all very seriously, starting with SPF coverage and going up to something she calls “microneedling”, which is something I choose to pretend does not exist. If you’re like me and you have zero skin care products (not entirely true, I do use a bit of lotion on my arms and legs) and are blithely ignoring the sunscreen warnings, you treat skin texture changes with a badge of honor (the award will undoubtedly need to reference just how stupid you have been about it all). With age, skin gets increased crepiness, that fine wrinkling with a tissue-paper quality caused by loss of dermal thickness. You get age spots, on me, particularly on the back of the hands and forearms, but also on the neck. For some (luckily not me …yet) there is also Poikiloderma of Civatte, a reddish-brown mottled discoloration on the sides of the neck from cumulative sun damage, extremely common in older adults.
Fat distribution changes are also happening. Body fat redistribution with age affects the neck specifically, even in people who maintain overall weight. Fat tends to redistribute toward central and visceral locations with age like under the chin (the term submental is bothersome, but it’s what the area is called). It’s prone to fat accumulation that is notoriously resistant to diet and exercise.
The recommended cures for all these neck issues are:
Don’t get older (the Ponce de Leon solution)
Lose weight (Zepbounding)
Get spinal and/or plastic surgery (Not gonna happen…ever)
Go to Stretch-U, Gyrotonics and strength training to improve your posture, open up your spine and strengthen your neck and shoulder muscles (takes commitment, but I’m into it)
Walk more (the Buddy Solution)
Buy some end-of-season turtlenecks and mock turtlenecks to hide the problem (May I suggest Lands End, True Classics and LL Bean?)
Accept and embrace your inner turtle and remember who ultimately wins the race.