Rejuvenecimiento del cuello

La zona cervical especialmente compleja tanto anatómicamente como por su función y su localización. Esto hace que el rejuvenecimiento del cuello sea todo un reto por distintos motivos.

Por una parte la piel del cuello está sometido a movimientos continuos así como a la acción de la gravedad, teniendo además poco soporte óseo a diferencia de la cara. Además, es una zona expuesta al sol de forma casi continuada y que muchas veces nos olvidamos de proteger y cuidar apropiadamente.

The History of Sports Betting Regulation in America: A Betzonic Perspective

The regulation of sports betting in the United States represents one of the most complex and evolving areas of American gambling law. From outright federal prohibition to a fragmented but rapidly expanding state-by-state framework, the legal landscape has shifted dramatically over the past century. Understanding this history requires examining not just the legislation itself, but the economic pressures, moral arguments, and technological changes that shaped each major turning point. The story is neither linear nor simple, and its consequences continue to unfold across every corner of the country.

The Federal Prohibition Era: PASPA and Its Origins

For most of the twentieth century, sports betting in America existed in a legal gray zone, tolerated in Nevada but largely criminalized or ignored elsewhere. The pivotal moment came in 1992 with the passage of the Professional and Amateur Sports Protection Act, commonly known as PASPA. Signed into law by President George H.W. Bush, PASPA effectively banned sports wagering in all states except Nevada, Delaware, Montana, and Oregon, which were grandfathered in due to pre-existing betting frameworks. New Jersey was given a one-year window to opt in and failed to act, a decision the state would spend the next two decades regretting.

The rationale behind PASPA was largely driven by the major professional sports leagues — the NFL, NBA, MLB, and NHL — who argued that widespread sports betting would compromise the integrity of their games. Congress accepted this framing largely without challenge. The economic arguments in favor of regulated betting were not seriously entertained at the federal level. As a result, billions of dollars in annual wagers were driven underground into illegal bookmaking operations and, eventually, offshore online platforms that operated beyond the reach of American regulators.

Nevada remained the sole legal market for full-scale sports betting for 26 years. During this period, the state developed a sophisticated regulatory infrastructure under the Nevada Gaming Control Board, setting licensing standards, integrity monitoring protocols, and tax frameworks that would later serve as partial models for newly legalizing states. The Nevada model demonstrated that regulated sports betting could generate substantial tax revenue — the state collected over $300 million in sports betting taxes during the 2017–2018 fiscal year alone — while maintaining competitive market conditions.

The Murphy Decision: A Constitutional Turning Point

The legal architecture of PASPA began to crack when New Jersey, facing severe budget pressures and the economic decline of Atlantic City, decided to challenge the law directly. Between 2011 and 2018, New Jersey pursued a sustained legal campaign arguing that PASPA violated the anti-commandeering doctrine of the Tenth Amendment, which prohibits the federal government from compelling states to enforce federal regulatory schemes. The case, Murphy v. National Collegiate Athletic Association, reached the Supreme Court after years of lower court defeats for the state.

On May 14, 2018, the Supreme Court ruled 6-3 in New Jersey’s favor, striking down PASPA as unconstitutional. Justice Samuel Alito, writing for the majority, held that PASPA’s prohibition on state authorization of sports betting was a direct violation of the anti-commandeering principle. The decision did not legalize sports betting nationally — it simply removed the federal barrier, leaving each state free to legislate as it chose. The ruling was immediately recognized as one of the most consequential gambling law decisions in American history, comparable in scope to the 1988 Indian Gaming Regulatory Act that transformed tribal casino operations.

The aftermath was swift. Within weeks of the Murphy ruling, New Jersey launched legal sports betting operations. By the end of 2018, six states had passed enabling legislation. The pace accelerated significantly in subsequent years. By 2023, more than 30 states and the District of Columbia had legalized sports wagering in some form, generating a combined handle — the total amount wagered — exceeding $100 billion annually. The American Gaming Association estimated that legal sports betting generated approximately $7.5 billion in gross gaming revenue in 2022 alone, compared to negligible figures just five years earlier.

State Frameworks and the Regulatory Patchwork

One of the defining characteristics of post-PASPA sports betting in America is its profound inconsistency across state lines. Each state has designed its own regulatory model, producing a patchwork of licensing requirements, tax rates, permitted betting markets, and technological standards that vary enormously. New York, for example, operates an online sports betting market with a 51 percent tax rate on gross gaming revenue — among the highest in the world for a regulated market — while neighboring New Jersey taxes operators at 8.5 percent for retail and 13 percent for online revenue. These disparities have significant consequences for market competitiveness and operator profitability.

Some states have opted for limited retail-only models tied to physical casinos or racetracks, while others have embraced fully open online markets accessible via mobile devices. Illinois initially required in-person registration for online betting accounts, a restriction that suppressed market adoption before being lifted in 2022. Tennessee operates an online-only model with no retail component at all, an unusual structure that reflects the state’s lack of commercial casinos. These variations create compliance challenges for operators working across multiple jurisdictions and make meaningful national market analysis difficult.

The role of tribal gaming compacts adds another layer of complexity. In states like Arizona, California, and Michigan, tribal nations hold significant influence over sports betting licensing through their existing gaming compacts with state governments. California’s Proposition 27, a 2022 ballot initiative that would have permitted online sports betting operated by tribal entities and major commercial operators, was rejected by voters with nearly 83 percent opposition — demonstrating that public appetite for expansion is not unlimited and that the politics of tribal sovereignty remain deeply intertwined with gambling regulation. Platforms tracking regulatory developments across these markets, such as http://betzonic.com/, reflect how diverse the operational landscape has become for both consumers and industry participants navigating state-specific rules.

Integrity, Technology, and the Road Ahead

The integrity concerns that originally motivated PASPA have not disappeared with legalization — they have simply taken new forms. The emergence of in-game or live betting, which allows wagers to be placed on individual plays, pitches, or possessions during a contest, has created new surveillance challenges for both regulators and leagues. The speed at which live betting lines move makes manipulation detection significantly harder than in traditional pre-game markets. Several states now require operators to use official league data feeds for in-game wagering, a provision that has generated substantial revenue for the leagues themselves — the NBA and MLB have been particularly aggressive in negotiating data licensing arrangements with operators and state governments.

Problem gambling has emerged as a serious public policy concern alongside rapid market expansion. A 2023 study published in JAMA Psychiatry found that rates of gambling disorder were notably higher among sports bettors who used mobile applications compared to those who bet through retail channels, a finding attributed to the frictionless accessibility of mobile platforms and the prevalence of aggressive promotional offers. Several states have responded by tightening restrictions on advertising — particularly advertising directed at college students or broadcast during sporting events with large youth audiences — and by mandating responsible gambling tools such as deposit limits, cooling-off periods, and self-exclusion programs integrated directly into operator platforms.

The federal government has not entirely stepped back from the space. The Department of Justice has periodically revisited its interpretation of the Wire Act of 1961, which prohibits the use of wire communications for interstate sports betting. A 2019 DOJ opinion attempted to expand the Wire Act’s scope to cover all forms of online gambling, not just sports betting, creating significant uncertainty for operators and state lottery systems. That opinion was subsequently challenged in court and largely reversed, but the episode illustrated that federal regulatory intervention remains a live possibility even in the post-PASPA environment.

The history of sports betting regulation in America is ultimately a story about the tension between federal authority and state autonomy, between economic opportunity and social harm, and between the interests of established industries and those of consumers and governments seeking new revenue streams. The Murphy decision did not resolve these tensions — it simply relocated them from Congress to fifty state legislatures and dozens of regulatory agencies. What has emerged is a market of extraordinary scale and complexity, one that continues to evolve as technology outpaces regulatory frameworks and as the cultural normalization of sports wagering reshapes public expectations. The next chapter of this history is still being written, and the regulatory decisions made in the coming years will determine whether America’s experiment with widespread legal sports betting ultimately serves the public interest or primarily benefits those with the resources to shape the rules.

¿Cómo envejece el cuello?

Existen una serie de cambios que determinan el envejecimiento del cuello:

  • Pérdida del reborde mandibular: la línea mandibular marcada es un signo de juventud y belleza.
  • Ángulo cervicomentoniano más amplio de 105-120º: la barbilla se continúa con el cuello con poca angulación.
  • Laxitud de la piel que se muestra “descolgada” a lo largo del cuello.
  • Acumulación de grasa submentoniana que impide marcación de borde anterior de músculo esternocleidomastorideo y del borde del cartílago tiroideo. La famosa papada.
  • Fotoenvejecimiento de la piel: deshidratación, manchas solares y alteraciones vasculares.
  • Arrugas horizontales del cuello: collares de Venus.
  • Prominencia de las bandas platismales de disposición vertical.

 

¿Cómo prevenir el envejecimiento del cuello?

Antes de que se produzcan cambios irreversibles, existen algunos hábitos que podemos adquirir para evitar el envejecimiento cervical. En primer lugar, es de vital importancia mantener una buena fotoprotección e hidratación de esta zona. Ya se sabe que el cuello es el gran olvidado en el cuidado diario con cosméticos. Proteger la piel del sol evitará cambios en forma de manchas, alteraciones vasculares y laxitud.

Además, es importante mantener buenos hábitos de alimentación y de ejercicio físico, que nos permitan evitar en la medida de lo posible el acúmulo de grasa submentoniana (también conocido como papada o doble mentón). El acúmulo de grasa es además uno de los aspectos más difíciles de abordar en el rejuvenecimiento del cuello.

Otro aspecto a cuidar es el de la postura cervical. Pasamos muchas horas sentados con ordenadores o consultando otros dispositivos electrónicos como tablets o móviles. Por lo tanto, es importante que el cuello esté erguido y no doblado la mayor parte de este tiempo. Están ya descritas las arrugas horizonatales acentuadas en lo que se ha llamado el tech-neck: pasar muchas horas con el cuello flexionado marca más estas arrugas.

 

Técnicas de rejuvenecimiento del cuello

Una vez tenemos los problemas anteriormente descritos, por suerte cada vez tenemos más técnicas que nos van a permitir abordar el rejuvenecimiento del cuello. Como hemos visto, existen distintos problemas asociados al cuello envejecido. Por ello, para dar respuesta a estos problemas, tendremos que combinar distintas técnicas en función de los aspectos que predominen.

Mejora calidad de piel: manchas alteraciones vasculares y laxitud

  • Luz pulsada intensa: muy buena opción para tratar en un mismo momento tanto manchas vasculares, como alteraciones de pigmento y aumentar síntesis de colágeno.
  • Láseres fraccionales de resurfacing: el más eficaz es el láser de CO2, ya que al depositar calor en la piel y así consigue mayor retracción mejorando la laxitud.
  • Láseres de pigmento o vasculares: cuando predominan alguna de estos dos tipos de problemas. Se pueden combinar con los anteriores.

Mejora de flacidez y descolgamiento cutáneo

  • Radiofrecuencia: existen distintas modalidades de dispositivos de radiofrecuencia para rejuvenecimiento cervical: monopolar, fraccionada con microagujas, subcutánea controlada por temperatura, etc. En todos estos casos el objetivo es, mediante una corriente eléctrica, llegar a calentar las capas más profundas de la dermis a una temperatura entre 40-45ºC y hasta 60-70ºC para producir un aumento de síntesis de colágeno y una retracción.
  • Ultrasonidos microfocalizados de alta intensiad con visualización: el objetivo es parecido al de la radiofrecuencia, pero pudiendo actuar aún a mayor profundidad: tejido subdérmico e incluso fascia muscular. En este caso se producen múltiples zonas microtérmicas de coagulación de 65ºC, a distintos niveles de profundidad, con el mismo objetivo de conseguir un retensado.

Mejora de arrugas cervicales y atrofia cutánea

Mejora de grasa submentoniana (papada)

Varias de las técnicas que ya hemos visto, como la radiofrecuencia o los ultrasonidos, tienen cierto efecto en reducción de la papada o grasa submentoniana. Sin embargo, cuando esta es muy evidente, tendremos que hacerle frente de forma específica con ténicas concretas:

  • Criolipolisis: mediante el enfriamiento de los adipocitos (células de la grasa), se consigue su destrucción parcial. Requiere de distintas sesiones.
  • Ácido desoxicólico ATX101: se inyecta a nivel subcutáneo para producir una destrucción de la grasa. Además también parece mejorar la laxitud cutánea. Requiere de varias inyecciones repetidas mensualmente.
  • Liposucción convencional o mediante láser (láserlipo): cuando el acúmulo de grasa es importante puede ser una opción que mejore mucho el aspecto.

Mejora de las bandas platismales

El platisma es un músculo muy amplio y fino, que se extiende desde la zona del escote, donde se inserta en las clavículas y esternón, hasta la zona facial donde se inserta en la mandíbula y se entremezcla con otros músculos de la zona inferior de la cara. Con la edad, por la atrofia de la piel, se pueden marcar más ss bandas fibrosas longitudinales, lo que llamamos bandas platismales. Esto puede ser corregido con las siguientes técnicas:

  • Toxina botulínica: inyectada en distintas zonas a nivel subdérmico consigue reducir la fuerza de este músculo. Su inconveniente es que el efecto es limitado en el tiempo por lo que tendría que repetirse 2-3 veces al mes.
  • Ablación por radiofrecuencia de inervación muscular: existe la posibilidad de destruir selectivamente las ramas del nervio facial encargadas del movimiento del platisma. Es una técnica más definitiva que la toxina botulínica, aunque entraña mayores riesgos y su uso en el rejuveneicmiento del cuello aún no está tan extendido.

 

En total, se han resumido hasta 12 técnicas no invasivas distintas que pueden emplearse en el rejuvenecimiento del cuello. Lo ideal es realizar distintas combinaciones en cada una de las sesiones, dependiendo del problema predominante en cada caso. A pesar de todo, en ocasiones no hay más remedio que recurrir a la cirugía (lifting cervical) para conseguir resultados óptimos.

 

REFERENCIAS:

  1. Vanaman M, Fabi SG, Cox SE. Neck Rejuvenation Using a Combination Approach: Our Experience and a Review of the Literature. Dermatol Surg. 2016;42 Suppl 2:S94–S100. doi:10.1097/DSS.0000000000000699
  2. Peterson JD, Kilmer SL. Three-Dimensional Rejuvenation of the Décolletage. Dermatol Surg. 2016;42 Suppl 2:S101–S107. doi:10.1097/DSS.0000000000000758
  3. Oram Y, Akkaya AD. Neck Rejuvenation with Fractional CO2 Laser: Long-term Results. J Clin Aesthet Dermatol. 2014;7(8):23–29.
  4. Locketz GD, Bloom JD. Percutaneous Radiofrequency Technologies for the Lower Face and Neck. Facial Plast Surg Clin North Am. 2019;27(3):305–320. doi:10.1016/j.fsc.2019.03.003
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