Skin tightening

The aging process and the cumulative effects of sun, gravity, genetics, and other factors cause a loss of skin elasticity, which leads to sagging, lipoatrophy, and other loosenings of the skin and facial structure.  We tend to refer to aging-related sagging skin with unflattering terms like loose jowls, turkey neck, and falling face. Another cause of loose skin, regardless of your age, is a significant loss in body weight. 

As we age we lose volume in our face, primarily fat. As a result skin can hang down as gravity acts on it creating droopiness, wrinkles and bands. This can be thought of as excess skin and is similar in concept to a dress that becomes too large as its owner loses weight. In cases where you have a signficant amount of this loose skin, you may find no other solution than plastic surgery (e.g. facelift, body lift, arm lift, etc.) because the underlying muscles need to be addressed and repositioned. 

Nonsurgical skin tightening

Prior to deciding on surgery, people tend to ask medical experts for alternatives. Tips on how to tighten skin without undergoing surgery include:

1) Dermal fillers like Juvederm, Restylane, or Radiesse can soften the shadowing that occurs around your nasolabial fold and facial creases, thus making the jowls and cheek folds appear less prominent.  Fillers act like inflating a beach ball to address the pockets and bulges. For example, by using a filler to restore volume to the cheeks, you can lessen the appearance of the jowls to some extent.

2) There are a number of skin tightening devices or machines used in medical offices that may tighten skin such as Refirme, TITAN, or Thermage. Titan uses infrared light (IR) to tighten the skin, Thermage uses unipolar radiofrequency energy (RF), and Refirme uses IR and bipolar RF.

3) A doctor may suggest you rejuvenate skin with laser skin resurfacing. The erbium laser with Profractional technology or the CO2 laser with Fraxel are additional options.

Tighten skin with cosmetic surgery

Many doctors believe a combination of treatments (surgical and nonsurgical) get the best tightening results.

          Skin tightening from a combination of neck liposuction and thermage, by Richard Baxter, MD

After weight loss or a pregnancy, a person can be left with excess, loose skin. In most cases, excess skin will not go away with just diet and exercise. In such cases, a surgeon may recommend a procedure called a panniculectomy, which essentially remove excess skin.

Going one step further, a formal tummy tuck would then not only remove this skin but also tighten loose muscle underneath. A tummy tuck leaves a bikini line scar, as shown below.

For significant facial sagging, the Facelift or mini lift may be the appropriate solution. The goals of a facelift are to lift the jowls and clean up the neck.

             Facelift image by William Portuese, Seattle facelift surgeon

Typically during a facelift the neck is sculpted by removing both the fat on top and underneath the muscle fibers that extend from the collarbone to the jaw (platysma). This muscle is tightened in the front of the neck and underneath the jaw-line to improve the jowl line. To lift the jowls, the facial superficial musculoaponeurotic system (SMAS) is also tightened.

More skin tightening information

• Skin tightening answers and tips by experts
• How can I tighten sagging skin?
• Is there a non-surgical way to tighten arm skin?
• What's the best way to tighten sagging facial skin?
  

Sources: James Grotting, MD, Paul Leong, MD, John LoMonaco, MD, Kamran Jafri, MD