Unfortunately, thread lifts are no longer available...

Unfortunately, thread lifts are no longer available because the manufacturer has stopped making the threads.

However, there are two good alternatives for patients seeking non-invasive ways to tighten skin: Thermage ThermaCool Non-Surgical Facelifts and Titan Non-Surgical Tummy Tucks can tighten skin all over the body and provide a non-invasive alternative to procedures such as face lifts and tummy tucks.

These treatments can be combined with fillers and Botox injections, as well as other non-invasive laser procedures. These procedures are ideal for younger patients just starting to notice sagging in the jowls, abdomen and underarms, for example.

The aging process causes loss of volume in the face and thinning of the skin. The loss of volume results in the skin hanging more loosely over the face.

You can think of the skin as a t-shirt which would fit tighly on a heavy person and hang loosely on a thin person.

One way to improve this condition without undergoing surgery is to add volume to the face using filler products. This will improve the sagging by making the skin fit more tightly over a fuller face.

There are a number of filler products available with dirrerent characteristics. I will mention them in order of longevity.

The first group are the Hyaluronic Acid products. There are a number of products containing this material. These include:

Rastylane, Perlane, Elevess, Prevelle, Hylaform, Juvederm, and Captique

The differences in the products are subtle despite claims made by the manufacturers. The newest products are Elevess and Prevelle. These 2 contain a numbing medicine that decrease the discomfort associated with the procedure.

All the products mentioned above last about 6 months despite claims to the contrary by the manufacturers. And they are avaiable off the shelf with no preparation.

Other types of fillers include Radiesse and Sculptra. These are also available off the shelf with no preparation.

Radiesse is a hydroxyapatite product (similar to the material found in bone) and lasts about 8-9 months

Sculptra is a poly-L-lactic acid product (similar to suture material used in surgery) and lasts about 2 years.

All of these products can be used to effectively add volume to the face. However, as mentioned, all of the products listed above are temporary fillers.

The only FDA approved permanent filler that is available off the shelf is Artefill. This product can add volume permanently to the face with excellent results.

Last but not least is fat injections. Fat injections can also permanently add volume to the face. Although this is a surgical procedure, with proper technique excellent results can be achieved.

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As we age, we need to address both the quality of the skin (thinning, looseness) and the loss of volume in the face that causes the skin and face (especially the cheeks and jowls) to droop.  It isn't that there is one best treatment, it's really a multi-pronged approach.

The skin gets thinner and wrinkled as we get older, but if you have had much sun exposure and/or you smoke, the texture of the skin really suffers.  So you want to avoid excess sun exposure by wearing sunscreen every day.   And do not smoke- it's the worst thing you can do for your skin.  Using creams containing the vitamin A derivative Retinol or Retinoid acid will help promote collagen building in your skin and will help improve your skin tone and texture.

Dermal fillers, like Restylane, Perlane, Juvederm, and Radiesse, replace the volume that has been lost over the years.  By injecting these fillers into the cheeks and the lower face, sometimes including the mouth, the skin appears lifted and does not look as "saggy."  You would need this treatment every 6-12  months.  Fillers can give a "liquid facelift," which means that by replacing the lost volume the skin and face appears more lifted and youthful.

Another option is skin tightening with radiofrequency, like Thermage.  Thermage helps tighten the skin by directly tigening the collagen, and can give you a bit of a lift.  One Thermage treatment should last 1-3 years, but as time continues to march on you will probably want to get treated more often than that.

Of course none of these treatments replaces surgery.  It is important to discuss with your doctor exactly what concerns you and what each treatment will do for you.  You may not be a candidate for surgery, or it may be better for you to use a combination of all these treatments and surgery in order to get your desired result.

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We have had very good results tightening sagging skin without surgery using Thermage which relies on radiowaves to contract the collagen of the deep layers of the skin. I have discussed Thermage in answering other related questions. Thermage has received mixed reviews, but the inconsistent results are primarily due to inappropriate patient selection and incorrect use of the technique.

Thermage is particularly valuable in areas like the arms and the thighs where there is no great surgical solution because of unacceptable scars associated with surgery. So women with mild to moderate looseness of the skin of the arms and of the thighs should consider Thermage as a reasonably effective technique with no downside and no down time.

We have also found Thermage to be very effective for women with looseness of the abdominal skin, especially around the belly button.

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The cheapest easiest way to fix it is with scotch tape. Yes, I am kidding. Many movie stars use tape to pull, primp and prop there physical features on short notice without any surgery.

But for the rest of the world, interested in improving their features without going under the knife, I would suggest a filler. The fillers include Restylane, Juvederm, Radiesse and Fat. They should be placed inside the jowl to camouflage the depression on the inside part of the jowl.

Other options include:

1. Muscle-stimulating devices - don't work
2. Botox - not appropriate for this problem
3. Topical skincare - not appropriate for treating jowls. Jowls are the result of sagging of the underlying fat, muscle and fascia. Without surgery, camouflage is the best option.

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If you hae really prominent jowls, you will be better going under the knife.  If the jowls aren't too bad, facial fillers can help. This can include Radiesse, Restylane, or Juvederm. 

Some lasers promote skin tightening. I have one and tell my patients that it can probably improve it by about 20-30% at most. 

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