I think for most patients, a combination of techniques is most effective.
In my practice, I will start someone on a skin care regimen to prepare the face for resurfacing. Once the skin is ready, Botox is used on the forehead and around the eyes to smooth the skin. This is followed by Active FX fractional carbon dioxide laser resurfacing. This new technology allows for fairly striking improvement in tone, tightness, and texture of the skin with a social downtime of roughly 6-7 days. It can be performed in the office using oral sedation and topical anesthesia. The results are not on par with surgery, but will help most patients.
If you have generalized sagging of different areas of the face, then surgical lifting procedures would be recommended. In an ideal world, all my patients would have their surgical procedures performed first, followed by resurfacing to improve the skin itself.
