How Can I Tighten Sagging Skin Without Surgery?

Wouldn't it be nice if we could simply tighten the skin all over our bodies? That would certainly make the aging process a lot more agreeable to most of us. Alas, it is not that easy. Not only do we lose elasticity in our skin (dermis), but we also stretch out the vertical attachments that bind our skin to the underlying muscle and bone. We also loose elasticity in the connective tissue that invests and supports the fat compartments of our face and body. The latter is what underlies the expansion and descent of the jowl fat compartment in our face.
That is why there is no magical non-surgical procedure or minimally invasive device that can reliably tighten sagging skin in the face. That doesn't mean that good results aren't possible without surgery. You can get good results when you combine several minimally invasive procedures. My approach is to first consider whether fat or filler is needed to support a deflated face.  As we age we lose deep structural fat in the cheeks, temples and around the eyes. Fat in the upper face is important because it acts as a scaffold to support and prevent sagging of skin in the lower face and neck. Injecting filler or fat not only restores the graceful contours of the upper face, but it acts to minimize sagging in the jowl area and neck. Second, I recommend a combination of fractionated CO2 laser to improve the skin's surface texture and wrinkles, and micro needle RF to restore the elasticity and thickness of the skin.  Radiofrequency is the best modality for increasing the number of "elastin fibers" in the skin's dermis, which are needed for the skin to hold its shape (elasticity).  I strongly favor the Profound RF (Dermal) in combination with the fractionated CO2 laser. Finally, if there is expansion of the jowl fat compartment (heavy jowls), or fatty changes in the neck, I add a different type of RF energy to improve those areas.  I use the needle based Profound SubQ system, or the ThermiTight cannula to tighten this deeper space under the skin.  Unfortunately, none of these procedures are very effective in reducing platysma bands, although Botox can be of value. These procedures can be combined into a single office-based  "skin tightening" treatment, which is my preferred approach.  I wish you the best.

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Without photos, I can only make some general comments. Happily, we now have a number of robust, natural, hyaluronic acid-based fillers that can achieve the following usually in one sitting: restoring upper cheek projection and lift in order to create a more heart-shaped face and to diminish smile folds; to straighten and better define the jawline and eliminate jowls; the elevate and straighten marionette lines and downturned angles of the mouth. We also have have some less robust hyaluronic acid injectables for addressing the vertical "lipstick bleeding" lines around the mouth and the horizontal "worry" lines along the forehead and "frown" lines between the eyebrows. And we other other injectable hyaluronic acid products, known as skin boosters that can be deposited throughout the skin to increase skin hydration and tautness. None of the aforementioned requires going under the knife, and particularly in the case of volumizing and lifting fillers, the results are typically immediate and elicit a "Wow!" response. Be "buyer beware" cautious in evaluating claims for this or that fraxel laser or radiofrequency devices as to date the purported benefits of these "bells and whistles" are far more backed by device manufacturer supported marketing hype than hard science. Hope this helps and best of luck.