How can I tighten sagging skin without surgery?

If the laxity is not severe, Thermage combined with fillers like Sculptra or Radiesse are very helpful. With aging, there is a loss of volume in the face which can be associated with loose skin. Thermage uses radiofrequency to heat up the dermis and stimulate collagen production. it can take 6 months to see the full results of Thermage. There is a synergy in the results if it is combined with fillers like Radiesse and Sculptra. There fillers are very different from each other but both help with stimulating collagen production and restoring volume in the face.

Radiesse is very effective in restoring volume in the midface area ( around the cheekbones). Loss of volume in this area is associated with lines around the nose and the mouth. Building up this area helps to lift the nasolabial fold and make it less visible. Building up the lateral cheek can help with sagging jowels. The advantage of Radiesse is that results can be seen immediately and last up to 12 months. Sculptra usually requires more than one treatment. It can take time to see the full result of the collagen stimulation from Sculptra, but the results can last as long 2 years or more.

 
Laser skin tightening is a no-downtime procedure that is very effective in improving facial skin tone and reducing fine lines and wrinkles, and it can also reduce the effects of fine or superficial acne scarring in many patients.  We have come to view it as effective ‘facelift insurance’ for some patients, as it can put off the need for a more invasive procedure for many years.
 
Lasers, Botox, injectable fillers and fat grafting are not a replacement, of course, for facial rejuvenation surgical procedures when facial skin sagging is more advanced. For instance, floppy neck skin requires a necklift, a droopy and deflated midface requires a midface lift, and significant upper and lower eyelid skin excess requires a blepharoplasty.  In most patients undergoing these ‘lifting’ operations I perform structural fat grafting as well, as I feel very strongly that restoring facial volume is a critical step in achieving a truly rejuvenated appearance.  Compare your current appearance to photographs from 10 or 20 years ago and the importance of facial soft tissue volume will be quite obvious to you.
 
Ideally a patient should have a consultation in a plastic surgery practice that offers a full range of surgical and non-surgical options so that an appropriate, comprehensive and highly individualized treatment plan can be developed. 

There are several options for non surgical skin tightening today and these are wonderfully effective if they are used for a good candidate for the procedure.

Some patients who complain of sagging skin are better first treated with fillers to replace lost volume in the face which either causes or aggravates the looseness of the skin. Examples of agents that replace precious volume in the skin include Radiesse and Sculptra.

As far as tightening procedures, the two most effective treatments today include Thermage (if no downtime is required) and Fraxel Repair laser, if a period of downtime is ok. Thermage is a tolerated quite well, takes about an hour to perform and has a very low rate of any complications. Unfortunately it takes several months to see the full effect of the treatment.

Fraxel Repair laser is the most effective technology at tightening the skin and can be used on the face, eyelids and neck too. With this treatment, one will notice decreased wrinkles, improvement in skin tone and texture. The tightening effect is noticed early and improves with time. Side effect profile with Fraxel Repair is great.

i have been less impressed with the results of Titan.

Although many skin tightening procedures have been developed, none of them is perfect. Therefore, we are always looking for new ways to improve skin tone and texture.

The main reason why your skin is sagging is hormone levels decline. The most important is testosterone drop. Even though testosterone is considered to be a male hormone, it is still responsible for sagging skin in women as well as men.

So what is the solution? Bioidentical hormone replacement is definitely an option to consider. Bioidentical hormones are chemically the same as your own. Given as an individually compounded cream, they restore the hormonal balance, improving not only your skin tone, but also your sleep, sex life, mood and energy level.

What about laser, Thermage, mesotherapy and fillers? They are also very effective for skin rejuvenation and can be used if indicated.

Everyone is beautiful! One more, one less. And the doctor's job is to enhance your natural beauty. In order to do this we should consider every reliable procedure available.

There are many great options to avoid surgery, and in many patients these will make more sense than traditional face-lifting procedures.  However, for some people with advanced aging they will not be able to achieve truly great results without a surgical procedure. i.e. for the problem of jsignificant neck skin laxity and jowling a "mini" face lift is usually all that is indicated, not the full traditional facelift... this is similar to the "lifestyle lift" (yes that is also a surgical facelift.)

For non-surgical options for jowling, one can start with a skin tightening laser such as the Sciton SkinTyte.  This uses infrared heat to stimulate collagen tightening.  It works very well, but as a word of caution be weary of any products or doctors advertising lasers as a "non-surgical facelift."  This is not a responsible claim, although you will see improvement from certain lasers,  nothing can achieve surgical results except surgery.  That being said, SkinTyte followed by some radiesse or Perlane injected into the jowl areas (this is off label and needs to be done by experienced doctors) will improve the majority of patients by recontouring and revolumizing the face so that the jowls smooth out and disappear. 

Remember, we cannot see the patients on this website to determine their needs, so you will need a fellowship-trained dermatologic surgeon, plastic surgeon or facial plastic surgeon to evaluate you.  They will have all the tools available and know what is best for you.  Lastly, be weary of the "free lunch" phenomenon.  To get results you will need to invest time to get results (multiple laser treatments, and or some bruising or swelling from fillers or more significant downtime such as surgery) 

Your question is very good one, as cosmetic surgery has more and more options for nonsurgical rejuvenation. The key in to consult with a Plastic Surgeon who is familiar with, comfortable with, and trained in all aspect of facial rejuvenation, from nonsurgical options such as fillers, lasers, and Botox, as well as surgical options. This is really the best way to have all of your options laid out in front of you, with the pros and cons of each, so that you can make the best decision for yourself. A couple of thoughts:

One of the classic signs of aging is loss of facial volume in combination with an increased laxity of skin-- this may very well be contributing to your jowling. Mild jowling and loss of facial projection can be improved with nonsurgical options, including Radiesse fillers to restore the volume as well as laser tightening, but these options have a limit. In other words, the more severe the jowling and loose skin, the less likely it will be to achieve a natural, durable improvement without surgery. Which brings me to my second point:

Many people think that surgical procedures on the face will either require too much downtime or produce an unnatural appearance. In experienced hands, this is simply not likely. Your recovery will be quicker than you may have realized, and the results from facial surgery can often be expected to last for years.

So discuss your specific concerns carefully with someone who is capable of providing you with more that one option, and then pick the choice that best suits your needs.

Think Titan, a laser designed specifically to tighten skin. If the skin laxity is not excessive, Titan results are dynamite. When combined with other lasers the results are even better, much better. This is commonly called 3D or 5D.

Using modalities that work on different layers of the skin and treat different problems together greatly enhances results. The cumulative result is better.

The key is to treat each patient as an individual and design the program on an individual basis.

There are lots of choices but the best answer I can give you is combination treatments, combinations treatments, combination treatments. No one type of aesthetic treatment is enough.

I use a combination of the following to get the individual result the person desires. There is no one treatment that is 100% effective all the time in all the patients. One has to look at the individual and figure out the best combination in consultation with the person seeking the improvement.

1. Rhytec plasma
2. CO2
3. Erbium
4. Fraxel
5. Thermage
6. Refirme
7. Fillers
8. Botox
9. Skin care creams

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.

Sagging is the manifestation of aging through a number of mechanisms. First, your skin and soft tissue lose volume, thereby causing you to "deflate" in certain regions of your face, therefore causing the redundant skin to sag. Second, the skin itself loses the tightness and elasiticity exhibited during youth because of sun damage and the loss of dermal matrix. Third, weight gain can result in fat being preferentially gained in areas that have sagged already. Fourth, some sagging in the jowl area may be related to overactive frown muscles that cause wrinkles and bulges around the mouth.

Several options for nonsurgical treatment of sagging jowls exist in my practice.

To tighten sagging skin without surgery, I routinely employ Aluma, a noninvasive radiofrequency soft-tissue tightening technology that is nonpainful and involves no down time. Treatments are performed every 1-2 weeks for 6-8 treatments and result in significant reduction of sagging facial folds, crepy skin, and wrinkles. The Aluma treatment causes collagen rearrrangment and realignment, providing tighening of the skin and underlying soft tissue. Positive changes continue even after completion of all treatment sessions, with improvement continuing over 6 months and lasting for 2-4 years. One or two extra treatments every subsequent year to maintain tightness is recommended.

As jowls may be simply the manifestation of the leftover of volume depletion in the face, I will also perform fillers (and/or fat grafting treatments) in the areas around the jowl to augment the surrounding "valleys" of the face that exists in front of the "peaks" of the jowl.

For sagging related to muscle-related wrinkles and bulges, I will also employ Botox to relax muscle areas that are overacting. Other wrinkles can also be significantly improved with fractional laser resurfacing.

Fat maldistribution in sagging areas can be strategically remove using minor liposuction performed under local anesthesia.

The above nonsurgical or minimally invasive treatments can be performed singly or in any combination to provide synergistic effects. In my experience, combination therapy can in fact provide dramatic results that would restore a jaw line to the the youthful look of yesteryear without going under the knife.

First of all, you should go to an American Board of Plastic Surgery certified surgeon who can offer all of the surgical and non-surgical treatments that are available.  Only this person is uniquely qualified to help you sort this process out and find a treatment option that will meet your expectations. 

Other people who offer cosmetic services but are not ABPS certifed surgeons will tend to offer whatever it is that they do regardless of whether it will meet your expectations. 

"When all you've got is a hammer, all the world is a nail." 

This is why so many people in the column to the right are not happy - because nobody properly determined their expectation level and whether these less invasive treatments would meet them. 

Absolutely!

For today's health concsious consumers, there are several options to improve facial tone and elasticity without going under the knife, especially if you start relatively early at mild or even moderate elastosis ( saggy skin) stage

• First, I suggest to improve your skin care routine as a preventive and to some extent corrective  measure . Better skin care aimed at improving skin health, reducing activity of oxidating (aging) enzymes, reversing aging by stimulating collagen production of your own skin, free of irritants  (like retin A) and toxins(parabens and preservatives) and finally with adequate sun protection factor (SPF 15 or higher everyday indoor and cloudy days) will prove to be your best long term investment on your skin.http://www.nailamalikmdskin.com/inside_page.php?id=21
• Healthy lefestyle is paramount in keeping your skin healthy from inside out thus slowing down and rebersing age. Avoid prolonged periods of intense sun, healthy diet , regular exercise, adequate stress management, avoidance of ciggarettes and moderation of alcohol are a few things that will certainly have a great impact on your skin.
• For mild sagging, I have had excellent results with no needle mesoitherapy http://www.nailamalikmdskin.com/inside_page.php?id=9 this is a non invasive procedure which produces cumulative results over a period of weeks to months. Most of my patients notice a moderate improvement in facial tone, texture, elasticity with regular treatmentys over 2 to 3months. The cost of 6 face and neck treatments at out office is $1200. You can call around for treatment costs.
• For moderate sagging in patients who are looking for more dramatic results, I recommend Rhytec plasmaportrait skin regeneration http://www.portraitpsr.com/. One in office treatment under local anesthesia takes about 30 to 40 minutes for face and neck and for $4000 to $5000 produces very impressive results in all aspects of aging from deep lines, rough texture, brown spots to jowls and saggy eyelids. You dont have to take a chance of bieng "overstretched" or having too much skin taken off your eyelids, like some of the celebrities you see on TV.

Fat injections will help sagging skin and are a great alternative to surgery.  Eveyone has enough fat to take, regardless of how small you are.

As my grandfather used to tell me, there are no free lunches.

Although there are other ways to tighten the skin without surgery, they can't compete with taking out skin. Sure there is some contraction of the dermal elements with radiofrequency (like Aluma, Thermage, or Titan) and with resurfacing of the skin (chemical peel, or laser such as Active FX), but I tell my patients that these other treatments will only tighten the skin about 5-15% depending on the treatment, and the specifics of each patient (how much collagen one has in their skin, and or how much impedence their skin has when using radiofrequency). I liken it to the shine of your car paint. A wash and a wax to your paint job can only do so much, and can't compete with a new paint job.

Of course your downtime is less also with the smaller alternatives. All you have to do is look at the survey on the right hand side of RealSelf to see how patients think if it is worthwhile or not to see the differences of the alternatives or the surgery itself.

As with all surgeries, and their alternatives, who better to give you all your choices than a Board Certified Plastic Surgeon, because he has all the choices to offer you - not just one thing, but the whole spectrum of services.

There are several non-surgical options for treating facial skin laxity and volume loss, which can be used alone or in combination.

Thermage uses radiofrequency to stimulate collagen, has minimal downtime and takes roughly 2 hours to complete. It can be used to treat the full face, cheek and jowls, and neck. The results are typically seen 3-6 months after treatment but can be subtle.

Using fillers to improve facial volume can also improve skin laxity and jowling. Sculptra and Radiesse work well in broad areas such as the cheeks (malar region), below the cheeks (submalar region), and temples. And HA fillers (Juvederm, Restylane, Perlane) are great for adding volume to smaller regions, lines or folds.

One of the earliest signs of aging occurs in the cheek or mid-face. The common descent, “drooping” or hollowing of our cheek and mid-face area that we see occurring as we age occurs because of a “droop” in our cheek fat pad.

Over time, gravity, repeated muscle contraction and lifestyle choices cause skin, fat and muscle to move downwards particularly in the area between the lower eyelids and mouth known as the mid-face. Aging changes around the mouth and chin are accentuated with a descended mid-face.

Of course surgical options exist to lift this descended tissue up to its natural anatomic position.

However, for the patient who does not desire to undergo a surgical correction, we have the option of a "liquid face lift."

There are many effective products on the market today, which we typically refer to as dermal fillers, that can restore some of the volume and lift up some of the descended tissue in the face.

While the dermal fillers add volume and last anywhere from 6 months to 2 years, we can also inject Botox to relax the muscles and smooth out wrinkles particularly in the forehead, in between the eyebrows and in the crows feet.

In addition to Botox and dermal fillers helping to restore volume, adding a lift and smoothing out wrinkles, a laser resurfacing procedure would help to diminish fine lines and wrinkles while stimulating collagen to give a skin tightening effect. Laser resurfacing also helps with sun damage to the face.

A consultation with a specialist will help determine which products and treatments would give the best outcome.

A good option that may delay the need for a facelift requiring surgical intervention is what we often refer to as a "chemical facelift." This involves the use of Botox strategically placed to soften lines, lift the brow and much more. When combining this with fillers such as Perlane, Restylane, and Juvederm, one can really re-shape the face by adding volume.

As we age, we often feel as if our face is falling. This usually is a result of a loss of volume to the mid-face area. By using filler products, we are able to restore the shape and volume with minimally-invasive techniques.

The types of modalities are a good option for those not quite ready to undergo surgical intervention. Make certain you pick a practitioner that is skilled, knowledgable with all technqiues, listens to your concerns, and has an artistic eye.

Every patient is different. However, there are MANY treatment options that can be combined for optimal results. Here are some of my favorite techniques (I will often combine them as part of a single session):

1. Thermage - Uses radiofrequency to tighten facial skin and enhance collagen. No downtime but prefer to use as part of a combination therapy.
2. Bridge Therapy Fractional CO2 Laser - ActiveFX/DeepFX (TotalFX) - Laser than improves skin tone, texture, discoloration, fine lines and deep wrinkles. There is 4-5 days of redness but the results are magnificent.
3. SmartLipo - Decrease fat below the chin, jowls and along the mandible. Tightens skin in the region as well.
4. Volumalift - Using fillers to fill deflated areas in order to bring back youthful contours above the eyes/brows, below the eyes, nasolabial folds, cheeks, jawline, marionette lines, and around the lips. Any of the following products can be used:

a. Autologous Fat Transfer - Using the microdroplet fat transfer technique
b. Radiesse
c. Restylane
d. Juvederm
e. Sculptra

 I am currently working on a study showing the great results that can be achieved by combining several of these treatments in ONE session. These results are incredible! Of course, Botox and a good skincare regimen are nice; Botox is always a great way to make dramatic improvements if used on a regular basis. However, they will not "tighten sagging skin" like the other treatments will do.

There are many non-surgical ways to tighten skin. The recommended procedure depends on the extent of loose skin as well as the location. It is important to remember that any non-surgical skin tightening procedure will not be as effective as surgery, and all non-surgical skin tightening procedures require multiple treatments given every 3-4 weeks to reach maximal effectiveness.

My favorite skin tightening procedures are:

• Aluma which is used for the neck and body areas. (Usually requires 6 treatments with best results 3 months after the last treatment).
• Active FX for the face, neck and chest. (Usually requires 1-2 treatments and takes 3 days to heal.)
• Affirm for the face, neck and chest. (Usually requires 3-6 treatments with best results after 4-6 weeks)
• Cool Lipo and/or Smart Lipo for the neck, abdomen, knees and arms. (Usually requires one treatment with best results in 2-6 weeks).

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.