What's the best way to tighten sagging facial skin?

Before you go for the expense and risks of surgery, try non-invasive procedure like Titan.
For sagging skin in jaw area it's remarkable.
After only 2 or 3 treatments you will see results that you might be happy enough with to avoid surgery.
The procedure is not painful and if done by an experienced specialist, the results are lasting.

Although the skin is sagging and the jowls look unsightly, the best way to correct these problems is to tighten the underlying structures. These structures include fat, muscle and fascia (strong connective tissue that holds it all together) in a structure called the SMAS (submusculoaponeurotic system). There are many different techniques to accomplish this but they all have several key points;
1- Lifting the SMAS to its original position makes for a more natural result.
2- Lifting the SMAS will restore facial volume where it is needed most and in a smooth natural way.
3- Lifting the SMAs will take the tension off of the skin so it can be pulled and stretched without undue tension creating an nicer overall appearance with less scarring.
Thus, any surgical skin tightening procedure should include treatment of the SMAS.
Non-surgical treatments are all about prevention.
1- Retin-A
2- Anti-oxidants
3-Zinc Oxide Sunblock
4-Alpha Hydroxy Acids
5- Hydroquinone
6- Frequent Chemical skin peels in your physicians office.
7- Lots of sleep.
8-Lots of water

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.

Surgical or even non-surgical treatment of facial aging changes must be carefully individualized to match each patient's aesthetic needs and desires. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized plan is then developed which addresses each patient's specific concerns and needs.

A "liquid facelift" is a procedure that is performed using temporary dermal fillers like Juvederm Restylane or Perlane. There is little to no downtime with a liquid facelift. This might be an ideal treatment for some, but the results are temporary and it does not address excess skin.

Structural fat grafting, sometimes referred to as microfat grafting can provide fullness to lips, cheeks, hollowed upper or lower eyelids and can fill lines and wrinkles on the face. Unlike the liquid facelift, the results from structural fat grafting can be permanent

Laser Skin tightening is a non-invasive treatment with little to no downtime. For individuals with early signs of aging, uneven skin tone, scarring or large pores a laser skin tightening procedure can provide dramatic results.

Full Facial rejuvenation or a full facelift may be the answer for some. Some people looking for facial rejuvenation are interested in the lower face, midface and eyes, others are interested in one area only. Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.

Most modern approaches to the face tighten and replace volume. The patient's own tissues placed into hollow areas give the longest lasting, most stable results. LiveFill and fat injection are two techniques that use the patient's own tissues to restore fullness to the face, and are often used in combination with facial tightening procedures.

Most people come in the office and say they want their jowls to "go away" and to be able to see their neck again. They then look in the mirror and push the skin from their cheeks up and out. Their next question is how do I accomplish this without surgery. It is best to think about the face like a grape and a raisin. When a grape is dehydrated, it looses volume and turns into a raisin. With the aging process, the face looses fat and volume, which leads to loose skin and wrinkles. If the problem is addressed soon enough, it can be corrected with fillers such as Radiesse, Evolence, Restylane and Juvederm to bulk up the midface. Additionally, fat grafting can be used to replace the missing fat in your face from other parts of your body. Fillers and fat, however, do not address your neck. Over time, gravity pulls the volume from your face into your neck. The only way to tighten up your neck and define the jawline is a lower facelift. This is accomplished through a small incision under your chin and an incision around your earlobe and behind your ear. In this procedure, the muscles are tightened, preventing the volume from your face falling into your neck. Additionally, excess skin is removed as the skin is gently re-draped over the tightened muscles. This allows a significant improvement of a wrinkled and loose neck without giving you a tightened or windswept look.

Like many on this forum have indicated,there are many factors that contribute to facial aging (intrinsic aging that occurs with time, sun exposure, smoking, gravity, etc.) Depending on your goals, there are different options for you, both operative and minimally invasive. It sounds like based on your desire to correct sagging cheeks and jowls, you would benefit greatly from a cheek lift (or as i term it, a mini facelift)- In this scenario, there is a small incision in front of your ear, which is used to tighten the deeper layer (SMAS-muscular layer) and skin. This procedure, which takes 1 and 1/2 to 2 hours and can be done under local anesthesia will effectively address these areas for you with not much down time - this has become a popular procedure in my practice. With all that said, you still may benefit from additional skin care modalities (fractional resurfacing) and injectible fillers to enhance your results.

I assume you are talking about changes that are occurring and noticeable to you as you age. In reality, the reason why any of us looka certain way at any point in time has to do simply with anatomy. it involves the bony skeleton, the muscle tone, the amount and distrbution of fat, the amount and quality of the skin. You and your surgeon have to separate out the factors that are affecting you. One factor may be dominant that another. For example the loss of fat in some who is young but losing weight or perhaps the loss of skin elasticity due to your exposure to the sun or genetic background. There are a multitude of remedies for each component of the anatomical cause from various peel and resurfacing agents and treatments that essentially tighten the skin,by inducing the scarring or collagen deposition process to various lifting procedures like midface lifts, to volume resoration with implants and fillers like fat grafts. Surgeons have favorite approaches but it is important for you to discuss the options thoroughly since each has its own pros and cons. The 'gold' standard for pure skin quality tightening is the CO2 laser.

Hello Ms Anne,

Lots of great answers to your question here.  I wanted to specifically also recommend the option of autologous fat grafting for sagging cheeks.  As you have learned by now aging changes related to volume loss are best addressed by volume correction.

The BEST way to tighten jowels?  Vertical elevation with cranial suspension.  Sorry but that is surgery!

There may be more than a single option available to treat signs of facial aging.  They may range from a traditional facelift to non-invasive treatments, such as Thermage.  The option will depend in great part on how much 'sagging' is present.  Fortunately, there are options. 

A consultation with a plastic surgeon, certified by the American Board of Plastic Surgery, is your next step.  It is amazing how many times I see patients that have thought about addressing signs of aging, have been anxious about proceeding, but once they get all the information specific to their needs, the process turns into a wonderful result and experience.

With every patient that comes into my practice, it is important to evaluate three key components of aging:

1. Skin
2. Gravitational changes
3. Volume loss

If your problem is sun-spotted, wrinkled skin with mild laxity, then skin resurfacing with either laser or chemical peel should be considered.

If the issue is gravity, then the answer is surgery to restore the skin & underlying structures to their former position. The aggressiveness of the facelift (from "mini" to traditional) will be determined by your expectations and your own physical characteristics.

An open & honest conversation with your facial plastic surgeon is incredibly important. Sometimes the sagging cheeks & early loose jowls can be corrected with volume replacement, better known as injectible fillers. As we age, we lose fat & volume from where we would like it & seem to collect where we don't! Fuller, higher cheeks are youthful and early jowls can be "hidden" with a small amount of filler.

Before jumping ahead with any of these approaches though it is essential that you have a consultation with an honest, versatile facial plastic surgeon who will really discuss with you your options.

The key to facial rejuvenation is first, proper analysis of the problem, and then to design a treatment plan to provide the patient with a durable, safe result.

The fundamental issue with jowling is that it makes the jawline look too square, and a youthful jawline is shaped more like a triangle. While some lasers can tighten the skin, and fillers can hide the jowls a bit, the underlying issue of relaxation of the skin AND the underlying tissues will not be durably addressed with these techniques.

So in my opinion, surgery is usually the best way to go, and it will certainly provide a more durable result (10-15 years) versus fillers, lasers, or Botox.

Still the best option is a well performed facelift. That said, technology has caught us and there are non-surgical alternatives.

If the amount of lax skin is not excessive, non-surgical approaches can work wonders. The Titan laser is the keystone and the best results are achieved by using different lasers together. Each offers something different and the cumulative result is far better that results for one laser alone. Additionally, fillers and Botox can be added to further enhance.

The first evaluation and determination is the area and severity of the sagging facial skin.

If full face is needed then a facelift (for primary improvement) or a Smartlift (for secondary cases) tighten the muscles and undermine the SMAS.

For just the neck, a neck lift would be sufficient.

For the eyes, a blepharoplasty may help.

If a patient only needs mild improvement in volume, fillers such as Restylane or Juvederm would help.

Procedures such as Thermage, contour threads, or Lifestyle Lift have uneven results and should be generally be avoided.

The answer, simply put, is a facelift. There's lots of hullabaloo about lasers and Thermage tightening the layers of the face, but in the absence of real controlled and peer-reviewed data (not provided by the manufacturers of the devices) and before and after photographs documenting any longterm results of these methods (and thousands of dollars/ multiple treatments later), the facelift is still the gold standard for lifting and tightening sagging facial skin and soft tissue.

When facial skin begins to sag this is laxing of the underlying muscle and facsial layer called the superficial musculoaponeurotic system (SMAS). Additionally, fat above and below the platysma muscle in the neck must also be addressed.

The best way to tighten sagging facial skin is to perform a full comprehensive facial rejuvenation, whereby the muscles and SMAS are made taut and fat is removed. Excess skin is trimmed without tension on the skin, to avoid the operated look or “wind-tunneled” look.

The treatment for sagging facial skin is determined by the extent and location of the sagging.

My treatment of choice for the neck and jaw line is a minimal incision neck lift.

For sagging upper eyelid skin, a blepharoplasty can correct everything in a one hour, painless procedure and painless recovery. If the lower lids are baggy and sagging a blepharoplasty can also correct the situation.

If there is mild sagging, then a non-invasive treatment with Aluma radio frequency technology can offer non-invasive, no down time improvement.

The first thing to consider when evaluating the face is whether the skin has sagged or volume has been lost.  Think of a grape becoming a raisin.  The raisin's "skin" did not become saggy - it lost volume associated with water.

As a person ages, it is common to lose facial fat, resulting in a loss of facial volume.  This loss results in "sagging skin."  One option is to restore this volume with an injectable filler material.  There are many options for this, including Juvedern, Restylane, Radiesse, and Sculptra.  One may also consider fat transfer where one's own fat is harvested from the lower body and transferred to the face.

In addition to loss of volume, gravity takes its toll and results in jowls and descent of the facial tissues.  A facelift helps move these tissues back to their original position.  It is important to maintain the proper direction so as not to have a windswept look.  There are a variety of techniques to perform facelifts, some of which require IV sedation or general anesthesia.  Scars will vary depending on the technique of the surgeon.

Other procedures exist such as Thermage and ThreadLifts.  These procedures generally provide subtle improvement and realistic expectations are critical to avoid disappointment. 

It is important to check the credentials and experience of your surgeon.  See if you like the way other patients look on whom that surgeon operated.  Be sure to clearly communicate your goals to your surgeon so he/she can meet and hopefully exceed your expectations.

Saggin facial skin is often the result of deflation of the face as well as weakening of the elastic properties of the skin.  Really, the only way to treat this is by performing a facelift and perhaps augmenting this with fillers or autologous fat injections to compensate for the deflation of the soft tissues.  A facelift should not tighten the skin. A facelift should reposition the deeper tissues of the face to provide rejuvenation.  The skin should only be redraped to remove any excess that has developed from the laxity of the tissues.

• 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.
• 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 facial aging.
• For mild sagging, I have had excellent results with no needle mesotherapy. 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 treatments 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. 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.
• For severe sagging and excess loose skin, the best option will be surgical facelift . There are several types of facelifts. Your plastic surgeon can evaluate you for best option suited to your specific needs.

When I see a patient for facial rejuvenation, I take the whole picture into account.

We discuss more than just the options for tightening the skin but what are they trying to achieve.

Do they want the best long term result, which would be a full face lift and a 2-4 week recovery and scars around the ears, or do they desire a minimal downtime, no scar rejuventation with moderate improvement?

There is no doubt that a full face lift with elevation and tightening of the muscle and skin achieves the best result in tightening the skin but is not always the BEST WAY for every patient.

I have been performing tightening with both the Skin Tyte from Sciton, which achieves mild imrpovement and also Profractional Treatments which provides moderate improvements. These have been the BEST Way for many patients who want some tightening but need to return to their social life quickly.

How We Age

The effects of gravity, sun exposure, intrinsic aging, and the stresses of daily life take their toll on our faces over time.

On the surface, the skin accumulates sun damage, leading to age spots, blemishes, and fine lines. Deeper lines and creases develop as the skin loosens and sags.

Beneath the skin, the support structures of the face (muscles, ligaments, etc.) loosen, and the soft tissues atrophy so that our face loses volume. This causes a constellation of age-related changes to the face – the nasolabial folds deepen, the jawline slackens, fat collects beneath the chin, the eyelids droop and fat protrudes from the lids, the eyebrows, cheeks, and tip of the nose go southward.

How To Turn Back the Clock

The first step to turning back the clock is to maintain a proper lifestyle, including a healthy diet rich in antioxidants, regular exercise, the avoidance of smoking, and proper skin care.

Treatments for the aging face include nonsurgical cosmetic treatments and cosmetic surgery. In general, nonsurgical treatments are best suited as main treatments for younger patients with milder signs of aging or as adjunctive treatments for older patients. Older patients with more pronounced signs of aging typically need surgery (in addition to the nonsurgical treatments) to produce effective results.

Improving the skin’s quality, texture, and appearance can benefit many patients both younger and older. Options to achieve this include:

• Topical medicines (e.g. proven medicines, such as tretinoin, hydroquinone, Obagi, etc.)
• Chemical peels
• Dermabrasion
• Laser skin resurfacing

Additional nonsurgical cosmetic treatments, such as Botox and injectable fillers, can also play an important role in facial rejuvenation. Botox reduces smile lines by inactivating facial muscles. Fillers, such as Restylane, Juvederm, Radiesse, Artefill, and autologous fat, plump up areas that have “hollowed out” over time, such as the nasolabial folds, lips, and around the eyes.

Noninvasive “tightening” procedures, such as Thermage, Titan, etc., may tighten the skin, but to date patient satisfaction rates have been low.

Older patients with more pronounced signs of aging, including sagging skin, prominent jowls, etc., typically need cosmetic surgery to produce good results. Surgical options include the face lift, forehead lift, eye lift, midface lift, and neck lift. These procedures are often done in combination along with nonsurgical treatments.

If you are a patient interested in turning back the clock, I recommend that you see a qualified cosmetic specialist (e.g. plastic surgeon) who can offer you the full range of cosmetic treatments so that you can choose the best options for your particular needs.

In my opinion turning back the clock on sagging facial skin requires a multi-layered approach.

Firstly, your skin needs to be tended to with a good exfoliant, a quality sunscreen (30 SPF or greater), and a good moisturizer. I like to use retinols on a daily basis with my patients.

Next, photorejuvenation and possibly laser resurfacing needs to be considered to add more collagen to the deeper layers of the skin. This should help the skin portion of the aging problem.

Facelifting is really the only way to get rid of grossly lax skin. The problem at this point is that you now have tighter, younger looking skin. Why is that a problem, you ask? It is a problem because aging occurs in other places besides the skin of the face. Issues of loss of facial volume need to be addressed. Men and women lose fat and bone volume with age. I think that the improvement in facial volume adds the finishing touches to your overall rejuvenation. This is best performed using fat injections and injectible fillers. I will occasionally add facial implants if the volume loss is severe.

I hope this helps you!

A facelift tightens aging facial skin but it doesn't improve the skin quality. Bad skin quality can ruin a good facelift result and should also be treated.

Skin with lots of blemishes and wrinkles is bad quality skin and can usually be treated with skin care programs, chemical peels or laser therapy.

There are several essential truths that must be stated in order to fully answer this question completely.

• There is an old saying that states: "Small surgery, small results." With rare exception, this continues to ring true. This also applies to treatments in general.
• A patient and a procedure must match each other in two key ways:
  • A patient's anatomy must be appropriate for the proposed surgery, because surgeries are based on anatomy.
  • A patient's expectations must be appropriate for the expected results.
• A patient's goals must be clearly understood by the physician so that the appropriate treatment plan can be made.
• If something sounds too good to be true, then it probably is.
• Try not to be the first person on the block having a new procedure.

If you remember these facts when considering treatment options, then you will likely make the right decision about cosmetic treatments for facial aging.

There are so many options available to patients that it can be quite difficult to reach an informed decision. Trends are constantly changing and new treatments emerge, while others disappear.

Therefore, if you have a small problem with photoaging of the skin, then topical therapies (Retin-A, acid peels), non-ablative lasers, Botox, and volume fillers will all likely help you achieve your goals. These treatments, in general, have shown benefits in the vast majority of patients and are reliably safe.

If you facial aging problem is severe, then it is likely you will need some of these treatments as well as surgery. Facelifts of all varieties help to elevate the skin, but do not create changes to the skin itself. That is why a comprehensive program involving skin care, sun avoidance, laser therapy or chemical peels are usually suggested to patients undergoing this procedure.

Those patients that fall into the middle category are the most challenging to treat. Although some patients will opt to wait a few more years for formal treatment, many want improvements now. Thermage, stronger laser treatments, portrait plasma resurfacing, and modified facelifts (with small incisions and quicker healing) are perfect solutions, as long as the patient understands the limitations of each therapy and the likely need for further treatments in the future.

So think of your problem, your goals, and your lifestyle needs. If you problems are small or your goals are modest, then quick minimal downtime solutions are probably right for you. If your problems are big or your goals are big, then you will likely be disappointed with simple solutions and probably need comprehensive treatment, likely including surgery. Most facial surgery will required 1-2 weeks of downtime before you feel comfortable socializing with others.

Sagging facial skin results from the loss of volume from the face, and the aging of the superficial skin.

Traditionally surgeons correcting the problem pulled the sagging tissue and cut away the excess. You can tell who those patients are when you see them walking down Rodeo Drive in Beverly Hills, Park Avenue in Manhattan, and Collins Drive in Miami.

Natural results can be obtained today by restoring volume to the face, and then by treating the face and neck with Fraxel repair. Fraxel repair will tighten the skin, reduce wrinkles, improve the eyelids, and improve the tone, color, and texture of the skin.

In the great majority of my patients this will restore an amazing youthful, rested appearance to the face. This will not leave a patient as "tight" as they might be after a surgical facelift. In some cases of excessive skin "sag", traditional surgery may still be needed.

Tightening sagging facial skin is always the goal in any rejuvenation procedure. Sometimes the actual skin can be tightened, but other times it just appears tighter because the sunken areas are filled. Combination treatments often work the best.

Of course, a facelift is the gold standard. However, there are risks of poor healing and having visible scars that can frighten even the most die-hard individual. One must also remember that the actual skin is unchanged and the areas that have deflated are still deflated. We have all seen "old" people with tight skin that look startling!

• Thermage can have a subtle effect in the right individuals. Pretty effective on the chin region. It usually works best in people under 60.
• Bridge Therapy (TotalFX = ActiveFX + DeepFX) can have great effects on the face. I love the results especially around the mouth and eyes. Fill areas that are deflated.
• The VolumaLift procedure is a great way to address this.  Different fillers or fat can be used to accomplish this.
• The best way to address this is to change those things that you are doing to damage your skin, e.g. stop smoking and stop tanning (use sunscreen and consider applying a self-tanning agent).

To solve this problem, you have to know what has caused it. Some factors are beyond your control, such as the genetics and the type/quality of skin you have inherited. Other things that cause skin to sag early or severely are:

• Smoking
• Dry skin
• Injured skin (sun damage)
• Connective tissue diseases
• Anything else that does not promote nourished, healthy skin.

Here are some pointers:

• To treat sagging skin right, the underlying stuctures need to be tightened and shaped so that the skin has LONG-TERM support. Even a tummy tuck follows this important concept. Like a REAL facelift, the abdominal muscles are tightened and shaped and only then is the excess skin removed.
• Occasionally, certain areas will respond well to skin removal such as: the upper and lower eyelids, some necks, arms, and thighs.
• Another effective technique that tightens and stimulates collagen and skin are various "ablative" lasers.
• Light/heat sources such as Titan and Thermage only offer modest improvement in certain individuals.
• The most common error surgeons make in treating "sagging skin" is not recognizing that the skin, (once it sags) is not a strong stucture anymore. It has lost its elasticity and its connections with the deeper fat compartments, muscles, and ligaments of the face.
• To treat this effectively, your surgeon should not JUST PULL AND TIGHTEN SKIN. This has been done as far back as the 1920s and some still rely upon this method.  If you do a "quick" facelift, your face will sag again, sometimes as soon as 3 months later!
• One of the only creams that has shown a "skin tightening effect" is Retin-A or any prescription-strength retinoid product. Many other products can help, but this one is the most powerful and proven.

Listen to Dr. Sam Post describe the finer points of the facelift, including its indications and evolution.

At Celibre, our physician, Dr. Harold Kaplan is a plastic surgeon, so we must qualify our responses by saying that for most patients interested in sagging skin, we are going to recommend surgery. With that said, the reason our laser facility does not use Thermage or Titan is because of the low patient satisfaction rates.

On this very site, realself.com, the patient satisfaction rate for Thermage is (as of this posting) only 37%. We would rather not have 2 out of 3 of our patients leaving our facility with disappointing results. For this reason we do not provide the procedure. For Titan it is simlar, with the Titan having a 50% patient satisfaction rate.

For our laser facility our target patient satisfaction rate is 80% across all procedures. While we realize that we will never be able to please everyone, we do not believe that a 37% (Thermage) or 50% (Titan) satisfaction rate is high enough to view this as a credible option for our patients. If you're serious about sagging skin, go the surgery route, you'll be much happier in the long run (and the results will be much longer lasting).

Choosing between different types of lifts and fillers really depends on the quality of the skin, how far the individual is willing to go, what result they are looking for and how permanent they wish the result to be.

Dermal fillers give an instant result for the typical wrinkles between the nose and the corners of your mouth, but needs repeating every 6 months. You can also get a neck and eyebrow lift with only Botox.

Threadlifts are great for a moderate amount of excess skin, with not too heavy jowls and not too skinny a face. Another option is a small neck lift to get rid of beginning jowls without threads, under local anaesthesia, only leaving scars around the ears.

A full face and neck lift is of course more invasive but also lasts the longest. This is the best option for a full and lasting rejuvenation in the right patient.