Best treatments for skin sagging and laxity (midface) after weight loss? 34 year old woman.

Question

We're doing fillers for immediate improvement, but my derm says that for long term management, he suggests other types of treatments. I have no other skin concerns, just the looseness in texture. I have a limited budget so want to focus on the most effective, long-lasting options to lift, tighten & put off the need for surgical interventions at least for a decade. Of Ultherapy, Fractora, Thermage, & Insta-Lift threads, which of these would be most beneficial for firming the lax midface?

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Ron Shelton, MD · Answer

I have found Ultherapy to have a higher patient satisfaction than Thermage for cheek lifting but Thermage provides treatment for tightening of the upper eyelids that Ultherapy can't do because of physical limitations of Ultherapy's  larger handpiece. These radiofrequency and hi intensity ultrasound energies create tightening by heating the dermis which stimulates the patient's production of collagen for many months after the procedure is done. Despite a nominal immediate tightening that may occur from Ultherapy, the results typically are seen 3-6 months, or more, after the procedure is done.The Silhouette Instalift suture lifting provides an immediate lift, specifically designed to lift the jawline (jowls) and lower cheek, and as the suture material dissolves it helps the body produce more collagen. Both Ultherapy and silhouette Instalift can provide improvement for two or more years.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Jason Emer, MD · Answer

Hi Elise, unfortunately the improvements you're seeking are best achieved through a combination of non-surgical treatments. Pending a formal evaluation, I recommend Ultherapy with radiofrequency treatments like Thermage, lasers, microneedling with PRP and Sculptra to get increased collagen, skin tightening and improved skin tone. I suggest getting a formal evaluation with a cosmetic dermatologist and facial sculpting expert who can develop a treatment plan that suits your needs and budget. Best, Dr. Emer

David A. Schlessinger, MD · Answer

When treating facial skin laxity needs to be viewed as an on-going maintenance process and not a one time fix. Even facelifts are not permanent and many patients require on going treatments with fillers toxins and lasers to maintain the integrity of a facelift over time.There are many  treatments and devices on the market which are effective in treating facial laxity and they usually work best in combination.  In your 30's most facial sagging is due to a loss of volume. Therefore it is usually best to start with dermal fillers.Ulthera and Thermage work on the deeper layers of the face and seem to work best for upper face sagging (Brows) and lower face (jowls).  Radiofrequency Microneedling devices (The Secret et al) work more superficially and improve skin tone, fine lines and wrinkles. Fractional Laser Resurfacing (Fraxel et.al) work best on deeper facial wrinkles. Threads acts both as a temporary lifting tool with immediate results.Without seeing your photographs it is hard to say which is best for you, but in general with a young person with early sagging, I have had success by starting with dermal fillers and combing them with threads and Ulthera or Microneedling RF.As always, you need to thoroughly discuss your needs with an experienced surgeon.

Best treatments for skin sagging and laxity (midface) after weight loss? 34 year old woman.

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