Will a CO2 Resurfacing with a Sciton Laser Diminish Marionette Lines and Jowls?

Question

Some information I am finding contradicts other I find so I am not sure if this procedure will realistically give me the results I seek. I am 50 and have a prejowl sulcus and mild jowling...also noticing neck sagging. I am torn between this CO2 resurfacing and an "injectable facelift" with eventual neck lift. Do I lack volume? Yes some..do I have sun damage also? Yes some. Unfortunately money matters so I cannot have both procedures. Torn between which one will fix my main concern, jowls which have really aged my face.

Brent Moelleken, MD · Answer

Lasers and fractional lasers help greatly for skin tone and fine wrinkles.  They do not adjust jowls or correct volume loss.

	Your picture shows a very pretty face with early signs of facial aging.

	Patients such as yourself obtain their best results with a volume adjusting facelift and necklift.  Laser may be added as an adjunct treatment but is not a substitute.

	A midface lift is the wrong procedure to correct jowling.  We reference several chapters and articles below.

Ivan Wayne, MD · Answer

I have a DeepFX laser and while it does wonders on fine wrinkles and acne scars, the limited skin tightening you see with laser resurfacing doesn't have a substantial effect on the folds and deep lines that occur around the mouth, as in your case. Fillers would be helpful. Lifting procedures would help as well.

Kevin M. Robertson, MD, FACS · Answer

First, let me tell you I have been a Sciton user for 5-10 years, so I am quite comfortable telling you what it can and can not do.  Sciton's laser is not CO2, but erbium.  Not really a big difference, given it's advanced generation power, meaning it can promise as much result as a CO2 but without the down time.  But the truth of the matter is that any resurfacing modality, whether it's erbium, CO2, or phenol peels, won't give you enough tissue tightening to really resolve your concerns for the marionette lines and jowls.  No resurfacing agent has that kind of tightening power.  Let me add that other tightening procedures like Sciton's Skintyte, Thermage, Titan, or other non surgical tightening technology are all pretty weak, and I don't recommend them.  Even though I have one.

	Soft tissue fillers, on the other hand, are ideal for those two regions.  Immediate improvement, no down time, lasting, affordable, natural results.  Restylane, juvederm and radiesse are all options there, promising 6-14 mos of duration in most patients.  My preference is radiesse, and it's also the best value with the longest duration.

	That still leaves the question of fine lines and skin discolorations.   You have a full spectrum of options for that, from dedicated skin care lines involving retin-a or glycolic acid like Obagi, to light peels and lasers.  Sciton has two options here, including their microlaser peel and their profractional peels.  We usually combine them to provide dramatic improvement with comfortable, rapid recovery.

Ron Shelton, MD · Answer

your photograph does show volume depletion and fillers would help rejuvenate your face, but if the jowls are your biggest concern, a midface lift will provide you with more "bang for your buck" than any laser resurfacing or multiple fillers which need to be redone every year or a series of fat injections. Volume augmentation would probably not lift your jowl enough. Certainly fillers can be placed in the prejowl sulcus but this is treating the sympton, not the cuase.

Christopher J. Peers, MD · Answer

I can certainly empathize with your dilemma. There are several approaches, all with their advantages and weaknesses.

	The C02 laser (Sciton, Affirm, etc) will reduce fine lines and give a younger appearance. It also reduces small discolorations like red or brown pigmentations. There are better options for jowls, which would likely only respond slightly to this.

	Slightly more aggressive is the fibre optic laser such as Smart Lipo. Because this is used beneath the surface it can stimulate considerably more tightening in the jowl and neck areas. It does not have any effect on the surface otherwise.

	More aggressive yet would be a neck/face lift.

	All of these procedures can be done by a qualified physician without general anesthetic. 

	In terms of overall cost / benefit, I think injectible fillers could let you reclaim your natural beauty and maybe give you the time to think about later possibilities.

	I hope this helps sort things out a little.

Will a CO2 Resurfacing with a Sciton Laser Diminish Marionette Lines and Jowls?

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