What is the best non surgical treatment alternative to a Facelift? Would it be radio frequency? If so which one is best? (photo)

Patients with moderate skin laxity of the lower face and neck are ideal candidates for the Endolift Laser which is FDA approved and used throughout Europe. I brought it to the Connecticut area to offer my patients an alternative to a surgical facelift. When used in combination with PDO Threads and possibility facial fillers, the results are ideal and the downtime is minimal.
The combination of the Endolift Laser, PDO Thread Lift and selective Facial Fillers is the choice for patients who wish rapid recovery, have moderate laxity of facial and neck skin and wish a natural and rejuvenated appearance.

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

The most effective way I’ve found to treat sagging in the lower face and neck is a combination procedure using liposuction and ThermiTight’s radiofrequency (RF) energy, which is delivered through a needle-like probe. The combination of removing fat and tightening the skin makes a big difference in the jawline that is very close to the effects you would get with a neck lift. The benefits can last about as long, too — up to 7 years — as the RF energy stimulates your skin to produce new and robust collagen. 
For the upper face, I would suggest the Silhouette InstaLift, rather than an energy device, because your Ulthera was disappointing in the past.  Energy devices like Ulthera are worthwhile, adding structure and tightness, but in some cases, the lift just isn’t enough. I’m excited about the results of InstaLift because it is a very safe means of actually mechanically lifting the tissues.  The sutures are made of the same substance as Sculptra, so as they dissolve, they add volume and hold the lift up.  A treatment will last approximately 2 years, at which time you could add more if desired. Based on your photo, you may also need to restore lost volume in your upper cheeks with a filler, which may help alleviate your tear troughs, too, depending on your results with the InstaLift. Combination therapy like this often gives the very best results. Please find a board-certified dermatologist to evaluate your anatomy and skin in depth to come up with a combination therapy that will help you look as young and healthy as you feel. 

Thank you for the question, and thank you for posting your photo. First of all, you look great! To turn back the clock a bit, you may find better results by volumizing the cheek area (Apple and zygomatic) to provide a natural youthful look with dermal fillers. Thr Ulthera is operator dependent, and results will vary from experience to experience. I tailor my treatment plan for each individual to get the kind of results each patient is excited about. But I wonder if all along it was some volume that was needed in the mid face that left you dissatisfied with the Ulthera? Best luck, Dr. P.

There are several non-surgical alternatives to a facelift, but it is difficult to say which one is the best.  Some procedures may work better in some than others and the physician performing the treatment can also influence the results.  Aside from Ultherapy, which you stated you already had, I would look into radio frequency treatments as an option.  There are many different devices but the one I am most familiar with is called Fractora.  It is possible you could get some improvement with any of these radio frequency devices.  

We still don't have a magical non invasive procedure that can lift as much as surgery. Some patients with heavier thicker and more sagging skin won't respond as well to Ultherapy and minimally invasive non cutting procedures such as injectable radiofrequency energy done with ThermiTight and possibly using a new suture lifting technique from InstaLift, may provide some patients with better results than ulthera but there can be downtime with swelling and bruising that could last as much as a week and a half or more. The results as good as they may be for some patients still don't match a surgical face lift for the face but some necks do get as good a result, especially if their double chin is only a consequence of excess fat .

One of the most common requests for patients in the office is to seek improvement in facial and neck sagging without a scalpel.  The answers from a few years ago was not as exciting as many treatments which were above the skin were found to be not as effective.  While none of these options is as dramatic as a surgical facelift here are a list of nonsurgical options:-"Under the Skin Radiofrequency"-  This is the hottest area of facial rejuvenation and an area that is expected to rapidly grow over the coming years.  There are several devices here including Facetite, ThermiRF and others who place a probe under the skin which causes contracture of the skin and tightening. This bottom up approach will often demonstrate visible tightening and contracture of the office and can take up to 6 months to see a final result.  I personally like the Facetite since it involves a contained thermal field rather than uncontrolled heat and in this regard think of it as safer and allows surgeons to heat with higher temperatures.  These procedures do involve some downtime and are done comfortably in the office.-Filling out the Face-  Fillers around the face can add volume where volume has been lost.  There are a variety of facial fillers available including hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid which can be used to fill out cheeks, lips, temples, nasal labial folds and other areas of the face.-Smoothing out the Skin-  Here a variety of techniques can be used including fractionated C02 resurfacing of the face, radiofrequency ablation of skin (a top down approach), erbium resurfacing, chemical peels and other treatments to treat fine lines and wrinkles.  Options not mentioned as ideal include the following:-Botox Neck Lift or Nefertiti Lift-  This involves placing a large amount of botulinum toxin in the neck to selectively tighten the neck muscles.  While patients may see some improvement, it needs to be repeated every 4 months and since it requires a large amount of Botox other treatments include the Bottom Up Radiofrequency techniques are probably more cost effective and offer more longevity to the result.-Radiofrequency (Top Down) or Ultrasound treatments- Treatments such as Thermage, Ultherapy are probably better at maintaining facial contour than lifting face and necks.  Unfortunately, the pricing on these options makes many of these treatments not as ideal.  

I find that a combination of lasers or RF, sculptra for collagen building, microneedling/prp and skin care help the skin rejuvenation and prevent aging.  Please see a cosmetic dermatologist for a long term treatment plan.  Best, Dr. Emer.

Thank you for your excellent question and photograph.  I think you are an excellent candidate for facial rejuvenation using a number of different treatment modalities that should offer your predictable, safe, and noticeable results.  I would first ensure that you are on a good skin care regimen that incorporates a retinol, sunblock, lightening cream, and serial chemical peels.  I would then advise the use of Botox to help smooth wrinkles to the forehead, crow's feet and between the eyes.  Lastly most of your narrative concerns can be addressed with the use of dermal fillers.  A long-acting HA filler like Voluma can help restore your cheek volume while lifting the surrounding tissues of your jowls and smile lines while taking tension from your lower eyelids.  A thinner HA filler, like restylane or belotero, can then be used in the undereye area to smooth the transition from the eyelid to the cheek.  Hope this helps.

From your photo you will likely have the best results from a combination of treatments. Fillers can be used to add volume and lift the cheek area. Botox can be used to treat dynamic lines and wrinkles. Treatments such as FaceTite and Morpheus8 can tighten skin, melt fat, and increase collagen production. See a board certified plastic surgeon or my website to learn more.