76, female - What is the least invasive procedure (non surgical) to achieve improvement in skin texture? (Photo)

Thank you for sharing your history and photos—it really helps to understand your concerns and what you’ve already tried. At 76, with minimal prior skincare and past experiences with fillers, the focus for non-surgical improvement is usually on skin quality, texture, and subtle rejuvenation rather than dramatic volume changes.

Since Profilho didn’t give the results you hoped for and you’re cautious about repeating Radiesse, here are some less invasive options that can help improve skin texture and overall quality:

Fractional or non-ablative lasers – These stimulate collagen and can smooth fine lines, improve uneven texture, and gently brighten the skin. Recovery is usually minimal compared to more aggressive resurfacing.

Microneedling with growth factors or PRP – Microneedling encourages collagen remodeling, and using platelet-rich plasma or other growth factors can enhance skin thickness, tone, and smoothness over a series of treatments.

Superficial to medium-depth chemical peels – These can help refine texture and brighten the skin gradually. Gentle, repeated treatments tend to be safer and more effective at your stage than aggressive peeling.

Energy-based skin tightening (ultrasound or radiofrequency) – These treatments improve firmness and subtly lift sagging areas, which can also make the skin surface look smoother over time.

Optimized topical regimen – Continuing your tretinoin is excellent for collagen support. Adding antioxidants like vitamin C and moisturizers with ceramides or hyaluronic acid can further improve skin health and texture.

Given your history with malar bags from filler, focusing on collagen stimulation, skin quality, and gentle tightening is the safest and most predictable way to see improvement without surgery. These approaches may not erase all lines completely, but they can make a meaningful, natural-looking difference over time.

From the history and the one photo provided, for improving overall skin texture and brightening, it would be reasonable to consider a series of in-office superficial peels using high concentrations of either glycolic or salicylic acid, Jessner's Solution, or low concentrations of TCA Additionally, a change in the at-home regimen would seem appropriate at this time, as well. This could mean a higher concentration of tretinoin or switch to a stronger retinoid combined with the use of a topical Rx alpha hydroxy acid cream. You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist who can help with all these issues. Best of luck.