Deka Co2 dot laser settings for deep wrinkles and sagging skin? Would you use stacking around the mouth? Thank you. (photo)

As we age the skin sags and develops writinkles there is nothign you can do that but try preventative treatments or get a neck/facelift earlier in the aging process.  For the sagging there are numerous options and some can be used in combination to get best outcomes but you need a consultation with an expert.
Options include for skin tightening :
thermage radiofrequency to heat skin and tighten it over time and prevent the aging process
ultherapy highintensity ultrasound to contract muscle and tighten the face and neck and prevent the aging process
PDO nova threads or instalift threads for immediate lifting without surgery and long term collagen production
sculptra injections for collagen production to areas of the face and neck with crepe skin or early sagging
btl exilis ultra, venus legacy, and thermi250 for constant collagen stimulation monthly with facials
facelift/necklift with fat grafting/fillers if you need a big improvement
ThermiRF or J plasma or Inmodebodytite  internal heating and tightening to long term internal heating and tighting with or without surgery
Platysmaplasty to tighten the muscles of the neck long term and create contour
Facial implants or fillers to contour the jawline and chin to improve the apperance of the neck
yes you need laser resurfacing for your texture but you will need numerous treatments of this with long term mainteannce to get the improvements you are seeking espceilaly for the lip . lines. you can consider j plasma first to get a big improvement and then maintaining with lasers and peels.  Best, Dr. Emer.  See an expert!

Hi Bandon,
Stacking CO2 passes around the mouth will be helpful with fine lines, texture, sun spots, tone and general quality of your skin. The skin around the mouth is thick and can handle a deep aggressive treatment.
Typical settings around the mouth, nose, and cheeks would be to double stack with the rectangle shape at 25 watts, 800 dwell time and between 300 to 600 density. Follow with a second double stacked pass with the octagon shape, using the same settings. This would be the equivalent of four passes. Using different shapes will help avoid overlap lines. Adding PRP and/or growth factors at the time of treatment will improve recovery and results. I would vary the settings based on the quality of your skin, your personal health, lifestyle, results required, and how well your skin is prepared prior to treatment. I like to prep skin with a ZO skin care program, starting at least 6 weeks prior to CO2 and continuing long term. CO2 healing time and results will be affected by these important variables. Expect 4-7 days of crusted skin and 4 weeks of redness. Mineral makeup can be worn once the crusting resolves.
Dealing with the deeper lines and the sagging skin will require dermal filler. In addition to loss of collagen and elasticity of your skin, your facial bones change as you age, and soft tissues deflate, resulting in descent or sagging. Dermal filler in your temples, scalp, cheeks, chin, and jawline will help restore structure and volume where it has been lost.  
By combining dermal filler, CO2, and an ongoing skin program you can obtain a wonderful result. You are asking good questions - keep it up! Look for a physician who is experienced and willing to take the time to discuss your options; then, work together to create a comprehensive personal treatment plan that addresses your specific needs. Good luck, and thank you for the opportunity for me to share my opinion with you.