How Can I Tighten Sagging Skin Without Surgery?

My jowls are dropping along with my other facial features.  Can you suggest some skin tightening procedures that don't require going under the knife?

Doctor Answers 50

Multimodality approach is best for skin tightening - Titan, skin resurfacing, fillers

I have a large practice with patients who ask this same question. Additionally, I myself ask the same question when I look in the mirror, as the years pass by. I have a formula for success.

It begins with the basic foundation-effective medical skin care -skin care products that have therapeutic agents in them in concentrations that can truly effect changes in the collagen- laden dermal layer of the skin. Other vital ingredients boost the vitality of the skin in both the epidermal and dermal layers are topical, including:

Vitamin A
Topical Vitamin C
Antioxidant-rich ingredients
Botanical agents
Drinking enough water, avoiding the sun, getting enough sleep and avoiding stress, avoiding cigarettes and religious attention to your diet and excercise are all the keystones for preserving the elasticity and radiance of your skin.

Then, there are treatments that do not involve the knife, but can be quite effective, especially if started early and continued on a regular schedule several times a year or what we term as "the club membership approach" to non-surgical treatments.

I advise patients to consider skin tightening procedures that interact with collagen to help it remain organized and supportive in the dermis of the skin.

The Cutera-manufactured "TITAN" procedure is very effective method of tighteninig the skin of the face, jawline, neck and other body areas. The skin is treated with a special wavelength of light and it is very comfortable, and can be completed in one hour with no downtime. We recommend an intial series of 3 to 5 treatments spaced @ 3 weeks apart.

Following the series of inital treatments, the patient is advised to return for the "club" treatments 2 to 4 times a year, quarterly is preferred, to maintain the results and keep the collagen in a regenerative state of flux, favoring collagen generation and preservation. The skin feels immediately smooth following the Titan, and over time, the patient will see a difference, a tightening of the treated areas, especially if you look at picture from 1 to 2 years ago.

You will be pleasantly surprised at how much better you look. It is great for the jowl region, if the jowls are not so saggy that they are in need of being surgically lifted. This is why starting early-at the 1st signs of jowling-is the best time.

I am also impressed with the Cynosure "Affirm" which is a fracional CO2 peel that can be a "programmed peel' for anywhere from 3 to 5 to 7 days of downtime. This is a nonsurgical peel and is quite effective for wrinkles, scars, pigment and demonstrable skin tightneing.

Skin resurfacing techniques can also be used, and I have used various combinations of laser and non-laser light and plasma treatments to peel the skin which can not only treat the surface, smoothing wrinkles, but also treating pigment and causing skin tightening, This can be very effective around the eyes, mouth, jawline and neck.

Dermal fillers, such as Juvederm, Restylane, Radiesse and others are also great allies to have in the battle of aging-as they can be precisely placed along the jawlines to blend the jowl tissue with the surrounding tissue, adding a support layer so the skin in the jowl area does not sag. It is remarkable how powerful the fillers are along the jawline, mouth, cheek and brow regions.

The modern day fillers can be used to lift the face- jowls included, and this is what you hear termed as a "Liquid Facelift."

The Cynosure SmartLipo MPX is a minimally invasive surgical techniques in which a laser beam is used to melt fat and tighten the skin, and this is very effective in the neck.

In the face, one does not want to remove fat, as fat can fill the face and makes it have a youthful plumpness- so in the region of the face, no fat is melted, but the MPX double beam laser is blended to produce skin tightening and this is termed "SmartLifting." It can be combined with other procedures used to rejuvenate the face, and is surgical, but effective and minimally invasive.

These are the major keystones in my practice. I also recommend lighter treatments for maintenance of the skin vitality such as MicroPeels, Vivite Peels (GLX technology glycolic /botanical peels), and microdermabrasion.

Looking great? It is a battle, but is is one that can be won with education, dedication and execution of a maintenance plan, or formula, which I have devised and outlined above.

Los Angeles Plastic Surgeon
4.4 out of 5 stars 18 reviews

Laser Skin Tightening, Fat Injections and Other Options for Skin Tightening

Laser skin tightening is a no-downtime procedure that is very effective in improving facial skin tone and reducing fine lines and wrinkles, and it can also reduce the effects of fine or superficial acne scarring in many patients. We have come to view it as effective ‘facelift insurance’ for some patients, as it can put off the need for a more invasive procedure for many years.

Lasers, Botox, injectable fillers and fat grafting are not a replacement, of course, for facial rejuvenation surgical procedures when facial skin sagging is more advanced. For instance, floppy neck skin requires a necklift, a droopy and deflated midface requires a midface lift, and significant upper and lower eyelid skin excess requires a blepharoplasty. In most patients undergoing these ‘lifting’ operations I perform structural fat grafting as well, as I feel very strongly that restoring facial volume is a critical step in achieving a truly rejuvenated appearance. Compare your current appearance to photographs from 10 or 20 years ago and the importance of facial soft tissue volume will be quite obvious to you.

Ideally a patient should have a consultation in a plastic surgery practice that offers a full range of surgical and non-surgical options so that an appropriate, comprehensive and highly individualized treatment plan can be developed.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 109 reviews

Tightening sagging skin without surgery - expect small benefits

People should not expect facelift results from non-facelift treatments. Radiofrequency, fractional laser and CO2 laser all help to tighten skin slightly but won't restore the youthful architecture to the face the way a volume restoring facelift does.

Many patients are happy with minimally invasive treatments, but not patients who have been expecting facelift results.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 133 reviews

Sagging skin can usually be improved with a combo approach

Sagging skin may be due to a combination of factors. In today's world of patients wishing less invasive procedures, we have had quickly and extensive experience of using combinations of liposuction, various fillers, and the Mixto laser in the "shrink Mode" to create improvements that we could not achieve even two years ago.

For instance the "soft round face with jowling and good skin"

Submental and jowl smartlipo
Naso labial fold augmentation with Radiesse
Full face MiXto blend
The thin weathered face with sun induced pre-mature aging:

Sculptra augmentation of the cheeks
Radiesse fills of the naso-labial and Marionette lines
Juviderm augmentation of the lips.
Full face aggressive Mixto shrink

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon
4.5 out of 5 stars 7 reviews

Talk to a doctor who offers non-surgical & surgical options for sagging skin

I've been performing facelift surgery for 18+ years, but I continue looking for effective non-surgical alternatives. I use many other techniques as well. You should seek the advice of someone who can look at your facial bone structure, muscle, deep fibrous support, fat and skin, and then offer you options that best suit you.

Lasers that work to firm or tighten the fibrous portion of the skin (dermis) can give mild to dramatic results, depending on how deep they treat the skin. The most effective proven lasers require longer recovery periods and may have more risks and side effects. The effectiveness and risks of the newest technologies are not known yet. In summary, energy-based skin tightening can help.

Injectable fillers, such as hyaluronic acid (Restylane & Juvaderm), can reduce the appearance of some facial aging changes. Adding volume can be helpful. On the other hand, excess volume (fat) may not be removed without surgery.

Improving or restoring deep fibrous support, muscle and bone structure is done with surgery.

Your jowls are one feature that can best be treated with cheeklift or complete facelift, but minimally invasive options can give lesser improvement.

Sutton Graham II, MD
Greenville Plastic Surgeon
4.8 out of 5 stars 5 reviews

There are many non-surgical ways to tighten skin. The...

There are many non-surgical ways to tighten skin. The recommended procedure depends on the extent of loose skin as well as the location.

It is important to remember that any non-surgical skin tightening procedure will not be as effective as surgery, and all non-surgical skin tightening procedures require multiple treatments given every 3-4 weeks to reach maximal effectiveness.

My favorite skin tightening procedures are:

  • Aluma which is used for the neck and body areas. (Usually requires 6 treatments with best results 3 months after the last treatment).
  • Active FX for the face, neck and chest. (Usually requires 1-2 treatments and takes 3 days to heal.)
  • Affirm for the face, neck and chest. (Usually requires 3-6 treatments with best results after 4-6 weeks)
  • Cool Lipo and/or Smart Lipo for the neck, abdomen, knees and arms. (Usually requires one treatment with best results in 2-6 weeks).

Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.8 out of 5 stars 15 reviews

Skin Tightening, yes - Jowl elimination, no

This is another question that would be much easier to answer had you included a photo. As we grow older, the cumulative effects of sun, gravity, genetics, and other factors cause facial structures to descend, producing jowls and other physical signs of aging.

Surgery remains the best options to lifts "sags and bags," which may be misinterpreted as loose skin.

Some patients are candidates for laser skin resurfacing. The erbium laser with Profractional technology or the CO2 laser with Fraxel are both good options.

Injectable fillers such as Radiesse and Restylane can soften the shadowing that occurs in that nasolabial and labiomental creases, making the jowls and cheek folds appear less prominents.

Chemical peels are also an effective way to tighten and rejuvenate the skin.

Finally, preventative maintenance with a daily medical grade skin care product line, such as NIA 24 or Laroche Posay, is imperative in keeping healthy and youthful appearing skin.

James C. Grotting, MD, FACS
Birmingham Plastic Surgeon
4.9 out of 5 stars 14 reviews

Realself survey: facelift satisfaction is 78% vs Fraxel is 51%. What do you think?

If we could we wouldn't have to perform neck lifts, eye lifts, breast lifts, tummy tucks, or any other post-bariatric (massive weight loss) contouring procedures.

That is one of the "holy grails" of plastic surgery. How do we make the skin shrink with the least amount of surgery and scarring.

Unfortunately, it comes down to the elasticity of the skin which is hard to restore once it is gone. Instead we remove skin to make the remaining skin tight.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 72 reviews

Treating the jowls without surgery

The cheapest easiest way to fix it is with scotch tape. Yes, I am kidding. Many movie stars use tape to pull, primp and prop there physical features on short notice without any surgery.

But for the rest of the world, interested in improving their features without going under the knife, I would suggest a filler. The fillers include Restylane, Juvederm, Radiesse and Fat. They should be placed inside the jowl to camouflage the depression on the inside part of the jowl.

Other options include:

  1. Muscle-stimulating devices - don't work
  2. Botox - not appropriate for this problem
  3. Topical skincare - not appropriate for treating jowls. Jowls are the result of sagging of the underlying fat, muscle and fascia. Without surgery, camouflage is the best option.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 28 reviews

Sagging is the manifestation of aging through a number...

Sagging is the manifestation of aging through a number of mechanisms. First, your skin and soft tissue lose volume, thereby causing you to "deflate" in certain regions of your face, therefore causing the redundant skin to sag. Second, the skin itself loses the tightness and elasiticity exhibited during youth because of sun damage and the loss of dermal matrix. Third, weight gain can result in fat being preferentially gained in areas that have sagged already. Fourth, some sagging in the jowl area may be related to overactive frown muscles that cause wrinkles and bulges around the mouth.

Several options for nonsurgical treatment of sagging jowls exist in my practice.

To tighten sagging skin without surgery, I routinely employ Aluma, a noninvasive radiofrequency soft-tissue tightening technology that is nonpainful and involves no down time. Treatments are performed every 1-2 weeks for 6-8 treatments and result in significant reduction of sagging facial folds, crepy skin, and wrinkles. The Aluma treatment causes collagen rearrrangment and realignment, providing tighening of the skin and underlying soft tissue. Positive changes continue even after completion of all treatment sessions, with improvement continuing over 6 months and lasting for 2-4 years. One or two extra treatments every subsequent year to maintain tightness is recommended.

As jowls may be simply the manifestation of the leftover of volume depletion in the face, I will also perform fillers (and/or fat grafting treatments) in the areas around the jowl to augment the surrounding "valleys" of the face that exists in front of the "peaks" of the jowl.

For sagging related to muscle-related wrinkles and bulges, I will also employ Botox to relax muscle areas that are overacting. Other wrinkles can also be significantly improved with fractional laser resurfacing.

Fat maldistribution in sagging areas can be strategically remove using minor liposuction performed under local anesthesia.

The above nonsurgical or minimally invasive treatments can be performed singly or in any combination to provide synergistic effects. In my experience, combination therapy can in fact provide dramatic results that would restore a jaw line to the the youthful look of yesteryear without going under the knife.

Thomas T. Le, MD
Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 54 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.