Which is the best dermal filler to address skin tightening without using energy devices?

For addressing sagging in the lower face (jowls), dermal fillers can be highly effective depending on your specific goals, skin quality, and how much lifting and tightening you want to achieve. Here's a breakdown of the options you're considering and other potential treatments:

1. Radiesse (Calcium Hydroxylapatite):
Best For: Skin lifting, volumizing, and collagen stimulation.
How It Works: Radiesse provides immediate volume and works over time to stimulate collagen production. It’s a great option for lifting the lower face, including jowls. It is sometimes referred to as a “liquid facelift” because of its ability to provide structure and contour to the face.
Pros: Immediate and long-term results due to collagen production.
Cons: It’s not reversible and should be placed by an experienced injector to avoid any complications.
2. PLLA (Sculptra):
Best For: Gradual volume restoration and collagen stimulation.
How It Works: Sculptra is not a traditional filler in that it doesn’t provide immediate volume. Instead, it gradually stimulates your body to produce collagen over several months, making it an excellent option for subtle, natural lifting of sagging skin in the lower face.
Pros: Long-lasting results (up to 2 years) and a very natural appearance.
Cons: Results are gradual and may require several sessions to see full effects.
3. Juvederm (Hyaluronic Acid-Based):
Best For: Immediate volume, especially in areas like the cheeks and jawline, which can help lift the jowls.
How It Works: Juvederm products (such as Voluma or Vollure) are popular for contouring and adding volume to lift sagging skin. While they don't stimulate collagen in the same way as Radiesse or Sculptra, they provide instant results and can be used to create more definition along the jawline.
Pros: Immediate results and reversible with hyaluronidase if needed.
Cons: Results typically last 9-18 months, so maintenance is required.
4. Polynucleotides:
Best For: Skin regeneration and subtle tightening.
How It Works: Polynucleotides are newer to the market and work by improving tissue regeneration, boosting skin hydration, and subtly tightening the skin. While not technically a filler for lifting, they can improve skin quality and provide mild lifting over time.
Pros: Improves skin texture and hydration.
Cons: Subtle results and not as effective for significant lifting.
5. Exosomes:
Best For: Regenerative treatments and skin rejuvenation.
How It Works: Exosomes are derived from stem cells and contain growth factors and other molecules that promote healing and regeneration. They are primarily used for skin rejuvenation, improving skin texture, and potentially for tightening, though more studies are needed to confirm their lifting capabilities.
Pros: Cutting-edge, promising regenerative benefits.
Cons: Not primarily used for lifting, more suited for improving skin quality and promoting healing.

In our experience, injectable fillers are useful for adding lost volume to somebody's face, as it ages. When there is sagging of the lower face, that tends to necessitate a surgical approach. I hope this helps! Sincerely, Dr Joseph

Dermal fillers with HA add only volume. Biostimulators like Sculptra or Radiesse restore the internal structure of the skin , improving quality and volume but are not directly tightening the skin. You still need an energy device to tighten the skin. The RF devices or HIFU devices are designed and approved for that concern and it always depends on the proper patient selection, prover expectations, proper device selection and the proper settings performed.
Best, Dr.Anna Avaliani ,NYC