Trying to choose a non surgical skin tightening procedure for face and neck. Does skin thickness really matter?

Hello and thank you for your question! Based on the information provided there are a few different directions you may want to go depending on your skin thickness. Since you are mid-40s with concerns about jowling and brow drooping, Morpheus8 or a combination of Morpheus8 + Agnes could be your best bet. If you have thinner skin or are prone to redness, SylfirmX might be better for gentle tightening. However, if you’re looking for a no-downtime, single-treatment option, Thermage could be worth considering. Here is a breakdown of these treatments:

1. Morpheus8 (Microneedling + RF)
How it works: Combines microneedling with radiofrequency (RF) energy to target the dermis and subdermal layers, promoting collagen production and skin tightening. Adjustable needle depths allow for treatment tailored to your skin thickness.

Best for: Mild to moderate laxity, texture improvement, and contouring. It’s particularly effective for jowls and crepey skin on the neck.

Skin Thickness Considerations: If your skin is thicker, Morpheus8 can deliver energy to deeper layers (up to 4mm or more) to reach the collagen-rich zones. Thinner skin may require shallower depths and lower energy settings, which can result in slower or subtler results.

Number of Sessions: Usually requires 3-4 treatments for noticeable tightening.

Downside: Results take 3-6 months to develop fully, and swelling or temporary lumps are common after each session.

2. Thermage (RF Skin Tightening)
How it works: Uses radiofrequency energy to heat the dermis, tightening existing collagen fibers while stimulating new collagen production. It treats larger areas in one session.

Best for: Mild to moderate laxity with thinner or aging skin. Good for overall tightening, especially for brow lifting, the jawline, and neck.

Skin Thickness Considerations: Thermage is a surface-level treatment compared to Morpheus8, so it’s better for people with thinner skin who don’t need deep penetration. On thicker skin, it may not deliver as dramatic results since it doesn’t reach the SMAS or deeper dermal layers.

Number of Sessions: Typically a single session every 12-18 months.

Downside: Results are gradual and subtle; it’s not as effective for significant jowling or deeper tissue tightening.

3. Agnes (RF Microneedling for Targeted Fat Reduction)
How it works: Delivers RF energy through specialized microneedles to selectively destroy fat cells while tightening the skin. Commonly used for jowls, under-chin fat, and contouring.

Best for: Patients with localized fat in areas like the jowls, double chin, or under-eye bags, combined with mild skin laxity.

Skin Thickness Considerations: Agnes is ideal for those with thicker skin or visible fat pockets contributing to sagging. For thinner skin without excess fat, other modalities like SylfirmX might be better.

Number of Sessions: Results may be noticeable after 1-2 sessions, but 2-3 are often recommended.

Downside: Agnes is not a comprehensive skin-tightening treatment; it’s more focused on contouring and fat reduction.

4. SylfirmX (RF Microneedling + Pulsed Wave Technology)
How it works: Combines microneedling with RF energy and pulsed wave technology, which specifically targets vascular issues (like redness and rosacea) while also stimulating collagen and elastin.

Best for: Mild skin laxity, redness, and fine lines. Works well on thinner skin or skin with crepey texture. Great for neck skin that’s too delicate for aggressive RF treatments.

Skin Thickness Considerations: SylfirmX’s dual wave mode makes it gentler for thinner skin compared to Morpheus8. It doesn’t target fat layers, so it’s better for skin tightening and rejuvenation rather than contouring.

Number of Sessions: Typically 3-4 sessions for best results.

Downside: Less effective for significant jowling or deeper tissue tightening compared to Morpheus8 or Agnes.

Best of luck, I hope this helps!

Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Boston, MA

You may be a candidate for FaceTite. This minimally invasive procedure uses RF technology to tighten skin. No general anesthesia is required. It's great for those with mild to moderate skin laxity who are not quite ready for a facelift. You can learn more by visiting my website or a provider near you.

Before jumping into more expensive, light and other energy-based gizmo treatments, you should be aware that the hard science to back up the use of these often "here-today-gone-tomorrow," bells and whistles devices lags woefully behind the heavy marketing hype and social media buzz to promote their use. So, before pursuing this route any further, a heavy dose of "buyer beware" might be in order.
On the other hand, robust HA fillers have been successfully used for nonsurgical cheek augmentations, nonsurgical temple augmentation and browlifting, as well as for defining and straightening the jawline, diminishing jowls and for achieving a nonsurgical filler necklift. The aforementioned are all advanced injection techniques, so not to be left to the hands of novice, inexperienced injectors familiar mostly with filling simple smile lines with ordinary Juvederm or plain Restylane.
Before wasting any more time and money, you would be wise to make sure to consult an experienced, board certified cosmetic dermatologist. In the hands of experienced injector, if you wished, ALL of the aforementioned could be done in one approximately 45 minute treatment session. What's more, the results are typically immediate and the treatment usually engenders little to no significant downtime.
Hope this helps and best of luck.