Recommendations to correct skin texture/skin laxity? (Photo)

Question

I am 42 years old, 5’5.5” and 124lbs. I strength train regularly, but have started to fight some weight gain around the mid/section during perimenopause. My main concern, though, is the sagging skin and the uneven texture of the skin on my abdomen. I have very irregularly used my at home nebulyft rf device on the area. I am curious about options. I am curious what non-surgical options might be best. More clinical/powerful RF? Threads? I am open to suggestions. Thank you!

Chad Deal, MD · Answer

You are on the right track! The most powerful skin tightening and smoothing device that you can use on the body is the Morpheus8. Though there are other great micro needling RF technologies like the Sylfirm but the Morpheus goes deeper than all of them at 8 mm

Ryan Rebowe, MD · Answer

For these areas, I think noninvasive treatments such as RF are a good place to start. You may progress to more moderately invasive (but non-excisional) options such as BodyTite, Renuvion, etc. where energy is applied to the skin to tighten it. However, just based on your submitted pictures, I don't think any type of excisional contouring, such as a tummy tuck, would be advised.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Addressing skin texture and laxity, especially during perimenopause, can be challenging but there are several non-surgical options available that can offer significant improvement. Here are some recommendations:

1. **Radiofrequency (RF) Treatments**
Your at-home RF device is a good start, but clinical-grade RF treatments can provide more powerful and effective results. These treatments work by heating the deeper layers of the skin to stimulate collagen production, which can improve skin texture and firmness.

- **Thermage:** This is a single-session treatment that uses RF energy to tighten and contour the skin.
- **Profound RF:** Combines RF with microneedling to enhance collagen and elastin production. It’s known for significant skin tightening and texture improvement.

2. **Microneedling**
Microneedling creates tiny punctures in the skin, which promotes the production of collagen and elastin. When combined with RF (Radiofrequency Microneedling), it can be even more effective for improving skin texture and laxity.

- **Morpheus8:** A popular RF microneedling treatment that can remodel and contour the face and body.

3. **Laser Treatments**
Lasers can resurface the skin, improving texture and stimulating collagen production.

- **Fractional CO2 Laser:** This laser can provide significant improvement in skin texture and laxity by creating controlled micro-injuries in the skin.
- **Erbium Laser:** Less aggressive than CO2 lasers but still effective for improving skin texture.

4. **Ultrasound Therapy**
- **Ultherapy:** Uses focused ultrasound energy to lift and tighten the skin by stimulating collagen production. It’s particularly effective for treating sagging skin.

5. **Injectable Treatments**
- **Biostimulatory Fillers (e.g., Sculptra):** These injectables stimulate collagen production over time, which can improve skin texture and firmness.

6. **Thread Lifts**
- **PDO Threads:** These are absorbable threads that are inserted under the skin to lift and tighten sagging areas. They also stimulate collagen production over time.

7. **Topical Treatments**
- **Retinoids:** Prescription-strength retinoids (like tretinoin) can improve skin texture by increasing cell turnover and collagen production.
- **Peptides and Growth Factors:** These can help improve skin elasticity and texture when used consistently.

8. **Lifestyle and Skincare Adjustments**
- **Hydration:** Keeping the skin hydrated with quality moisturizers can improve its appearance.
- **Sun Protection:** Regular use of sunscreen can prevent further damage and degradation of collagen.
- **Healthy Diet:** A diet rich in antioxidants, vitamins, and minerals supports skin health.

9. **Hormonal Balance**
Since you are experiencing perimenopausal changes, discussing hormone replacement therapy (HRT) with your physician might be beneficial for overall skin health and other perimenopausal symptoms.

Recommendations for Action:
1. **Consult a Dermatologist or Plastic Surgeon:** They can provide a personalized treatment plan based on a thorough evaluation of your skin.
2. **Consider Combination Treatments:** Often, combining different modalities (e.g., RF microneedling with laser treatments) can yield the best results.
3. **Consistency:** Regular maintenance treatments and a consistent skincare regimen are key to long-term improvement.

Remember, non-surgical treatments can offer significant improvement, but results vary and multiple sessions may be required for optimal outcomes.

Camille Cash, MD · Answer

If you are wanting nonsurgical options you can consider Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Topical anesthetic is generally used for comfort.  Three treatment sessions are recommended for optimal results.  See my website or a provider near you to learn more.

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