J Plasma or Ultherapy? (Photo)

Question

I'm getting conflicting advice in virtual consults so I wanted to reach out here for input. I'm a 45 year old male with laxity starting in neck and on face. Which way would you recommend going? I have big cheeks despite being lean and fit so anything to minimize that also welcome (had buccal fat removed). Thanks!

Jason Emer, MD · Answer

I am not sure what advice you have been given but you need a neck/face lift, fillers, and morpheus long term with thermage/ultherapy every 6 months AFTER you get the lift.

if you want a dramatic change necklift/facelift, Implants and fillers will give you that. noninvasive will improve the area and facetite, threads, morpheus, and fillers can be used.  start at home dermarolling to tighten you skin, see emeragecosmetics where we recommend MTS roller with anteageMD ampules daily (see dermarolling package).

With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel,  co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles.  You need a formal consultation, as the neck can be treated with a combination approach:
1. micro needling and lasers for texture
2. botox, disport or xeomin to help platysmal bands
3. intensif or fractora RF microneedling for crepe skin and lifting
4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds
5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening)
6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening
7. ultherapy and thermage for external tightening
8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness
9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production
see an expert for a full evaluation and treatment plan based on your individual situation and goals.
Best, Dr. Emer

Dean P. Kane, MD, FACS · Answer

Dear SoCal212,

Thanks for sharing your photos. They are helpful and demonstrate your concern. Your lean body, sun exposure and weathering along with aging produce the skin excess and laxity you describe. The beginnings of facial skin laxity start at 30 years old when collagen skin repair diminishes and passive skin aging relaxes downward. The web of fibrous compartments under the skin loses fat, stretches and elongates forming 5 growing “waves” of skin at points of attachment, developing:
1.	hooding along the eyes,
2.	lower eyelid / cheek junction or tear trough / nasojugal fold
3.	nasolabial fold,
4.	lateral mouth commissure and marionette folds,
5.	jowls and neck.

Please consider:
1.	Consultation with a Board Certified Plastic Surgeon with skills in facial aesthetics including non-invasive, minimally invasive and surgical options. 
2.	Your best duration and value will probably be a face and neck lift.
3.	If you desire a minimally invasive option, ThermiTight will provide the best skin tightening BUT consider neck and face hairloss as a side-effect to this option. It can be combined with  Silhouette InstaLift or EuroThread suture suspension lift. These are advanced techniques so choose your surgeon carefully. They provide a 30 to 50% improvement without removal of skin excess. 
4.	Externally applied non-invasive skin tightening options as you ask about have been terribly disappointing in my experience and require 3 to 6 month sessions to keep the collagen stimulus going. 
5.	Sculptra, a injectable collagen stimulator is wonderful following or in place of  the above to maintain your results. 
6.	A retinoid topical skin health regimen will also stimulate collagen topically.

I hope this helps. Good luck!

Mats Hagstrom, MD (license on probation) · Answer

I think the underlying reason for your premature skin laxity of your neck it’s related to the shape and size of your mandible.

Unless you’ve had significant weight loss.

My best guess is you will be left disappointed with either J plasma or ulthrapy.   These procedures are more likely to diminish underlying fat then tighten your skin.

While it may seem premature a proper facelift is probably your realistic best option.

I had my facelift when I was about your age.

In the hands of the right surgeon it can be a very very good experience.

I do recognize that hesitation some people may have for this.

Male facelift surgery should be done by providers who have extensive experience in a proven track record.

I personally owned the J plasma device but found it completely disappointing and have since sold it.

Best of luck in your decision making.

Mats Hagstrom MD

J Plasma or Ultherapy? (Photo)

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