Sagging jowls and neck lines at 34, will laser tightening work or do I need surgery for a youthful lift? (photo)

Sagging neck requires excess skin removal not laser. Save your money for a facelift even though you are young in years your genetics give sagging skin.

A combination of non-surgical options like Kybella, PDO NovaThreads, Ultherapy and Thermage would do well in combination for skin tightening for the neck. VASER Liposuction (with ThermiRF, Renuvion and InMode FaceTite) is a great alternative for contouring and tightening the chin and neck and can be combined with a neck lift at the same time, if you're a candidate. I suggest getting a formal evaluation with a cosmetic dermatologist to develop a long-term treatment plan that works for you. Best, Dr. Emer.

From the photos it appears you are a candidate for Morpheus8. This noninvasive treatment combines RF technology with microneedling to improve overall skin tone and texture. Three sessions are typically recommended for optimal results. We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Might consider "PRECISION SMART LIPO LIFT", ThermiTight RF Lift, Fat grafts or Voluma fillers, and finally a mini facelift. Or combination of all three... 

You have a beautiful and elegant jawline and I sure wouldn't be thinking about surgery at this point. I would see Dr. Cynthia Mizgala or Dr. Von Graham right there in New Orleans and let someone put a little botox in your neck since this is most likely due to platysmal banding. Both of them are very experienced and excellent. Dr. Mizgala was the gold medalist in Surgery in Canada which is the award given to the top surgical resident in the nation when she trained at McGill university and was number one in her class every year of her life from grade school through medical school! I was her boss at Ochsner when she was right out of residency and she is outstanding as a person and a doctor. Dr. Graham was also in my department when I was there before Dr. Mizgala came to join us and he did a facelift on my mother if that tells you what I think of him. You can't go wrong with either one.  Also there are now some great noninvasive techniques for giving you back a little facial volume as well as some skin tightening. I use sculptra, Voluma, and Juvederm HC depending on the issue. Unfortunately a lot of nonsurgeons use that stuff too and it looks bizarre so be sure to go to a surgeon for injectables.  Also you need to consider doing some Sciton microlaser peels to keep your skin looking good.  Also you might want to check into a program called "Forever Young BBL" which is a program where Exilis and BBL is used to tighten skin and also prevent aging. Studies out of Stanford with a 12 year study show BBL can actually cause genes in the skin to express younger with one to two BBL's per year. I would say you are a good 10 years away from even just a mini-lift. Stay out of the sun or use great sunscreen too.  Hope this helps.    

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon