I have had polynucleotides and Morpheus8 this year - what else can I try for sagging skin? (Photos)

Hi there! Dr Peterson here - I’m a board-certified cosmetic and dermatologic surgeon in NYC. When patients notice sagging skin, it’s usually the result of both collagen loss and changes in the deeper support structures of the face. Many people first try topical products, microneedling, or non-invasive devices, but sometimes those only go so far. At that point, there are a few more advanced options to consider: • FaceTite: a minimally invasive treatment that delivers radiofrequency energy under the skin to contract tissue and stimulate new collagen. • Fractional CO₂ laser resurfacing (TotalFX): improves laxity, texture, and fine lines by creating controlled injury that triggers collagen remodeling. • Biostimulatory fillers (Sculptra, Radiesse): restore volume that’s been lost with age while encouraging the body to rebuild its own collagen over time. • Facelift surgery: the most definitive option, which repositions the deeper facial layers and removes excess skin for more significant correction.
The right choice depends on the degree of laxity, skin quality, and how much change the patient hopes to see. Often, a combination approach works best, especially after more conservative measures have already been tried.

Unlike other tightening treatments, Ultherapy only requires a single treatment every one to two years and has long-term effects in skin stimulation and collagen production. Ultherapy is ideal for men and women who are experiencing mild to moderate skin laxity and desire a noticeable and long-term skin tightening treatment without the complications and risks of more invasive surgical procedures. Ultherapy can be combined with dermal fillers, Botox treatments, chemical peels, skin tightening lasers, and skin facials. Our plastic surgery and cosmetic center in Santa Monica offers Ultherapy as a complement to other skin treatments and cosmetic rejuvenation procedures.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for sharing the photos. You have some of the typical hallmarks of facial ageing and age-related gravitational forces, such as loss of tone and support, soft tissue ptosis, volume loss with jowls and marionette lines, and as such, in reality, nothing apart from a facelift would address these features. Please keep in mind that your saggy skin is not in isolation, but rather part of the bigger picture of the changes mentioned earlier, and no other treatment, apart from a facelift (preferably Deep Plane), is likely to give you an ideal outcome.

I am not surprised with the lack of success with the expensive "bells and whistles" gizmos that you have already tried. I have been cautioning my regular followers for years that the hard science to support the use of these supposedly "next big thing" devices lags well behind the heavy marketing hype and social media buzz to hawk them. Sorry.
Fortunately, we have a host of different robust HA volumizing, lifting and contouring fillers that can contour the face into a more ideal, oval, heartshape, those that can smooth the cheeks, and others that can straighten and define a saggy, jowly jawline. And what's more, in the hands of an experienced, board certified cosmetic dermatologist filler expert all the foregoing could be done in the course of one, approximately 45 minute treatment session, with immediate results, and little to no significant downtime.
At-home the proper use of a regimen consisting of topical retinoid and a topical alpha hydroxy acid cream go go a long way to helping to brighten the fabric of the skin and prolong the effects of the aforementioned filler treatments.Overall the above is a treatment strategy that I have been using with very gratifying results for many years. Hope this helps and best of luck.

Given your treatment history — including multiple sessions of Morpheus8, polynucleotides, and Halo laser — and the persistence of skin laxity, you may benefit from exploring the following:

Combination Therapies with Energy Devices

High-Intensity Focused Ultrasound (HIFU) or Ultherapy® can target deeper tissue layers to stimulate collagen and lift sagging areas, complementing your previous treatments.

Injectable Biostimulators

Agents such as calcium hydroxylapatite (Radiesse®) or poly-L-lactic acid (Sculptra®) can help gradually restore volume and improve skin firmness over time.

Surgical or Mini-Surgical Lifting Options

When non-surgical treatments have plateaued in results, procedures like a lower face/neck lift or thread lifting can directly reposition sagging skin for a more noticeable lift.

Advanced Skin Tightening Lasers

Fractional CO₂ or Er:YAG resurfacing can improve skin texture and stimulate collagen in a way that pairs well with prior treatments.

Supportive Skin Regimen

Consistent at-home use of prescription-strength retinoids, peptides, and antioxidants can help maintain and enhance in-clinic results.

Because your skin has already undergone multiple tightening modalities, any new approach should be tailored carefully to avoid overtreatment and to address underlying structural changes due to natural aging.