Which non-surgical treatment is best for skin tightening on face and upper eyelids?

Question

I have seen options like Thermage FLX, Fotona 5D/6D, HIFU, Ultherapy, Face threadlift at aesthetic clinics. May I know which one is the best option for saggy skin on face, and thick/sagging upper eyelids? Which one is longer lasting and most effective? Any other option to look into for the best and lasting results? Thank you in advance!

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Bernard Tan, MBBS, MRCSB · Answer

Hi! 
Non surgical skin tightening on the face, neck and eyelids is in huge demand, and there are a good variety of options. 
I have experience with all of the treatments above and my answer reflects my personal experience/opinion, results may vary, work with a provider you trust :)
Thermage FLX- This is a monopolar RF device that bulk heats the superficial skin to about 40-42C for skin tightening and new collagen production. 
Pros: can be performed for eyelids (special tip used), face and neck. Annual treatments Cons: quite expensive (3-4K sgd), quite painful (some clinics give painkillers)
Fotona 4D (some clinics brand it 7D 8D 9D but the official protocol is known as 4D)- this uses the Fotona SP Dynamis laser to perform bulk heating of the skin and superficial skin rejuvenation
Pros: fairly comfortable, no downtimeCons: need quite a few sessions for results (usually at least 3-5).
Ultherapy/HIFU: Focused ultrasound energy is used to create small pockets of heating (thermal coagulation points) at the deeper layers of the skin 3mm 4.5mmPros: great for deeper face lifting, burns fat of the double chin/cheeksCons: excess fat reduction may leave the patient looking sunken and tired, not able to treat eyelids
RF microneedling (eg SecretRF)- Fine gold tipped needles penetrate the skin to emit RF energy to tighten skin and trigger new collagenPros- can treat eyelids eyebags face and neck, burns some fat, depth of needles adjustable. 3-5 treatments requiredCons- mildly uncomfortable.
The question "which is best" would really depend on your specific area of concern, your skin thickness and your personal prefence/pain tolerance.
Which is best FOR YOU? find a trusted provider and have a detailed discussion :)

Camille Cash, MD · Answer

Accutite may be an option for you.  This non surgical treatment uses RF technology to tighten skin up to 40%.  Your results can be enhanced by adding Morpheus8 to improve overall skin tone and texture.  See an expert provider near you to learn more.

Kathleen Griffin, MD · Answer

Hello there! There are many options for treating sagging skin on the face, and choosing the best option involves consulting with a provider who can see your skin and understand your expectations. Radio frequency microneedling and fillers can help lift the skin and improve skin laxity. For the upper eyelids, the plasma pen could be a good option for you. Hope this helps some!

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