Age-related volume loss, particularly in the deeper fat pads of the skin, as well in the muscle and bone below, is largely responsible for the sagging, jowls and supposed overall "laxity" of the surrounding envelope of the skin. Unless, the underlying volume deficit is addressed, any attempt to tighten the skin envelope is unlike to result in a rejuvenated look. More commonly, by simply stretching the skin over the underlying residual tissue, as is often the case in surgical facelifts that cut off the supposedly excess overlying skin, the result is a skeletonized-looking face that so often engenders the much feared comment by observers, "Oh, she's been done." If volume loss is the underlying issue, as seems to be the case here, volume repletion with the use robust volumizing and lifting fillers is naturally the appropriate way to go. Filler augmenting of the cheeks will create a more ideal, feminine heart-shaped face, which will, at the same time, lessen the smile folds, create a more gradual transition between the upper cheek and tear troughs, and even to some extent improve the incipient marionette lines. To repeat, volume loss requires volume repletion, not cutting away supposedly "excess" skin. As to the skin tightening devices out there currently, unfortunately (even if the need for skin tightening were really the issue), the hard science to support the purported benefits of the current "bells and whistles" devices lags well behind the intense marketing and advertising to promote their use. Make sure to consult with a board certified cosmetic dermatologist and best of luck.
