Best treatment for face tightening, fine lines, under eyes and pigmentation? (photos)

Question

Hi Doctors! First of all, I know an in-person consultation with a board certified doctor is what I need but I'm seeking advice on which procedures to research. I had a facelift two years ago along with an upper Bleph and I'm satisfied with those procedures. I will be 58 in two days and as a gift to myself, I wish to address my pigmentation/dark spots, fine lines, loose skin (perhaps facelift was not tight enough) and under eye area. I'll be looking in either the Boston or Miami areas.

Nadir Qazi, DO · Answer

Of course, I'd be happy to help! It sounds like you're interested in addressing several common concerns related to aging skin, including pigmentation, fine lines, loose skin, and under-eye wrinkles. While there are many different treatments available to address these issues, here are a few options that you may want to research further:
Laser skin resurfacing: This procedure uses a high-energy laser to target and remove damaged skin cells, stimulating the growth of new, healthier tissue. Laser resurfacing can be used to address pigmentation, fine lines, and uneven skin texture, and is typically performed in a series of treatments for optimal results.
Chemical peels: A chemical peel involves applying a solution to the skin that causes the outer layer of cells to peel away, revealing smoother, more even-toned skin underneath. Chemical peels can be customized to address specific concerns, such as pigmentation and fine lines, and are often used in conjunction with other treatments for maximum impact.
Microneedling: This minimally-invasive treatment involves using a small device with tiny needles to create micro-injuries in the skin, triggering the body's natural healing response and promoting collagen production. Microneedling can be used to address fine lines, uneven skin tone, and mild pigmentation issues.
Dermal fillers: Injectable fillers can be used to add volume and plumpness to areas of the face that have lost elasticity and firmness over time, such as the under-eye area and cheeks. Fillers can also be used to minimize the appearance of fine lines and wrinkles, and can be a great non-surgical alternative to a facelift.
Radiofrequency skin tightening: This treatment uses radiofrequency energy to heat the deep layers of the skin, stimulating collagen production and tightening loose or sagging skin. Radiofrequency skin tightening can be used to address fine lines and wrinkles, as well as areas of loose skin such as the jowls and neck.
As you mentioned, it's important to consult with a board-certified dermatologist or plastic surgeon to determine which treatments may be best suited to your individual needs and concerns. They can help you develop a customized treatment plan that takes into account your skin type, previous procedures, and desired outcomes. Best of luck with your research and happy birthday!

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Farhan Taghizadeh, MD · Answer

Dr. T has some non-surgical and surgical options for you.
For Sun Damage, CO2 is your best option, in combination with fillers and radio frequency to help tighten.
For a more permanent treatment, a facelift and lower bleph would be your best option.
thanks!

John Michael Thomassen, MD · Answer

You can do laser or a 35% TCA peel for the fine lines pigmentation.  A lower lid bleph can address the lower lids and a facelift revision can be entertained if you would like to be tighter.

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Michael I. Echavez, MD · Answer

In my opinion, you appear to be a good candidate for CO2 laser resurfacing of your face.  This will help with fine lines, pigmentation and tighten the skin of the eye area and the face.