Sagging neck, keloiding skin - What are the most effective non surgical options that give real results? (Photos)

Question

53 year old female with fair freckled skin that keloids badly. I have gained and lost weight throughout my life. Now I have sagging jowls and no jawline. The skin is still smooth, except when I'm looking down. I don't have neck bands. I know a necklift would be the best option. I also know that I will get keloided scars. I have done ultherapy previously and gotten good results.But my skin is losing the battle. What are the most effective non surgical options that give real results?

Mert Demirel, MD · Answer

For true jowling and loss of jawline definition, non-surgical treatments can improve skin quality and mild laxity, but they usually cannot reproduce the result of a neck lift or lower facelift. If the skin is already sagging, the most predictable correction is still surgical lifting and redraping.
Ultherapy or similar ultrasound/RF tightening can help selected patients with mild laxity, and it sounds like you responded well before. However, the result is usually modest and temporary compared with surgery. It may slightly tighten the skin and improve the jawline, but it will not remove significant loose skin or fully restore a sharp neck contour.
Because you keloid badly, avoiding surgery is understandable. But any treatment that injures the skin, including energy devices, threads, microneedling, or lasers, should be approached carefully. Keloid risk is usually lower with non-incisional treatments than with surgery, but it is not zero, especially if your skin scars aggressively.
Threads are often not ideal for this situation. They can give a short-term lift, but results are limited, and they may cause dimpling, inflammation, or palpable irregularities. Fillers can camouflage mild jawline weakness, but if there is true laxity, adding volume can sometimes make the lower face look heavier.
Realistic non-surgical options would include conservative Ultherapy/RF tightening, possibly small amounts of jawline/chin filler if your anatomy is suitable, and good skin-quality maintenance. But if your goal is a major, durable improvement, surgery remains the most effective option. In your case, that decision would need a very careful discussion about keloid prevention, scar placement, steroid/silicone scar care, and whether the benefit is worth the scar risk.

Sean Fisher, MD · Answer

Non-surgical devices can deliver reasonable results when used in younger patients with modest signs of aging. As skin laxity and tissue descent becomes more prominent, it is very difficult to get a result that most patients are excited about. Based on the provided photos, I think it is likely that you have passed into the stage of aging where considering surgery is really the best solution. I would recommend consulting with a plastic surgeon with advanced training in facial rejuvenation who can discuss options with you and assess your scaring- often times, what patients think are "Keloids" may be something else, such as hypertrophic scaring- this can be assessed with a detailed physical exam. 
Sean Fisher, MD Aesthetic Plastic SurgeonSeattle, WA

Sagging neck, keloiding skin - What are the most effective non surgical options that give real results? (Photos)

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