Alternatives to Thermage for Loose Skin?

The skin around my jowls is loosening noticebly. I was researching Thermage. Are there better more cost-effective skin treatments for my problem?

Doctor Answers 10

Thermage works well with younger patients

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If you have severe jowls and are older with poor quality skin then Thermage will be ineffective. You will need a facelift to get good results. However, if you have some mild sagging with good quality skin tone then you are the ideal candidate for this procedure.  Patient selection is very important. Also going to an experienced dermatologist is key.

Thermage Alternatives Work Well

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Thermage is a very good procedure for tightening the facial skin in patients who only have relatively minor amounts of laxity. Such patients tend to be relatively young, generally 35-50 years old.

When patients have a greater degree of laxity, Thermage should be combined with a dermal filler such as Juvederm or Restylane. The dermal filler provides additional lifting of the cheeks and softening of the folds on the face. The use of Thermage and a dermal filler together will give completely natural appearing facial rejuvenation in patients who have a somewhat greater amount of skin laxity.

For patients who have more skin laxity and wish to achieve greater amounts of skin tightening, I recommend the Fraxel Repair laser. The Fraxel Repair laser is a very effective non-surgical skin tightener. It provides much greater skin tightening than either Thermage by itself or Thermage and a dermal filler. Fraxel Repair treatment results in visible skin tightening and significant improvement in wrinkles, fine lines, and pigmentation in the treated areas. The skin also heals with an improved texture.

Today’s options for non-surgical skin tightening are truly excellent and result in completely natural appearing facial rejuvenation. The key is to ensure that the correct procedure is performed on an appropriate patient in order to give the expected results. A patient who is considering non-surgical facial rejuvenation should consult with an expert in the field to determine which approach is best for that particular patient.

Take care and be well.

George Anterasian, MD

George Anterasian, MD
Santa Monica Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Optimizing results with Thermage

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The first thing to know is that none of the nonsurgical treatments such as Thermage produce the same results as surgery; in other words, there is no "nonsurgical facelift." We have learned a few things about optimizing results with Thermage however. One is that older patients, whose collagen in their skin is depleted, don't respond as well. The ideal patient is someone in their 40's to mid-fifties. The other thing is that Thermage applied immediately after liposuction enhances the skin tightening. A great option for some patients is to do a little bit of lipo under local anesthesia, followed by Thermage. (some pictures here: and video here:

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

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Improving Jowls With Thermage or a Mini-Facelift

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Jowling can occur secondary to a loss of fascial support in the lower one third of the face. Thermage, unfortunately, cannot acheive a structural change in the underlying fascial support system and is thus less effective than a facelift. If you are considering a lesser procedure than a face lift, a mini lift may improve the appearance of jowling. In any case, results for jowling are typically seen only after a surgical procedure. Consult with your plastic surgeon.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Non-Ablative is an option but will not achieve the same as a face lift

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There are no superior options merely alternatives such as Titan, Velasmooth, Accent.

However, none of these will achieve the degree of improvement that a facelift can perform. Granted there are more risks to surgery.

Non ablative interventions can achieve an improvement of 1-3 on a scale of 10 versus surgery which can achieve a 7-8.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

A full assessment is needed!

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In my experience, jowls are formed by skin in addition to deeper structurees (descending cheek fat pad). If skin tightening alone is done, and there are untreated deeper structures that are not treated, the result will be unsatisfactory.

Usually, jowls are more effectively treated with a cheek lift, frequently in association with a neck lift, for best results.

If you are set on skin treatments, you may want to look into CO2 laser, Coblation, deep chemical peels (phenol), are options you may want to look into.

Alternatives to Thermage

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Thermage has noticeable but very limited results. Other skin resurfacing procedures tend to tighten the skin to an extent to smooth some of the fine lines, improve pigment problems and diminish pore size. What they do NOT do well is to minimize jowls and other signs of facial soft tissue laxity. Only a mini facelift or facelift will take care of this problem in a significant fashion.

Al;ternatives to Thermage fo loose skin

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There are surgical and nonsurgical alternatives.

If the skin around your jowls is loosening noticeably, most likely the Thermage procedure alone will not suffice.

Injecting fillers (Restylane, Juvederm, Sculptra,etc) followed by Thermage may be quite effective in many cases.In fact the fillers will also improve the appearance of your cheeks above the jowl lines.

In many cases, injecting 2 or 3 syringes of a filler at the same session may be necessary.

If the loose skin around jowls persists, plastic surgery becomes the obvious choice,

Make sure that you are being treates by a Board Certified Dermatologist or Plastic Surgeon.

Eugene Mandrea, MD
Chicago Dermatologist
4.6 out of 5 stars 5 reviews

Thermage for loose jowls

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If you are a candidate for surgery and are considering a face lift, then you should consider that over Thermage. If you do not want surgery or if you have medical conditions that prevent you from having surgery, then Thermage is a good choice.  The newer technology allows sufficient tightening in some patients to see a dramatic improvement, although it is not as excellent a result as surgery.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.