One of the most common requests for patients in the office is to seek improvement in facial and neck sagging without surgery. So here are in my opinion the some of the better treatments that can actually deliver a result:
-"Under the Skin Radiofrequency"- This is the hottest area of facial rejuvenation and an area that is expected to rapidly grow over the coming years. There are several devices here including Facetite, ThermiRF and others who place a probe under the skin which causes contracture of the skin and tightening. This bottom up approach will often demonstrate visible tightening and contracture of the office and can take up to 6 months to see a final result. I personally like the Facetite since it involves a contained thermal field rather than uncontrolled heat and in this regard think of it as safer and allows surgeons to heat with higher temperatures. These procedures do involve some downtime and are done comfortably in the office.
-Filling out the Face- Fillers around the face can add volume where volume has been lost. There are a variety of facial fillers available including hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid which can be used to fill out cheeks, lips, temples, nasal labial folds and other areas of the face.
-Smoothing out the Skin- Here a variety of techniques can be used including fractionated C02 resurfacing of the face, radiofrequency ablation of skin (a top down approach), erbium resurfacing, chemical peels and other treatments to treat fine lines and wrinkles.
Options not mentioned as ideal include the following:
-Botox Neck Lift or Nefertiti Lift- This involves placing a large amount of botulinum toxin in the neck to selectively tighten the neck muscles. While patients may see some improvement, it needs to be repeated every 4 months and since it requires a large amount of Botox other treatments include the Bottom Up Radiofrequency techniques are probably more cost effective and offer more longevity to the result.
-Radiofrequency (Top Down) or Ultrasound treatments- Treatments such as Thermage, Ultherapy are probably better at maintaining facial contour than lifting face and necks. Unfortunately, the pricing on these options makes many of these treatments not as ideal.