What is the Best Laser Treatment for Saggy Jowls?

The Thermage and Cutera Titan lasers have been advertised as being alternatives to a traditional facelift for tightening of the face. Somehow collagen is miraculously made which tightens the skin, rendering it tight, with a minimally invasive no downtime treatment. This is not even close to what actually happens.
We have used radiofrequency treatments and IPL machines in our practice. They give minimal benefits, virtually not observable on before-after pictures taken at 3 months. If the pictures are taken days later, you often see a minor difference, presumably because of the swelling caused by the treatments. They do nothing for significant jowling.
On our website we have pictures of patients who have undergone CO2 laser resurfacing. CO2 laser is the most effective tightening procedure available by far. In patients who who have jowls, even CO2 alone does very little for the jowls. In order to reduce jowls to a minimum, patients should consider a well done facelift.
Many patients were happy with their IPL and radiofrequency treatments, but only because we told them the tightening benefit would be minimal; sun damage could be reduced, but not to expect significant tightening, and they were OK with that. On this website, the satisfaction rate with Titan is 36%, and Thermage is 37%, hardly stellar. The satisfaction rate for a facelift is 82%, despite the much greater cost. Had we promised a $2000 alternative to a facelift to our patients, and had the patients been expecting to have facelift results from a minimally invasive treatment, they would have been very disappointed as well.

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

A combination approach would give the most improvement with Ultherapy for neck skin tightening. I recommend Ultherapy with radiofrequency treatments, lasers, microneedling/PRP, and/or Sculptra to get increased collagen, tightening and improved skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Ultherapy® is a safe, non-surgical ultrasound treatment that counteracts the effects of time and gravity on your skin. It uses the body’s own regenerative response to gently and gradually lift skin on the eyebrow, under the chin and on the neck, and smooth lines and wrinkles on the décolletage. It is the only non-invasive treatment cleared by the FDA to actually lift the skin.
Ultherapy® is also the only cosmetic procedure to use ultrasound imaging, which allows practitioners to see the layers of tissue targeted during the treatment to ensure the energy is deposited to where it will be most beneficial.
With the addition of the new Ultherapy® décolletage treatment, Ultherapy® is also now the only non-invasive procedure specifically indicated by the FDA to improve lines and wrinkles on the chest.

Thermage works on everyone.  Thermage works by heating the skin, and is not a laser as are other devices.  I use Thermage on arms, legs, stomach, but it works particularly well on the lower face and jowls.  There is no pain with the new CPT Thermage and no pre-treatment or down time. It generally takes 90 minutes and within 2 to 4 months your body starts producing collagen and rejuvenates the skin.

The best treatment for saggy jowls is not a laser treatment. I would probably recommend Ultherapy if you are not interested in face lift surgery. Face lift surgery will tighten the tissues around the jowls by lifting them. Ultherapy is a non-invasive way to lift tissues which will reduce the appearance of jowls. Ultherapy is a newer technology which works deeper than Thermage. It is preferable because the results actually work more like a surgical facelift.

The best Laser Treatment for jowls is Titan (Cutera; Brisbane, CA). Thermage uses different, non-laser technology and many believe it to be much less efficacious and/or, all too often, does not work at all. Titan specifically targets Collagen and stimulates new Collagen formation, thus rejuvnating and tightening skin. It does not hurt and does not interrupt your lifestyle. Combining Titan with other lasers (the so-called 3D treatment) greatly enhances the results.

I have had excellent results for laser skin tightening for the jowl, jawline and neck using SmartLipo, SlimLipo and ProLipo.  This is an exception area to see more skin tightening than in other regions, especially if there is an accumulation of at in these regions.  I have also done skin tightening using these lasers when there was minimal fatty accumulation and the results have been just as good.  However, you must seek out a surgeon with a lot of experience, since if the skin is too lax, a surgical procedure would be most beneficial and you can waste your money expecting too much from the laser.  But for mild to moderate sagging it is a good non-surgical (i.e. minimally invasive) procedure.       I do not do Thermage or any external laser treatments any more since the results are temporary and disappointing for the costs.