I'm open to a face lift or facial plastic surgery but wanted more opinions on a variety of skin tightening options to tighten jowls and skin laxity in the face in general.
Facial Skin Tightening Options
Doctor Answers 68
Facial rejuvenation options
How We Age
The effects of gravity, sun exposure, intrinsic aging, and the stresses of daily life take their toll on our faces over time.
On the surface, the skin accumulates sun damage, leading to age spots, blemishes, and fine lines. Deeper lines and creases develop as the skin loosens and sags.
Beneath the skin, the support structures of the face (muscles, ligaments, etc.) loosen, and the soft tissues atrophy so that our face loses volume. This causes a constellation of age-related changes to the face – the nasolabial folds deepen, the jawline slackens, fat collects beneath the chin, the eyelids droop and fat protrudes from the lids, the eyebrows, cheeks, and tip of the nose go southward.
How To Turn Back the Clock
The first step to turning back the clock is to maintain a proper lifestyle, including a healthy diet rich in antioxidants, regular exercise, the avoidance of smoking, and proper skin care.
Treatments for the aging face include nonsurgical cosmetic treatments and cosmetic surgery. In general, nonsurgical treatments are best suited as main treatments for younger patients with milder signs of aging or as adjunctive treatments for older patients. Older patients with more pronounced signs of aging typically need surgery (in addition to the nonsurgical treatments) to produce effective results.
Improving the skin’s quality, texture, and appearance can benefit many patients both younger and older. Options to achieve this include:
- Topical medicines (e.g. proven medicines, such as tretinoin, hydroquinone, Obagi, etc.)
- Chemical peels
- Laser skin resurfacing
Additional nonsurgical cosmetic treatments, such as Botox and injectable fillers, can also play an important role in facial rejuvenation. Botox reduces smile lines by inactivating facial muscles. Fillers, such as Restylane, Juvederm, Radiesse, Artefill, and autologous fat, plump up areas that have “hollowed out” over time, such as the nasolabial folds, lips, and around the eyes.
Noninvasive “tightening” procedures, such as Thermage, Titan, etc., may tighten the skin, but to date patient satisfaction rates have been low.
Older patients with more pronounced signs of aging, including sagging skin, prominent jowls, etc., typically need cosmetic surgery to produce good results. Surgical options include the face lift, forehead lift, eye lift, midface lift, and neck lift. These procedures are often done in combination along with nonsurgical treatments.
If you are a patient interested in turning back the clock, I recommend that you see a qualified cosmetic specialist (e.g. plastic surgeon) who can offer you the full range of cosmetic treatments so that you can choose the best options for your particular needs.
The Essential Truths of Facial Rejuvenation
There are several essential truths that must be stated in order to fully answer this question completely.
- There is an old saying that states: "Small surgery, small results." With rare exception, this continues to ring true. This also applies to treatments in general.
- A patient and a procedure must match each other in two key ways:
- A patient's anatomy must be appropriate for the proposed surgery, because surgeries are based on anatomy.
- A patient's expectations must be appropriate for the expected results.
- A patient's goals must be clearly understood by the physician so that the appropriate treatment plan can be made.
- If something sounds too good to be true, then it probably is.
- Try not to be the first person on the block having a new procedure.
If you remember these facts when considering treatment options, then you will likely make the right decision about cosmetic treatments for facial aging.
There are so many options available to patients that it can be quite difficult to reach an informed decision. Trends are constantly changing and new treatments emerge, while others disappear.
Therefore, if you have a small problem with photoaging of the skin, then topical therapies (Retin-A, acid peels), non-ablative lasers, Botox, and volume fillers will all likely help you achieve your goals. These treatments, in general, have shown benefits in the vast majority of patients and are reliably safe.
If you facial aging problem is severe, then it is likely you will need some of these treatments as well as surgery. Facelifts of all varieties help to elevate the skin, but do not create changes to the skin itself. That is why a comprehensive program involving skin care, sun avoidance, laser therapy or chemical peels are usually suggested to patients undergoing this procedure.
Those patients that fall into the middle category are the most challenging to treat. Although some patients will opt to wait a few more years for formal treatment, many want improvements now. Thermage, stronger laser treatments, Portrait plasma resurfacing, and modified facelifts (with small incisions and quicker healing) are perfect solutions, as long as the patient understands the limitations of each therapy and the likely need for further treatments in the future.
So think of your problem, your goals, and your lifestyle needs.
If your problems are small or your goals are modest, then quick, minimal downtime solutions are probably right for you. If your problems are big or your goals are big, then you will likely be disappointed with simple solutions and probably need comprehensive treatment, likely including surgery.
Most facial surgery will required 1-2 weeks of downtime before you feel comfortable socializing with others.
Fill the face with volume, tighten the skin with Fraxel repair
Sagging facial skin results from the loss of volume from the face, and the aging of the superficial skin.
Traditionally surgeons correcting the problem pulled the sagging tissue and cut away the excess. You can tell who those patients are when you see them walking down Rodeo Drive in Beverly Hills, Park Avenue in Manhattan, and Collins Drive in Miami.
Natural results can be obtained today by restoring volume to the face, and then by treating the face and neck with Fraxel repair. Fraxel repair will tighten the skin, reduce wrinkles, improve the eyelids, and improve the tone, color, and texture of the skin.
In the great majority of my patients this will restore an amazing youthful, rested appearance to the face. This will not leave a patient as "tight" as they might be after a surgical facelift. In some cases of excessive skin "sag", traditional surgery may still be needed.
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Limited alternatives to surgery, if surgery is indicated
I use the "onion" as a good analagy of how we are put together anatomically.
The skin is the outer layer, followed by a layer of fat, and then, a strength layer, fat pads, and neres/muscles/blood supply.
Procedures like chemial peels, laser, coblation, are great for tightening the skin, and reversing the signs of premature aging due to sun, cigarette smoke, and environmental oxidants, etc. This will do nothing for lifting the deeper layers that have descended over time as a result of time and gravity. On the other hand, facial rejuvenation procedures such as face lifting, are great at restoring the deeper structures to a more youthful state, but they do not restore the skin (outer layer of the onion) to a more youthful condition.
The deeper layers contribute to the nasolabial folds (the ()'s) around the mouth, the jowls, the hollowness of the cheeks, and the loss of crispness of the neck. The face lift procedures are ideally suited for correcting the problems that are deeper than skin deep.
Tightening sagging facial skin
The answer, simply put, is a facelift. There's lots of hullabaloo about lasers and Thermage tightening the layers of the face, but in the absence of real controlled and peer-reviewed data (not provided by the manufacturers of the devices) and before and after photographs documenting any longterm results of these methods (and thousands of dollars/ multiple treatments later), the facelift is still the gold standard for lifting and tightening sagging facial skin and soft tissue.
Thermage:The Best Way to Tighten Sagging Facial Skin.
Ideally a patient should have a consultation in a plastic surgery practice that offers a full range of surgical and non-surgical options so that an appropriate, comprehensive and highly individualized treatment plan can be developed.
Surgical or even non-surgical treatment of facial aging changes must be carefully individualized to match each patient's aesthetic needs and desires. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized plan is then developed which addresses each patient's specific concerns and needs.
A "liquid facelift" is a procedure that is performed using temporary dermal fillers like Juvederm Restylane or Perlane. There is little to no downtime with a liquid facelift. This might be an ideal treatment for some, but the results are temporary and it does not address excess skin.
Structural fat grafting, sometimes referred to as microfat grafting can provide fullness to lips, cheeks, hollowed upper or lower eyelids and can fill lines and wrinkles on the face. Unlike the liquid facelift, the results from structural fat grafting can be permanent
Laser Skin tightening is a non-invasive treatment with little to no downtime. For individuals with early signs of aging, uneven skin tone, scarring or large pores a laser skin tightening procedure can provide dramatic results.
Full Facial rejuvenation or a full facelift may be the answer for some. Some people looking for facial rejuvenation are interested in the lower face, midface and eyes, others are interested in one area only. Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.
Facelift and LiveFill
Most modern approaches to the face tighten and replace volume. The patient's own tissues placed into hollow areas give the longest lasting, most stable results. LiveFill and fat injection are two techniques that use the patient's own tissues to restore fullness to the face, and are often used in combination with facial tightening procedures.
Sagging face - consider fat grafting and surgery
Hello Ms Anne,
Lots of great answers to your question here. I wanted to specifically also recommend the option of autologous fat grafting for sagging cheeks. As you have learned by now aging changes related to volume loss are best addressed by volume correction.
The BEST way to tighten jowels? Vertical elevation with cranial suspension. Sorry but that is surgery!
The key to facial rejuvenation is first, proper analysis...
The key to facial rejuvenation is first, proper analysis of the problem, and then to design a treatment plan to provide the patient with a durable, safe result.
The fundamental issue with jowling is that it makes the jawline look too square, and a youthful jawline is shaped more like a triangle. While some lasers can tighten the skin, and fillers can hide the jowls a bit, the underlying issue of relaxation of the skin AND the underlying tissues will not be durably addressed with these techniques.
So in my opinion, surgery is usually the best way to go, and it will certainly provide a more durable result (10-15 years) versus fillers, lasers, or Botox.