Published: January 31, 2018
Category: Ask Dr. Ridenour

My jowls are dropping along with my other facial features. Can you suggest some skin tightening procedures that don’t require going under the knife?

Recently a patient asked Dr. Ridenour this question on Real Self. His response is as follows.

“Wouldn’t it be nice if we could simply tighten the skin all over our bodies? That would certainly make the aging process a lot more agreeable to most of us. Alas, it is not that easy. Not only do we lose elasticity in our skin (dermis), but we also stretch out the vertical attachments that bind our skin to the underlying muscle and bone. We also loose elasticity in the connective tissue that invests and supports the fat compartments of our face and body. The latter is what underlies the expansion and descent of the jowl fat compartment in our face.

That is why there is no magical non-surgical procedure or minimally invasive device that can reliably tighten sagging skin in the face. That doesn’t mean that good results aren’t possible without surgery. You can get good results when you combine several minimally invasive procedures. My approach is to first consider whether fat or filler is needed to support a deflated face.  As we age we lose deep structural fat in the cheeks, temples and around the eyes. Fat in the upper face is important because it acts as a scaffold to support and prevent sagging of skin in the lower face and neck. Injecting filler or fat not only restores the graceful contours of the upper face, but it acts to minimize sagging in the jowl area and neck. Second, I recommend a combination of fractionated CO2 laser to improve the skin’s surface texture and wrinkles, and micro needle RF to restore the elasticity and thickness of the skin.  Radiofrequency is the best modality for increasing the number of “elastin fibers” in the skin’s dermis, which are needed for the skin to hold its shape (elasticity).  I strongly favor the Profound RF (Dermal) in combination with the fractionated CO2 laser. Finally, if there is expansion of the jowl fat compartment (heavy jowls), or fatty changes in the neck, I add a different type of RF energy to improve those areas.  I use the needle based Profound SubQ system, or the ThermiTight cannula to tighten this deeper space under the skin.  Unfortunately, none of these procedures are very effective in reducing platysma bands, although Botox can be of value. These procedures can be combined into a single office-based  “skin tightening” treatment, which is my preferred approach.”


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