After two years of an ongoing pandemic that brought the world to a standstill, I’m excited to attend in-person social events again. I’ve also learned that I can’t bring my social media filters and Facetune to IRL events. It’s not really what I want—our faces reflect our race, our personality, our well-being, and how long we’ve been in the human experience. But I’m happy to make adjustments, especially when it comes to sagging skin.
As a child, my angelic face took on an oval shape at the onset of puberty. But I love the defined jawline and high cheekbones I see on Hollywood stars and on Instagram. Starting at age 35, I also noticed a loss of volume in my face. My skin began to sag, which doctors say is due to rapid weight loss and the natural effects of time and environmental factors.
So I was looking for ways to firm things up. I was willing to try anything that would help improve sagging skin. I initially tried skin care with chemical peels, such as alpha and beta hydroxy acids, which improved texture but didn’t cause the sagging skin I was worried about. Now for the bad news: “You can never combat any form of sagging skin with topical medications,” says Dr. Paul Jarrod Frank is a New York City board-certified dermatologist and author of The Anti-Aging Handbook. If I want to combat sagging skin, I have to resort to injections.
Fortunately, my work gives me access to a group of experienced dermatologists who can tell me more about the various non-surgical procedures for treating sagging skin than I ever needed to.
What causes sagging skin?
By understanding the causes of skin volume loss, you can combat and proactively prevent skin sagging. In short, explains Dr. Lara Devgan, a board-certified plastic surgeon in New York City, “Sagging skin as we age is caused by the gradual loss of collagen and elastin.”
These are two naturally occurring proteins that are present in large quantities in our tissues until they disappear as we age. “Collagen provides tissue support and structure, while elastin provides tissue elasticity, flexibility, and extensibility,” says Dr. Devgan. “Collagen and elastin are important to skin quality because together they improve the skin’s plumpness and suppleness, making it look and feel stronger and healthier over time, due to genetics or sun exposure, as well as other factors like UVA and UVB radiation that begin to break down our cellular proteins.
There are ways to mitigate these factors, such as wearing sunscreen every day and eating certain foods—Dr. Devgan recommends “a diet rich in biotin, folate, B vitamins, lean protein, and micro- and macronutrients.”
However, there are some factors you can’t control. “Ethnicity also determines how soon or late the signs of aging appear: Skin with less melanin will show signs of aging much earlier,” explains Rosemarie Ingleton, MD, a board-certified dermatologist in New York City and assistant clinical professor of dermatology at Mount Sinai Hospital.
What are some nonsurgical options for treating sagging skin?
First, many of the experts I spoke to said that minimally invasive treatments for sagging skin are still being tested for their effectiveness. “Nonsurgical treatments for sagging skin are still the black box of plastic surgery,” says Dr. Devgan. She adds that while there has been extensive research on the topic, “We don’t have a perfect answer to the question of how effective nonsurgical skin tightening is. Many companies and research institutions are actively working on this topic.” But we don’t have the perfect treatment yet. So there’s no silver bullet.
Nonetheless, Dr. Devgan has found some promising approaches. Dr. Frank says he often uses a combination of treatments to target deep and superficial tissues and combat general sagging. Experts have identified several nonsurgical options for treating sagging skin that should be considered and discussed with a qualified health care professional to determine which is right for your skin.
Skin Tightening with Radio Frequency (RF) and Ultrasound
According to Dr. Devgan, radio frequency (RF) skin tightening technology sends radio waves under the skin to stimulate the production of collagen and elastin. In addition to RF skin tightening, ultrasound is another method to consider because it can achieve similar results, says Roy Geronemus, MD, director of the New York Center for Laser and Skin Surgery and clinical professor of dermatology at NYU Medical Center.
I always associate ultrasound with diagnostic devices used during pregnancy to monitor fetal development or a wand that radiologists use to detect kidney stones, but the process of skin tightening is a little different. Ultrasound skin treatments involve directing a concentrated energy beam from an ultrasound machine to a targeted area. They generate heat in the dermis and stimulate collagen production.
RF skin tightening starts at about $250 per session, with prices varying depending on the size of the treatment area.
Injectable fillers
Dr. Ingleton tells us that patient interest in fillers is increasing. “For two years, people have been staring at pictures of themselves on Zoom calls and noticing all sorts of age-related changes in their faces,” she says. “They are increasingly seeking fillers and Botox to look better on camera and in life.”
Hyaluronic acid fillers like Juvéderm and Restylane can help compensate for collagen loss, Dr. Ingleton adds. “Some of these hyaluronic acid products can not only restore volume, but also tighten sagging facial areas, depending on the product used and the doctor’s injection technique,” she says.
Dr. Devgan also points to the potential benefits of fillers, which “can build better bone structure in an aging face, support sagging tissue and give the face a more comfortable shape,” with Voluma being an example of a hyaluronic acid filler developed by the U.S. Food and Drug Administration (FDA) approved for cheeks.
This isn’t new to me—I’ve been using it to enhance my cheekbones for years. Like many nonsurgical procedures, fillers need to be repeated from time to time to achieve the desired results. Most experts say how often varies from person to person, but generally every six months is a good rule of thumb.
Dr. Ingleton tells us that fillers start at around $900 for a 1-mL syringe, but prices vary depending on the amount and type of filler used.
Microneedling
Dr. Ingleton believes that nonsurgical treatments can actually help reduce the appearance of sagging skin, citing microneedling as a treatment that has shown results. Microneedling is a procedure that uses very small needles to make tiny punctures in the skin to stimulate collagen production. According to Dr. Ingleton, skin tightening can be effective through a combination of microneedling and radiofrequency.
“Microneedling radiofrequency devices like the EndyMed Intensif puncture tiny holes in the skin and then deliver radiofrequency heat deeper into the skin, stimulating skin tightening over time,” she says. Dr. Ingleton warns us, however, that “special precautions must be taken when performing radiofrequency microneedling on darker skins,” as people with more melanin are more likely to experience hyperpigmentation. Regardless of skin tone, Dr. Frank adds that it’s best to avoid direct sunlight for a few weeks after microneedling, or any procedure where inflammation could occur.
Microneedling
For those who like to stay up to date: Dr. Geronemus says microneedling is “a new way to tighten the skin,” and according to Practical Dermatology, dermal microneedling involves drilling tiny holes in the skin using a non-powered needle. The needle passes through a mesh.
Microneedling is a very thin needle, so it’s generally not painful for the patient. The procedure removes a small amount of superficial skin and doesn’t leave scars. This causes the skin to contract and tighten while stimulating the production of collagen and elastin.
Last year, the FDA approved a microcoring drill called the Ellacor. Dr. Geronemus says it costs $2,000 to $3,000 per treatment, noting that more than one treatment is often needed.
Lasers
The experts I spoke to say laser resurfacing is a useful skin treatment, though they don’t all agree it’s effective for skin tightening. Laser — which stands for stimulated emission of light amplification — uses small, focused beams of light to stimulate collagen production.
As a proponent of laser skin tightening, we have Dr. Devgan, who explains that erbium lasers “tighten the skin envelope.” The erbium laser beam is absorbed by the water in the skin and vaporizes skin tissue. The heat from the laser stimulates collagen formation, which is said to help tighten the skin.
While Dr. Frank recognizes the advantages of lasers over other skin-enhancing treatments, he remains skeptical of their skin-tightening effects: “Laser is best for removing sun damage, broken capillaries, and melasma, but it doesn’t necessarily tighten the skin,” he says. “However, removing sun damage can improve the overall quality and texture of your skin.”
Laser treatments vary widely depending on the type of laser used and the size of the area being treated. Fraxel laser treatments typically cost $750 per session and Clear + Brilliant laser treatments cost $500.
Thread Lifts
When I was in my 30s, I noticed that the skin around my eyes and chin was losing elasticity. I looked tired, and my jawline felt weak. Finally, I tried a thread lift from Dr. Devgan, who describes it as a “modern thread lift.” “The technique involves lifting and re-suspending hanging or sagging tissue. It’s often used to tighten the cheek or brow area.
The procedure involves making several small incisions with internal sutures to sculpt the shape of your face. Sounds painful, right? Don’t worry, it wasn’t for me. Because according to Dr. Devgan, “Because the sutures are inserted through small needle sticks, there are no incisions.” ”
And it’s fast, too. “It causes the same downtime and discomfort as injectable fillers,” Dr. Devgan adds. “It’s an outpatient procedure that takes about 15 minutes, and patients will return to their normal appearance within an hour.”
What’s the pain and recovery time for each treatment?
Dr. Frank tells Allure that for most patients, the recovery time and pain level for these recommended methods should be very short. How painful something is and how long a person needs to complete the treatment are both subjective, but Dr. Frank adds that both factors “are related to the amount of anesthesia the doctor uses and how aggressive the treatment is.” Theoretically, the deeper the needle or suture, the worse the pain and the longer you’ll need to rest.
“The key here is that nothing is unbearable — no more than a 5 or 6 on a 10-point pain scale,” Dr. Frank adds. The experts I spoke to say post-procedure recovery time for nonsurgical procedures is minimal, ranging from looking and feeling normal the same day to a week.
“With injectable fillers, radiofrequency, and suspension sutures, downtime is kept to a minimum, and patients seem to be able to return to work or other activities shortly after the procedure,” says Dr. Devgan. “Bruising and swelling are always a possibility, but can be quickly covered up with makeup. Lasers produce varying degrees of redness depending on the energy setting.”
Dr. Geronemus adds that most patients who choose micropiercing can expect a recovery time of about three days.
Which treatment is right for me?
One thing is clear: Everyone deserves to treat or maintain their skin the way they want to. No one needs to spend the time or money to treat sagging skin, but there are other options if you choose. Only you and a licensed professional can determine the right path.
According to Dr. Devgan, “Some treatments vary greatly depending on the patient’s needs and concerns. Personal advice is necessary because the scope of interventions can vary greatly.”
When meeting with a doctor, Dr. Geronemus asks the doctor about his or her experience with the procedure, whether the procedure was ordered or performed by a physician, and whether the device the doctor uses is best suited for the specific clinical need.
