Non surgical skin tightening of the lower face

Hi Dr. Irwin, I recently found your site and am so glad I did! I'd like your opinion on non-surgical skin tightening technologies for the neck/chin area (turkey neck/double chin). I'm 59 and in good health but have always been bothered by the genetics (and aging) effects that have markedly changed in me over the last 8 years. I recently read an article that stated the top 3 non-surgical approaches are: 1) Ultherapy, 2) Profound and 3)ThermiTight. I researched and found a board certified plastic surgeon (American Board of Plastic Surgery) and recently saw him for a consultation. Based on the consultation, he suggested I consider ThermiTight of neck/lower face with liposuction OR a lower facelift. He said that I will see results from ThermiTight that will last about 3 years, but it won't be the "wow" I may be looking for that a facelift would provide. I asked him what he would advise if I were his wife and he replied that if this is something that really bothers me, he recommends the surgical approach - he thinks I'll be happier overall. I'm scheduled to talk with a patient (same age as me) who used him for a facelift, and am wondering what your thoughts are. I realize of course you haven't examined me, but still value your opinion, limited as it may be. Thank you.

So glad you asked this. It comes up often. When we think about it… why do we want tightening? It’s really because we are perceiving sagging! Most of our patients point to the jowl area when they are talking about it. Or they pull up on the sides of the face to demonstrate. Haven’t we all secretly done this, if we are over 40, in the mirror sometime??  🙂 I really recommend getting 2 or 3 opinions from different surgeons, whenever surgery is on the table. Talking to one of his patients, would be not very useful, in my opinion. In my experience, many plastic surgeons now often offer non surgical skin tightening services, and use patient interest in that to get patients in the office, where they are then offered surgery. In fairness, we refer at times to plastic surgeons, because it may be the most cost effective option for one of our patients.

Sagging is due to 3 things:

  1. Loss of facial volume as we age. This includes skin, fat and bone! Visualize a balloon gradually deflating.
  2. Loss of elasticity of the skin. The loss of elasticity is due mostly to sun damage and some to intrinsic aging.
  3. Shifting and redistribution of fat pads.

The Nonsurgical Fix:

For the best results for sagging, we would want to:

  • Replace volume by looking at ourselves and old photos and replacing it with the right fillers in the right spots. And making sure we still look like ourselves!
  • Tighten the skin with existing technology.
  • By adding back some volume and tightening the skin over that, we will look like ourselves still, but usually 5-15 years younger.

This all assumes we have good texture and not too much sun damage.

Brief Skin Tightening Summary:

All these give very similar results, except Profound, but that technology is still too new to be sure it’s better. These are all treatment to the surface of the skin. Our top choices are:

  • Thermage (600-900 pulse tips) – mostly comfortable except for a few “zingers.” Uses a sapphire cooled tip and a “stamping” method.
  • Thermismooth and Excilis – very similar with a wand about the size of a microphone that is rolled across the skin.  The most comfortable.
  • Ultherapy –   Painful.
  • Pelleve –  also reported to be painful. We have no experience with this one.
  • Profound –  Interesting reports of better results than the others. Jury is still out I think. Also painful, unless very numb.

Thermitight is a different system, but also made by Thermi, where a probe is placed under the skin. There is more potential for burns and temporary nerve damage.

Hope this helps,
Dr. Brandith Irwin
Founder, SkinTour
Director, Madison Skin & Laser Center
Follow my skin tips and travels on Instagram!




Dr. Brandith Irwin, MD

Ask me your skincare question!

Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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