The Sad Case of the Falling Face

Sooner or later, we all get to that day when we realize that things aren’t as tight as they used to be. Whether it is our face and neck, skin on our belly and thighs, any of the other “jiggly bits” or a combination of all of the above, it’s a bummer.

Youthful Skin is Tight Skin

In youth, skin is tight. It has a natural elasticity that allows it to rebound to its original position quickly when stretched. It holds everything up where it is supposed to be. Naturally occurring fat pads under the eyebrow, up tight under the lower edge of the eyeball, and up high on the cheek give the face and jawline youthful contours. Skin feels smooth, firm and tight. The jaw line is taut, with the fat pads and skin up against the muscle and bone. The neck is firm without sagging. This is good.

Then, repeated exposures to the damaging effects of daily sun exposure, or even worse, tanning bed, gravity, smoking, environmental toxins, glycemic diet, weight fluctuations, and hormonal changes damage collagen and elastic fibers in the skin. Collagen and elastic fibers are broken down, reabsorbed, and the skin loses elasticity.

Naturally occurring fat pads in the skin diminish in size and drop as the tissue surrounding them loosens with aging. Everything starts to sag. The fat pads end up dragging the eyebrows down, bags develop under the eyes, and the cheeks end up at the lower face as jowls. Add to that loss of muscle mass and tone, and reabsorption of bone structure from aging and hormonal changes, then gravity takes over and the face and neck sags. Gravity wins.

Steps to Help Prevent and Slow Down Skin Sagging

Although there is a genetic factor to sagging and early wrinkling of skin, especially in women, there are steps you can take to slow down sagging of the face and neck. Like all anti-aging preventative plans, the earlier you start the better results you get. If the older women in your family, especially your mother, had early sagging and wrinkling, then it is even more important that you start early.

The best way to slow down this progression is prevention:

• Don't tan
• Daily sun protection with sun block every day to your face and neck
• Avoid weight fluctuations, toxins and smoking
• Eat a healthy non-glycemic diet
• Use topical skin care with retinoids, antioxidants, peptides, growth factors, fruit acids
• For females, dealing with estrogen loss helps too

Tightening Mild to Moderate Sagging Skin Without Plastic Surgery

When you start to see skin looseness and sagging but it is not yet pronounced, then it is time to start in-office non-surgical aesthetic skin tightening treatments. Non-surgical cosmetic procedures to combat sagging can also be useful in patients who have more pronounced sagging, but who are either not candidates for surgical tightening or who don't want a surgical procedure and are willing to accept less tightening than they would get with surgery.

There are two ways to approach mild to moderate loss of skin tightness and sagging on the face and neck. Often, patients get the best results by utilizing both in a combination program. The first approach is a skin tightening procedure that increases collagen and tightens existing collagen and elastic fibers. The second option is to restore the aging related lost volume with volume replacement with the fillers Sculptra, Juvederm, Restylane, or Radiesse to lift the skin in what some call a "liquid lift" or "liquid face-lift."

All skin-tightening treatments work best on patients with some remaining collagen, elasticity and underlying fat; on those who are healthy; non-smokers; those with mild to moderate skin looseness and good underlying muscle tone. They all work less well on those with very thin skin lacking collagen and fat, smokers, those who continue to tan, and older patients with decreased ability to make new collagen. They are not a substitute for a face-lift.

The result is a natural looking youthful fullness with tightened skin on the face and neck.

Non-Invasive Skin Tightening

There are three main FDA approved technologies for non-invasive tissue tightening for skin and subcutaneous tissue—radiofrequency, infrared and ultrasound energy. The original technology, refined and improved over the years, is Thermage which uses a treatment tip to deliver radiofrequency (RF) energy into the deeper layers of skin giving immediate tightening of collagen and underlying tissue. Following this is gradual skin tightening over time by promoting growth of new collagen. After Thermage came an infrared device, Titan, and finally an ultrasound procedure, Ultherapy. Other less well-known devices, some of which use lower energy and less effective, are available, but these are the big three. In my opinion, Thermage and Ultherapy give equivalent results. Check out photos of our real results with Thermage.

Thermage and Ultherapy require one treatment for many patients; some patients require more than one treatment for optimum results. With each touch of the tip, a brief intense heating sensation is felt with Thermage, and moderate pain with Ultherapy. At Advanced Skin Treatment Center, we use Thermage for our non-surgical skin tightening. We prescribe oral pain and anxiety medications before the procedure and our patient s tolerate the treatment well. Titan is less uncomfortable with each treatment, but requires multiple treatments and gives more modest results.

After treatment, skin may feel flushed as with mild sunburn. Rarely patients develop swelling of the face and neck, occasionally lasting up to a week. Some patients may experience thickening of the tissue deep in the skin, numbness or mild discomfort when placing pressure over bony areas (such as jaw line). This may last several weeks, rarely longer, and is normal. Patients return to their regular activities immediately following treatment. The vast majority do not have any down time at all.

Tightening Skin on the Body

Thermage and Ultherapy are also used to tighten skin on the body that has loosened from weight fluctuations, pregnancy, and aging. Surgical procedures give more pronounced tightening, but do leave scars and have a recovery time.

Non-Surgical Skin Tightening vs a Face-Lift

Well-done face-lifts are great. Poorly done facelifts are a disaster. All face-lifts change the direction of structures in the face by pulling them outward, which can lead to the dreaded “wind tunnel” effect. To reduce this effect and provide upward lifting, plastic surgeons may perform a “mid-face lift” where the structures in the center of the face are re-suspended. All facelifts leave scars, which vary from imperceptible to obvious.

There are patients who need a surgical face lift for the improvement they want. Cosmetic dermatologists need to be honest with patients about the degree of improvement that can be gained non-surgically. I discuss this candidly with my patients. I refer those that need, and are willing to have plastic surgery to a board certified facial plastic surgeon.

Natural Appearing Skin Tightening

While not a replacement for a traditional facelift, non-invasive Thermage and Ultherapy can provide tissue tightening on the face and neck for patients who have mild to moderate looseness or sagging, and for those who do not want or do not need a surgical facelift. The advantage of these procedures is that there is no surgery and no recovery time, and provide natural looking results. Patients want real results, but above all, they want natural looking results.

When that day comes that you find things aren’t where they used to be, and you want to put them back, come talk with us. We understand. Call us at 806-358-1117, 800-417-SKIN, or come by the office—Advanced Skin Treatment Center, Elaine Cook M.D., 7620 Hillside #100, Amarillo Texas, 79119.