Skin Tightening / Wrinkle Removal

Extra skin in the jowls, face or neck can be due to one or more of at least three factors:

  • Volume loss which can involve skin as well as the underlying fat
  • Muscle and connective tissue
  • Loss of collagen and elastic fibers in the skin related to photoaging; as well as gravity related effects.

Years ago, we believed that jowls, skin laxity of the face and neck skin were only due to the effects of gravity. That is now an outdated concept.

Loosening of the cheeks and neck are caused by changes at multiple levels. As you have heard about many times,  the first level is the skin.  Over time the amount of collagen and elastic fibers decreases and the skin thins.  Besides the passage of time this develops as the result of a process called photoaging due to years of sun exposure.  These changes can gain the greatest improvement from lasers, and peels.  Medical skin home care can also improve this.

The next level is the soft tissue level.  Losses in this level occur gradually but can be quite noticeable.  These changes are commonly called volume loss changes.  Finally, there are also changes in the underlying boney framework which also can affect your appearance.

In order to obtain a natural younger appearance, your treatment should be directed towards correcting the problem(s) causing the loose skin. It is important to perform these procedures to give a natural appearance and avoid a too-tight or overfilled appearance.

Treatment of jowls, face and neck skin laxity due to loss of facial volume

Facial volume loss is very common with the passage of time. It results from changes at all of the levels as described. Usually this is not immediately obvious since it occurs gradually over multiple years. The best way to evaluate for facial volume loss is to compare a photo of yourself when you were twenty with your present appearance. You will probably notice flattening of your mid cheeks and lower face. Frequently there is loss of definition along the chin and the jawline. There also may be a downturn of the corners of your mouth making you look sad even when you’re happy. You may have noticed flattening of your lips.

If you have a significant volume loss just tightening your skin will not make you look younger. Aesthetic volume restoration by a surgeon who has an artistic sense and an understanding of facial anatomy will give that refreshed natural look. The ideal procedures for volume restoration vary depending on your needs and the area that is being treated.

This patient presented with significant facial volume loss. She has associated laxity of her neck, cheeks and jowls. The top photo is the way she appeared at the start of her consultation. The photo below was taken on the same day after she had facial volume restoration with fillers: Perlane® and Radiesse®.

Treatment of loose skin and related wrinkles

The latest innovation for treatment of facial skin laxity is the fractional CO2 laser, such as the Cortex and Matrix. Skin laxity can also be treated with other lasers, radiofrequency (such as Pellevé®), and/or surgery. Chemical peels can also produce some skin tightening.

Before recommending treatment for your loose facial skin, Dr. Carniol will evaluate your skin and then work with you to arrive at a treatment that fits your budget and schedule. Other procedures that can improve your skin may include a resurfacing laser, a vascular laser for redness or facial spider vessels, chemical peels, radiofrequency, and/or a microdermabrasion.

Fractional lasers are also used to make skin smoother, improve skin tone, reduce scars, and reduce wrinkles. The benefits of these lasers are permanent, since they induce histochemical skin changes.

Before and 14 Months After Two Fractional Laser Treatments. In the second photo in which the patient is fourteen months older she has tighter, smoother skin including less jowls and an improved cheek and upper neck line.

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