Facial laxity at a Glance
- Best Results 1-4
- Treatment Recovery0- 6 days
- Procedure Time10-80 min
- Skin SpecialistNurse, Davin Lim
- Duration of Results12-60+ months
- AnaestheticAs per procedure
- Back to WorkNext Day- 7 days
- Cost$$-$$$$
Facial Laxity
The ideal facelifting or skin tightening treatment depends on many factors including the degree of laxity, the amount of background sun damage, your age, dermal thickness, lower face volume, ethnicity, lifestyle, downtime, budget & expectations. I employ surgical as well as non-surgical procedures to lift the face, neck, & eyelids.
FactsFacts on Facial Laxity
- Non-surgical facelifting can yield good results if performed correctly
- Laser resurfacing is useful if there is background sun damage & poor skin quality
- Dermal fillers can displace volume, providing a lift. This is termed a liquid face lift
- New collagen stimulating injectables reduce skin laxity & wrinkles without adding volume
- HIFU or Ultherapy can be a useful treatment for lifting the lower face
- RF or radiofrequency energy can be delivered on the skin’s surface
- RF Microneedling can be useful for lifting the lower face & neck contouring
- Thread lifting can give a good result in some patients with facial laxity
- PRP does not provide any lifting (contrary to though and advertising)
- Majority of patients will benefit from a combination approach to facelifting
When do I use non-surgical procedures?
Facial Laxity
Non-surgical face lifting & skin tightening is used in the following scenarios-
- Patients who have mild to moderate skin laxity who are not yet candidates for surgical face lifting. This group of patients are usually between the age of mid 30s to late 50s.
- Patients who are candidates for surgical face lifts but choose not to undertake a surgical procedure.
- Patients who have had surgical procedures including face & neck lifts, however would like further improvements.
The MOST important factor in determining what is the best treatment is based upon a complex algorithm as outlined below.
What is the ideal non-surgical treatment for facial laxity?
In reality the algorithm is very complex. Put simply it is NOT one device, or one method. I take into consideration factors such as the grade of laxity, dermal thickness, background skin quality, degree of volume loss, ethnicity, downtime, & patient expectations.
This table is a quick summary of non-surgical options. Read more on the specific treatments for more information.
| Treatment | Laxity Grade | Skin Quality | Dermal Thickness | Number of sessions | Duration of effects |
| Liquid lifts – Collagen stimulating injectables | Mild to moderate | All types | All thickness | 2-3 | 2-4 years |
| Lasers | Mild to severe | Poor skin quality | All thickness | 1-2 | 3-10 years |
| Threads | Mild to moderate | All types | Moderate to thick | 1-2 | 3 -8 months |
| RF Bipolar RF FaceTite | Mild to moderate | Good | Moderate | 1-4 | 2- 3 years |
| HIFU- Ultherapy | Mild to moderate | Good | Thick | 1-2 | 2-4 years |
What are biostimulatory injectables?
Introduced into Australia in late 2022, biostimulatory hyaluronic acid injections have revolutionised the way we manage skin laxity. This injectable tightens skin without adding volume.
They work by stimulating cells to produce collagen. The result? Firmer, tighter skin with less wrinkles & better skin quality. This *injectable can be used to treat both facial & neck laxity.
Two sessions spaced 4-5 weeks apart. For severe laxity & sun damage, 3 sessions are required. Maintenance intervals of 8 to 16 months.
What is a laser face lift?
Laser resurfacing using both ablative erbium & CO2 lasers can provide collagen stimulation & contraction. This can improve the jowls, marionette lines as well as eye wrinkles, & laxity. In most cases lasers can provide an upper eyelid lift as well as marked tightening of the lower lids.
Lasers should be reserved for patients with significant sun damage with poor skin quality. The downside with laser resurfacing is the downtime of 5 to 10 days. Laser resurfacing only addresses skin quality & tone, volume should be addressed with dermal fillers or fat transfer.
What are liquid face lifts?
Liquid face lifting is a term to describe dermal fillers. Placed in strategic locations, dermal fillers displace volume loss, in turn creating lift. The exact placement of fillers depends on your facial shape, & area of concern.
In the context of lifting, the most commonly displaced areas include your cheeks, chin & jawline. The art of filling is to provide traction & counter traction in key vectors (area of pull). This displacement of volume tractions soft tissue & skin in an upward & backward vector. This causes lifting.
I use both hyaluronic acid & collagen stimulating dermal fillers to achieve this lift. In most cases I combine fillers with HIFU, RF, threads, injectables & lasers.
Refer to the section on dermal fillers for a better understanding on what specific areas can be targeted.
View our Treatment Gallery
Can laxity be treated with thread lifts?
Thread lifting uses either suspension sutures or monofilament PDOs; I use both MINT threads & Silhouette threads. Threads can stimulate collagen as well as provide instant vector lifting of the lower face, jawline & neck. The problem with threads is that longevity is an issue. They last between 3 to 9 months in most.
Ideal thread patient profile; mild to moderate laxity, thicker dermis, moderate to good volume with variable sun damage. I often combine threads with HIFU & RF to achieve better results.
My practice of late is to incorporate PDO threads placed in vectors, with combined dermal heating devices. This has a better effect for skin tightening in comparison to cog-suspension-anchoring threads.
How can HIFU or Ultherapy treat facial laxity?
Yes, if you are a suitable candidate for the procedure. Remember the ideal device depends on your skin quality, age, laxity, dermal thickness, current volume & ethnicity. This is why I employ many devices & methods for lifting.
Ideal HIFU patient profile, mild to moderate laxity, thick dermis with good volume & minimal sun damage. The logic is that we can contract lax collagen & not worry about volume loss– especially in the lower face.
Lighting could be better, however in the after photos the better light reflex & luminosity reflects the better skin quality following treatment
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👉The Procedure: Jessner TCA peel & low density CO2 in key vectors in addition to 60 PDO threads in vectors, RF at 3.5 mm. One session only. Predicable non-surgical skin tightening follows a complex algorithm based on clinical features, genetics, ethnicity, goals, equipment, & more
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👍🏻The logic: Stimulation of all layers from the mid to superficial dermis (peel), deeper dermis (low density but high power CO2), hypodermis (RFM) & hypodermis & fibroseptal network (PDO threads)
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⏭Next stage: dermal fillers to further improve the outcomes
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🙄Suitable patients: mild to moderate laxity (leaning towards mildish). For lighter types, I prefer lasers or medium to deep peels, for darker skin types I use RF devices (RFM, NuEra, Pelleve) & HIFU
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🎬Action: For an opinion on threads & skin tightening book a consult with Katie or Alison at Cutis Dermatology
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
AU
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#lskintightening #HIFU #pdothreads #threadlifting #skinlaxity #brisbanedermatologist #dermatology #skinscience #facelifting #nonsurgicalfacelift #threadlift #mintpdo #mintthreads #pdothreadlifting
🎇Woooohoooo, new device
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🧐What is it? NuEra. It is a radiofrequency device from Lumenis
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👉Applications: Non-surgical skin tightening. It also does body contouring
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👱🏻♀️👩🏽Candidates: Selection is critical to get great results
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👍🏻Ideally: Mild to moderate skin laxity, thicker dermal layer, with little or no photodamage. Thick dermis means more collagen. No sun damage means better quality unbroken collagen
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😁Can’t wait for my team to show off the before and afters. Non-surgical skin tightening is one of the hardest things to predict, but I think (hope) we found the formula….been working at it for the past 12 months. With each new generation of devices, we come closer to predictable treatments 💯
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😎Davin Lim
Dermatologist,
Brisbane🇦🇺
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#skintightening #skin #skinrejuvenation #collagen #rejuvenation #nuera #lumenis #nonsurgicalfacelift #facelift #radiofrequencyskintightening
Outside or near the outer circle, the less science & predictability. It’s not possibility, it is about probability💯
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🔬Skin Science: stick to the basics. SPF, antioxidants, ABCs, Skin Acids such as alpha, hydroxy acids
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🔫⚡️🍌Lasers, peels, energy devices are somewhat predictable. Less so with threads (however used appropriately & in synergy, there is value). HIFU & RF can work for mild laxity, in appropriate skin types/profiles (little or no elastosis, thick dermis). HIFU is not ideal & can be counter productive in someone with photodamage, low subcutaneous fat & a thin dermis, same applies to RF (though consequences not as severe). PRP? For hair loss 🧑🏾🦲& joints 🦴👊
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💉Hyaluronic acids? You will get far more benefit if it is under, not on your skin
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😎Dr Davin Lim
Dermatologist.
Brisbane🇦🇺
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#dermatologist #drdavinlim #brisbanedermatologist #skincare #dermatology #skinscience #skinrejuvenation #dermalscience #dermaltherapy #cosmeticscience #skinrepair #retinol #retinoids #antioxidants #chemicalpeels #retinoicacid #laserrejuvenation #AHApeels #HIFU #threadlifts #PRP #vampirefacials #microneedling
#dermalfiller #hyaluroniccid
One treatment only, by Alison using a combination of energy devices in the same session. HIFU, CO2 & Thulium 1927. 6 weeks between before and after photos, I expect better results in the next 8-10 weeks
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🔬Skin Science: Logic as follows 1927 for superficial aspects of skin, fine lines, pigment, dyschromia & dysplasia (mild), CO2 high energy but low density, matching healing time of thulium (6 days). Bulk heating of thulium adds to the collagen stimulating effects of carbon dioxide laser. #HIFU for jawline area to stimulate deeper collagen💯
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💪🏼🔫How we employ HIFU/Ultherapy/Ultraformer: We only use this device if solar elastosis is minimal on clinical examination. ‘Lax’ collagen has a better chance to contract, compared to ‘fragmented’ collagen
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👉Combination therapies can be effective. Skin feels & looks firmer. Firmness can not be easily measured, it is often subjective. We are getting the similar results with a combination of PDO threads combined with HIFU or RF
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😎Dr Davin Lim
Dermatologist
Brisbane🇦🇺
@drdavinlim
#drdavinlim #dermatologistbrisbane #dermatology #skinscience #skincare #skinrejuvenation #skin #HIFU #ultherapy #ultraformer #thermage #pelleve #skintightening #skintone #skinclinic #dermatologistbrisbane #collagen #skintightening
Special thanks to Danae Lim for the videos. Give sis a follow>>
@drdanaelim
This video discusses PDO monofilament threads. This is the most commonly used thread type
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👉What are thread lifts?
This procedure is meant for mild to moderate skin laxity.
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👉What is the difference between monofilament & barbed/suspension threads?
Monofilament treads are made from suture material, most commonly used PDO. Other substances like poly-lactic acid are also used.
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👉What areas & concerns can be addressed with monofilament PDO threads AND who are good candidates for threads?
Lower face, neck, mild jowling. Patients with good dermal thickness & minimal sun damage do best.
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👉Do threads work on everyone?
Nope. They are good for mild laxity. Moderate laxity can be corrected with suspension - barbed - conical threads. If your collagen is lax, with minimal breakage (solar elastosis- sun damage), & if your dermal thickness is good, threads may be an option.
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👉How long do the results from threads last?
About 6 to 12 months. Honestly, more towards the former than the later. PDO threads dissolve in 6-7 months however histological studies have shown collagen stimulation for up to 9 months.
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👉What is the science behind thread lifts?
Thread in the dermis & hypodermis causes tissue fibrosis, meaning collagen stimulation. This improves laxity. Another theory is that threads in the subcutaneous tissue cause mild apoptosis of fat cells & tightening of the fibrous septae between fat lobules.
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👉What combinations work best?
Really depends on your clinical presentation, age, dermal thickness, ethnicity & expectations. Dermal fillers can be placed under threads. RF & HIFU can give synergistic effects. If skin quality needs improvement, certainly lasers can be beneficial.
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👉What threads can not do?
They can not give meaningful volumetric displacement. They are not a substitute for surgical intervention
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😎Davin Lim
@drdavinlim
Dermatologist
Brisbane🇦🇺
#threads #pdothreads #pdothreadlift #pdothreadslift #mintthreads #mintthreadlifting #facelifting #monothreads #drdavinlim #dermatologistbrisbane
Why is NuEra my preferred skin tightening device?
NuEra is a new device acquired in 2022. To date it is the most effective way to treat mild to moderate skin laxity. It is classed as slow heat radiofrequency, hence it requires multiple treatments. All devices including RF, HIFU & lasers are best combined with superficial to medium depth collagen stimulating methods such as lasers, peels, vectored threads, & injectables. Learn more about NuEra.
What is Thermage for facial laxity?
Thermage is a form of collagen heating, delivered with RF or radiofrequency technology. I employed this device for 5 years, however I have replaced it with NuEra & Tempsure, other RF heating devices.
The reason why I moved away from Thermage is the consumable cost that is passed on to the patient. The success of RF heating is low- around 20%. Tempsure gives equal efficacy at a fraction of the cost of Thermage, & importantly it is much more comfortable.
For bulk RF heating, I prefer the InMode device called FaceTite. This delivers a precise level of energy to areas that need it most.
What is Tempsure?
Tempsure or Pelleve is a proven method of skin tightening. The device gently heats collagen to a skin temperature of 43 degrees. Unlike Thermage, Tempsure is painless. Treatments are delivered over 2-4 sessions, spaced 4 to 6 weeks apart.
The ideal Tempsure candidate are patients with thick collagen, mild to modest laxity, with little or no photodamage (sun damage). Tempsure can also safely lift the eye & neck area. Volume loss if not an issue with Tempsure.
What is FaceTite?
This is a new semi-invasive skin tightening device that uses focused radiofrequency energy. I mainly use this for lower face skin tightening & contouring, mostly in combination with RF microneedling.
The ideal patient profile for FaceTite has mild to moderate skin laxity, thick dermis, medium to heavy lower face volume.
What is RFM or radiofrequency microneedling / Infini RFM / Genius RFM?
This treatment is very different from normal microneedling. RFM uses radiofrequency delivered through deeper needles aimed at stimulating collagen. This treatment can be useful for treating the lower face & neck area. I normally combine this with other RF treatments such as Facetite, or during laser resurfacing. I also use this device for neck tightening, especially when I perform neck & lower face liposuction.
Genius RFM is one of the leading devices as it provides deep dermal rejuvenation using insulated needles. Additionally this device has impedance control which ensures both safety & efficacy.
I also employ the Morpheus8 RF system for deeper treatments.
The ideal patient profile for RF Microneedling/ Genius RFM has little sun damage, mild to moderate lower face laxity, moderate to thick dermis, moderate lower face volume. This device is best employed as part of a combination approach to skin tightening & rejuvenation
RFM, or radiofrequency microneedling is a useful treatment for many things, however I employ it specifically to treat
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👉Acne scars: rolling subtype, in all skin types. I adjust the depth according to the amount of atrophy. Sticking a cannula under the scars is a superfast & reliable method for depth adjustment💯
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👉Lower face laxity: as part of our combined skin tightening approach. Best if collagen is ‘loose’ & not fragmented (solar elastosis). RF can be used with threads, lasers & other tightening modalities
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👉🐔Neck laxity: hit and miss, best used in mild to mild-moderate laxity. Neck is one of the least predictable treatment areas
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💦💧Axillary HH; failing Botox, miraDry & topicals. Can be dialed in for most cases to within 0.1-0.2 mm
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👍🏻Neck liposuction: I use it in some cases to aid in skin tightening during the liposuction procedure
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🔫☄️Genius RF: one of the better RF devices. Has heaps of power. I have modified my settings to delivery longer pulse duration & lower power
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😎Davin Lim
Dermatologist
Brisbane,🇦🇺
#genius #infini #geniusRF #RFM #microneedling #rf microneedling #acnescars #skintightening #skinlaxity #drdavinlim #davinlim
Can muscle relaxants provide a face lift?
Muscle relaxing injections can lift some areas of the lower face, including the lip depressors (Depressor angularis oris), as well as the muscles of the neck & chin. DAO injections are most effective, whilst platysma injections can give a very mild improvement of the jawline / neck. These injections are often combined with threads & dermal fillers for optimal results.
What are vampire facelifts or PRP facial injections?
In theory this provides skin tightening using microneedling in addition to autologous platelets (from your own blood). Patients undergo 2-6 sessions over 2-6 months. Recovery ranges from 2-4 days.
In reality, the results are underwhelming at best. The microneedling bit works, the PRP bit gives marginal differences. I do believe that PRP has its place in the treatment of alopecia (hair loss).It can potentially speed up the healing time. If you are after Vampire Facials / Vampire Facelifts, my therapists & some of my nurses perform this procedure.
The ideal patient profile for Vampire facelifts has very mild laxity, fine lines, wrinkles, open pores, with minimal volume loss & sun damage.
Can creams & skin care provide a face lift?
Creams such as retinol, retinoids & antioxidants are an important part of skin care. These creams have an invaluable role in protection & prevention. They do not produce an objective improvement in skin tone & firmness.
The use of antioxidants such as ascorbic acid, ferulic acid, tocopherol & resveratrol forms an integral part of skin care, namely protecting the underlying collagen, elastin & hyaluronic acid from breakdown. Additionally, vitamin C, retinol & AHAs can stimulate collagen, reducing the appearance of fine lines & wrinkles.
In summary, skin care products are an important part of any anti-aging routine & should be encouraged.
Does NuFace & other microcurrent devices work for facial laxity?
I have trialled the leading brands of microcurrent devices over the past few years & here are my thoughts-
- They give a consistently good satisfaction rate, in many cases the patient reports that their skin feels firmer. I have noticed this as well when I use them.
- They do not give consistent objective findings, namely we can not demonstrate an improvement in skin tone, volume or quality using serial photography.
Overall, given the relative costs of microcurrent devices, I do think that some patients will be satisfied with their investment. As with other dermal targeted devices, the ideal patient has mild laxity, little or no sun damage, a thick dermis & realistic expectations.
I do think that incorporating them with a sensible skin care routine, as well as integrating their use with medical procedures such as HIFU, RF, RFM, threads, & lasers are ideal.
Do home roller & microneedling kits work?
I do like microneedling as an entry level treatment. This treatment can be effective for diminishing mild scars, enlarged pores & fine lines.
As a rule, stamping kits are safer than home pens & rollers. A sensible needle length is around 0.25 mm. Anything deeper may cause skin scars, especially for home use. I have done many videos on how to safely use these kits at home.
Does plasma pen resurfacing work?
Can you light a candle with an oxy torch or a flame thrower? Plasma pens are widely available, and cost $90 to $200. There is no regulated training, & this energy source is not licenced. I see more cases of scarring from plasma pens than results. This is one treatment that you should be super careful of. You are better off buying a DIY safe microneedling kit than investing in this procedure.
Why are neck treatments important?
The neck forms a logical extension of the face, hence in most cases, we should also address neck laxity.
In Queensland I see an extraordinary amount of sun damage, hence why improving the skin quality of the neck is essential. I employ lasers, peels, HIFU, RF, collagen stimulating fillers to treat & lift skin of this area. The algorithm of ‘best combinations’ is similar to non-surgical face lifting.
When is surgical intervention required?
If you have too much facial laxity, a deep plane face lift is required. This type of surgery is more complex compared to mini-s or short scar facelift. Should you require this procedure, I will refer you to a plastic surgeon.
Remember to consider volume replacement as surgical procedures are aimed at improving skin, fat pad & ligamentous laxity.
How much do treatments cost?
Costs vary depending on the treatment, number of sessions as well as the complexity of the procedure, as a guide
HIFU / Ultherapy/ Ultraformer III: From $990 (therapist/nurse)
RF Tempsure: From $790 (therapist)
RF Microneedling Infini/Genius: From $790 (therapist)
Level 4 Resurfacing $1,990 (CO2 fractional laser +/- Thulium laser)
Level 5 Resurfacing $3,990 +++ (CO2 fully ablative / erbium) Davin Lim
Liquid Face lifts: From $690 (nurse) to $1290 ml (Davin)
Thread lifting: Variable depending on the number required
Vampire PRP Facelifts: Consult our nurses for suitability
If you would like to get an obligation free consultation, book with my senior nurses Katie, Alison or Maya @cliniccutis
What are the limits of non-surgical face lifting for laxity?
The Gold Standard of face lifting is of course, a surgical procedure, namely a face lift. Surgical face lifting is more than just skin deep, as we plicate (fix) deeper structures such as the SMAS & muscle to other structures, thereby lifting the entire depth of skin.
Lasers, RF, HIFU & other devices target the skin (collagen, connective tissue), firbroseptal network of fat & in some cases the SMAS layer covering muscles. This contraction is not as powerful, predictable nor as long lasting than say a deep plane facelift. In some patients, the amount of laxity is too great (or too heavy) for non-surgical modalities.
In other patients, the amount of laxity is too little to warrant a surgical procedure. This is why seeing a specialist who performs non-surgical & surgical methods will give you a balanced understanding of what each procedure entails as well as the expected results.
Davin’s Viewpoint on treating Facial Laxity
The ideal treatment or combination of treatments follow an extremely complex algorithm. If it was that easy, everyone would be having a low downtime, affordable, predictable procedure that negates surgery & reverses aging. Fact of the matter is that one single treatment does not exist.
For a good, predictable non-surgical face lifting result I take into consideration background skin quality. This is one of the most important factors to consider when using energy devices such as Ultherapy, Ultraformer, Thermage, & Tempsure. If you have broken collagen, or elastosis, chances are, deeper treatments as above will not work. In this case, addressing skin texture with an ablative laser will be required.
For super-powerful devices such as Ultherapy, Ultraformer III and other HIFU/Microfocused ultrasound, one has to take into consideration facial volume & dermal thickness. If one has a ‘slight’ facial build, with low volume (especially of the lower face/jawline area), I don’t recommend these treatments. Whether it actually ‘melts’ fat or not is really dependent on how this energy is delivered. (Much akin to a pair of scissors, namely the scissors can give you a great haircut, or used in the context of a weapon can cut the ear, or worse still, cut your jugular artery. Same device, different outcomes. Context is paramount). There is so much misinformation on this device on the internet, including denial of side effects from companies themselves. If you contract lax skin on someone who is volume depleted, the volume will decrease because the skin is tighter. If the operator pulses too deep, with too many ‘shots’ and overlaps, one may decrease fat & cause too much collateral damage. Always apply the device accordingly in the correct skin type.
In the context of low facial volume with associated laxity, I do prefer slower heating devices over fast heating-high energy devices. My pick is Tempsure or Pelleve over Thermage, purely based upon safety, efficacy & cost effectiveness.
Thread lifts, again pick your candidate. Ideally, good dermal thickness (or the thread will be visible; especially suspension threads, less so monofilament). The downside with threads is not that they do not work, it is their longevity (3 to 8/9 months for most). I often combine threads with devices such as Tempsure as they give a synergistic effect.
Dermal fillers or liquid face lifts is actually volumetric displacement of skin in a certain vector. In the context of ‘lifting’ using a high viscosity, high G prime filler can ‘lift’ certain areas. The ideal placement is dependent on the patient’s profile. Additionally hyper diluted collagen stimulating fillers are underutilized.
In summary, the algorithm of optimal treatments is complex. In most patients, there are multiple causes of laxity including age related, sun related as well as volume loss. The answer does not lie on one procedure, it certainly does not lie in one device. Finding the correct combination of treatment/s is the key to predictable non-surgical face & neck lifting.
