Probably, the simplest Band-Aid approach is to inject a filler such as Juvederm or Radiesse in the nasolabial and marionette creases. A filler for lack of a better analogy is like caulking material which is injected under the skin and lifts the line to mask the shadow. Juvederm is hyaluronic acid in a gel form while Radiesse is hydroxyapatite which is more like a paste. When either product is injected under the crease, the shadow is lessened.
Voluma is a filler that is best suited to augment the cheek and mid face area.
This is an in-office procedure which takes a matter of minutes and delivers immediate results. The amount of improvement, of course, is dictated by the amount of volume injected. Results typically last between 6 and 12 months depending on which product is used. Occasionally, patients may experience some swelling or bruising, which usually resolves within a few days.
Ulthera is a noninvasive, nonsurgical skin tightening tool which utilizes ultrasound energy to heat the skin’s collagen elements. Collagen contracts and tightens when heated to sufficient temperatures. Ulthera can be used on the face, neck, and chest with minimal discomfort and essentially no downtime. We all have different pain thresholds and some patients take a Percocet and Valium before an Ulthera treatment. Results appear in 3 to 4 months and last 12 to 18 months. It is a great option for someone who just started noticing looseness. Results are subtle, so if you already have considerable laxity or anterior banding in the neck, you probably won’t appreciate much change. The challenge with Ulthera is in making sure patients have proper expectations.
I believe Ulthera is great for someone who is just starting to notice looseness of the skin, but as we age, we lose collagen, so Ulthera’s effectiveness decreases. In many older patients, particularly patients with thin skin, the amount of improvement with Ulthera may be masked by the severity of the skin laxity. One of the concerns with deep tissue heating by Ulthera is subcutaneous fat loss in patients with thin skin. We do have a special handpiece, which delivers less heat energy in these cases.
Micro Needling Radio Frequency (INFINI)
Micro Needling Radio Frequency (Infini) is the newest device we are using to tighten the skin and I am very excited about this device which combines micro-needling with radiofrequency heat. When the microscopic needles pass through the skin, Infini applies heat directly to the skin’s collagen layer. Ulthera heats the outer skin. We hope enough of the energy reaches the deeper dermal collagen layer whereas Micro Needling Radio Frequency ( Infini) delivers the heat directly to the dermal layer where tightening occurs.
Micro Needling Radio Frequency (Infini) is minimally invasive and associated with minimal discomfort. The procedure which takes 30 to 40 minutes is usually tolerated well with just a topical anesthetic cream and a nonsteroidal anti-inflammatory or Tylenol.
Micro Needling Radio Frequency (Infini) is new to the United States. The FDA has approved Infini for skin tightening in the face. However, Micro Needling Radio Frequency (Infini) is being used on other body areas with good results. Recovery is quite minimal with 24 to 36 hours of pinkness. The best results come with three separate treatments usually spaced a month or so apart.
Fatty fullness under the chin can often be addressed with liposuction alone. The skin is expected to contract after liposuction; however, in patients with a lot of skin laxity, the amount of contraction may not be sufficient. If I suspect this may be the case, I will recommend skin tightening with either Ulthera or Micro Needling Radio Frequency (Infini) be added to the treatment regimen.
CoolSculpt is a nonsurgical, noninvasive device used to freeze fat cells and eliminate fatty fullness under the chin. The frozen fat cells die and are absorbed by our body. The overlying skin is expected to contract just as it does with liposuction. However the skin may not contract enough after Cryolipolysis alone (freezing the fat cells). Here again, I might recommend adding a skin tightening treatment with Ulthera to improve the result.
This is an exciting time for patients and practitioners like myself because of the variety of options that we now have available to improve and maintain our appearance. Not everyone is interested or a candidate for facelift. With all of the options I can offer my patients today, we can certainly devise a treatment plan which works for almost everyone.
Unfortunately, anyone can buy any of these devices, take a weekend course, and offer treatments to the public. Before you venture into these options, please do your research. I firmly believe that this is not a field for dabblers. Facial plastic surgeons, plastic surgeons, and dermatologists are specialists who are trained to understand the aging process and have the expertise to offer a wide variety of options to meet your needs and solve your concerns.