How to firm sagging skin

Why does skin become less firm?

Skin produces less collagen as it ages. Collagen and elastin are proteins that give skin strength and flexibility. After menopause, falling estrogen levels also leave skin thinner, drier and less taut. Ultraviolet light adds another source of damage: repeated exposure without protection can produce loose skin as well as wrinkles and uneven colour.145

What can you do at home?

• Protect your skin from the sun every day, including cold or overcast days. Stop using tanning beds. Continued ultraviolet exposure damages skin and can interfere with cosmetic treatment results.
• Cleanse and moisturize your face daily. These are maintenance steps after nonsurgical facial treatments, not substitutes for a procedure that addresses substantial sagging.
• Ask a dermatologist about a prescription topical retinoid if sun damage has left your skin loose. Growth factors and peptides applied to the skin are other treatment options for sun damaged loose skin.

Sun protection remains part of treatment, even when the treatment has a much more impressive name. Without it, you can continue accumulating damage while trying to reduce its visible effects.1

How can you firm sagging skin on your face?

Start by separating loose skin from lost facial volume. Fillers add fullness to sunken cheeks and other areas; ultrasound and radio frequency target skin firmness. A surgical facelift removes surplus skin and repositions the remaining skin around the lower face and neck. The term nonsurgical facelift covers several different procedures, which is a lot of work for one name.26

When is ultrasound a good option?

Ultrasound delivers focused energy into deeper tissue without cutting the skin. It can treat the eyebrow area, neck, under the chin and upper chest. Consider it for mild to moderate looseness when you want to avoid or delay a facelift. An appointment can take two to three hours, depending on the areas treated. One session is usually sufficient, although some people need three or more. Normal activities can generally resume immediately.4

Temporary redness, bruising and tenderness can occur; tenderness sometimes lasts a month. Speak with your healthcare provider before considering ultrasound if you are pregnant, breastfeeding or have an autoimmune disease such as lupus or rheumatoid arthritis. Choose a practitioner who is certified and experienced in the treatment, and ask about the total cost because most insurance does not cover cosmetic ultrasound.4

When should you consider radio frequency?

Radio frequency heats deeper skin layers to stimulate collagen, elastin and new skin cells. It works across skin tones, with little risk of darkening the skin, and is most effective when sagging is just beginning rather than severe. Treatment takes about an hour. Some people need two to six treatments, and effects can last one to three years with appropriate skincare.5

Tell the provider about pregnancy, active skin disease and any other skin treatments before your appointment. Warmth, tingling and mild discomfort can occur during treatment, but report an uncomfortable burning sensation immediately. Mild redness and swelling should settle within 24 hours. Burns are a rare complication, so choose an experienced healthcare provider using a device approved for skin treatment. Contact the provider if redness or swelling lasts several days, or if a rash or unexplained skin changes develop.5

What about microneedling, lasers and fillers?

Microneedling uses tiny needles to create small wounds that stimulate collagen and elastin. Sessions are often spaced three to eight weeks apart. Laser resurfacing removes older outer skin layers while stimulating collagen through heat. Fillers instead restore volume. These procedures address different concerns, so a dermatologist can combine treatments rather than expect one procedure to do everything.12

Discuss active acne, cold sores, eczema, psoriasis, rashes or skin growths before a nonsurgical facial procedure. Risks depend on the treatment and include infection, burns, scarring and swelling. Afterwards, contact your provider for worsening or persistent pain, severe swelling, infection, flu like symptoms, or loss of facial sensation or movement.2

When is surgery worth discussing?

Discuss a facelift when lower facial and neck looseness needs a larger change. A facelift removes surplus skin, so the word lift is doing more than marketing duty. Surgery usually takes two to three hours, commonly under general anaesthetic, with an overnight hospital stay. Plan for two to four weeks off work, bruising for at least two weeks and six to nine months before the final result is visible.6

Surgery leaves scars and carries risks including nerve injury, uneven facial features, healing problems, bleeding and infection. Discuss the likely result, complications and arrangements for follow up before committing. In England, check that the clinic is registered with the Care Quality Commission and the surgeon with the General Medical Council. UK costs range from a few thousand pounds for a mini facelift to £10,000 for a face and neck lift, with consultations and follow up potentially adding to the bill. Contact the clinic promptly for severe pain or unexpected symptoms after surgery.6