As we age, one of the most common signs we have no control over is the appearance of sagging skin. “The most common cause of sagging skin is age-related volume loss,” explains New York facial plastic surgeon Andrew Jacono, MD. “This includes the loss of dermal collagen, facial fat atrophy and gravitation, which means the elongation and stretching of the skin. Unfortunately, because this is a loss of skin elasticity, skin- care products won’t minimize the look of sagging.”
While there are no magic potions or lotions to turn back the clock, there are effective ways to prevent and minimize sagging, which include a combination of updated formulas, nonsurgical tightening and more permanent surgical options.
How to Firm Up Sagging Skin
When it comes to ingredients and formulas that help strengthen skin, Northville, MI dermatologist Farhaad Riyaz, MD says there is nothing better than the combination of retinoids and sunscreen. “Nothing beats tretinoin, and you also have to use sunscreen of course to prevent the UV-induced breakdown of elastic tissue,” he advises. “Couple that with a good hyaluronic acid moisturizer to draw in water, and you’ve got plumping and lifting.”
Look for firming face and body creams, lotions and serums with these ingredients, as they play a crucial role in maintaining youthful-looking skin, especially when sagging or thinning is the concern.
Dr. Jacono says a new innovative solution for wrinkly skin is Ellacor, a micro-coring treatment that tightens by removing microscopic cores of excess skin. “Other options like Ultherapy, which heats the tissue with ultrasound energy, can help lift and tighten mild-to-moderate loose skin,” he adds.
According to Austin, TX dermatologist Sarah Gee, MD crepey skin can also be treated with a carbon dioxide laser, which creates a controlled thermal injury, prompting skin to heal itself. “I like CoolPeel for improved tone and texture, fine wrinkling and aging skin.”
To further address deeper sagging, Dr. Gee suggests radio-frequency microneedling. This technique enhances elasticity and collagen by inducing microinjuries in the skin, promoting its natural healing. “The devices with longer needles go deep into the dermis to tighten loose skin on the abdomen or other parts of the body, like the knees.”
For more significant sagging on the face and neck, surgical facelifts and necklifts may be considered. “Aging is a very personal journey, but it’s very common for people to start considering surgery in their late 40s and early 50s. The median facelift age in my practice is 47 to 53,” says Dr. Jacono. Only surgery can address deeper sagging by repositioning tissues. “It’s not just one procedure that effectively treats sagging skin. Gravity doesn’t affect just one part of the face, so the patient may need various approaches.”
According to Bloomfield Hills, MI dermatologist Linda C. Honet, MD, a crucial mistake people make is focusing only on tightening sagging skin without plumping it, too. “Improving skin laxity is quite complex,” she says. “To rejuvenate the face and neck for a beautifully youthful contour, volume loss needs to be addressed as well. Whether it’s via noninvasive procedures or a surgical lift, the use of fat transfer, dermal filler or Sculptra poly-L-lactic acid injections as add-on treatments can help fill in areas that need to restore volume.”
New York dermatologist Marina Peredo, MD often collaborates with plastic surgeon Dr. Andrew Peredo, her partner and son, for more comprehensive enhancements. “For patients who have gone as far as they can with noninvasive options, a scarless facelift and necklift, combined with MyEllevate suture suspension and FaceTite skin tightening, provides optimal results,” she explains.
“This is a great in-between solution for those who want to tighten sagging on their lower face without traditional surgery. The scarless facelift and necklift is great for the lower face and neck. If I need to address the upper face from the temples to the cheeks, then the combination of Sofwave with Sculptra is another great option. These procedures can be paired and customized based on the patient’s needs, and are effective for mild-to-moderate sagging.”
New York plastic surgeon Daniel Maman, MD emphasizes that diet and exercise alone cannot tighten skin on the body. Once gravity takes hold, sagging skin becomes a surgical problem that can only be corrected with surgery. “In fact, when you are losing weight too quickly, one of the side effects is sagging skin, and it won’t snap back on its own,” he says.
For the abdomen, he recommends either a tummy tuck or panniculectomy, with options like the front-only or circumferential belt-pack. To address breast drooping, he recommends a breast lift with or without implants. “The decision is based on the amount of breast tissue that needs to be removed.”
For the arms and legs, Dr. Maman notes that procedures like thigh lifts and arm lifts are less common, but can be essential for some patients who want to streamline their bodies. “These surgeries are typically secondary to breast and abdomen procedures. When there are multiple areas of the body to address, I always advise patients to establish priorities. If your arms and breasts really bother you, it’s reasonable to address them together,” he notes.
However, the breasts and abdomen are usually the most bothersome, and as such, their treatments are often combined.
When it comes to addressing cellulite, Denver plastic surgeon Philippe A. Capraro, MD recommends Avéli as a treatment option. “Avéli provides a very quick and sleek treatment for cellulite,” he says. “With just a small incision around the treatment area, usually less than 2 millimeters, the device enters under the skin, releases a small hook, and cuts the fibrous bands that pull on the skin. You can see the results almost immediately as the tension is released and the skin ‘pops’ back into place.”
Delray Beach, FL dermatologist Dr. Janet Allenby says she has found the winning cellulite combination that is completely noninvasive. Using Resonic, which harnesses high-frequency soundwaves, and Morpheus8 radio- frequency microneedling, she can effectively address common cellulite concerns. Sofwave is an ultrasound-energy based treatment that was FDA cleared to treat cellulite as well. “It heats up the tissue to help lift and tighten mild to moderately loose skin,” Dr. Allenby explains. “The microneedling with radio-frequency further heats and tightens the skin to give the area a smoother look.”
Toning Tools for Sagging Skin
The mix of forskohlii root oil, caffeine and botanicals in this cream give it smoothing power anywhere you apply it from the neck down.
This lotion is an anti-aging moisturizer that uses natural ingredients like rosa canina and date fruit extract to firm and tone.
Nushape Lipo Wrap ($499)
This LED-powered wrap is used to help stimulate blood flow and increase collagen formation in the skin.