Best non-surgical treatment to lift skin and build collagen?

Ultimately the best available treatment is a facelift. Understandably not everyone is prepared to go under the knife for a variety of reasons. Recent advances in minimally invasive cosmetic procedures have brought about a number of other choices. In fact, it makes sense to explore these other less invasive modalities to 'postpone' a facelift for a number of years.

In your specific case, I'd suggest a consultation with a few physicians as a starting point. Knowledge gained here and elsewhere on the web will not replace a one on one consultation with a physician but will certainly help you find a comfort level.

If the wrinkles you describe are not deep, ablative fractional resurfacing would improve their appearance. Note that it has to be 'ablative'. It is quite apparent from reading elsewhere on the web that 'fractional resurfacing' has not been adequately explained to the consumer. non-ablative fractional resurfacing would not give dramatic results to the appearance of wrinkles, sun damage and general skin texture. Ablative resurfacing on the other hand would. The ablative modalities of resurfacing currently in clinical use are CO2 and Erbium lasers. In good hands either one will give excellent results.

That said, your results will be even better if you have this procedure done to the whole face and not targeting the wrinkles only.

The sagging at the jowls (where facial sagging seems to be most apparent), can be improved with a combination of therapies. No single therapy alone will solve facial sagging short of a facelift. A a filler (Parlane, Juvederm, Radiesse) injected right at the jaw line to fill in dimpling and more filler into the area of the cheek bone to help lift up the sagging skin. Some Botox shots carefully placed aroung the face will help too. An additional step would be skin tightening. There are different technologies out there for skin tightening. Infrared light (Titan, SkinTyte) seem to work well.

Incidentally, as a single procedure laser lipolysis (Smartlipo etc) to the chin and jowls can improve facial skin sagging quite remarkably.

As for creams, it seems all the advertisements you see are about creams that mask fine wrinkles for the day and not truly try to eliminate them. If there ever was snake oil in cosmetics this may be it.

For your particular situation, as always consultation with a qualified physician is your best option. On a more general question of building collagen, there was a recent article in the New York times about collagen rejuvenation (August 18,2008 available online). The article was cited a review in The Archives of Dermatology which indicated that there were only 3 treatments scientifically proven effective at increasing collagen: topical application of retinol, carbon dioxide laser resurfacing, and injection of hyaluronic acid. Though these were the only treatments with studies, the theory should also hold for other laser ablative resurfacing modalities and probably other injectibles. 

Laser resurfacing (CO2 or plasma resurfacing) is the best way to tighten skin and rebuild collagen, but still has a significant down time. If it is a no down time treatment that you are looking for then a combination of treatments should be considered.

First, skin tightening and lifting can be performed using a Thermage radiofrequency treatment. This treatment can help lift the cheeks and better define the jawline and does stimulate some new collagen under the skin. Another option is the Affirm Multiplex laser that combines a fractional laser to resurface and smooth the skin surface while also penetrating deeper to heat and tighten the deep portions of the skin.

Second, add some fillers to the cheeks or jawline to plump, fill and restore lost volume to the face to lift and fill. Radiesse, Perlane for short term filling (8-12 months) or Fat transfer, Sculptra, or Artefill for longer lasting results (>1yr).

By tightening skin and filling from underneath you can achieve a really great non-surgical lift and avoid the downtime.

Perlane injections can make a dramatic difference in restoring the facial volume, balance, and harmony. We use Perlane injection to the cheeks and surrounding area to have an instant mid-face lift, and improve the nasolabial fold area. These injections are also helpful for the patients who had too much fillers in the area of the fold itself, to the point that it distorts their midface. Cheek injections can help bring back the facial balance and youthful contours.