What's the best way to tighten loose skin?

When addressing "loose skin" of the face it is important to address the issue from both a "quantity" perspective as well as a "quality" perspective.

Lets us first discuss "quantity".  As we age we lose volume in our face (primarily fat).  As a result skin can hang down as gravity acts on it creating droopiness, wrinkles and bands.  This can be thought of as excess skin and is similar in concept to a dress that becomes too large as its owner loses weight.  Facelifts, S-lifts, mini-lifts, etc. are surgical procdures which can help remove the excess skin and address the issue of the "quantity" of skin.  It is also very important that the underlying muscles/SMAS be addressed and repositioned as well during these procedures as "skin only" procedures rarely harbor worthwhile results.

Addressing the "quality" of the loose skin is also very important.  Through genetics, sun exposure, smoking and the natural aging process,  the inherent elasticity and tone of our skin gets worse as we age.  Surgical treatments do not address the "quality" of skin.  Therefore in order to improve "quality" treatments such as chemical peels, fractionated lasers, Retin-A and even intradermal Botox can be used to improve skin "quality" to a very desirable endpoint.

While an individual patient may choose to address "loose skin" of the face based on "quantity" or "quality" alone, it is best to address both factors in order to get the most satisfying and long standing results.

Always remember to clean, moisturize and protect your skin everyday!

The best way to tighten loose skin is through a comprehensive face/neck lift.

Loose facial skin will also have loose fascial attachments and muscles of the face, specifically in the neck and jowl area. Therefore the skin and its underlying structures must be tightened to achieve long-lasting results.

Tightening the skin alone can leave the patient with a pulled, tightened, and wind tunneled look.

There are several "Skin Tightening" devices, and none are created equally.  The two main categories are:

1. Ablative (vaporized some elements of the skin)
2. Non-ablative.  

The non ablative procedures have little to no downtime and tend to cost a little less per procedure while the ablative procedure tend to provide better results but can have significant down time.

Ablative: higher cost, better results, more downtime, usually single treatment

CO2
The "gold standard" of tissue tightening is full CO2 resurfacing.  This procedure ablates 100% of skin over the treated area.  It can range in cost from $5000-$15000 dollars and usually requires at least two weeks of downtime but usually more.  Results are normally significant and last several years.  Redness after the procedure can last months and other side effects can include permanent lightening of the skin and or scaring.

Fractionated CO2
Fractionated procedures, such as Active/DeepFX and CO2 Fraxel, normally ablated anywhere from 20-80% of the skin by punching holes about twice the diameter of a human hair into the skin.  These procedures offer many of the tightening benefits of full CO2 with less downtime, cost and risk of long term side effects.  

Although I am not aware of any head to head studies that specifically address skin tightening between full CO2 and fractioned CO2, I can say that during an Active/Deep FX procedure a provider can actually watch the skin tighten as the laser passes over the treatment area. 

Cost is about $2500-$4000.  Expect anywhere from 5 day to 2 weeks of downtime with fractionated CO2 depending on how aggressively your provider performs the treatment. Very good results that last several years.

Non-Ablative: Lower cost, little or no downtime, less results, usually a series of treatments

Titan
Infrared light used to heat collagen so it shrinks and simulated new collagen growth over a 3-6 month period.  I have used this machine since 2004 and works well for laxity around the eyes, cheeks and neck, so-so for jowls. 

Procedure cost about $1000-$1500 for a full face. There is no downtime but plan on at least three procedures.  Results usually last about 12-18 months, and about 80-85% of patients are happy with results. This is a very tolerable procedure, and the side effects are limited to a very rare blister.  

The LuxIR also uses infrared light to treat skin laxity, but there seems to be slightly less consistency in the literature with this devise.

Thermage
Uses Radiofrequency to heat tissue.  Although I have seen this machine be effective the reports in the literature say that it only works well about 29% of the time. 

The treatments can be very painful and in rare cases radiofrequency can cause damage to the fat layer under the skin resulting in loss of volume over that area.  Cost range from $1000-$3500 and plan on 1-3 procedures with little to no downtime.