Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding Skin Tightening as a Prelude to Surgical Face and Neck Lift

Dr. Dean Kane Q. What procedures can best address sun damage and skin laxity on my face/neck/chest/eyelids? Rhinoplasty to soften nose, lip lift and how to best address sun damage and skin laxity on face/neck/chest/eyelids. have been recommended Ultherapy, CO2, and Profound RF. I have had 3 Ultherapy during my 40’s with good success as well as Botox around eyes, fillers in lip and marionettes, and a series of 3 sculptra injections to help crepey skin. I’m 52 now and have tried to avoid surgery but am wondering if I need something more aggressive.

A. Thanks for sharing your photos. 

The beginnings of facial skin laxity start when skin repair diminishes and passive skin aging relaxes downward. The web of fibrous compartments under the skin loses fat, stretches and elongates developing 5 growing “waves” of skin at points of attachment such as the:

  • hooding along the eyes,
  • lower eyelid / cheek junction or tear trough / nasojugal fold
  • nasolabial fold,
  • lateral mouth commissure and marionette folds,
  • jowls and neck.

The skin itself is not dissimilar to crepe paper held together by collagen, elastin and other structural molecules which also passively diminish with aging, weather and UV exposure, oily irritation such as rosecea and smoking.

Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone. During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend.

So, it is important to understand there are 2 layers of the face and neck to rejuvenate; the laxed visible skin AND the sagging soft tissues under the skin. 

Today’s options offer non-invasive, minimally invasive and surgical options. In general:

  • The lower face can be reduced, lifted, tightened, and / or
  • The mid-face can be filled. 

Since I do not have the advantage to examine you, I hope you will be helped by the information below. My immediate recommendations are to obtain:

  • consultation with a talented, Board Certified Plastic Surgeon with extensive skills in:
  • non-surgical skin tightening using Obagi ZO Skin Health Rx regimen for oil control, pigment control and tightening and chemical peels
  • Sculptra injection
  • micro-needling
  • Minimally invasive EuroThread Lifting of 

o    soft tissues for lifting the jowls and folds and 

o    skin firming – tightening – smoothening

  • I do not believe you need a face and neck surgical lift yet. Obtain maximum tightening first including face and neck, decolletage and hands
  • You may have come to my conclusion that transcutaneous lasers are expensive and almost don’t work.

Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon with great experience to evaluate your needs and find a plan that works best for you. All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.


Read more about similar topics:

Facial Rejuvenation

This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.

Give us a call at  410.602.3322  or email Lauri@DrDeanKane.com and make an appointment soon. We’re located on Reservoir Circle just a block off the Baltimore beltway, convenient to greater Baltimore, Annapolis, the Eastern Shore, Southern Pennsylvania, Delaware and Carroll County.

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