What are the alternatives to a facelift for treating skin laxity?

The facelift may be a relatively common procedure, yet it remains a surgical operation. It always carries risks and complications associated with anesthesia, infections, hematomas, bleeding, scarring, etc. That is why many people seek other, less invasive alternatives that can achieve a similar result. Here they are.

• Botulinum toxin injections to reduce wrinkles.

  Botox, or botulinum toxin, is a neurotoxic molecule commonly used in aesthetic medicine. The botox injection causes a temporary paralysis of the muscles that are responsible for the appearance of wrinkles and fine lines. It aims to smooth the skin and give it a rejuvenated look. It is primarily used on the face and forehead. The results of a botox injection become visible once the paralysis subsides. They typically last between three and six months.

  The Botox injection is not without risks and can result in bruising, redness, headache, muscle weakness, allergic reaction, and facial asymmetry if improperly administered.

• Injections of hyaluronic acid, amino acid, and peptide solutions to restore firmness in sagging areas such as the cutaneous retinacular tissue.

  Naturally present in the body, hyaluronic acid is a molecule with outstanding hydrating and water-attracting (hygroscopic) properties. It retains water within tissues, thereby helping to preserve volume and skin suppleness. As we age, its concentration decreases, causing a loss of firmness and the appearance of wrinkles. When injected into the dermis or hypodermis, hyaluronic acid restores lost volume, enhances skin elasticity, and stimulates collagen production, a protein essential for supporting skin structure.

  A study investigated the efficacy, tolerability, and effects of an injectable solution composed of hyaluronic acid, amino acids, and peptides on facial skin laxity, specifically targeting the dermal reticulum. For this purpose, 28 volunteers aged 25 to 65 received four monthly injections of the solution. The results showed a 29.2% improvement in skin elasticity at T1 (30 days after the last session) and a 20.7% improvement at T2 (120 days after). Concurrently, collagen density increased by 20.27% at T1 and by 16.71% at T2.

  The session of injections of hyaluronic acid, amino acids, and peptides generally takes place in a medical office under the supervision of a trained professional. Using fine needles or microcannulas, the solution is injected into the deep dermis or hypodermis at the level of lax areas such as the retinacular dermal tissue. The procedure is minimally painful, but a topical anesthetic cream can be applied beforehand for added comfort. It is advisable to avoid taking anti-inflammatories or anticoagulants in the days before to minimize the risk of bruising. After the session, redness, slight swelling, or small bruises may occur, but they generally resolve within a few days. It is recommended to avoid sun exposure, heat (hammam, sauna) and intense physical activity for 24 to 48 hours.

• Radiofrequency microneedling: a noninvasive technique to counteract skin laxity.

  This method requires the use of a radiofrequency device. It delivers electromagnetic pulses to the deeper layers of the skin. This produces controlled heat to stimulate collagen production. Radiofrequency treatment improves skin texture and reduces the wrinkles and fine lines. It yields progressive results, meaning multiple sessions are required. However, this type of procedure may cause temporary redness, a sensation of warmth, swelling, and even superficial burns.

  The microneedling by radiofrequency combines the action of micro-needles penetrating the skin with that of electromagnetic waves delivered deep into the tissue. The session takes place in a medical office, with a topical anesthetic cream applied beforehand to minimize discomfort. The needles emit radiofrequency energy into the dermis, generating controlled heat that stimulates collagen production and enhances skin firmness. The procedure typically lasts 30 to 60 minutes, depending on the area being treated. It is advised to avoid sun exposure, abrasive treatments, and the use of irritating products in the days before and after the session. Redness, swelling, sensations of warmth, or mild crusting may occur, but typically resolve within a few days. Using a high-SPF sunscreen is essential after the treatment.

• Ultrasound as a solution for skin laxity.

  Focused ultrasound, particularly high-intensity focused ultrasound (HIFU), represents a noninvasive alternative to surgical lifting for combating skin laxity. Ultrasound waves are precisely focused at a predetermined depth (typically between 1.5 mm and 4.5 mm), thereby reaching the deep dermis, an area also targeted during a surgical facelift.

  When ultrasound waves reach this focal point, they induce a localized temperature rise (approximately 60 to 70 °C), leading to controlled thermal coagulation. This microthermal lesion stimulates the body’s natural tissue repair response, resulting in the production of new fibers of collagen and elastin. Additionally, the ultrasound promotes an instantaneous tightening of the existing collagen fibers, producing an immediate firming effect.

  However, ultrasound is only used in cases of moderate skin laxity.

  Before treatment, a topical anesthetic cream is usually applied to the treatment areas to minimize discomfort associated with ultrasound. It remains in place for approximately 60 minutes, then is rinsed off before the session begins. Once the skin is cleansed, the practitioner applies a coupling gel to the targeted area. This gel facilitates the transmission of ultrasound waves between the device’s handpiece and the skin, while ensuring smooth movement. The treatment then commences. Using a handheld device, high-intensity focused ultrasound (HIFU) is delivered to specific depths, depending on the objective: superficial dermis, deep dermis, or the subcutaneous tissue (SMAS). Each pulse generates a targeted thermal micro-coagulation without damaging the epidermis. A sensation of warmth or tingling may be felt, varying according to individual sensitivity. The session lasts between 30 and 60 minutes, depending on the area(s) treated (face, neck, jawline, etc.). No special aftercare is required beyond proper skin hydration. Mild redness or tightness may occur but generally subsides within hours to days.

  In a study published in the Journal of Dermatologic Surgery, the efficacy of ultrasound in the treatment of facial skin laxity was evaluated in 22 patients with moderate facial laxity. Two months after a single session of focused ultrasound treatment, visible improvement was observed, particularly in the nasolabial fold and along the jawline. Histological analysis of skin samples taken before and after treatment revealed a 23.7% increase in collagen fiber thickness, as well as strengthening of the reticular dermis. These structural changes reflect an overall thickening of the dermis, contributing to enhanced skin firmness and tone.

• Tension threads for tightening the skin of the face and body.

  The thread lifts are less invasive than a facelift and help improve skin laxity of the face and certain body areas. These very fine threads, inserted under the skin using needles or cannulas, are often absorbable and stimulate the production of collagen by acting as tissue inductors. There are several types of threads, including barbed threads, which have small projections along their structure. These barbs, oriented in one or two directions, allow the threads to anchor securely into the subcutaneous tissues. Once placed under the skin, they exert immediate traction, lifting the skin and enhancing its support. Barbed threads deliver a gradual, natural lifting effect, particularly well suited to mild to moderate skin laxity.

  Cone threads are lifting threads equipped with small conical structures distributed along their shaft. When inserted under the skin, these cones exert more powerful traction than simple barbs, thanks to their specific shape and orientation. They also allow for a more uniform distribution of tension, ensuring a more homogeneous effect. Cone threads are particularly indicated for areas with significant skin laxity or when a more pronounced lifting effect is desired.

  The placement of thread lifts takes place in a medical office under local anesthesia. The practitioner inserts the absorbable threads into the subcutaneous tissue using fine needles or cannulas, following a precise pattern tailored to the treatment area. Once in position, the barbs or cones on the threads anchor into the tissues, providing immediate lift and gradually stimulating collagen production. The session typically lasts between 30 and 60 minutes, depending on the area treated. Before the procedure, it is advisable to avoid alcohol, anticoagulants, and anti-inflammatory drugs to limit the risk of bruising. After placement, some redness, swelling, or temporary tightness may occur. It is advised to avoid excessive facial movements, cosmetic treatments, heat exposure, and strenuous physical activity for a few days.

  Before turning to either of these techniques, it is recommended to consult your physician.