Solutions for sagging skin and the dreaded double chin

Source: Best Health magazine, May 2015

‘Stick your chin out’now bring it down just a little,’ coaches a friend whenever she’s taking my photo. Her aim? To minimize my sagging chin and create a more streamlined jawline.

Let’s face it: If there’s anything that shows the creeping effects of age, it’s the slackened skin on your jaw and neck, whether in the form of a wobbling wattle, a double chin or dreaded jowls.

The good news? Hiding imperfections doesn’t mean resorting to scarves and turtlenecks or going under the knife (unless you want to!). Thanks to advances in technology, there are a variety of tools and therapies to suit your budget and level of commitment. Read on for your go-to list of solutions.

Botox

Most commonly used in the upper face to relax forehead creases, crow’s feet and vertical lines between the brows, Botox can also be used to soften the thick V-shaped platysma bands, which are the contracting muscles that run from under your chin to your Adam’s apple. That said, it’s rarely used for this purpose, says facial plastic surgeon Dr. Mark Samaha, who runs a practice in Montreal, ‘because people are usually interested in a more all-encompassing solution.’ Also, the more pronounced the bands are, the fewer results one will see with Botox. If you choose this option, note that Botox must be injected by a medical doctor (MD), or a registered nurse (RN) under the supervision of a doctor.

Best for: Ages 30+
In-office time: 15 minutes
Downtime: None, but it usually takes three to seven days for results to show
Ouch factor: 1-3 out of 10
Lasting effects: About four months
Cost: $300 to $600 per treatment

Fillers

Hyaluronic acid (HA) fillers with brand names like Restylane and Juvéderm can camouflage mild jowls. The doctor or RN will inject filler into the marionette lines between the corners of your mouth and chin, as well as along the jawbone in front of (and sometimes behind) your jowl to create a smoother line, says Dr. Samaha. 

Although the HA used in fillers is synthetically produced, it’s almost identical to the HA your skin produces naturally. The caveat: It won’t do a thing for loose skin on your neck.

By law, fillers must be injected by a doctor, or an RN under a doctor’s supervision. Aestheticians and lay people are not authorized, but some treat those guidelines loosely. Your best bet? Check that there’s a doctor on board before you inject.

Best for: All ages
In-office time: 15 to 45 minutes
Downtime: Usually none, although there could be slight bruising or redness for 24 to 48 hours
Ouch factor: 2-4 out of 10 (most fillers contain lidocaine for pain control)
Lasting effects: 10 to 18 months
Cost: $400 to $700 per syringe (most patients will need one to two syringes)

Infrared light

Infrared light (under brand names such as Titan and SkinTyte II) heats and inflicts tiny injuries on your skin’s collagen layer, causing it to contract and tighten. It can’t penetrate as deeply as a technology like Ultherapy, so it’s less effective, according to Roberta Segar, treatment director of Skinpossible Laser & Light Solutions, a Calgary clinic. She uses it to ‘freshen’ the face and for superficial skin laxity, often in the neck area. ‘The skin on your neck is thinner than the skin on your face [making it easier to penetrate].’ Results take time to show ‘ usually three months ‘ ‘but some people heal slower as they age, so the full results might not be obvious until six months later.’ How is it administered? You lie back while the practitioner (MD or MD-supervised nurse/aesthetician) delivers pulses of infrared light through the handpiece. One caveat: There is a possibility of minor or, in rare cases, even severe burns with Titan. Make sure your practitioner is experienced and has a solid reputation. 

Best for: 40s to 60s
In-office time: 45 minutes to 11/2 hours per treatment
Downtime: None
Ouch factor: 4 out of 10
Lasting effects: One to two years
Cost: $300 to $500 per treatment (three to five treatments recommended)

Liposuction

This is a quick and effective solution for removing excess fat deposits in the chin area and can be performed under local anesthetic. Basically, the doctor makes small incisions below the chin and sometimes behind the ears and then vacuums out the excess fat using tiny suction tubes. But Dr. Samaha warns that skin needs to be firm enough that it snaps back once the fat is removed. ‘If you go in and remove fat in an older woman, the skin will droop even further,’ he says. For that reason, the procedure may be combined with a facelift or neck lift or a non-surgical tightening treatment.

Best for: All ages
In-office time: 15 to 40 minutes
Downtime: seven to 10 days
Ouch factor: 1-2 out of 10 (with oral pain medication)
Lasting effects: Many years
Cost: $1,500 to $2,500

Ultherapy

Ultherapy, under the brand name Ulthera, uses focused ultrasound waves to deliver energy to the muscle layer below the skin, says Dr. Sandy Skotnicki, founder and medical director of Bay Dermatology in Toronto. The zap of energy kick-starts your body’s natural repair process, causing the muscles to tighten and spurring collagen growth. The result? Subtly tighter, more toned-looking skin, but it’s not an overnight fix. Results take between three and six months to be noticeable, says Dr. Skotnicki.

You lie back while the practitioner applies ultrasound gel to the skin to ensure a good seal and then runs the handpiece over the targeted area. You’ll feel a series of zaps, like the snap of a rubber band or, in the worst-case scenario, a bee sting. The Ultherapy handpiece shows the underlying layers of skin on a screen (as with ultrasounds), allowing practitioners to deliver energy to a precise depth.

Ultherapy has been approved by Health Canada to lift skin on the eyebrows, neck and under the chin. The therapy can be administered by a physician, as well as an RN or aesthetician under the supervision of an MD.

Best for: Early to mid-40s
In-office time: 11/2 to two hours
Downtime: Two to four days (for mild swelling and redness to disappear); Bruising and welts are possible
Ouch factor: 4-8 out of 10 (with prior pain medication)
Lasting effects: one to three years
Cost: $1,500 to $3,800

Radio frequency waves

Controlled doses of radio frequency (RF) energy gently heat the underlying layers of your skin to shrink fat cells and impose microscopic injuries. Collagen fibres respond by contracting and tightening as they heal. The treatment aims to reduce fat volume in your lower face, tighten skin on your face and neck and provide a more distinct jawline.

You recline while the practitioner moves the handpiece over the treatment area. You’ll feel a sensation of heat, as well as a pummelling feeling against your skin that can be uncomfortable, particularly in the neck area. The Health Canada-approved brands for skin tightening include Thermage, Venus Freeze and Viora Reaction.

Marina Vashkevich, owner of MedVSpa in Toronto, prefers Viora because she can target RF waves at four depths of skin penetration with the device. ‘The thickness of skin in men and women, old and young, varies,’ she says. The therapy can be administered by a physician, as well as an RN or aesthetician supervised by an MD.

Best for: 40s and 50s
In-office time: 20 minutes to one hour per treatment
Downtime: None, although you may have bruising and redness for a few days
Ouch factor: 2-3 out of 10
Lasting effects: Six months or more
Cost: $125 to $300 per treatment (three to six treatments recommended)

Facelift

A traditional facelift combined with a neck lift remains the best bet for a striking, lasting fix, including a smooth, tight neck and a well-defined jawline. The doctor will make small cuts that are hidden in the creases around your ears. ‘Then we get under the skin and tighten up the muscle by suspending it with sutures,’ explains Dr. Samaha. Your skin is then ‘redraped’ and the excess trimmed away. Although you can have a procedure on your neck alone, ‘Generally, when someone has a loose neck, they also have jowls,’ he says. ‘The overwhelming majority of patients will do a lower face lift and neck lift.’

Best for: 50s to 70s
In-surgery time: 21/2 to 31/2 hours
Downtime: Two weeks before swelling and bruising subside enough to go out in public
Ouch factor: 1 to 3 out of 10 (with oral pain medication)
Lasting effects: 10 years or more
Cost: $7,000 to $11,000 (depending on whether there are concomitant procedures)

‘or mini-me version of a facelift

A mini-facelift requires shorter surgical incisions and less downtime than a traditional facelift, but it addresses only jowls and drooping cheeks. The results will be less dramatic than for a traditional facelift. ‘If you look in the mirror and prop up your cheeks and jowls with your fingers, you’re mimicking what a mini-facelift does,’ says Toronto plastic surgeon Dr. Lawrence Tong. The procedure is best for people with minimal facial sagging and those who’ve previously had a facelift and just need a touch-up.

And make sure you know what you’re signing up for, he cautions. Procedures such as the so-called ‘lunchtime lift,’ ‘trampoline lift’ and ‘S-lift’ claim to give you great results quickly but often don’t address the underlying muscles in your face, so the results can be short-lived. For best results, your surgeon should tighten and reposition the SMAS, as well as the skin itself. Best suggestion? Do your homework before you go under the knife.

Best for: 40s
In-surgery time: one to 21/2 hours
Downtime: one to two weeks
Ouch factor: 1 to 2 out of 10 (with oral pain medication)
Lasting effects: four to 10 years
Cost: $4,000 to $8,000

‘ All prices are offered as a guide only. Procedural fees may vary based on an individual’s skin health, as well as clinics’ rates.