What are your choices for sagging skin?

You probably already know that sagging skin is a natural part of aging.

More than just wrinkles, sagging skin is the drooping cheeks, the falling jowls, and neck creases that women — and men — of a certain age would like to do something about.

But what?

Wrinkles can be filled in, but sagging skin? Not so easy of a fix.

That’s because collagen and elastin, the proteins of taught, firm skin that give it its thick, elastic and youthful appearance, are produced less as we age.

But there are other factors that contribute to weakening the collagen and elastin proteins of your skin, including:

  • Repetitive facial expressions
  • Sleeping positions
  • Smoking
  • Sun exposure
  • Prolonged stress
  • Extreme or rapid weight loss

It’s possible to avoid these factors and cut down on further damage. But to reverse the look of sagging skin, you would likely need to consider a cosmetic procedure. These days, that doesn’t mean a full-on face lift. In fact there are many, less-invasive options to choose from…

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Cosmeceuticals to reverse sagging skin

Cosmeceutical skin cream products will have a very mild if any effect on correcting sagging skin. However, these are recommended to help prevent further sagging.

Look for the following product ingredients:

Hyaluronic Acid: this is also called hyaluronan or glycosaminoglycan

Stem cells, when combined with correct growth factors, will grow new tissue and can increase collagen. Many serums and creams on the market contain stem cells.

Growth factors turn on stem cells to grow into specific tissue types. They naturally become depleted with age. Current studies prove they increase dermal collagen.

Peptides or amino acids increase cells in the skin to produce more collagen. In particular, The Cleveland Clinic writes about copper peptides: “Studies have shown that copper peptide promotes collagen and elastin production, acts as an antioxidant, and promotes production of glycosaminoglycans (think hyaluronic acid, as an example). The substance helps to firm, smooth, and soften skin, doing it in less time than most other anti-aging skin care products.”

Non-invasive (non-surgical) skin tightening interventions

These procedures done in the medical spa leave your skin intact (no incisions or raw, painful skin afterwards) with maybe only temporary redness and swelling. Results appear gradually. You can expect:

  • No or little social downtime: you can return to work the same day if needed
  • Most procedures take 45 to 90 minutes per treatment; expect multiple treatments
  • Topical numbing cream makes pain minimal
  • Can often apply makeup immediately after the procedure

Here are your main options:

Microcurrent: A subtle electric current delivered by a pulse to the facial muscles stimulates them and the surrounding tissues to tighten. You will get only subtle results.

Microneedling: Dermatologists generally teach that a cosmeceutical cream, lotion or serum cannot penetrate the skin deep enough to reverse sagging. However, by injecting stem cells, growth factors, and peptides into the skin, tightening does occur and quite noticeably and can also reduce scarring, improve wrinkles and stretch marks, and build collagen.

What happens during microneedling is that a device with small needle points is rolled across the skin, causing tiny invisible punctures in the top layer of skin. The skin goes into repair mode and that spurs production of collagen, elastin and increases cell turnover. Microneedling also helps topical products better penetrate the skin.

PRP (Platelet Rich Plasma) involves withdrawing your own blood, extracting out the platelet-rich portion, then re-injecting this into your skin with tiny (nearly painless) needles or with a microneedling device.

Platelets and growth factors from your own blood stimulate a stem cell response, and thus, growth of new young collagen and blood vessels where it is injected. The effects of PRP to the face lasts from 12 months to 2 years depending on your age and initial skin health. PRP can be combined with dermal fillers and botulinum toxin for optimal overall cosmetic results.

Ultrasound waves vibrate the skin to boosts new collagen formation.

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Radiofrequency energy is a type of electromagnetic radiation with long wavelengths that causes dermal tissue molecules to oscillate at specified penetration depths. This triggers an inflammatory response, with is the pathway to generating new healed tissue. A soft metal handpiece is place on your skin with a thin layer of conduction (ultrasound) gel to heat up the tissue beneath. This allows your therapist to provide heat exactly where you need it to tighten loose skin. This is a safe and effective in office procedure to tighten the face, chin, neck or upper arms.

Treatments are done every 1-2 weeks, and most people can expect to start seeing results in about one month. In some research studies, patients see gradual tightening and lifting for close to 1 year and can maintain this with only one treatment every six months.

PDO threads: Thread lifting is the latest treatment for skin tightening and lifting as well as V-shaping the face. These threads are made of PDO (polydioxanone) — similar but much faster-absorbing than surgical stitches.

When inserted into the skin, they act as a “scaffold” for the skin and helps to “hold” the skin against the effects of gravity. The threads stimulate a collagen synthesis under skin, but also absorb and dissolve within 4-6 months, leaving nothing behind but the skin structure created which continues to hold for another 15-24 months.

Laser: this intense synchronized light therapy sends heat deep into and below the skin surface and can also wound the top layer of your skin. This is the most aggressive non-surgical way to tighten sagging skin, and give the fastest results — within 2 weeks. This however, does require social downtime: expect to stay home for 5 – 7 days.

To long term health and feeling good,

Michael Cutler, M.D.


  1. Understanding the Ingredients in Skin Care Products — Cleveland Clinic
  2. el-Domyati M, el-Ammawi TS, Medhat W, Moawad O, Brennan D, Mahoney MG, Uitto J. Radiofrequency facial rejuvenation: evidence-based effectJ Am Acad Dermatol. 2011 Mar;64(3):524-35.
Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.