Commentary by Barry Eppley

Q: I am a 63-year-old female who recently had a facelift. Because I am thin, I really had no fat just loose skin in the neck and jowls. Now that I have gotten the skin tightened, how can I keep the facelift in place? I have read about a lot of things such as Thermage, Ultherapy and others and, while they sound good in theory, I have read that they don’t work for a lot of people. Some have said that the only really effective method of skin tightening is through collagen regeneration using a fully ablative CO2 laser. But laser resurfacing of the face can be associated with long-term pinkness of the skin. What do you recommend?

A: The reality is that nothing can keep a facelift ‘in place’ forever as surgery does not stop the effects of time and gravity. But there are certainly things to do to help slow down the process and make the results of a facelift last longer. Skin tightening and collagen rebuilding would be the correct approach after a facelift and, for many, should be considered maintenance therapies. There are numerous energy-based devices for skin tightening and you have named a few of the most well known. I do think they have some benefit even if it is not the same for every patient. Light laser resurfacing also is a good choice and can be done with the other skin tightening treatments. And don’t forget such basic preventative measures for skin aging which include avoidance of excessive sun exposure, no smoking, a stable weight and a good daily skin treatment regimen.

Q: I am a 37-year-old and have lost 90 pounds during the past two years. I have been body building during that time and cannot seem to get rid of my stubborn belly skin/fat. I have some abdominal definition but too much skin underneath my navel. I am almost to the conclusion that some form of a tummy tuck is the only way I can get rid of the extra skin.

A: You are to be congratulated on making such a body change. Not many people can lose nearly 100 pounds and end up with a fairly well sculpted body. But you are correct in that you have done all you can do and the lower abdominal skin will only respond to surgical removal. Mini-tummy tucks are what most men need as their abdominal skin shrinks much better than women because of retained skin elasticity. The biggest problem in men is to control their activity level afterward for three weeks or more to avoid a fluid collection from developing.