Your Dermatologist: Macrene Alexiades-Armenakas, MD, New York City

"Genetics, sun exposure, and collagen and elastin breakdown cause our skin to sag as we age. There is no topical remedy. As for treatment options, I start with the gold standard: a lower facelift. If you have laxity, it offers the most dramatic results. It also requires general anesthesia and weeks of downtime, and leaves scars around your earlobes.

"If you've ruled out surgery, I would suggest a treatment with the microneedle radiofrequency device Miratone (widely available in early 2010). Electrodes inserted beneath the skin conduct radiofrequency energy into the dermis, triggering collagen and elastin synthesis. The process is painful, so we use injectable lidocaine to numb your face. For a week afterward you will be swollen, red, perhaps bruised; you might then be sore for several weeks after that. If that sounds too intense, the Titan laser and Accent radiofrequency device heat only the surface of the skin, and can also minimize skin laxity; you need three sessions to get results comparable to a single Miratone treatment, but they're painless and involve no downtime. These treatments yield maximum results after six months (it takes time for new collagen to form); Miratone seems to last the longest (several years), but none have had long-term follow-up studies. If you're over 55 with sun damage (discoloration, redness), consider a fractional ablative laser treatment. It builds new collagen, which has a skin tightening effect, and also improves skin's tone and texture."

Your Options:
  • Lower face- and necklift, $18,000 to $25,000
  • One Miratone treatment, about $3,500
  • Three monthly Titan or Accent treatments, $800 to $2,000 each
  • One fractional ablative resurfacing treatment, $1,500 to $8,000


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