Skin Tightening
For a softening jawline, early jowls and loosening skin.
With Dr. Juliya Fisher and Dr. Shereene Idriss.
In Brief
Skin tightening firms loosening skin without surgery, most often along a softening jawline, early jowls and the area under the chin. We use focused ultrasound (Ultherapy) and radiofrequency microneedling (Morpheus8, SecretRF), adding Sculptra and Radiesse or PDO threads when the cause is lost volume or a receding jawline. Most plans combine more than one.
Diagnosis First
Jowls are structural. In Dr. Idriss’s experience about eight in ten of us develop them, and a strong jawline spares the rest. Underneath, three layers change with age.
- Bone. The structure that holds your face up changes with age, as the jawline narrows and recedes.
- Cushion. The fat pads in your face shrink and drop, so the lower face starts to sag.
- Skin. Skin loses collagen and elasticity and drapes around those changes, like fabric over a couch.
Habits play a part too. Talking with your lower teeth showing, biting your cheeks and smoking can bring jowls on sooner. “We are either going to sink or sag,” as Dr. Idriss puts it, and the plan for a face that sags is not the plan for a face that sinks.
Whether your face is sagging or sinking decides which device, if any, belongs in the plan. That call is a dermatologist’s to make.
What We’d Skip
Several popular fixes for jowls do nothing, and a couple make them worse.
Don’t buy a firming cream for jowls
Jowls come from bone, fat and skin changing beneath the surface. Of a firming cream, Dr. Idriss says: “It’s not going to do anything.”
Don’t remove your buccal fat to prevent them
Taking out the fat pads in your cheeks can make the face sink sooner and the jowls drop faster, especially in a younger face.
Don’t melt the fat in a jowl
Dissolving jowl fat with a fat melting injection can leave your skin with less to hold, so it falls around the space. Your doctor tightens the skin instead.
Don’t turn the heat up for a stronger result
Ultrasound and radiofrequency devices can melt the fat that supports your face when they go too deep, especially in a face that lacks volume. Less is more.
Don’t buy a package before anyone has looked at your face
You may need fewer sessions than a package assumes. “You buy your shoes on sale, you do not get your face on sale,” says Dr. Idriss.
How Are Loose Skin and Jowls Treated?
The right treatment depends on what sits behind the loose skin.
- Your face still has its volume and is starting to sag. Ultherapy uses focused ultrasound to lift loose skin under the chin and on the neck and to firm the jawline, with little or no downtime. This is the face it suits.
- Heavy fullness under the chin, in skin that is still firm. Morpheus8 reaches deep enough to help reduce that fat and define the jawline, which is also why it isn’t used that way on crepey skin.
- Skin that is thinning or crepey rather than sagging. Radiofrequency microneedling at low energy, such as SecretRF, improves the skin itself, especially when crepiness starts young. Ultherapy isn’t the pick here.
- Sagging that comes from lost volume or a receding jawline. Sculptra & Radiesse work in two ways. Sculptra rebuilds the under padding a sinking face has lost, and Radiesse adds structure along the jaw.
- A little more hold, if you do not want a facelift. PDO Threads hold the skin in a chosen direction, alongside the treatments above rather than alone, and not at every visit.
When skin is very loose and heavy, surgery may serve you better, and we’ll tell you.
The Treatments
Five treatments tighten or support loosening skin.
UltherapyFocused ultrasound that lifts without breaking the skin
Morpheus8Microneedling with radiofrequency heat to firm, smooth and reduce fullness
SecretRFGentler radiofrequency microneedling for thin, crepey skin
PDO ThreadsDissolvable threads that hold early sagging in place
Sculptra & RadiesseCollagen building injectables that restore support
Side by Side
Ultherapy, Morpheus8 and SecretRF tighten skin with heat, each at its own depth. Sculptra, Radiesse and PDO threads support it instead, and the two kinds are often combined.
| Treatment | How it works | Suited to | Downtime | Sessions | Results |
|---|---|---|---|---|---|
| UltherapyFocused ultrasound | Focused ultrasound heats the layers 1.5 to 4.5 mm beneath the skin, which is never broken; your doctor sees those layers on screen | Early sagging of the jawline, jowls and under the chin in a face that still has its volume | None; brief redness or swelling possible | Usually one | 2 to 3 months |
| Morpheus8RF microneedling | Fine needles release radiofrequency heat beneath the surface, up to 4 mm deep on the face, deep enough to reduce fat | Loosening with fullness under the chin or along the jaw, in skin that is not crepey; texture | 4 to 5 days of pink, slightly bumpy skin | One or a short series | Over months; full effect at about 6 months |
| SecretRFGentler RF microneedling | Needles up to 3.5 mm deep, with the energy passing sideways between them rather than down | Thin, crepey skin, including crepiness that starts young; fine lines around the eyes and mouth | A few days of pink, slightly bumpy skin | Often a short series | Over months; full effect at about 6 months |
| PDO ThreadsDissolvable PDO threads | Dissolvable PDO threads placed beneath the skin hold it in a chosen direction and build firmer collagen around them | Early sagging along the jaw and cheeks, alongside other treatments, for those who do not want a facelift | A few days; possible swelling, bruising or tenderness | Usually one; not repeated every visit | Right away, settling over about 2 weeks |
| Sculptra & RadiesseCollagen building biostimulators | Injections that rebuild lost support: Radiesse gives structure right away, Sculptra builds collagen gradually | Sagging from lost volume (Sculptra) or a receding jawline (Radiesse) | Little; possible swelling or bruising | Sculptra: a series; Radiesse: as your plan needs | Radiesse right away; Sculptra over months |
“With Ultherapy I can see the layers beneath your skin on a screen before I treat them. I trained as a surgeon, so that kind of precision matters more to me than raw energy.”
In Their Words
“
I decided to visit Dr. Fisher after all the reviews I had read about her online and she did not disappoint! Right from the initial consultation through the ultherapy session today she was professional, thorough and considerate while giving recommendations and administering treatment. She put me completely at ease from the get go and my experience with her was a 11/10! And I will be returning! Thank you Dr. Fisher!
Chitra R.
“
I would recommend Dr Idriss a thousand times over and over. She is extremely knowledgeable, knows what will work and what won’t and will always give you an honest recommendations. You will never feel pushed into moving forward with any injections or procedures.
Hiva F.
“
I highly recommend Dr. Fisher. I followed her from her previous practice and I continue to be happy with my results. I’ve gotten fillers and laser. Whenever I’ve wanted to do more, she was always honest with me. If I didn’t need it, I could count on her to tell me
Lillian J.
“
Absolutely love Dr. Idriss. She has a very thoughtful approach to her practice and really wants you to look and feel like the best version of you. I’ve been seeing her for years and trust her completely with all my skincare needs. She is also just a lovely person and my appointments are always a pleasure.
Ekaterina B.
Bryant Park, New York
Your Dermatologists
Founder
Dr. Shereene Idriss
Candid advice, subtle results.
Board-certified, Practicing since 2013
Dermatologic Surgeon
Dr. Juliya Fisher
Trained to work in millimeters.
Double Board-certified, Columbia Mohs fellowship
Both doctors share one philosophy, so either is a good place to start. Book online with Dr. Fisher, or call (212) 612-1520 for Dr. Idriss.