What are the alternatives to a facelift for treating skin laxity?

A lift is an aesthetic surgical procedure. It aims to correct skin laxity and sagging, so as to restore a firm, more youthful appearance. It is performed exclusively by a plastic surgeon. A series of tests, as well as a preoperative interview, must be carried out prior to the operation. Lifts are often associated with the face. While facelifts are quite common, this type of surgery also extends to thigh lifts, or cruroplasty; breast lifts, or mastopexy; buttock lifts; arm lifts; and so on.

The facelift may be a relatively common procedure, yet it remains a surgical intervention. It inherently carries risks and potential complications associated with anaesthesia, infections, haematomas, bleeding, scarring, etc. This is why many seek other, less invasive alternatives capable of delivering comparable results. Here they are.

• Botulinum toxin injections to reduce wrinkles.

  Botox, or botulinum toxin, is a neurotoxic compound commonly used in aesthetic medicine. Thebotox injection causes a temporary paralysis of the muscles that are responsible for the formation of wrinkles and fine lines. Its purpose is to smooth the skin and give it a rejuvenated appearance. It is mainly used on the face and forehead. The results of a botox injection become apparent once the paralysis subsides. They typically last between three and six months.

  Thebotox injection is not without risk and may result in bruising, redness, a headache, muscle weakness, an allergic reaction and facial asymmetry if performed incorrectly.

• Injections of hyaluronic acid solutions, amino acids and peptides to restore firmness in sagging areas such as cutaneous retinacular tissue.

  Naturally present in the body, the hyaluronic acid is a molecule with remarkable hydrating and hygroscopic properties. It retains water within the tissues, contributing to the maintenance of skin volume and suppleness. With age, its concentration decreases, leading to a loss of firmness and the appearance of wrinkles. When injected into the dermis or hypodermis, hyaluronic acid restores lost volume, enhances skin elasticity and stimulates collagen production, an essential protein for preserving skin structure.

  A study assessed the efficacy, tolerability and effects of an injectable solution composed of hyaluronic acid, amino acids and peptides on facial skin laxity, specifically targeting the dermal reticulum. Twenty-eight volunteers aged 25 to 65 received four monthly injections of the solution. The results show an improvement in skin elasticity of 29.2% at T1 (30 days after the final session) and 20.7% at T2 (120 days after). Concurrently, collagen density increased by 20.27% at T1 and 16.71% at T2.

  The session of hyaluronic acid, amino acids and peptide injections generally takes place in a medical clinic under the supervision of a trained professional. Using fine needles or micro-cannulas, the solution is delivered into the deep dermis or hypodermis in lax areas such as the cutaneous retinacular tissue. The procedure is minimally painful, although a topical anaesthetic cream can be applied beforehand for added comfort. It is advisable to avoid the intake of anti-inflammatory or anticoagulant medications in the days leading up to treatment in order to minimise the risk of bruising. After the session, redness, mild swelling or small bruises may appear but typically resolve within a few days. It is recommended to avoid sun exposure, heat (hammam, sauna) and strenuous physical activity for 24 to 48 hours.

• Radiofrequency microneedling: a non-invasive technique to counter skin laxity.

  This method requires the use of a radiofrequency machine. It emits electromagnetic pulses into the deeper layers of the skin. This generates controlled heat to stimulate collagen production. The radiofrequency treatment improves skin texture and reduces wrinkles and fine lines. It delivers gradual results, which means multiple sessions are necessary. Nevertheless, this type of procedure can cause temporary redness, a feeling of warmth, swelling, and even superficial burns.

  The microneedling by radiofrequency combines the action of micro-needles penetrating the skin with that of electromagnetic waves delivered deep into the tissue. The session takes place in a medical clinic, with a topical anaesthetic cream applied beforehand to limit discomfort. The needles deliver radiofrequency into the dermis, generating controlled heat that stimulates collagen production and improves skin firmness. The procedure typically lasts 30 to 60 minutes, depending on the area treated. It is advisable to avoid any sun exposure, abrasive treatments and the use of irritating products in the days before and after the session. Redness, swelling, sensations of warmth or slight crusting may occur, but these generally subside within a few days. High-factor sun protection is essential following the treatment.

• Ultrasound as a solution against skin laxity.

  Focused ultrasound, notably high-intensity focused ultrasound (HIFU), represents a non-invasive alternative to facelifts for combating skin laxity. The ultrasound waves are precisely focused at a predefined depth (typically between 1.5 mm and 4.5 mm), thereby reaching the deep dermis, a layer also targeted during a surgical facelift.

  When they reach this focal point, ultrasound waves induce a local temperature rise (around 60 to 70 °C), causing controlled thermal coagulation. This micro-thermal lesion stimulates the natural tissue repair response, which leads to the production of new collagen and elastin fibres. Moreover, the ultrasound waves also promote an immediate tightening of existing collagen fibres, providing an instant firming effect.

  Ultrasound, however, is used only in cases of moderate skin laxity.

  Prior to treatment, a topical anaesthetic cream is typically applied to the areas to be treated to minimise ultrasound-related discomfort. It is left in place for approximately 60 minutes, then rinsed off before the session begins. Once the skin is cleansed, the practitioner applies a conductive gel to the target area. This gel facilitates the transmission of ultrasonic waves between the handpiece and the skin, whilst ensuring smooth gliding. The treatment then commences. Using a handheld device, high-intensity focused ultrasound (HIFU) is delivered at specific depths according to the objective: superficial dermis, deep dermis or subcutaneous tissue (SMAS). Each pulse generates a focused thermal micro-coagulation without affecting the epidermis. A sensation of warmth or tingling may be experienced, varying with individual sensitivity. The session lasts between 30 and 60 minutes, depending on the area(s) treated (face, neck, jawline, etc.). No particular aftercare is required beyond maintaining adequate skin hydration. Mild redness or tightness may occur but generally subsides within hours to days.

  In a study published in the Journal of Dermatologic Surgery, the efficacy of ultrasound in treating facial skin laxity was evaluated in 22 patients presenting moderate facial laxity. Two months after a single session of focused ultrasound treatment, visible improvement was observed, particularly in the nasolabial fold and along the jawline. Histological analysis of skin samples taken before and after treatment revealed a 23.7% increase in collagen fibre thickness and a strengthening of the reticular dermis. These structural changes indicate an overall thickening of the dermis, contributing to improved skin firmness and tonicity.

• Tensioning threads for tightening the skin of the face and body.

  The tension threads are less invasive than a facelift and can improve skin laxity of the face and certain body areas. These very fine threads, inserted under the skin using needles or cannulas, are often absorbable and stimulate the production of collagen by acting as tissue inducers. There are several types of threads, notably barbed threads, which feature small notches along their structure. These barbs, oriented in one or two directions, allow the threads to anchor securely to the subcutaneous tissues. Once placed beneath the skin, they exert immediate traction, lifting the skin and reinforcing its firmness. Barbed threads provide a progressive and natural tightening effect, particularly well suited to mild to moderate skin laxity.

  Conical threads are tensioning threads equipped with small conical structures distributed along their axis. When inserted beneath the skin, these cones exert a more powerful pull than simple barbs, owing to their specific shape and orientation. They also allow for a more even distribution of tension, ensuring a more homogeneous effect. Conical threads are particularly indicated for areas exhibiting significant skin laxity or when a more pronounced lifting effect is desired.

  Thread-lift insertion is performed in a medical clinic under local anaesthetic. The practitioner inserts the absorbable threads using fine needles or cannulas into the subcutaneous tissue, following a precise pattern tailored to the treated area. Once in place, the barbs or cones of the threads anchor into the tissues, providing immediate lifting and progressively stimulating collagen production. The session generally lasts between 30 and 60 minutes depending on the area treated. Prior to the procedure, it is recommended to avoid alcohol, anticoagulants and anti-inflammatory medications to minimise the risk of bruising. After placement, redness, swelling or temporary tightness may appear. It is advisable to avoid excessive facial movements, aesthetic treatments, heat exposure and strenuous physical activity for a few days.

  Before considering either of these techniques, it is recommended that you seek advice from your doctor.

• SONG K.Y. et al. Intense focused ultrasound tightening in Asian skin: clinical and pathological results. Dermatologic Surgery (2011).

• GUTOWSKI K. A. et al. Micro-focused ultrasound for skin tightening. Clinics in Plastic Surgery (2016).

• BENOUAICHE L. & al. What is the role of thread lifts in facial rejuvenation? Annales de chirurgie Plastique Esthétique (2017).

• SATRIYASA B.K. et al. Botulinum toxin (Botox): for reducing the appearance of facial wrinkles – a literature review of clinical applications and pharmacological aspects. Clinical, Cosmetic and Investigational Dermatology (2019).

• ALEXIADES M. et al. Microneedle radiofrequency. Facial Plastic Surgery Clinics of North America (2020).

• RUMYANTSEVA E. et al. Safety and efficacy of an injectable solution enriched with sodium hyaluronate, amino acids and peptides in relation to the superficial facial connective tissues (dermis and retinacular cutis). Journal of Cosmetic Dermatology (2024).