Treating Sagging Skin of the Face & Neck

While numerous other skin-tightening machines have been FDA approved since 2002, none have been proven as effective as the device called ThemaCool TC (the procedure itself is called Thermage). Like most electronic devices, the machine continues to be improved upon, but Thermage has reigned supreme in the skin tightening field because its parent company continues to prioritize funding of  research and development. Dr. Degnan has owned several Thermage machines over the years and is frequently upgrading to the latest version.

Dr. Degnan is obsessed with searching out the least invasive approaches for any disorder. So his prayers were answered in 2002 when a machine was developed that tightens skin without the expense, infections and scars of plastic surgery. The procedure was called Thermage and also showed no evidence of a “done” look so commonly seen after face lifts.

Thermage Logo - White Background


thermage-treatment-degnan-dermatologyThermage is an extremely safe FDA approved non-surgical method for tightening skin of the face and neck. Now offered in over 50 countries, it has been showcased numerous times by Oprah Winfrey. Mere radio-frequency waves applied for an hour and a half tighten the deep collagen layers that support the skin. Results are seen immediately and last for years. Experience is important towards optimal results. No one performs more Thermage in northern Nevada or Northeastern California than Dr. Degnan.

Thermage tightens the most important supportive layer of the skin, known as the collagen layer, using mere radio-frequency waves. It is now FDA approved to be used on numerous areas of the body, but Dr. Degnan mainly uses it to tighten the skin of the face and the neck where the machine works best and the results will be most appreciated.

When the device was first FDA approved in 2002, the procedure took over 2 hours to properly complete the face and the neck, and there were complications reported comprised of superficial burns and “melting” of fat under the skin. Because the procedure was uncomfortable, patients required pain pills administered just prior to the treatment (necessitating them to arrange for a driver to safely get them home). Also, about a fourth of patients were not getting adequate results. Because of these issues, Dr Degnan did not purchase this first generation Thermage device.

Since Dr. Degnan first started offering the procedure in Palm Desert and Lake Tahoe, Thermage has fortunately undergone several major generational improvements.  In a large study performed on almost 6,000 patients that was published in August 2007 in the prestigious Dermatological Surgery journal , it was proven that using an upgraded treatment tip (see the blue tip in above photo) and a newer “multiple pass” technique over the skin (running the tip not just once, but up to 10 times),  Thermage was able to deliver a 94% patient satisfaction rating.  Whereas in the past, it was typical for a patient to have to wait 2-3 months to see results, now 87% of patients reported appreciating results immediately upon completion of the procedure. Furthermore, the new treatment tip was enlarged so the treatment could be completed in less time. The newer tip is far more comfortable and pain pills are no longer necessary. (A competing treatment called Ulthera, has fallen out of favor after much marketing fan fare due to its discomfort relative to Thermage.)

Dr. Degnan recently updated his Thermage device to the “CPT Model.” This machine provides even greater results and comfort than the model used in the study just mentioned. It was not surprising that a more recent study showed that 100% of patients preferred the CPT advances over the original technology. Dr. Degnan agrees that the CPT device is the most comfortable and effective skin-tightening machine available worldwide. A recently developed new treatment tip now provides 25% more pulses per Thermage treatment.

NOTE: Dr. Degnan feels it is imperative that prospective patients rely on recent studies to evaluate any medical procedure as oppossed to random comments made on the internet by those that may stand to benefit a particular point of view

With the latest Thermage tip, patients are seeing immediate skin tightening. Thermage will also slightly raise the brow and  upper eyelids. The tightening of the skin lasts as long with Thermage as it does with other methods of skin tightening, including surgery. In other words the tightening does not “undo” over time, but rather mother time and the sagging process marches on. While individuals vary, in general, the patient will probably gain the same amount of sagging they had before the treatment within a matter of about 3 years. Most patients seem to want to repeat the procedure yearly or at least every other year. Many in the Hollywood crowd undergo Thermage 2-3 times per year since they can financially afford it.

Thermage not only tightens sagging skin, but it also thickens it. Thick skin is desirable because it ages better (thus the old adage of male skin aging more gracefully than female skin).

Dr. Degnan’s office has performed nearly 1,000 Thermages over the last 11 years in Lake Tahoe. No office in northern Nevada or Northeastern California has performed more Thermage treatments during that period. This is important because as with most medical procedures, there is no substitute for experience and technique, and frequently upgrading equipment.

Sculptra Logo - White Background


Dr. Degnan almost always combines Sculptra with Thermage to treat facial sagging. Sculptra safely stimulates one’s own collagen production which is used to refill empty pockets formally occupied by fat. Missing fat predictably causes sagging of skin in the temples and cheeks (not the cheek bones, but rather the sides of the face). So filling these empty areas with long-lasting Sculptra gives a far more youthful appearance when a face is viewed from the side, but also provides significant lifting of the outer-upper aspects of sagging eyes and especially cheeks. Thermage works in tandem to tighten skin wherever applied and especially the neck.

The Mid Face Lift is the easiest way to get immediate improvement in one’s appearance by lifting sagging of the central face. For a more complete improvement in skin sagging, Thermage is recommended to address the remainder of facial sagging as well as that of the neck. And the long-lasting filler, Sculptra, beautifully replaces the missing fat in our temples and cheeks (we all lose fat in these areas as we age, especially if we are thin or have lost weight). Dr. Degnan’s favorite methods are usually to use Thermage and Sculptra as they provide the most long-lasting “bang for the buck.”

There is no area of skin research more exciting than that devoted to improving the deep supportive collagen layer. As it turns out, both Thermage and Sculptra are prime examples of the world’s best technology for adding thickness and tightening to the skin via their affects on collagen. Thermage is wonderful since it affects all the skin in the treated area, generally all the way from the top of the forehead down to the collar bones (including the dreaded neck sagging). Sculptra, on the other hand, is probably the most powerful way to stimulate collagen in a smaller specific area. As we age, we lose skin-supporting fat that normally occupies our temples and the sides of our cheeks. This fat loss causes skin to drape down as jowls around the upper and sides of the mouth, as well as our jawlines. Sculptra “volumizes” the empty areas previously occupied by fat. It is akin to the modern use of foam insulation in homes to fill empty attic spaces. Studies show your new collagen will not begin to go away for 25 months! Sculptra is Dr. Degnan’s favorite substance to place in faces due to its safety, ability to assist in the sagging of large areas and its long duration. Palm Springs was full of older women who had maintained healthy lifestyles, but paid the price with facial gauntness and secondary sagging skin. Dr. Degnan found that Sculptra was the single most effective non-surgical way to help them look better. (Thermage had not been invented yet). He gained vast knowledge in the proper use of Sculptra in Palm Springs without knowing someday it would be the most powerful injectable for reversing sagging caused by fat loss in aging faces. 



After Scupltra and Thermage is used to approach most of the facial sagging, depending on a patient’s budget, the next in line “big-bang-for-the-buck” priority is lifting the sagging mid-face muscles: loss of cheek bone definition, parenthesis around the mouth, dropping mouth corners, and sagging jowls at the sides of the chin area.

In 2009, Dr. Degnan discovered that far superior results could be obtained by using fillers to lift sagging facial tissue back into its youthful position. The older, time-proven way of using fillers to disguise sagging was to merely fill the “downhill” crevices caused by sagging. For example, instead of filling in the “parenthesis” lines around the mouth, the results were far more outstanding if the filler was used horizontally under the eyes and up into the cheekbone areas to actually lift all the sagging muscle and skin of the central face back into their former position.

From the first patient Dr. Degnan treated with such a “mid-face lift,” it was apparent that the sagging cheeks and mouth corners lift nicely back up into place, while mouth parenthesis reduce in a more effective and natural way. The fuller upper cheeks look especially improved when one smiles and older women appreciate the way their outer mouth corners also get lifted (using the older more common method of putting filler directly into the parenthesis, none of the muscles were returned to there youthful position, so none of  these other “side benefits” were achieved).

In Dr. Degnan’s experience in performing this mid-face lift procedure on hundreds of patients, he has found it to be the single most patient pleasing procedure he administers.
That is because a typical patient, of say 60 years old, immediately appears 5 years younger in the central and cheekbone areas of the face. The Mid-Face Lift was initially performed by Dr. Degnan using either Juvaderm or Radiesse, but is now done with the more longer lasting and equally safe Voluma.

There is no other procedure preformed by Dr. Degnan that is more appreciated by his patients, for its immediate and natural improvement in appearance, than a Mid Face Lift. That is why, with the exception of Botox, it is the most common cosmetic procedure he performs. He places it third on his “biggest for the buck” list for approaching sagging, however, only because the results don’t last as long as those seen with Thermage or Sculptra. The results of a Mid Face Lift last about a year and touch-ups are often needed approximately 7-9 months (some patients can go over a year). Typically, Dr. Degnan uses two syringes of Voluma initially, then one syringe for subsequent touch-ups.

The Mid Face Lift takes only a few minutes to perform and Dr. Degnan often performs several daily.  As with all treatments offered, you are welcome to observe someone else being treated.  You will be taken back by the immediate improvement seen after one side is completed. The Mid-Face Lift is performed using a very thin needle so pain is minimal and brief. Dr. Degnan holds his hands gently on each injection site (usually two injections each cheek) for about a minute and the vast majority of patients incur no bruising. The Mid Face Lift works well with Sculptra that is placed in the temples and cheeks.