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As you are a facial cosmetic surgeon, I don't know if you address issues below the neck, but here goes. I'm a 53-year-old woman, 4-feet-11 and 93 pounds. I've worked out all my life. I run five miles a day and weight train. I'm in excellent physical shape, but the skin on my body, particularly on my front thighs and my stomach, is getting saggy. My stomach muscles are flat as a board, and my legs are muscular also. Is there a procedure to reduce that saggy skin other than a tummy tuck or leg lift? I don't like the scarring involved.

I will address any issue as long as I can do it accurately, if not, my partners will offer input. You sound like you are in great shape. Congratulations! I would caution you about overdoing the running as you may soon need services for volume loss (fat loss) in your face.

There are no surgeries that can guarantee no scars, but the two surgeries you mention do have the reputation for scarring. Both the tummy tuck and the thigh lift are designed to remove a significant amount of excess baggage (skin) and are therefore big operations.

There is a skin-only tummy tuck that could help you remove your wrinkled skin and leave a minimal scar no bigger and no more noticeable than a C-section incision. This is something you would need to discuss with your plastic surgeon to determine whether you are a candidate. The thigh lift, if planned correctly, can also produce great, satisfactory results when the indications are correct for surgery and the incisions are well planned. My experience with tummy tucks (No, I have not had one.) is that most patients would do it again gladly and that they get a new lease on life (with a second mortgage to cover the cost of all the new clothing that they can't stop buying).

If none of the above procedures moves you, you might be interested in Thermage, which makes skin that is flaccid firm up. It is an FDA approved procedure that tightens loose skin around the face and is now being used off label for other body areas.

As I have said before, more research is needed to study the results of skin contouring with Thermage, but there really is no alternative for some one in your (running) shoes.

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