Skin Tightening Treatments

All of us over 30-40 see our facial skin start to loosen and sag, and many of us wish or skin could be tighter and more youthful looking. Skin tightening treatments such as Thermage, Titan, Refirme, LuxIR and others are often advertized as a non-surgical face lift. However, an objective comparison of a well performed surgical face lift with the results of a non-surgical skin tightening treatment reveals that the best skin tightening treatment achieves only 20-30% of the standard face lift result. Skin tightening results on the tummy and arms are at best 20% of what can be achieved surgically with a tummy tuck or arm lift.

Newer, but more invasive, subcutaneous laser treatments are achieving significantly better skin tightening than the currently available surface treatments using Thermage, Titan, Refirme and Lux IR, in my experience. I predict that the new laser technology will continue to improve and gradually replace the older surface technology which utilizes radiofrequency and infrared energy to tighten skin.

How Do Skin Tightening Treatments Work?
As our skin ages it loses elasticity. Elasticity is what holds our skin tightly to our face and body. Elasticity depends on collagen and elastin, two components of the deeper layer of our skin called the dermis. The elastin and collagen responsible for tight skin are found in the deepest part of the skin, just above the fat layer which lies beneath our skin.

When collagen is heated to 66 degrees centigrade, the collagen contracts and the skin is tightened. This is called remodeling and occurs over many months after the collagen has been heated.

The method of all these machines is to heat the deep collagen of the skin to cause contraction of the collagen and remodeling, which causes skin tightening. To accomplish this deep skin heating, radiofrequency energy (Thermage), infrared energy (Titan, LuxIR Deep), or a combination of both (Refirme) is passed into the skin to heat and remodel the collagen. These machines have sophisticated cooling devices to cool the surface of the skin to prevent a burn while the energy is passed through the skin into the deep dermis.

How Effective Are These Treatments?
These infrared and radio frequency based treatments do tighten the skin. However 3-4 treatments scheduled 4-6 weeks apart are usually required for a visible result. In my experience a 20-30 % result is the best I can achieve.

The most telling example of the benefit, in my experience, is that I have to show a patient a before photograph next to a 6 month after photograph for the patient to see the difference. This is decidedly different from a face lift or tummy tuck result which the patient can appreciate a marked improvement in skin tone immediately after surgery.

What Do These Treatments Cost?
Costs vary, but typically treatments cost about $1000.00 per treatment. Four treatments are usually discounted to $3500.00. In my experience, four treatments are necessary to see the best result.

What New technologies are on the Horizon?
New laser liposuction methods are producing remarkable skin tightening in addition to dissolving fat. Objective data as to percentage of skin shrinkage following laser liposuction treatments are not yet available. However, in my anecdotal experience, I am seeing very significant, visible skin shrinkage after laser liposuction treatments, and results have been maintained at least eight months, which is the longest experience I have to date.

The new laser technology is not truly non-surgical but is certainly minimally invasive. A small laser fiber is placed beneath the skin into the fat. Heat from the laser dissolves the fat and tightens the skin.

I assume that I am seeing better results because the laser energy is being delivered more closely to the deep collagen and elastin layer of the skin which is where skin elasticity resides.
My prediction is that this new minimally invasive technique will gradually replace the current transcutaneous (from on top of the skin) technique used by the radio frequency and infrared techniques mentioned earlier.

How to Decide Which Method is Best for You
I must admit my prejudice-I am a board certified plastic surgeon and my goal is always the best result for the patient. Currently if you have loose sagging facial skin and you want to look significantly younger, an expertly performed face lift will unequivocally give you the best result.

If you are adamant that you do not want surgery then I would recommend one of the non-surgical radio frequency or infrared methods. However I will warn you that you will need to study your face carefully to see the benefit.

I do use the non-surgical technique frequently around the mouth where face lifting is less effective. I also use the infrared device on the neck to treat recurrent laxity after a face lift.

If you are not in a rush, and are comfortable with the possibility of a minimally invasive procedure, which involves placing a small laser fiber beneath your skin, then I would wait. Undoubtedly, the new laser technology will continue to improve.