Whether it’s post-weight loss or a simple matter of wanting to firm up without going under the knife, non-surgical skin tightening treatments can do a lot for unwanted skin laxity. Instead of surgically removing excess skin, energy-based treatments tone what’s there. “Obviously there is no extraction of any tissue, so we’re using various forms of energy to stimulate natural collagen production and improve elasticity,” explains Paul Jarrod Frank, MD, a board certified dermatologist in New York City, of non-surgical skin tightening techniques.
Needless to say, non-surgical skin tightening are not going to be able to offer as a dramatic a result as any of the various surgical ‘lifts’ (think: facelift, neck lift, arm lift, thigh lift, body lift) would, but, for the right candidate, they can be seriously rejuvenating. Here’s what you need to know.
How Non-Surgical Skin Tightening Works
In the absence of the excision of skin, non-surgical skin tightening devices rely on energy-based technology to firm the skin from within. The two main sources used are ultrasound and radiofrequency. Both produce heat that can be delivered deeper into the skin than laser light, and they have none of the same skin tone restrictions. “[They] have the advantage of being colorblind,” Dr. Frank adds. “Both these forms of energy don’t affect the epidermis, which, in addition to being colorblind, also means very little downtime and no sun sensitivity.”
The Ideal Candidate for Non-Surgical Skin Tightening
It should come as no surprise that the best candidates for any of these non-surgical skin tightening devices are those who have mild to moderate laxity, Dr. Frank notes. Generally speaking, patients for these procedures are somewhere between their thirties and their fifties.
While the treatments can be used preventatively to delay (or eliminate) the need for surgery down the line, they can also be employed as maintenance for those who have already gone under the knife. “[They're good for] people who have had surgical treatments in the past and don’t want to have to go through that again,” Dr. Frank says.
For most, non-surgical skin tightening works best as a part of a larger prejuvenation or rejuvenation protocol. “These procedures do not replace other non-surgical techniques such as lasers and injectables, which are excellent complements to all of these treatments,” he adds.
The Best Non-Surgical Skin Tightening Treatments
The good news about non-surgical skin tightening? There are an array of treatments to choose from. The bad news? It can be hard to differentiate between them. Fortunately, your dermatologist or plastic surgery is here to help. “It’s not about choosing the best product, it’s about choosing the best candidate and we certainly have several varieties to choose from,” Dr. Frank says. From Ultherapy® to Thermage® and everything in between, here is our guide to the best of non-surgical skin tightening.
A favorite of patients and providers alike, Ultherapy® employs microfocused ultrasound imaging to deliver energy to specific layers of tissue. “It uses ultrasound to visualize the patients’ unique anatomy and allows the treatment to be customized for the individual patient,” says Jennifer Levine, MD, a double board certified facial plastic and reconstructive surgeon in NYC. In fact, “Ultherapy® is the only treatment that delivers energy to the SMAS, which is the layer you would lift, if you were doing a facelift,” she adds.
Ultherapy® is cleared by the United States Food and Drug Administration (FDA) to lift the neck, chin, and brow and improve the appearance of lines and wrinkles on the upper chest. It uses fractionated energy to create thermocoagulation points (TCPs), which, in turn, cause the body to produce collagen and elastin. “I would say the number one and most powerful non-invasive skin tightening device is Ultherapy®,” Dr. Frank says. “It’s been around for at least a decade and it’s still the standard of care, as it penetrates much deeper than most radiofrequency technologies like Thermage®.”
Safe for all skin types, Ultherapy® has no downtime and isn’t a sun-sensitive treatment. One downside? Dr. Frank says it is “more painful” and “can cause a bit more swelling” than some other energy-based treatments, but, “in the right hands and under the right pain management,” it “really is a far superior technology.”
When it comes to results, they “can be seen sometimes in a couple of months, but may take three to six months for the full effect,” Dr. Levine shares. Since Ultherapy® requires the body to produce collagen and elastin, patients who take certain anti-inflammatory medications are not good candidates for treatment, she adds. Most of Dr. Frank’s patients who like Ultherapy® do it once or twice a year as part of a larger maintenance plan. “It does not replace other treatments,” Dr. Frank emphasizes. “I consider these devices icing on the cake.”
Thermage® is a non-invasive skin rejuvenation treatment that is FDA-cleared to smooth, tighten, and contour skin for an overall younger-looking appearance. Like the name suggests, it involves heat. The treatment works by using radiofrequency (RF) energy to bring heat to the skin’s dermis under the surface layer and stimulate collagen production. Thermage® can be used on the eyes and along the jawline, but it can also be used on the backs of the hands, stomach, arms, thighs, knees, and butt.
Most patients see results after one 30 to 90 minute treatment, and the session is generally considered more comfortable (compared to Ultherapy®) because a cooling mechanism is integrated into the pulsed RF. Localized redness, swelling, and bloating is possible and usually resolves in 24 to 48 hours. Results last one to two years.
3. Emsculpt Neo®
While most people tout Emsculpt Neo® for its muscle toning and fat reduction (read about one editor’s experience), Dr. Frank says that one of the major advancements in skin tightening is the combination of energies. In the case of Emsculpt Neo®, it’s the pairing of high-intensity focused electromagnetic technology (HIFEM) with RF to treat the abdomen, arms, buttocks, and thighs. “The Neo is the second-generation of the Emsculpt® technology with added radiofrequency, which not only adds additional fat reduction to the muscle development but also its traditional skin tightening technique,” Dr. Frank says.
The duo makes an already multitasking technology even more versatile. “We’re able to see examples of these non-invasive energy forms being combined with other purposes to get what is called the synergistic reaction, like an Emsculpt Neo®,” he shares. The initial treatment protocol is four 30-minute treatments over the course of one month, followed by the occasional maintenance session. While the muscle toning benefits show up in a few weeks, the results of the RF fat reduction and skin tightening improve over the course of three months.
4. Thread Lifting
We often talk about thread lifts (also known as suture suspension lifts) for their ability to, well, lift, but they can have a tightening effect as well. “This is another non-surgical form of skin tightening people don’t commonly think about,” Dr. Frank notes.
During the minimally invasive procedure, dissolvable, barbed sutures are threaded under the skin to elevate lax tissue and stimulate collagen production. “People assume that these just shift and lift tissue, using the various lifting techniques, but the actual main ingredient in the threads, which are absorbable, is PDO,” he explains. PDO (a.k.a. polydioxanone) is an absorbable substance found in sutures, but it’s also a well-known biostimulatory agent. “The PDO in the threads themselves cause non-invasive collagen stimulation and overall skin tightening,” Dr. Frank adds.
For those looking to treat the lower face and neck, Dr. Levine is a fan of Evoke (read about one writer’s experience with the treatment). The device uses sustained bipolar radiofrequency to reduce fat, stimulate collagen, and/or lift and tighten the skin around the cheeks, jawline, and jowls. The and/or is because artificial intelligence allows the device to maintain the correct temperature for either skin tightening or fat destruction. “It can help get rid of fat under the chin but still maintain the fat in the lower face,” Dr. Levine says.
She usually recommends three to six treatments, spaced one week apart. There’s no pain or downtime, and it’s safe for all skin types. “Results are seen fully at 12 weeks,” Dr. Levine notes. “But there is some immediate effect, so it’s great before a big event.”
6. Frax 1550
The only laser of the group, Dr. Levine likes the ability of the Frax 1550 from Ellipse to tighten the skin; and there is also a Frax 1940 handpiece to better target pigment, she says. “Unlike traditional Fraxel®, which is an ablative fractionated laser, this is a non-ablative fractionated laser, which means it can have a similar effect with much less downtime,” Dr. Levine explains.
With that said, the face will be red and a bit swollen — like a sunburn — for a day or so, and she allows her patients to wear makeup after the first 24 hours. It’s safe for Fitzpatrick skin types I to IV and, in the hands of an expert, may be used conservatively on type V. “The treatment can also be customized to target skin quality, texture, and tightening and can also be combined with other treatments for pigment and dyschromia,” Dr. Levine says. For best results, she usually recommends two to three treatments spaced one month apart.
For those with mild to moderate skin laxity who aren’t ready to go under the knife or for those who are looking to maintain skin firmness after surgery, non-surgical skin tightening is a safe and effective solution for most skin types. Consulting with a board certified dermatologist or plastic surgeon will help determine the best treatment protocol for your needs.
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