Loose sagging skin on our face, stomach, arms and other areas is very distressing to many of us. Loose skin or integument (integument - medical term for skin) makes us look old and out of shape, no matter how hard we work out and try to stay fit. In the past, effective skin tightening required plastic surgical procedures like face lift and tummy tuck. However, in the past few years, many new non-surgical and laser skin tightening methods have been developed. The new skin tightening technology has been steadily getting better as the machines improve and as doctors learn how to maximize the results achieved.
Today, often using a combination of different methods, substantial skin tightening can be achieved without surgery, a very different situation than just 3-4 years ago when Thermage, Titan, Refirme, and LuxIR Deep were introduced. There are many skin tightening advertisements that can be misleading, so you really need to be an informed consumer and understand the technology if you are going to achieve the result that you desire. Below I will explain how the new skin tightening technology works and which methods are the best.
How Non-surgical Skin Tightening Works
Tight, firm skin requires good elasticity. Elasticity means the ability of the skin or integument to snap back or tighten after it has been displaced or pulled away from the body. Good elasticity depends on healthy collagen and elastin fibers that lie very deep, near the bottom of the dermis, the deep layer of our integument below the surface. Collagen and elastin fibers act like small rubber bands that hold the integument tight against our body, and pull the loose tissue back when it is stretched or pulled.
Aging, sun damage from ultraviolet (UV) light, smoking, stress, excessive alcohol intake and an unhealthy diet and lifestyle all destroy collagen and elastin in the dermis and cause the integument to loosen and sag. Stretching caused by pregnancy or rapid weight loss after dieting or gastric bypass surgery also destroys collagen and elastin in the dermis and results in sagging and loss of tone.
All laser and non-surgical skin tightening methods work by stimulating the growth of new collagen and elastin in the dermis. When you heat collagen and elastin to 66 degrees centigrade, the collagen and elastin fibers shrink or tighten, and are remodeled with new collagen and elastin formation. The effect of this skin tightening and new collagen and elastin formation is that the deep dermis contracts and becomes firmer and the loose tissue is tightened.
The elastin and collagen lie very deep in the dermis, and the major challenge is to get enough heat deep down in the dermis to remodel elastin and collagen without burning the surface of the integument as the heat passes through the more superficial layers.
This has been accomplished by using very effective cooling devices that cool the surface while the heat energy is passed through the surface on its way to the deep dermis. Machines that have this ability are the Palomar LuxIR Deep, Thermage, titan and Refirme to name a few.
A newer method applies heat to the deep layers from underneath. New laser liposuction technology like SlimLipo uses a small laser cannula placed beneath the integument to melt fat. The heat also causes contraction and firming of the overlying loose tissue. This technique has been very effective for the tummy and neck or double chin.
Laser Skin Tightening
Old time CO2 and Erbium laser resurfacing did effectively tighten loose tissue. However, recovery was very difficult with lengthy healing time, prolonged redness and hypo pigmentation or loss of color after the procedure. These techniques are no longer widely practiced.
New fractional laser resurfacing techniques are a great improvement. By fractionating or breaking up the laser into many small beams, untreated areas are left to speed healing and complications are less common. The new fractional resurfacing techniques also can go deeper into the dermis to firm up the deeper collagen and elastin layers. Fractional laser resurfacing machines include the Starlux 1540 and 2940, Fraxel, ActiveFX, DeepFX, Profractional, and Affirm machines.
These skin tightening techniques can be used on and are most effective on the face. Because integument healing is required, these fractional resurfacing techniques are less effective in other areas such as the neck, stomach, and arms.
Lasers are not the treatment of choice for sagging and laxity of the neck, abdomen and arms. These areas require more heat energy that can only be delivered by infrared and radiofrequency machines.
Infrared and Radiofrequency Skin Tightening
The most effective surface applied skin tightening machines today use either radiofrequency or infrared heat energy to firm loose and sagging tissue on the neck, arms and tummy. These machines have sophisticated cooling hand pieces to prevent burn injury.
These machines can penetrate deeply into the dermis, down to 2000 microns where the elastin fibers are most plentiful. These deep treatments are necessary for maximum firming and skin tightening. Commonly available machines are Palomar's LuxIR Deep, Thermage, Titan, and Refirme among many others.
Understand that 4 treatments are usually required for the best result with most machines. New collagen and elastin production will not occur until 6 months after your last treatment, so it takes time to see your final result.
In my opinion, the best results are about a 20-30% improvement. Even better results are possible with higher energies using the LuxIR Deep which has superb new cooling system which allows us to more than double the energy we are using. The new LuxIR Deep cooling with increased energy delivery also shortens the duration of treatments.
Still, infrared and radiofrequency machines cannot yet achieve the same results that I can achieve with a face lift, tummy tuck, or arm lift.
Laser Liposuction
Recently, new laser liposuction technology called SlimLipo has produced remarkable firming of the loose integument and fat during the fat dissolving process. Because the SlimLipo laser fiber is placed beneath the integument, the laser beam has closer and more direct access to the subcutaneous elastin fibers.
Laser liposuction has been used successfully to firm the loose tummy, loose arm, loose neck, and to firm the hips and thighs. This new laser liposuction method will be a very important in years to come.
Which Skin Tightening Method Is Best For You?
Your choice of a firming method will depend on how much loose skin you have and where the loose skin is located. If you have wrinkles, sun damage and mild laxity around the cheeks and mouth, then fractional laser skin resurfacing with combined Starlux 1540 and 2940 lasers are your best option.
If you have good skin, and mild to moderate skin laxity of your cheeks, neck, abdomen or arms, the Infrared or radiofrequency skin tightening will give you a 20-30 % result. I use the LuxIR Deep skin infrared skin tightening machine made by Palomar.
If you have both fat and loose skin on your tummy, arms, neck, double chin, hips or thighs, then laser liposuction is your best choice for skin tightening. I use the SlimLipo laser liposuction machine made by Palomar.
How To Find A Doctor
Board certified plastic surgeons and dermatologists are the laser experts, but all board certified plastic surgeons and dermatologists are not experienced in lasers.
Therefore, you will have to do your homework and inquire of the doctors if they are experienced with lasers and laser surgery. It is very important to consult an expert. Although the nurse or medical aesthetician may do the infrared or radiofrequency integument firming, the doctor who supervises the treatment must understand lasers and light technology. Laser liposuction and laser resurfacing must be done by an experienced physician.
Today there are many non plastic surgeons and dermatologists who advertise laser and light services who are not experts at these techniques. You really need to ask the right questions and investigate. These new technologies can be dangerous and harmful in inexperienced hands.
Good places to look are the websites of the following organizations:
American Board of Plastic Surgery (ABPS)
American Society of Plastic Surgeons (ASPS)
American Society of Aesthetic Plastic Surgeons (ASAPS)
Visit these websites and search for board certified plastic surgeons in your area. Visit their websites and see if the doctor offers laser and non-surgical skin firming treatments. Consult at least two doctors and ask to see photos of results on their own patients. Do not seek skin firming treatments in medical spas that do not have a board certified Plastic Surgeon or Dermatologist, experienced in laser surgery, present on site.
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