American Academy of Facial Plastic and Reconstructive Surgery
Skin Tightening

Can you really get a facelift without actually having a face lift?
By J. Randall Jordan, MD
www.thefacecenter.com

The hype on skin-tightening technology continues to escalate as more and more companies enter the ever enlarging market for baby-boomers and their younger comrades who want to look better but tend to seek non-surgical remedies instead of the more traditional surgical approaches. Thermage™ was the first entry into this market, receiving FDA approval for their device in 2002. This was followed by an intense marketing campaign (Oprah) and complications such as fat resorption leading to lumps and bumps in the treated areas as well as lack of improvement in some patients. This caused the company to rework their recommended treatment plan with improved results and far less complications. The type of technology used by Thermage™ is known as monopolar RF or “radiofrequency”. This is a form of electrical energy that is modulated in a way to heat the deeper layers of skin and thereby denature the collagen within the skin. Denatured collagen is equivalent to creating a wound, and since all these devices seek to cool and protect the epidermis or outer layers of the skin, you essentially are attempting to create a “wound beneath the skin”. As the wound heals, the collagen renatures and shrinks, so this leads to tightening of the skin, at least in theory.

 So does it work? Well, it depends on who you ask. The technique has been studied widely in patients, less so in animal models. In general, the studies show that in about 1/3 of patients, there is significant tightening of the skin for up to 2 years, perhaps longer, and in about 1/3, there is “some” improvement, and in 1/3 no improvement. The real problem is that at this point in time, there is no way to predict who will get a good response to treatment and who will get none. So basically, if you enter into this, there is no way to predict what you will get for your money, which is not a small amount, by the way, with physicians charges ranging from a low of 1200$ up to 4000$ for a full facial treatment.

 Following the introduction of Thermage™, several other companies have received FDA approval for “tissue heating or tightening” devices. Some of these use RF technology, but others have adapted a variety of different technologies to attempt to achieve a similar process. One of the first was the Titan™ by Cutera, which uses infrared light as the energy source to heat and denature collagen extending 1-2 mm beneath the surface. This device cools the surface to avoid damage to the outer layers of skin, like most of the other devices in this category. Again, results are variable.

 Other companies have also adapted radiofrequency technology for this purpose, many combining it with other types of devices. Syneron has developed the Refirme ST ™ device which combines bipolar radiofrequency with infrared energy, Lumenis has introduced the Aluma, which combines bipolar RF with a vacuum applicator. As these devices are relatively newer on the market, there are even less studies available. The next step appears to be the use of high energy sound waves, or ultrasound in a similar manner, to transfer energy to the subcutaneous tissue and heat and denature collagen.

The bottom line on all this is that there are some patients who get nice improvement in skin laxity with this technology, but this is only about one-third at the most, and the rest do not much improvement. At this time it is impossible to predict who will get a good result and who will get nothing. So, if you really want to get a reliable lifting experience, you still need to face the surgeon for a predictable result, but if you can’t afford the down-time or aren’t interested in surgery, there is technology available that may be able to give you some benefit!

Dr Jordan has no financial interest in any of the companies mentioned in this article. He does use both the Thermage™ and Syneron Refirme™ ST devices in his office.

References for this article:

1: Bunin LS, Carniol PJ.

 Cervical facial skin tightening with an infrared device.

Facial Plast Surg Clin North Am. 2007 May;15(2):179-84, vi. Review.

PMID: 17544933 [PubMed - indexed for MEDLINE]

2: Goldberg DJ, Hussain M, Fazeli A, Berlin AL

 Treatment of skin laxity of the lower face an individuals with a broad-spectrum infrared light device.

J Cosmet Laser Ther. 2007 Mar;9(1):35-40.

PMID: 17457764 [PubMed - indexed for MEDLINE]

3: Chua SH, Ang P, Khoo LS, Goh CL.

 Nonablative infrared skin tightening in Type IV to V Asian skin: a prospective clinical study.

Dermatol Surg. 2007 Feb;33(2):146-51.

PMID: 17300599 [PubMed - indexed for MEDLINE]

4: Dierickx CC.

 The role of deep heating for noninvasive skin rejuvenation.

Lasers Surg Med. 2006 Oct;38(9):799-807. Review.

PMID: 17044093 [PubMed - indexed for MEDLINE]

5: Taub AF, Battle EF Jr, Nikolaidis G.

 Multicenter clinical perspectives on a broadband infrared light device for skin tightening.

J Drugs Dermatol. 2006 Sep;5(8):771-8.

PMID: 16989192 [PubMed - indexed for MEDLINE]

6: Zelickson B, Ross V, Kist D, Counters J, Davenport S, Spooner G.

 Ultrastructural effects of an infrared handpiece on forehead and abdominal skin.

Dermatol Surg. 2006 Jul;32(7):897-901.

PMID: 16875471 [PubMed - indexed for MEDLINE]

7: Ruiz-Esparza J.

 Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients.

Facial Plast Surg Clin North Am. 2007 May;15(2):179-84, vi. Review.

Dermatol Surg. 2006 May;32(5):601-10. Erratum in: Dermatol Surg. 2006 Jun;32(6):preceding 773.

PMID: 16706753 [PubMed - indexed for MEDLINE]

8: Taub AF.

 Evaluation of a nonsurgical, muscle-stimulating system to elevate soft tissues of the face and neck.

J Drugs Dermatol. 2006 May;5(5):446-50.

PMID: 16703781 [PubMed - indexed for MEDLINE]

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