There are numerous cosmetic devices that claim to be able to tighten loose skin. This is of tremendous interest to many patients, whether it be on the face or the body. Galvanized by such non-invasive treatments as Botox and injectable fillers, obtaining tighter skin without surgery seems plausible. With the focus on non-invasive treatments over the past decade, skin tightening is a prime cosmetic target with great public appeal.
From wrinkle reduction to body fat loss, energy-based devices (laser, high intensity light, ultrasound, radiofrequency) have been developed and applied with variable success. Extending such devices for non-surgical skin tightening has a lot of applications such as improving sagging jowls, abdominal skin rolls, or loose skin on the back of the arms. I regularly see patients who come in to get rid of their turkey neck, bat wings, sagging breasts or roll of skin that bulges over their beltline…with the hope and belief that such devices will avoid the need for surgery.
In reality, non-surgical skin tightening devices (e.g., Thermage, Smartlipo) do produce some amount of skin tightening. A few patients will demonstrate dramatic improvements while most patients will have more modest changes. Despite their skin tightening abilities, many patients will never be happy with the outcomes of these treatments alone. This has to do with the differences in how patients perceive skin tightening and in how much skin tightening these devices can do.
My observation is that a patient’s perception of skin tightening can be measured by centimeters and inches. Any device’s skin tightening ability can be measured in millimeters or just small fractions of an inch. It is not that these devices can not tighten skin but that most patient’s loose skin problems far exceed what can be done without surgery. No skin tightening device can replace a facelift, armlift or a tummy tuck when truly sagging skin exists. Non-surgical skin tightening works best for very modest amounts of loose skin…that one wouldn’t consider undergoing surgery to remove.
Like trying to lose fat with only taking a pill, wiping the appearance of cellulite and stretch marks clean by a skin massager, or getting rid of those dark undereye circles by just applying a cream, hope is eternal. Getting rid of loose skin, as most patients define extra skin, will almost always defy any current method of device-based skin tightening. It is not always appealing to realize that surgical removal is still the best way to get rid of unwanted loose areas of skin. Having a ‘nip and tuck’ may not be high-tech, but it continues to provide a level of improvement that will satisfy most patient’s expectations.
There is a fine balance between creating some skin tightening by contraction (heat shrinkage) and causing a skin burn and irreversible damage. Unfortunately, the amount of energy required to cause the degree of skin tightening that most patients require is currently beyond what both patient’s and their skin can tolerate.
Dr. Barry Eppley