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We all know that surgery is the traditional way to tighten the skin, but nowadays most patients prefer non-surgical methods. This article will introduce some of the most common non-surgical skin tightening techniques available.
Ultrasound
Ultrasound devices are now the standard choice for skin tightening treatments. They use high-frequency sound waves to heat target tissue, causing thermal damage and forming ‘thermal coagulation points’ where collagen denatures and new collagen formation is stimulated.
Ultrasound energy can pass through the epidermis without causing damage, acting directly on deeper tissues (up to 5 mm deep). As the epidermis is not damaged, healing is fast, pain is minimal and scarring is reduced. Furthermore, ultrasound energy does not affect melanocytes or chromophores, making it safe and effective for patients of colour.
Applicability and effectiveness: The best results are seen in young, non-smoking, non-obese people with mild to moderate skin laxity. A single treatment lasts between 30 and 90 minutes with no recovery time. Pressure and mild pain are experienced during treatment, and the effect is immediate, with continuous improvement within three months. The final effect lasts six to twelve months, depending on the treatment plan and individual patient differences. Common side effects include mild redness, swelling, bruising and numbness.
Radiofrequency
Radiofrequency (RF) generates heat energy through an electromagnetic current in a closed circuit. Depending on the amount of energy applied, the current can penetrate tissue layers of varying impedance. When RF energy is applied to the skin and soft tissue, the collagen fibres thicken, initiating a wound-healing response and resulting in soft tissue tightening.
The two main electrode configurations for RF devices are monopolar and bipolar. There are also multipolar and fractional modes, as well as combination therapies that incorporate lasers, microneedling and negative pressure.
Monopolar RF
In 2007, ThermaCool/Thermage (Solta; USA) became the first monopolar radiofrequency (RF) device to receive FDA approval for treating periorbital wrinkles. Studies have shown that ThermaCool has a sustained effect on face and neck firming for up to six months. Since then, various monopolar RF devices have been developed with different treatment heads and cooling/vibration mechanisms to adapt to a variety of tissue depths and treatment needs.
Bipolar RF
The tightening mechanism is the same as for monopolar RF. Patients should be aware that improvements are only 5–20%. This method is suitable for patients with moderate skin laxity who want to minimise downtime and avoid surgery. This technology is safe for all skin tones as it does not stimulate melanocytes and carries a low risk of hyperpigmentation or scarring in patients with darker skin. Patients may experience a sensation of heat or stinging during treatment, and swelling, redness, stinging and soreness are common afterwards.
Laser
Ablative laser
Lasers can be divided into two categories: ablative and non-ablative. Ablative lasers heat the epidermis and the upper layer of the dermis to remove the top layer of skin, thereby promoting collagen synthesis. Ablative treatments require a longer recovery period involving more wound care, as well as swelling and pain.
Non-ablative lasers
Non-ablative lasers do not cause skin peeling, but rather thermal damage. This method is much less invasive than ablative treatments. It usually only requires topical anaesthesia, is less painful and has a very short recovery period. There is also a lower risk of hypopigmentation, redness and swelling. This treatment is suitable for milder skin pigmentation problems, acne and wrinkles.
Both ablative and non-ablative lasers are currently widely used for skin rejuvenation treatments. These lasers can also be used to improve acne, scars, and pigmentation problems by tightening the skin.
Chemical Peels
A chemical peel is a treatment that involves applying chemical agents to the skin. These agents can be used alone or in combination, and the depth of action can be adjusted according to the patient’s needs. Resurfacing takes about five days for a superficial peel and up to two weeks for a deep peel. Although lasers have largely replaced chemical peels for deep peels and skin tightening, chemical peels remain popular thanks to their lower cost and effectiveness in treating conditions such as acne, melasma and actinic keratosis.
Intense Pulsed Light (IPL)
Intense Pulsed Light (IPL) therapy uses a specific pulsed visible light source to induce selective photothermolysis. This causes thermal damage to the superficial tissue layer, thereby promoting collagen synthesis. The treatment takes just 30–60 minutes and does not require any recovery time. Most IPL devices are used primarily to treat vascular lesions, hyperpigmentation and wrinkles; however, there are also IPL devices designed specifically for skin tightening.
Non-energy Source Technology
While most skin tightening devices use energy source technology, there are also non-energy source devices available. One example is the SkinPen (Crown Aesthetics; United States), which was approved by the FDA in 2021 for treating neck wrinkles. These devices puncture the skin with many small needles to induce an inflammatory response, resulting in wound contraction, fibroblast proliferation and new collagen production, thereby achieving skin tightening. It has been shown to significantly improve facial wrinkles, achieving high levels of patient satisfaction. A 2022 clinical trial involving 32 subjects found that 94% of patients reported a significant improvement in their wrinkles after 90 days of treatment.
Limitations, Alternatives and Future Trends
The non-surgical skin tightening market is expected to grow over the next decade. However, each technology has its own limitations and is not suitable for all situations. Doctors must therefore consider multiple options to meet the needs of different patients.
In general, these technologies have only achieved significant results with appropriate populations, such as non-obese men and women with mild to moderate skin laxity. Currently, no device can consistently deliver results that rival those of surgery.
Given these limitations, exploring alternatives to enhance the skin tightening effect of body contouring procedures is particularly important. In the future, research and innovation will be crucial in overcoming existing limitations and expanding treatment options. By continuously improving safety, effectiveness and patient satisfaction, skin tightening technology will evolve to provide solutions that can rival surgical results for individuals looking to enhance their appearance.
