Noninvasive Skin Tightening: The Heat Is On
It has been more than 15 years since Thermage, the first radiofrequency (RF)-based noninvasive skin-tightening device, entered the United States market. In the years since, demand for noninvasive skin tightening and lifting procedures has skyrocketed, bringing dozens of competitors to the market. New iterations include RF devices that deliver treatment with less pain, ultrasound-based treatments, and minimally invasive systems that deliver energy to the skin’s lower layers through microneedles or wands.
Patients with mild-to-moderate skin laxity and those who do not wish to undergo surgery have three main dermal tightening options: noninvasive ultrasound or radiofrequency (RF)-based devices; RF-based microneedle devices; and more invasive options that deliver energy directly to adipose tissue and the skin’s deeper dermal layers.
To paint a picture of what is working in today’s cosmetic practices, we asked five practitioners with expertise in facial rejuvenation to share their preferred protocols for noninvasive skin tightening.
Mild To Moderate Laxity
For a truly noninvasive option, Neil Sadick, MD, of Sadick Dermatology Group in New York City, uses either microfocused ultrasound (MFU, Ultherapy) or RF-based systems, including the Endymed 3DEEP and Thermage, to deliver energy deep in the dermis to stimulate collagen production and tighten skin. “Depending on the patient’s degree of laxity, we can adjust the device’s energy output to deliver more energy to stimulate a higher level of tightening,” he says.
Around 70 percent of Dr. Sadick’s patients report satisfaction with their noninvasive skin-tightening treatments. “The rest have either modest results or no response; this can be due to either an insufficient number of treatments or excess skin laxity that requires more aggressive treatments,” he says.
The benefit of noninvasive RF treatments is that there are no incisions and thus, very little downtime; the drawback is that multiple sessions and several months are required to see results, and outcomes can be inconsistent.
“Typically patients require four sessions at two-week intervals for face and neck treatments,” says Yael Halaas, MD, a facial plastic and reconstructive surgeon based in New York City. “Depending on their age and the health of their skin, some patients may need a few more treatments than others. If they expect more results at the end of the package, then we can add a few more sessions. Setting client expectations is very important: Try not to over-promise, and show lots of before-and-after pictures so clients know what type of results to expect.”
Stanley Kovak, MD, of Kovac Cosmetic Centers in Oakbrook Terrace and Rockford, Illinois, uses the RF-based Thermi250 because it offers multiple applicators, including a small size specifically for the eye area. “My preferred protocol depends on the area to be treated,” he says. “For the eye area, we treat each eye twice during the session. On average, we would do eight treatments, spaced 10 to 14 days apart. Each treatment session takes about 15 minutes, and there is no discomfort. Some patients return for maintenance treatments four to six times a year to keep the area looking smooth.”
For full-face treatments, Dr. Kovak often starts with the Thermi250. “With this device, you can treat the cheeks and neck without worrying about damaging the fat and creating skin surface irregularities,” he notes.
About eight Thermi250 treatments are required, but some patients may not be willing to come in for that many office visits. “Patients tend to get impatient and not complete the recommended course of treatment,” says Dr. Kovak. “But most who do complete the recommended number of sessions get 75 percent improvement and are satisfied.”
For patients needing a more aggressive treatment, Dr. Kovak turns to Ultherapy. “Though more uncomfortable than RF, it requires only one treatment to tighten tissue over the course of a few months,” he says.
Ultherapy also allows practitioners to measure skin thickness for more customized treatments. “You can treat either the bottom layer or the top layer,” says Dr. Kovak. “Many times we treat near the bottom of the skin for a tightening effect and then again near the top for a little textural change. We start at the highest setting and lower the settings as necessary for comfort. We do multiple pulses so patients do need a topical anesthetic, and if they have someone to drive them home, we will give them something to relax them as well.”
Kristy Murrow, PA-C, of Mariposa Aesthetics & Laser Center in Oklahoma City, Oklahoma, also opts for either Ultherapy or Thermi250 for patients with mild-to-moderate skin laxity. “With the Thermi250 ThermiSmooth treatment, there is no pain. Some patients say the gradual buildup of heat feels a little like a hot-stone massage and can actually be relaxing,” she says.
Her ThermiSmooth clients typically undergo a series of four to six treatments, while Ultherapy is offered as a one-time treatment for mild laxity. With both treatments, complete results take approximately 90 days.
Linda W. Lewis is the contributing editor of MedEsthetics.