About one week. I understand that the brochures may say minimal downtime, however swelling takes 2-4 days before subsiding. Bruising can take 7 to 12 days before resolving. Most patients can start make up on day 4-5.

Skin tightening delivered from radiofrequency, focused ultrasound, microneedling, PRP, lasers, or other methods do not give a good predictable increase in facial volume in the context of age related volumetric losses.

Skin tightening, as the name suggests, tightens the skin by increasing collagen and collagen contraction. Facial volume is mainly due to fat, this can only be replaced with dermal fillers or fat transfer.

I am very mindful of applying skin tightening devices to patients with low facial fat. This especially applies to powerful devices like Profound, Ultherapy, Ultraformer III, Inifini RF & Genius RF. Collagen contraction in a patient with low facial volume can be perceived as fat melting or atrophy. There is always a theoretical risk of fat loss if devices are set too high, sequential pulsing or pulse stacking is delivered, or if energy delivery is at an incorrect depth. Be guided by your specialist in regards to your suitability.

I employ many non-surgical methods to tighten skin including-

• Infini RFM (now replaced with the newer model)
• Genius RFM (updated Infini since 2019)
• Ultherapy HIFU
• Ultraformer III HIFU/ Microfocused USS
• Tempsure RF
• Profound RF
• Thermage RF (replaced in 2018)
• Ablative CO2 & erbium lasers

  

In addition to the above I use threads including monofilament threads, suspension MINT threads, conical Silhouette threads as well as hyper dilute collagen stimulating dermal fillers. 

The ideal treatment depends on many factors including – degree of laxity, thickness of dermis, fat layer, degree of photodamage, age, ethnicity, previous treatments, downtime, area of laxity as well as patient’s downtime, & expectations.

One modality (or even five) does not cut it. Some patients are not suitable for any non-surgical procedure & are candidates for surgery, others may benefit from simple RF bipolar treatments, others from HIFU/Ultherapy or a combination of devices, threads & dermal fillers. The algorithm is very complex. 

OK, here are my thoughts, firstly microneedling RF (with any device) is not my preferred sole modality to treat skin laxity. I base treatment selection on many factors as above.

If I elect to perform microneedling RF, my prefered device is Genius RF. This represents the newest generation of insulated microneedling devices, while Profound represents generation one. Delivery of needles with Genius is vertical as compared to oblique delivery of Profound. This means much less collateral damage with the newer device. Both devices are insulated. This means better targeting of tissue.

Where Genius RF is ahead is the computer controlled real time impedance monitoring which allows for safer, & more effective treatments. As a guide, using very similar settings with both devices, healing following Genius is about 3 times faster than Profound. There is a significant cost saving for the patients (see below) with newer systems.

No, I don’t think anything works well long term for cellulite. I have used many different modalities to try to treat cellulite, including Tripolar RF, RF, RF microneedling as well as cannula stripping & even Celfina. Subcision with a stripping canular works best, but downtime is a significant issue (bruising for 3-6 weeks).

In my practice I do not treat cellulite, as the majority of my work is facial rejuvenation / reconstruction.

Firstly ignore all the BS from industry & clinic marketing. Any non-surgical technique is dependent on FOUR main factors-

1. Are you a suitable candidate to begin with? Mild to moderate laxity cases do best, moderate to severe skin laxity is not an ideal.
2. What is the ideal method or methods to give the highest chance of success? In Brisbane, Gold & Sunshine Coast, there is a marked amount of photodamage or elastosis. This means collagen is both loose and fragmented. Most patients will benefit from a skin tightening procedure & laser resurfacing. This tightens & replenishes damaged collagen.
3. What settings or techniques are suitable using the machine or methods? Settings matter, depending on the clinical findings. Additionally, non-surgical modalities like thread lifts also depend on the technique.
4. How much collagen regeneration your immune can produce is the rate limiting step. All non surgical procedures including threads, HIFU, lasers & RFM all rely on immune stimulation of collagen. This takes 3-6 months before maximal results are achieved.

In the scheme of things, RFM or radiofrequency microneedling is a low risk procedure. They include-

• Swelling (2 to 5 days considered normal)
• Bruising (about one week is the average)
• Infection (exceedingly rare)
• Pain (normal during procedure, mild after)
• Numbness (temporary)
• Nerve damage (very rare)

The RRP ranges between $3,600 to $4,900 per session. It is marketed as a one treatment only method of skin tightening. This is where I have a problem with the price structure of non-surgical skin tightening. All devices & methods, from Profound to HIFU & thread lifting are not predictable in their responses. To recommend or charge this much for any hit and miss treatment is not ethically correct, even though financial consent has been obtained.

This is where more cost effective treatments can be considered. As a guide HIFU such as Ultherapy or Ultraformer III is nearly half as much as Profound. Combine this with a bulk heating, superficial laser & it is still much cheaper than one treatment with Profound. The results with combination treatments are more predictable than monotherapy.