We have several RF microneedling (RFM) devices. Including the latest Genius RF, Morpheus8, Profound & Infini RFM. RFM is classed as medium depth skin tightening as it targets the deep dermis & fibro septal network of fat. 

RF Microneedling

• Downtime: 0-2+ days
• Pain relief: Nitrous gas & numbing
• Cost: $890 to $1990
• Best used: lower face laxity, thick fat & dermal layer 
• Best combined with: PDO monos, fractional lasers, collagen stimulators
• Done by: Nurse – dermatologist

*We have stopped Profound RFM & Infini RF as Genius & Morpheus8 are far superior.

We have access to over a dozen dermal fillers from all the big-name companies, however for skin tightening the top two product we use are:

Collagen stimulating injectable HA’s also known as biostimulators: This injectable is unique as it addresses skin laxity without adding volume. We also employ non-HA fillers that can address skin texture in addition to adding volume. 

Biostimulator HA’s

• Downtime: 0 days
• Pain relief: Nil required
• Cost: $800 per syringe, 2 syringes recommended, 4 wks apart
• Best used: Mild to moderate laxity of the face & neck
• Best combined with: PDO monos, fractional lasers, collagen stimulators
• Done by: Nurse – dermatologist

Calcium hydroxyapatite – PLLA

• Downtime: 0 days
• Pain relief: Mixed in with filler
• Cost: $990- $1790 per syringe
• Best used: Mild to moderate laxity of the face & neck
• Best combined with: PDO monos, fractional lasers
• Done by: Nurse – dermatologist

PCL or polycaprolactone is the most powerful biostimulatory injectable. Australia (as of 2024) has two types.

1. PCL with CMC gel particulate: for volume & skin tightening.
2. PCL liquid, best for tightening alone.

Both require 2-4 sessions for optional outcomes.

*PCL has a higher side effect profile compared to PLLA, CAH, Profhilo & Rejuran.

Rejuran is a new biostimulatory injectable. It is derived from a polynucleotide DNA & is superficially injected.

Though it can produce collagen, the biostimulatory potential is less as compared to PLLA, CAH & PCL injectables. Rejuran is best used for-

• Improving skin quality
• Treatment of fine lines
• Enlarged pores
• Superficial acne scars

2-4 sessions are required, spaced 4-6 weeks apart.

Specialists employ PDO threads very differently compared to cosmetic clinics & cosmetic GPs. We not only train the industry, but develop new ways to utilize threads to tighten, firm & in some cases lift. 

The most important concept to understand is- ‘by themselves, threads do very little to lift & firm skin.’ Threads require specific placement in vectors. The ideal vector depends on the patient’s area of maximal laxity. Threads are inserted in the hypodermis; they require adjunctive treatments to initiate clinically evident fibrosis or contraction. The type of treatment depends on factors such as degree of laxity, volume, ethnicity, dermal thickness, subcutaneous layer & most importantly the weight & volume of areas distal (or below) the level of laxity. It’s complex.

Threads do not work well on the neck & you are wasting time & money treating other areas. I also performed cogged, anchoring & barbed threads. The results are awesome, but they last between 11 to 26 weeks.

Superficial skin tightening procedures include-

• Laser Genesis
• Picoway or Picosure Pro
• Light resurfacing: Fraxel or low power CO2 lasers

This level of skin tightening has a limited window of application, namely improving fine lines & wrinkles, typically in the late 20s to early 40s age group. These lasers are more useful for improving skin quality.

This level of skin tightening addresses the following levels- epidermis, upper & lower dermal layer & the fat layer known as the hypodermis. They include:

• Lasers: Fraxel, fractional CO2, Hybrid laser
• RF microneedling: Genius, Morpheus, Potenza, Profound, Secret
• Medium depth: HIFU Ultherapy, Ultraformer
• PDO vector mono threads: Mint
• Radiofrequency: NuEra, Tempsure, Pelleve
• Dermal collagen stimulating fillers: Ca Oh, & PLLA
• HA Biostimulatory injectables: Hybrid HA biostimulators

Deep tightening involves the fat & underlying area (SMAS). Two energy devices go down this far, HIFU/Ultherapy & RF or radiofrequency. 

HIFU / Ultherapy & Ultraformer

• Downtime: 0-1 day
• Pain relief: Nitrous gas (it hurts)
• Cost: $990 to $2690
• Best used: lower face laxity, thick fat & dermal layer 
• Done by: Davin Lim & nurse

RF/ Tempsure & NuEra

• Downtime: 0 days
• Pain relief: Nil, painless
• Cost: $550 per session 3-5 recommended. Package pricing applies
• Best used: lower face laxity, medium fat & dermal layer 
• Done by: Dermal therapist 

HIFU has a narrow application window. I use Ultherapy for skin tightening in patients with a thicker dermal & fat layer. It works best in the lower face. It has minimal impact on those who have sun damaged skin or with a thin dermal layer. In summary-

• Downtime: 0-1 day
• Pain relief: Nitrous gas (it hurts)
• Cost: $990 to $2690
• Best used: lower face laxity, thick fat & dermal layer 
• Done by: Davin Lim & nurse

RF is my go-to. Why? Because it’s gentler than HIFU, more cost effective & hurts a lot less. Bang for buck RF NuEra is great. For those with mild laxity, it is used as a stand-alone treatment. Those who have mild to moderate skin laxity will benefit from procedures such as RFM, PDO threads & lasers prior to NuEra. 

In summary:

• Downtime: 0 days
• Pain relief: Painless
• Cost: $500 + per session
• Best used: mild to moderate skin laxity, pre or post combined treatments
• Done by: Nurse or dermal therapist

My team & I use one of three collagen stimulating injectables. These injections are used to provide collagen stimulation & improve skin turgor, in addition to reducing mild to moderate laxity. They all work in the same way, namely to stimulate your production of collagen. 

1. Biostimulatory injectables. Profhilo is a combination of specially linked HAs, 2 sessions are required, spaced 4 weeks apart.
2. Calcium hydroxylapatite. This dermal filler is excellent for strengthening the dermal layer of skin, in addition to improving volume.
3. Poly-L-lactic acid. Has the longest data as it is over 15 years old. I use this to help stimulate collagen in more mature patients. As a guide one vial is used for each decade of life. 

RF microneedling is a sidestep from radiofrequency, & worlds apart from microneedling. We use Infini, Genius & Morpheus8 systems. RFM produces controlled heat in various depths. It is used to tighten the deeper layers of skin & is best used in combination with other methods that address skin laxity, namely PDO monos, lasers & collagen stimulating fillers. 

In summary-

• Downtime: 2-6 days
• Pain relief: Local, sedation
• Cost: $890 to $1990
• Best for: Mild to moderate laxity, often in combination
• Done by: Davin Lim & nurse

Darker skin patients in general, will respond better to skin tightening procedures as dermal collagen is thicker & more reactive. The top four procedures are-

• Picosure Pro– for superficial skin wrinkles
• NuEra RF– for deep tightening
• Profhilo injectable- for collagen stimulation
• HIFU Ultherapy– for contraction of all layers

Here is an analogy. If you need to push a heavy object, it takes a bigger effort to get things moving than it is to keep it moving. Hence the biggest push is the first. The same applies to skin tightening. Here is an example of how my team & I approach this problem.

First push (the big one). I combine at least two of the following procedures. Vector PDOs, RF microneedling, deep laser resurfacing, HIFU, collagen stimulating fillers, biostimulatory injectables. 

Momentum. This means gentle pushes at intervals of 4 to 8 weeks. I prefer slow heat RF over fast heating devices. Tempsure & NuEra are examples of slow heat. HIFU & RFM are examples of fast heat. I also use collagen & biostimulatory injectables, often in the same session. The number of momentum pushes depends on your degree of skin laxity, your age, ethnicity, health & expectations. We normally perform 2-4 gentle pushes over 3-5 months.

Once you have generated collagen & skin tightening, you are then transferred to a maintenance program. 

Costs vary according to who performs the procedure. As a guide-

• Level 3+ lasers $1990-$2490* (Senior nurse)
• Level 4 lasers $2390 to $2990* (Senior nurse-dermatologist)
• Level 5 lasers $3990++
• HIFU: from $990 per session
• RF: From $550 per session 
• RFM: From $890 per session *
• PDO vectors: $990 upwards *
• Collagen stimulating injectables: from $800 per 2 mls

Discounts of up to 25% apply for combination treatments performed on the same day. 

The minimum depth is mid-level, namely Jessner-TCA peel. Deeper peels such as croton oil phenol peels can markedly improve skin texture, tone & provide a superficial to medium depth lift. Downtime following peels range from 7 to 14 days. It is epic.

If you have sun damage, the only way to improve skin texture is with deep laser resurfacing. Sun damage causes breakage of collagen, leading to laxity & non-contractility. In summary-

• Downtime: 7-14 days
• Pain relief: Injection for conscious sedation
• Cost: $5990- $6990
• Type of laser: CO2 or erbium ablative
• Done by: Davin Lim

Two options for assessment. Firstly, with our nursing team at Cutis Dermatology. My senior nurses Alison & Katie are the most experienced & will assess your skin. 

My colleagues & I deal with more complex cases of skin laxity as we employ deeper lasers, surgery & devices. Assessing skin laxity is best with a real time examination as we touch & pinch to skin to understand the degree of elasticity & recoil. 

A virtual examination can be performed; however it is nowhere as reliable as a traditional clinical examination.

Zero downtime: RF devices, collagen stimulation using injectables & fillers.

1-3 day downtime: Light level 2 lasers, PDO vector threads

3-6 day downtime: Medium depth peels, Level 3 lasers

6+ day downtime: Deep peels & ablative CO2 or erbium lasers

Skin care will not improve skin laxity, nor will it ‘lift’ skin, no matter what they promise. Skin care can however reduce UV damage to the deeper layers of skin & improve skin quality. A simple but super affordable & effective skin care routine is-

AM: Ascorbic & ferulic acids, tocopherol, SPF.

PM: Retinol plus pigment corrector if required.

Every 10-14 days: AHA & or BHA serum.

*Skin care consults take around 30 minutes to complete. Our dermal therapist provides this free consultation at The Formulated.

Following these instructions will save you a lot of grief & money. The concept is simple. If you lose too much weight off your face, your skin’s tensile strength cannot match the reduction in volume. The result? An increase in skin laxity. We see this all the time. Here are some hints to help your skin cope with this process.

1. Sensible weight loss. If you have had bypass-stomach surgery or Ozempic injections your weight loss can be epic. It’s literally like stepping on a brake. Modulate weight loss, ½ per week max. This translates to 2 kg per month, & 10 kg over six months. If your weight free falls, consider protein supplementation.
2. Skin tightening procedures. Two great non-invasive skin tightening procedures are RF slow heat (NuEra or Tempsure) & collagen biostimulatory injectables. RF causes contraction of dermal collagen, in turn reducing laxity, whilst injectables increase the amount of collagen.
3. Volume replacement. Simple soft tissue fillers can correct volume deficits. We employ over a dozen different HA & collagen stimulating fillers, depending on the clinical indication.

Once your weight loss stabilizes, you can explore more powerful skin tightening procedures such as PDO monos threads (vector), dermal fillers, RF microneedling, deep laser resurfacing as well as surgical options. 

Lots- everything from sleep, diet, supplements & habits. With all procedures, we ask your skin immune system to remodel collagen to lift & tighten. The ONLY exceptions are volume displacing dermal fillers, & or surgery as we physically lift, cut, & tighten. Hence for lasers, HIFU, RF, PDO threads & peels, the results largely depend on your ability to generate new collagen, hence the need for a healthy lifestyle. 

Diet: A well balanced diet is essential for results. You need protein to lay down new collagen. Eating at least 1.2 grams of protein per kilogram of body weight is my recommended intake. Additionally, a diet high in antioxidants has been shown to reduce photoaging, including the development of wrinkles. Foods to eat include fish, nuts, berries (blueberries, raspberries), leafy greens & 1 glass of wine (resveratrol) nightly. I am a great believer of intermittent fasting as it reduces spikes in sugar, & initiates minor stress levels that result in autophagy, namely clearing of damaged cells. Do not fast during your recovery period following procedures as these impacts on the final result (need protein to build collagen).

Supplements: are great if you are deficient in addition to literature supporting cellular metabolism. They include resveratrol, NMN, & amino acids. Collagen supplements?

I do encourage them for joint health, whether it helps collagen remodelling is questionable. Given the banal effects, & low costs, knock yourself out. 

Sleep: is important, 6-8 hours depending on your activity level. I sleep in a slightly colder environment, namely 16.5 to 18.5 degrees. Why? Because minor stressors can stimulate your immune system in a positive way.

Healthy habits: needless to say, no smoking, use sunscreen, don’t stress. All proven to help cellular metabolism & reduce damage to cells. Smoking inhibits blood flow, & severely compromises your recovery & the ability to regenerate collagen. 

In some cases, surgery is the ONLY option. We will inform you if you fall into this category. My team & I will not waste your time, effort or money to try to lift severe skin laxity. 

I am trained to perform mini-s-face lifts, also known as short incision face lifting, however in the past few years I know that a deep plane face lift by a plastic surgeon is the Gold Standard, & we are about Gold Standards. I refer most patients to Dr Liew in Sydney, Shape Clinic or Dr Dan Kennedy, Brisbane.