Skin Tightening Essentials. What you need to know.

Skin Tightening Essentials At A Glance

  • Best ResultsTreat all layers of the skin
  • Skin Texture ImprovementsLaser
  • InjectablesSoft tissue fillers, Tox, collagen stimulators
  • Added Skin CareVitamins A, B, C, AHAs

What can skin tightening achieve?

Skin tightening procedures, as the name suggests, treats laxity of the face & neck. Some treatments for skin laxity, such as lasers, will improve skin texture, whilst some injectables will address laxity & volume. Treatments are customized to each patient.

Why is it essential to tailor treatments?

A well-executed skin tightening program can reduce & reverse signs of sagging. Improving skin laxity with predictability ranks as one of most difficult procedures in aesthetic medicine, however my team & I do a smashing job by applying our skill sets & the very latest in lasers & energy devices to tailor each & every skin tightening program.

Improvement of skin laxity with PDOs & improvement of skin quality.

How do we approach skin tightening?

The first step is to determine the quality of your collagen. Sun beaten collagen will not contract, while collagen that is thicker with very little photodamage will respond much better to energy devices. 

The second step is to see the degree of laxity in key areas such as the cheeks, around the mouth area, eyes & the neck. 

The third step is to assess the thickness of collagen & the degree of volume loss due to collagen, bone & fat depletion. 

The fourth step is to determine a program that addresses all the steps above. We also take into consideration your age, ethnicity & goals.

Lasers can tighten skin in as little as one session. Best combined with treads.

What types of lasers do we employ for skin tightening?

The best skin tightening lasers are CO2 & erbium lasers as they penetrate deeply into the dermal layers of skin. These lasers are excellent for repairing sun damaged skin in lighter skin types. 

The second-best lasers are known as non-ablative fractional laser resurfacing. We have 6 different types of non-ablative lasers including Fraxel Dual, 1440, 1570 LaseMD, Frax 1940 & more. For superficial wrinkles & fine lines we use pico lasers such as the Picosure Pro or Picoway.

Lasers improve skin quality & tighten lax skin. We use various lasers based on the degree of laxity.

Davin’s viewpoint on skin tightening

Why does the industry fail to deliver results?  Because predictable skin tightening follows a complex algorithm. Here is a summary of how we come up with a bespoke, tailored skin tightening program. Factors that must be taken into consideration include-

Degree of laxity: mild to severe. For mild to moderate laxity, there are methods to improve collagen production in the dermal layers of skin, tighten the fibroseptal network of fat, address the SMAS layer below the fat, & display available volume deficits. For severe cases of laxity, the only solution is surgery.  

The high UV index in Brisbane predisposes to breakdown of collagen. If you have broken collagen, skin tightening devices are unlikely to work.

Presences of sun damage (photodamage): This especially applies to Queenslanders. If there is photodamage, the elasticity of the skin is markedly reduced. The elastic recoil of skin is different compared to skin sag, as in most cases there is broken elasin (elastosis) & diminished collagen bundles. In this group even powerful RF devices such as Thermage, NuEra & even deep RFM have little effect on collagen production. HIFU is a waste of time, effort & money. The only two predictable solutions are deep ablative CO2 or erbium laser, or deep chemical peels. These treatments are aimed at treating the superficial to deep dermal layer. The time taken to maximal collagen production is around 4-7 months.

Thickness of the dermal layer: This can be gauged clinically with a pinch test, or better still measured with a cannula. The thicker the dermis the higher the chances of dermal contraction. This translates to firmer skin. 

This program can stimulate collagen to reduce mild to moderate facial & neck laxity. The algorithm depends on clinical features & your expectations.

Thickness of the fat laer: This is one of the most important factors to consider, especially around the jawline & lower face. For patients who have mild to moderate laxity on a background of thick lower face laxity the use of HIFU can be considered. This treatment is aimed at tightening the collagen bundles in the fat layer. HIFU can be combined with RFM in these areas to amplify gains. 

Conversely, those who have a thin fat layer in the lower to mid face are not great candidates for HIFU as too much tightening can lead to a gaunt look. 

 In severe cases of jowling, surgery is the only option.

The amount of volume that can be displaced: This varies depending on your facial shape & volume. For ‘skinny’ low volume areas, we do have the option of providing filler to displace or redrape excess skin. Think of it as re-inflating a crinkled balloon. This can only be done in some, but not all patients. 

New generation dermal fillers can stimulate 3 types of cell that produce skin, collagen & fat.

Ethnicity: Darker skin types will generally have better collagen. Two reasons for this; firstly pigment protects the dermis. This reduces collagen & elastin breakdown. Secondly, thicker & more reactive collagen due to genetics. It is not all good news as dark skin is prone to post treatment hyperpigmentation, whilst brisk collagen remodelling & regeneration can lead to hypertrophic & keloid scars.

Device consideration: if you have a hammer, everything looks like a nail. For effective skin tightening apply the device of choice according to the patient’s clinical findings. Our repertoire of skin tightening devices include eCO2, Ultrapulse, MixTo, CORE, erbium Sciton, RF microneedling Infini, Genius, Morpheus8, RF Tempsure/Pelleve, NuEra, Profound RF, HIFU Ultherapy, Laser Genesis & a whole lot more. 

Great results (industry picture) following Profound RF.
Profound RFM, new model due in 2023-24.

Level of training: To tighten skin effectively, a breadth of skill sets including surgery, fillers, lasers, threads, deep peels & mastery of energy devices are required. Each element takes years to master. 

General health of the patient: Muscles need protein to grow, & so does collagen. Eat well, sleep well & if required take supplements. ALL non-surgical skin tightening (bar volumetric displacement of tissue) requires your immune system to remodel collagen.

Previous skin tightening procedures: Here is my ‘token theory of skin tightening’. Here is an analogy- so you work out at the gym to get stronger. The weeks go by & you achieve your goals, namely have a stimulus (resistance training), that ‘shocks’ you muscles which results in hypertrophy (growth). With each passing week you NEED to find new exercises to challenge your muscles. Put simply, more load is required- either push a heavier weight, or do more reps. The same goes for skin tightening. Therefore I don’t roll out the big guns like Ultherapy early on. It is important to pace yourself for the long run.

For effective skin tightening & wrinkle removal, M8 has no peers. Fast, effective treatments with minimal downtime.

Budget: My advice is as follows, if you have a finite amount of money to spend, you are far better off with cost effective treatments such as Clear & Brilliant or even Fraxel HD. Whilst these treatments will do nothing for your skin laxity, they will improve your skin quality. Save up & get proper treatments that address all the levels of laxity. Patients often undertake multiple procedures such as threads, microneedling, & HIFU with little or no clinical improvement. Do it right, it will save you a lot of coins in the long run.

Insight of the patient: Manage your expectations with knowledge & informed consent. We approach skin tightening medically, through science, research, device physics & the bioscience of injectables. If you view skin tightening like a menu, it may be difficult to achieve the best results with limited combinations. Skin tightening, it is not about one device or one method or even a package deal. We will guide you through what will or won’t work.

RF microneedling with the Morpheus8 system is integral in tightening the neck.

Do not overlook volume replacement. Firm tight skin without consideration of volume not only looks unnatural, but also looks unwell. Dermal fillers provide volume & structure. They last 1-4 years + or more, depending on the type of filler & your metabolic rate. Want something more natural? Fat transfer can be performed, however understand that the absorption rate varies from 20 to 80%. Want something permanent? Clinics in China & Mexico offer silicone injections, whilst the Italians & Swiss are great at cheek or chin implants. 

For more information on what procedure are right for you, book an appointment with our clinical staff at Cutis Dermatology.

For Sydney patients, please book a consultation with myself or Dr Kate at Dr Van Park’s clinic in the Eastern Suburbs.

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