In 2022 Australia has the newer hybrid lasers entering the market. These dermal fillers are classed in biostimulatory-Hybrid-fillers. They differ from other fillers that add volume (think lips, cheekbones, jawline).

Biostimulatory fillers are designed to wake up the collagen producing cells in your dermis. With time, expect an improvement in skin laxity & turgor. Skin tightening & less wrinkles are the benefits of this class of dermal fillers. These fillers can improve laxity on the face, neck & chest areas. 

A usual treatment course is two sessions of filler, spaced 4 weeks apart. For more lax skin (especially sun damage in Queensland), a third treatment is not uncommon. This filler is performed by me, or my clinical nurses at Cutis Dermatology.

Microneedling can marginally improve fine lines & wrinkles. My team & I microneedle daily, however I employ this technique to primarily treat scars or to increase absorption of various chemicals into the deep dermal layers.

You will get more out of one laser procedure than half a dozen microneedling procedures. PRP can speed up recovery from microneedling, however it does not add to the results of any procedure except for hair restoration.

RFM or radiofrequency microneedling is vastly different from normal microneedling. To start with, microneedling pens cost between 50 to 300 dollars. A good RF microneedling device starts at $120,000 with top line RFM costing close to $150,000.

RFM provides computer controlled artificial intelligence to deliver heat to predetermined depths in the skin. Heat is required to stimulate & contract collagen, hence improving fine lines, wrinkles & skin laxity. In summary, RF microneedling-

• Treats deep dermal issues in the skin including skin laxity, thereby giving skin tightening
• Has a recovery of 2-4 days
• Requires topical numbing creams 
• Can be used on all skin types
• Gives much better results than ‘cold’ microneedling
• Is often combined with lasers, peels, fillers & mono PDO threads
• Is especially effective for skin tightening of the neck & lower face

The two main groups of peels (that works) are; 

AHA peels such as glycolic acid. This has no downtime, but you will require 4-6 peels for optimal results. Best for mild laxity, fine lines & wrinkles.

Jessner TCA peels can markedly improve skin laxity of the face, eyes & upper lip. Downtime ranges from 7 to 10 days. I personally perform this procedure under sedation (you not me). I usually add low dose CO2 laser to compound the results.

This is my theory on what I call momentum neocollagenesis, which means treating skin at various depths. From the top down, this includes; 

Epidermis (upper part of the skin); cytokine & growth factor release to stimulate collagen. How? Laser resurfacing, pico lasers.

Papillary dermis (one level below); stimulates elastin & collagen production. 

How? Lasers & deep peels.

Reticular dermis (two levels below); as above. 

How? Lasers, RF, RF microneedling HIFU, PDO threads, collagen stimulating dermal fillers.

Fat & septae (three levels below); as above.

How? HIFU, RF, RF microneedling, biostimulatory hybrid dermal fillers like Profhilo, PDO threads.

Once the initial push is done, the momentum is then built around these layers using specific techniques that are modified according to the patient’s skin type, quality, age, expectations, & budgets.

Momentum treatments are typically performed 4-6 weeks after the initial push. Typically, slow heat RF devices are chosen, given they have no downtime. Most patients require 2-3 sessions. For patients with severe sun damage & laxity, I may perform collagen stimulating fillers at intervals of 4 weeks (2-3 in total).

Most patients will have a set budget, my aim is to make sure the treatment methods you choose will give you the biggest bang for your buck. 

1. Don’t choose Botox* as it lasts only a few months. It doesn’t tighten, in fact it’s the opposite- it relaxes. You are much better off with dermal fillers. Performed with skill & art, they last well over 2 years, over 10 times the longevity of tox. 
2. Don’t spend money on skincare. Nothing in a container will lift or tighten your skin. 
3. Don’t spend money on LED lamps, they don’t work, but they can give you a warm & fuzzy feeling.
4. Don’t just stick a sh*t load of PDOs in your face. They don’t work when performed this way.

   

5. Repair your skin before you try to tighten it. Lasers & deep peels can reverse sun damage. If you have broken collagen, it will not contract. 
6. See my nurses for treatments, they are very, very good & charge a fraction of what I charge.

   

*This is in the context of a budget.

Most non-surgical skin tightening results last 12 months or more. You can expect longer results with lasers, chemical peels (deep), RF, & HIFU treatments combined.

Dermal fillers that stimulate your collagen production last 9-14 months. PDO threads last 6-12 months. Microcurrent may only last 2-3 days, whilst a deep plane facelift will last many decades. For non-surgical skin tightening, you can schedule annual maintenance treatments to sustain your new collagen & keep you looking its best.

Between 2 to 6. The number of sessions is highly variable depending on your skin type, age, lifestyle, goals & expectations. With each passing session, your skin will look & feel tighter. Once we achieve the rejuvenation you’ve been looking for, you’ll be able to maintain results with occasional touch-up sessions.

* 2 sessions following treatments such as laser resurfacing, collagen stimulating dermal fillers & PDO threads. 

** 3 sessions following above + RF / NuEra

***6 sessions as the company guideline for stand-alone treatments.

Plasma pen, also known as fibroblasting is a cheap handheld device that can be purchased for about 50 dollars on eBay or AliExpress. It vaporizes tissue & is great for the treatment of viral-genital warts & skin tags.

Do not attempt to treat the face, neck, or chest. The side-effects are extraordinarily high as this procedure is not regulated.

LLED or low-level laser emission devices are herald to treat skin, improve laxity & firmness, & reduce inflammation. We run three of these devices at Cutis Dermatology. LEDs work for skin recovery following laser or surgical procedures. They do not work as a stand-alone treatment to improve skin laxity or wrinkles.

Microcurrent is best for subjectively improving skin firmness, hence there is a crossover for improving skin laxity. It rarely gives an objective measurement when it comes to improving wrinkles.

Microcurrent works primarily on immediate collagen contraction. In theory it can marginally improve collagen bundles in the deeper layers of skin. My analogy of microcurrent is this-can you tell the difference in firmness of jelly when you see it? Probably not, hence you need to press. Skin turgor is the same, hence it is a subjective assessment of your own skin.

I do not have a good before & after photo, because microcurrent works on self-assessment.

It is not that it doesn’t work, it is about giving predictable skin tightening & lifting. Thermage has great success in Asia (so does HIFU). This skew in good outcomes is primarily due to a different study population. For ethnic skin, there are differences in genetics to allow for better contraction of collagen & at the same time an increase in collagen production compared to lighter skin counterparts. This is partly due to genetics (contraction) as well as pigmentation that protects the underlying skin from UVA. 

I prefer slow heating RF such as NuEra, Tempsure-Pelleve as collagen stimulation is best with momentum (read below). For fast heating devices, I use RF (much like Thermage), but delivered via microneedling, namely Infini or the updated Genius RFM. This is not only cost effective for the patient, but IMO, it gives better results than Thermage (given the population base I am treating).

Even clinical creams are marginally at best. Skin care products are great for prevention, or in the case of pigmentation they are first line treatments. If you are after a good skincare routine that works, consider:

AM: Antioxidants such as ferulic, ascorbic acids & tocopherol, then SPF50+

PM: Retinol or retinoid

Every 2 weeks: AHA serum to exfoliate.

With the money you save, invest in a skin directed procedure that works.

Essential oils such as argan oil have been used for centuries to help tighten facial skin & reduce wrinkles. The most predictive way to tighten skin naturally is a process of fermentation of tiny little organisms known as streptococcus. These bacteria produce a sugar molecule that is called hyaluronic acid. These naturally sourced molecules are combined using high & low molecular weight HAs the packaged in sterile containers.

Your clinician can inject this naturally occurring by-product into your skin. This stimulates your body to produce collagen. Naturally.

Do collagen drinks work for skin tightening? No evidence but highly recommended if you have joint pains. Placebo can be useful. Considering how cheap they are, & if they make you feel good; knock yourself out!

If you have moderate to severe laxity of the mid to lower face, surgery is the only effective solution. The best form of surgery is called a deep plane facelift. This is often performed at the same time as a neck lift. Short scar (mini-s) face lifts are also effective, however if you are going to do it properly, an old school plastic surgeon will give you the best results. 

Remember, surgery improves skin tone (laxity), it does not address skin quality (lasers) or volume (fat, dermal fillers). For natural results, you need to address all three factors. 

We discussed face & neck lifts, other types of surgery that I perform include eyelid surgical lifting, known as blepharoplasty, as well as upper lip lift. A new automated procedure called Ellacor will be in Australia in 2023. 

Ellacor is only available in the United States. This procedure is fractional removal of excess skin & tissue. This improves wrinkles, tightens skin & addresses laxity. 

Generally, I prefer RF over HIFU (High Intensity Focused Ultrasound – Ultherapy- Ultraformer). This is why-

RF energy provides long-tail heating of collagen & the fibroseptal network (fat fibers). For patients with less facial fat, slow heating is safer. In contrast, HIFU is useful for patients with a ‘higher content’ of facial & neck fat. In this scenario, HIFU can provide slimming through collateral inflammation of fat & contraction of the fat network.

For patients with a lot of sun damage, Ultherapy & RF treatments will not work. This is because collagen & elastin is broken, a term we call elastolysis. Lasers & deep peels can repair broken collagen – solar elastosis. From there, the usual algorithm applies.

The fastest way to improve facial laxity & tighten skin is to-

• Surgically excise lax skin – either punch or Ellacor, followed by resurfacing. 
• Inject biostimulatory fillers a week or two later. 

The rate limiting factor is how quickly your body’s immune system can remodel collagen & tighten skin.

Here are two examples of programs made to prevent skin sagging, based upon skin type only.

Consider a 30–40-year-old female. Caucasian, light skin type. The yearly program goes something like this-

• Light CO2 yearly (48-hour recovery)
• RF using NuEra, Tempsure or Pelleve; 2 sessions
• Biostimulatory hybrid fillers; 1-2 sessions
• Skin care. Antioxidants, retinoids

Consider a 30–40-year-old female. Ethnic or darker light skin type. The yearly program goes something like this-

• Picosure Pro or Picoway  (48 hour recovery) 2 sessions over 12 months
• RF using NuEra, Tempsure or Pelleve; 2 sessions
• Biostimulatory hybrid fillers; 1-2 sessions (optional, usually not required) 
• Skin care

  

We have discussed the role of microcurrent & the feeling of firmness. Other DIY treatments that can marginally help include non-ablative non-fractional laser resurfacing. This laser takes 3-4 minutes to perform & is FDA cleared for under eye treatments only. 40 shots under eyes in three layers performed daily for 90 days. It can be effective in patients with very thin skin & mild to moderate laxity.

LED masks? Save your money. Even clinical strength LEDs do not have the ability to lift & tighten skin. 

You’re likely to get the best results if you:

• Protect your skin from the sun 
• Have mild to moderate skin laxity
• Are at a healthy & steady body weight 
• Don’t smoke
• Practice a healthy lifestyle

A skin-tightening procedure may not suit your goals & expectations & hence why we are very selective on finding the correct candidate.