Skin Tightening (How to)

Skin tightening, At A Glance

  • Best Results2-6 sessions
  • Treatment Recovery0-9 days
  • Procedure Time20-60 min
  • Skin SpecialistMy team & I
  • Duration of ResultsVariable; years+
  • AnaestheticVariable
  • Back to WorkVariable
  • Cost$-$$$$$

Skin Tightening

Effective skin tightening is one of the most highly complex procedures as there are many facets to consider including clinical findings, goals, ethnicity, age & budget. The best non-surgical outcomes are achieved when multiple layers of the skin are treated. My team & I employ collagens stimulating dermal fillers, high intensity ultrasound, radiofrequency (multiple devices), threads, lasers & chemical peels to tighten, firm & lift sagging skin.

FactsFacts on Skin Tightening

  • We have effective methods to treat mild to moderate skin laxity
  • The approach considers ethnicity, background sun exposure, thickness of skin layers, budges & goals
  • Radiofrequency devices can tighten & firm with no downtime
  • HIFU-ultrasound is best used for lower face skin laxity
  • Threads are best combined with other tightening procedures
  • New biostimulatory dermal fillers can treat laxity on the face & neck
  • Lasers are indicated if laxity is associated with compromised skin quality

How to approach skin tightening (to get an effective result)?

Approach skin tightening from the end point; namely clinical features. Then come up with a road map to get to the destination. Everyone is different, tailor bespoke treatments. Don’t approach it from a cookie cutter treatment/s point of view. Spend a few minutes reading this page to understand more about the complexities of non-surgical skin tightening. It will save you a lot of time, effort & heaps of $$$.

What are ways to tighten skin?

There are many devices that have the potential to tighten skin. They include simple, low-cost DIY- home microcurrent devices (more on that at the end of this page), to powerful lasers, deep chemical peels, radiofrequency devices, HIFU as well as new biostimulatory hybrid dermal filler. 

The ideal treatment/s is a combination of these methods, based upon your clinical findings.

Here is a list of what my team & I utilize to tighten skin-


CO2, erbium, hybrid lasers, fractional, pico

Best for: poor skin quality & laxity

Radiofrequency devices

Tempsure, Pelleve, NuEra, Genius, Infini RF

Best for: Thin skin, minimal photodamage, combination therapy

Chemical peels

TCA, Jessner

Best for: Sun damage skin with poor skin quality & mild to moderate laxity


PDO, screw, monofilament, cog

Best for: combination treatments

Ultrasound devices

HIFU, Ultherapy, Ultraformer

Best for: lower face laxity with thick dermis & or fat layer. Mild to moderate laxity

Soft tissue fillers

Hybrid fillers, calcium hydroxyapatite, PLLA

Best for: mild to moderate laxity, face & neck. 

Home devices

Microcurrent, home laser devices

Best for: Maintaining skin turgor & quality

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

What types of lasers can stimulate collagen & tighten skin?

The two main types of lasers include CO2  & erbium lasers. These lasers tighten skin by stimulating new collagen. The upside of lasers is that they give a predictable result. By stripping away decades of wrinkled & laxed skin, lasers can provide an improvement in skin laxity with only one treatment. 

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

The downside of laser resurfacing is the prolonged downtime of over one week. To help reduce recovery time, we may perform fractional laser resurfacing. This treatment can give close to 80% of the results of deeper lasers, without the long downtime, costs & risks of traditional deep resurfacing. 

What types of thread lifts are there & do they work?

The three main types of threads are barbed (suspension, anchoring-cogged), smooth PDO monofilament, & screw threads. I have been using threads for just over 12 years & will give you my take on these three groups, including why I prefer PDO monos. 

Suspension-anchoring-cog threads

  • Gives brilliant before & after photos
  • More predictable skin tightening & reduced skin laxity
  • Can markedly improve skin laxity 
  • Has longer downtime (feeling of the anchoring knots)
  • Has unpredictable longevity
  • Cost a lot more than PDOs

PDO monofilament threads

  • Don’t give brilliant before & after photos
  • Requires combination therapy to tighten skin
  • Has a much shorter downtime
  • Has good longevity esp. With combined treatments
  • Cost a lot less than suspension threads 
  • Has much fewer side effects than anchoring threads

Screw threads (tornado threads)

  • Single or double threads intertwined together 
  • Great effect on volumizing sunken areas of the skin
  • Intertwining threads have a stronger effect over the singular threads

In my practice, as of 2022, I much prefer mono threads as I combine them with other methods to tighten skin at all levels. Monos are placed in the subdermal layers, low down in the reticular dermis & the mid fat layer.

My fav threads are the PDO monos & Tornado or screws.

Threads work by creating fibrosis over a period of 6 (up to 12) months. The best-known thread is called PDO. This fibrosis stimulates collagen production, in turn tightening skin & improving skin laxity.  Read to the very end how I combine treatments to give more predictable skin tightening.

Threads must be combined with other treatments to be effective.


Davin’s viewpoint on skin tightening

Predictable skin tightening is one of the holy grails of dermatology. Very rarely is there only one treatment that can accomplish that, except for heavy laser resurfacing. When I mean heavy, that refers to a downtime of well over 10 days. 

The arena of skin tightening has made enormous gains over the last decade, with newer radiofrequency devices including high powered impedance RF microneedling with sequential delivery & slow heating devices without the consumables (like Thermage). The introduction of Profhilo to the Australian market in 2022 has also expanded the range of low downtime/no downtime procedures, whilst PDO threads have had an enormous boom, at the expense of reputation (as universal treatments for wrinkles & skin laxity). Additionally for clinics that offer one off treatment using one or two devices will invariably choose powerful devices such as Ultherapy – HIFU for patients with skin laxity & low facial volume-fat-thin-dermis. Aggressive treatments with ultrasound damages not only the patient’s facial features but also the reputation of the device.

Everyone sits on a graph. This goes for everything from IQ, height, metabolism & collagen remodelling. The aim is to push the ones to the left of the curve, to the centre & those in the middle to the right.

Story time. In mid-August 2022 I was closing some big, heavy metal doors at my house. These doors are mounted on rails, & weigh well over 250 kg. The art of closing heavy sliders is to initially push (with all your might), then exert some more force (less effort than the initial push) to keep the momentum up. So, this is how I could explain my momentum neocollagenesis theory, based upon how I have approached skin tightening over the past 12 months. Can this theory be explained with scientific evidence? In parts, however controlled, randomized, assessor blinded studies are impossible (at least in Australia) to perform. This is in part to the high numbers needed to be included to make a statistical significance. Combining this with the various methods I use, based upon the patient’s facial shape, volume, downtime, expectations, budget, previous treatments & skin type would compound the complexity of any meaningful study. Add to this the inherent difference of laser & device settings, parameters, volume-depth of fillers, number of threads, peel concentration, & more the equation is almost infinite. Great for tailoring outcomes & treatments, but really crap for any statistically significant study. 

Here is my theory on skin tightening, or the momentum neocollagenesis phenomena.

Day 0 is the biggest push to gain momentum. Methodology depends on clinical factors as discussed. With at least 2 procedures, we can start the ball rolling by targeting at least 3 layers.

Observation 1. Patients with sun damage don’t contract elastin & collagen bundles well. Hence any treatments aimed at ‘tightening’ the levels without significantly changing the collagen & elastin quality is bound to fail. Said another way, if you have sun damage, you are wasting your coin on RF, & HIFU treatments. You are better off with a deep peel, CO2 laser with or without biostimulatory fillers at month 2 & 3 after ablative procedures.

UV fragments collagen & elastin. This leads to skin laxity. If you have broken connective tissue, it will NOT contract. Hence the first push should be resurfacing or deep peels.

Observation 2. Patients with a thin dermis & or fat layer should not be treated aggressively with HIFU– Ultrasound or RF devices, simply because there is a lack of collagen to contract. The exception? The upper & lower eyelid skin; in the absence of sun damage. Skin tightening of the eyelids can be effective using most methods; RF, lasers, peels, Tixel & other energy devices.

Used in the correct patient, HIFU can be very effective in treating laxity in the lower face.

Observation 3. Start off the momentum with 2 or more combinations. The combination of skin tightening methods will depend on your experience (as the provider) & the patients clinical features (plus their own ‘research’ as to what they would like; yes, medicine is now a friggin’ menu selection).  The methods you can choose (excluding moderate to severe laxity when the answer is surgical) are as follows-

  • Lasers: ablative works a lot better than non-ablative, however the cytokine profile of superficial lasers (think pico or 1927-1940 wavelength) can produce extraordinary outcomes when only treating 200-240+ microns.
  • RF microneedling; I prefer insulation, top RFMs include Genius, Infini, & Morpheus8. You can get away with older RFMs like Intracel, Secret RF, & Intensif. You must dial in the depth based upon dermal (& subcutt) thickness. Until high resolution USS is available, you can surprisingly dial it in using your cannula to determine depth. In most cases RFM for improving skin laxity & aiding in skin tightening will require 2-4 sessions.
  • Chemical Peels. Not the fairy stuff, but an acetone scrub, then modified Jessner followed by 30-35% TCA or the croton-oil-phenol peel. Peels are better if skin is fine, with pigmentation rather than etched wrinkles (phenol can work in this situation). 
  • Threads. As reinforced, my MO nowadays is the PDO monos. Simple, cost effective with a good life span. I did use anchoring-barbed threads in the past, but the longevity is not predictable. Additionally, I’m not into hand holding as the knots can take several weeks to months to resolve.
  • Dermal fillers. I use one of three, Profhilo, PLLA & Calcium hydroxylapatite. Providing you don’t cross the level (depth) of filler, I do combine fillers with lasers & energy devices. Energy devices do not break up HA fillers, as we proved in a study in 2017.
  • HIFU, again, useful when indicated, especially for lower face fullness & laxity. In this case we are using off label & may conservatively sequentially pulse. 
  • RF slow heating devices reach above 115°F (46°C) for over 3 minutes, in turn causing your body to release heat-shock proteins. Examples include NuEra & Tempsure. This stimulates collagen production.

    I combine threads with other treatment modalities as we need to tighten all layers of the skin. PDOs in isolation do very little.

Observation 4. Follow up the first treatment with repeated sessions 4-6 weeks after the first procedure. Create momentum. My two most useful methods are;

  • Slow heating devices; NuEra, Tempsure, Pelleve.
  • Dermal fillers with biostimulatory effects; Profhilo, calcium hydroxyapatite
  • For most patients I introduce these ‘pushes’ at week 4, week 8 & occasional week 12.

Once the treatment has finished (usually 3 months after starting), you only require a ‘top up’ treatment annually- usually a series of RF sessions or biostimulatory dermal fillers. 

Observation 5. I was wrong about microcurrent devices. Logically how can a device, sold in shops & online deliver such a high satisfaction rate when it comes to skin tightening & reducing skin laxity? The answer lies in the subjective feeling of firmness & not the element of objective skin tightening. Microcurrent does not lift, it doesn’t remove or shallow up your nasolabial folds, but it can put you in that happy feel-good mood knowing your skin feels firmer.

Microcurrent devices can subjectively improve firmness, but do not deliver objective endpoints.

Observation 6. Now this, I must admit, is a wee bit far-fetched. But I do practice it. I think skin has a specific memory & a signature that allows certain procedures to be effective. This combination is determined by genetics, race, individual & environmental factors. You are in the game of skin rejuvenation-skin tightening, with a limited number of tokens. Spend too much early on tokens that work (eg. HIFU in your 30s, or powerful RF devices), then at some point you will run out of tokens, hence you’re kind of screwed (from a rejuvenation POV). Pace yourself. 

I’m so paranoid about this that I have only had one HIFU to my brows (off label, pull brow up then shoot, missing exploding my eyeball with ultrasound), that was in 2016. In 2022 I had ONE RF session with NuEra. The complexities of facial & neck skin tightening have been illustrated with this write up. I still think we will improve non-surgical methodologies in the next two decades with the introduction of micro-coring devices, new energy devices, lasers & of course dermal fillers.

The limitation is not technology, but will be the regeneration capacity of humans…dr-david-lim-cutis


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