There are numerous cosmetic devices that claim to be able to tighten loose skin. This is of tremendous interest to many patients, whether it be on the face or the body. Galvanized by such non-invasive treatments as Botox and injectable fillers, obtaining tighter skin without surgery seems plausible. With the focus on non-invasive treatments over the past decade, skin tightening is a prime cosmetic target with great public appeal.

From wrinkle reduction to body fat loss, energy-based devices (laser, high intensity light, ultrasound, radiofrequency) have been developed and applied with variable success. Extending such devices for non-surgical skin tightening has a lot of applications such as improving sagging jowls, abdominal skin rolls, or loose skin on the back of the arms. I regularly see patients who come in to get rid of their turkey neck, bat wings, sagging breasts or roll of skin that bulges over their beltline…with the hope and belief that such devices will avoid the need for surgery.

In reality, non-surgical skin tightening devices (e.g., Thermage, Smartlipo) do produce some amount of skin tightening. A few patients will demonstrate dramatic improvements while most patients will have more modest changes. Despite their skin tightening abilities, many patients will never be happy with the outcomes of these treatments alone. This has to do with the differences in how patients perceive skin tightening and in how much skin tightening these devices can do.

My observation is that a patient’s perception of skin tightening can be measured by centimeters and inches. Any device’s skin tightening ability can be measured in millimeters or just small fractions of an inch. It is not that these devices can not tighten skin but that most patient’s loose skin problems far exceed what can be done without surgery. No skin tightening device can replace a facelift, armlift or a tummy tuck when truly sagging skin exists. Non-surgical skin tightening works best for very modest amounts of loose skin…that one wouldn’t consider undergoing surgery to remove.

Like trying to lose fat with only taking a pill, wiping the appearance of cellulite and stretch marks clean by a skin massager, or getting rid of those dark undereye circles by just applying a cream, hope is eternal. Getting rid of loose skin, as most patients define extra skin, will almost always defy any current method of device-based skin tightening. It is not always appealing to realize that surgical removal is still the best way to get rid of unwanted loose areas of skin. Having a ‘nip and tuck’ may not be high-tech, but it continues to provide a level of improvement that will satisfy most patient’s expectations.

There is a fine balance between creating some skin tightening by contraction (heat shrinkage) and causing a skin burn and irreversible damage. Unfortunately, the amount of energy required to cause the degree of skin tightening that most patients require is currently beyond what both patient’s and their skin can tolerate.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

When facial laser resurfacing was first introduced over 10 years, the carbon dioxide lasers emitted precise levels of high energy for skin ablation. This resulted in a bloodless form of skin retexturing that had advantages over traditional demabrasion and chemical peels. Due to long recoveries with deep laser resurfacing, however, the current trend is the use of lower energy lasers that do not penetrate as deep, can be done without general anesthesia, and have quicker recovery times. While this approach to laser skin ablation will likely remain into the foreseeable future, the long-term effects of deeper laser resurfacing can not withstand scrutiny.

 
In the March 2008 issue of Plastic and Reconstructive Surgery, this very issue from a group in Chile was evaluated. They looked at long-term photographic results from 46 patients at 1, 5, and 10 year follow-ups. Their results showed that early results of skin texture was quite good. After 1 year, however, they were able to detect lines of demarcation between treated and non-treated skin and some skin had persistent redness. After 5 and 10 years, advantages were maintenance of good skin texture, elimination of fine wrinkles, and long-term correction of skin pigmenttaion. Some disadvantages included permanent hypopigmentation at the jaw-neck transition, skin telangectasias, and possible accentuation of skin redundancy.

 
This study supports what we have known for some time. Deep carbon laser resurfacing does an excellent job of removing many fine lines and wrinkles and this effect is maintained for some time. However, it does thin out the skin in some areas which is reflected in the development of telangectasias in the thinned skin. The line of demarcation between treated skin at the neck line is a well-known phenomenon. In other words, there are tradeoffs for wrinkle elimination and skin texture improvement….thinner skin with less pigment is some areas. These long-term effects support exactly why more superficial laser treatments are better. It may take more laser treatments to get similar effects but the results are more physiologic and natural.

 
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
htp://www.ologyspa.com
Clarian North Medical Center, Carmel, ,Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis