One of the more common things I hear patients say is ‘ I don’t want a facelift….can’t you just tighten a little bit of this saggy skin along my jowl line and neck?’ It is undoubtably a question asked to plastic surgeons around the world. Such a question has led to the development of non-invasive skin tightening devices. Their appeal remains great but their results to date have often been disappointing.

The concept is one of driving energy down to the underside of the skin, heating it up and causing it to contract and tighten. Whether the energy comes from pulsed light, ultrasound, radiofrequency, or lasers, multiple devices are currently available. Beginning less than 10 years ago, early non-invasive skin tightening was associated with significant pain and inconsistent outcomes. As these technologies have evolved, less discomfort with the treatments and more consistent results are being reported.

One critical question about non-invasive skin tightening is how it compares to that of the surgical approach, a facelift. While no one expects a non-invasive approach to be remotely similar to that achieved by surgery, from a cost and value standpoint it has merit to see what those differences may be. Such a study was published in the April 2010 issue of Archives of Dermatology. In this study, patients treated with tadiofrequency (FRF) were compared to patients who received a facelift. Photographs of 15 patients treated with FRF and 6 facelifts patients were evaluated. They reported that the non-invasive approach resulted in 37% improvement of skin laxity compared to that of a facelift.

The most believeable study results in comparing these two treatments would come if the patients had each side of their face treated by the two methods. But this is obviously impractical and will never be done. We are therefore left with the knowledge that non-invasive devices produce some effect but could one expect as much as a 1/3 result of that of a facelift?

While several devices are currently available, it is not known whether any of them works better than another. This comparative study used radiofrequency, whether better or worse results would be seen with other type energy-driven devices is a debate currently left to the manufacturers. But the one thing known for certain is that patient selection is more important than the type of energy used. Older patients with significant skin sagging and wrinkles could expect far less results than a 1/3 of a facelift, and probably closer to minimal observable improvement. Patients in their 30s or 40s with a little bit of jowling and a few wrinkles are much more appropriate candidates. But age aside, the most important determination is the elasticity of the skin and the amount of its looseness. If the skin is in better condition than one’s age would expect, modest results may still be seen.

Multiple non-invasive skin tightening devices exist using different energies including Thermage, Syneron, Cutera and Sciton who are the most visible currently. I currently use the Sciton (SkinTyte) in my Indianapolis plastic surgery practice and have a fair amount of experience with it for jowl and neck treatments. When a patient opts for a SkinTyte series, it is done on the basis that they know it is not a substitute for a facelift… even a more limited jowl lift. They have been educated that it is not a matter of whether one needs surgical skin tightening but whether they want to slow down the aging process and delay the time when one day they will need one.

Dr. Barry Eppley

Indianapolis, Indiana