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How Can I Tighten My Skin?
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How Can I Tighten My Skin?

Episode 21: How Can I Tighten My Skin?

How can I tighten my skin? This has been one of the most popular questions asked by patients and plastic surgeons alike since, well, pretty much since plastic surgery was a thing at all. And the reason is because almost everyone could benefit from some skin tightening as they begin to age. And we'll approach this question, “how can I tighten my skin?” from a few different perspectives, beginning with how does skin tightening work?
Where can we use these techniques and procedures for skin tightening? Can we combine these containing procedures with other things? How much does skin tightening tend to cost? Is it safe? And can I do it myself at home?

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How does skin tightening work?

So let's jump right in and talk about how skin tightening works. So the underlying problem is that as we age, our skin loses elasticity, because collagen and elastin and other compounds in our skin begin to break down and lose their strength. So our skin becomes stretchier over time and it can't withstand gravity as effectively.

There are three categories of things that people try to do to tighten their skin, and we can break them down essentially into creams and other topical treatments, devices and technologies of different kinds, and then finally, surgery. So to start from the beginning, there are the creams. And the theory behind skin tightening creams is that by applying specific chemicals or molecules or proteins to the skin through skin creams, we can have various effects on tightening the skin. Maybe there are attempts to add collagen to the skin or to make elastin tighter again. There are as many theories and approaches as there are brands of skin creams themselves.

And after having seen a lot of things and a lot of creams and a lot of studies and a lot of different ingredients, I can say that unfortunately, creams as a whole are not terribly effective in terms of skin tightening. And the analogy that I like to use is a falling wooden house. If you see a wooden house collapsing, it's not going to do a lot of good to throw wood at that collapsing house. And essentially, that's what a lot of these skin creams are doing. They are essentially throwing collagen or elastin or other proteins and things at the skin while it's losing its plasticity.

And if the body isn't able to properly metabolize those things and use them as it rebuilds its skin and connective tissues, those ingredients in those skin creams aren't going to do a lot of good. One exception to this rule are skin creams that are primarily aimed at moisturizing the skin. And the reason for this is that your skin can very effectively take in topical moisture in the right formulation. And when you moisten the skin, you are providing a temporary increase in volume and turgor, and this can improve the face's appearance, and it can make things look less loose or saggy. So moving into devices for skin tightening, there are a slew of these things out there on the market.

And I'm going to focus on the ones that I've brought into my practice because I made the decision to bring them into my practice after researching and demoing a large swath of what is available, so I can speak with confidence about the decisions that I've made, and I can tell you that these things tend to work from personal experience with my own patients. And I apologize, I will be mentioning specific product names and brands here because it's necessary for you to be able to identify these devices, so you know what I'm talking about when you go to your doctor's office and say, "Hey, do you offer such and such?" But we have not taken any funding or advertising money of any kind.

I'm purely providing my own objective opinion about what works the best here. So the underlying theme for devices that tend to work well for skin tightening is that they create a controlled injury. And in healing that injury, the skin actually tightens and contracts. And that makes sense from a scientific perspective because one of the main ways your body heals injuries is through wound contraction. If you get a cut on your arm and you watch it over time, it's going to shrink. And this is going to help the body because it gives it less of an area that it needs to cover with new tissue.

What’s the best way to tighten skin?

So the idea with these skin tightening devices is to create a controlled injury that will evoke a tightening and shrinking response in the skin, which in turn leads to a more youthful, pleasing appearance. And the class of devices that I've had great success with for skin tightening and even for skin resurfacing are the radio frequency devices, specifically those from InMode. And these really come in two flavors. The first is a completely external noninvasive, and this is called Morpheus8. And Morpheus8 is pretty unique in that it uses radio frequency microneedling to create two different kinds of controlled injury.

And specifically, the Morpheus8 device deploys a series of extremely small needles to a depth of four millimeters in the skin, and these are creating a controlled physical injury in the form of these microscopic little holes in the skin. And at the same time, the device is admitting radio frequency energy, which amps up the healing process. And together these holes and the essentially thermal injury from the radio frequency energy really triggers a robust healing response that over time the skin responds to by shrinking and tightening. To take this to the next level, we can go to a minimally invasive kind of skin tightening device, again, using radiofrequency from InMode.

And the most widely used device in this category is called BodyTite, and this is a bipolar radio frequency device. What do I mean by this? There are two poles or sites from which radio frequency is emitted. There is one pole that goes underneath the skin and one pole that stays on top of the skin, and radio frequency energy is essentially fired between the two poles to heat the skin. And there is a heat sensing device both on the internal pole and on the external pole. So this heat is very precisely regulated so things are kept safe, but we get hot enough to get the temperatures at which we know that skin contraction will be induced. And the way mechanically this device works is that a tiny incision is made.

It can be as small as two millimeters. And that internal probe is passed under the skin while the external probe follows on top. And the other thing we've had a lot of success with is actually combining Morpheus8 external radio frequency energy with this BodyTite form of radio frequency energy that actually passes from inside to outside the body and back again. And this has a really nice kind of cumulative synergistic effect to achieve very powerful skin tightening. The other form that these bipolar radio frequency devices can take are called FaceTite and AccuTite, and these are essentially just smaller sizes of that original BodyTite hand piece.

So the FaceTite one is kind of the medium size and it's great for the lower third of the face and the neck, whereas the AccuTite hand pieces is really tiny, and we can use this for areas as delicate and small as the upper and lower eyelids, the nasal labial folds, and the gel. So there's a lot of flexibility with these devices that allow us to achieve some really stunning results. The thing to know about any of these skin tightening devices though is that it does take time to see the results that we're talking about. Because remember, we're relying on a controlled injury to heal to produce this skin tightening, and that's not an instant process.

So while you can see a small improvement right away, it really does take several months to see the final result from these procedures. The other nice thing about these procedures is that they can be performed on an outpatient basis, and they generally don't take over an hour. So it's something you can come in, have done, and then head home without much of a fuss. So moving on from these minimally invasive devices, kind of the granddaddy of them all for skin tightening is surgery. And that's not really the subject of this episode, but it's just to say that the gold standard for getting really extreme skin tightening would be surgical skin removal. And for the face or neck, that's the facelift and the neck lift.

For the arms, that's an arm lift or brachioplasty. And for the thighs, it would be a thigh lift. And for the abdomen, it would be an abdominoplasty or tummy tuck. But again, these are the benchmarks that we're measuring these noninvasive and minimally invasive skin tightening devices against. And what we're seeing a lot of people are reporting is that with these minimally invasive devices, we can often get about 30% or so of the results that we would see with a true excisional surgical procedure. So for someone who wants to avoid surgery, either from a downtime perspective or a cost perspective, or maybe they're just not as medically prepared to have a real invasive surgery, these minimally and noninvasive options can be great.

Can we combine these technologies with other methods to improve outcomes?

So what can we combine these techniques and technologies with to help get an excellent result? And there are two main things that I like to combine them with, and the first one is some liposuction. So in a lot of cases, especially for things like dealing with double chins or what we call the submental region, the area kind of behind the chin and as we go down to the neck, we can really contour that area nicely by doing a little bit of microfocused and targeted liposuction at the same time as some of these skin tightening modalities. And the same thing goes for the abdomen, the arms and the legs, and really a lot of other areas. We can tighten the skin all we want, but if there's a lot of extra fat in the area, we're not going to get the contour that we want. So that's when it's time to do a little bit of liposuction along with the skin tightening.

And the other thing that we very frequently combine our skin tightening procedures with is PRP or platelet-rich plasma. And the theory behind PRP is that it can enhance the healing of these controlled injuries that we're creating with these radio frequency or a physical controlled injury creating devices.

Platelets are the first kind of blood cell to respond when you get some kind of injury, and their job is essentially to message the rest of the body and say, "Send in the reinforcements. We've got a problem. We need to heal this injury." So they're bringing in all kinds of growth factors and other proteins that are going to cause blood vessels to grow and other healing molecules and proteins to be activated to start treating that wound. So what platelet-rich plasma does is it actually concentrates those platelets and allows us to directly place them into the area that we've created a controlled injury to really amp up that healing process. And this is a totally customized treatment. It's made individually for each patient.

We draw their blood. We spin it down in a device called a centrifuge, and we concentrate the platelets into a form that we can either inject or place topically over the area, depending on what we're trying to achieve, to really ramp up the skin tightening and resurfacing effects of the skin tightening procedures that we are performing.

How much does skin tightening cost?

This is a question that has some very broad answers, because like we just said, there are all kinds of different forms of skin tightening. But a good rule of thumb is that the more invasive a skin tightening procedure is, the more expensive it's going to be. So on the very least invasive end of the scale, we have Morpheus8, which is that radio frequency microneedling treatment. And this in general is available from $1,000 to $1,500 per treatment. And we like to say that you should have three of these treatments to get the optimal result. And that's going to also vary with the size of the area that you're treating, because it takes more time to treat a larger area. Moving into the slightly more invasive devices like BodyTite and AccuTite and FaceTite, these are one-time procedures, and they're generally going to be in the range from three to five or $6,000, again, depending on the size of the treatment area and the complexity of the procedure that's necessary.

Then there are other factors that are going to determine price pretty much independently, and those are things that are like, where in the country are you? Are you in a relatively expensive area or less expensive area? And what are the qualifications and reputation of your surgeon? And all of these things are going to contribute, but hopefully that'll give you some guidelines when you start to look into these things. So is skin tightening safe? Well, like almost any procedure in plastic surgery or cosmetic medicine, it is safe if it's done the right way by an experienced provider. However, again, like any medical procedure, there are possible risks.

And possible risks that we talk about with a lot of these skin tightening procedures are things like infections or bleeding problems or damage to nerves in the area. And these are all things that you should discuss specifically with your provider before you have one of these procedures, so you can make an informed decision for yourself about if these are things that are right for you. And then one of the most common questions that I'm asked about skin tightening and that I see discussed on the internet and social media a lot is how can I do skin tightening at home? And there are all kinds of systems and creams and even devices being sold.

Conclusion

But the bottom line is that none of these home skin tightening devices and creams and whatever else are really going to work effectively. And it's probably more cost effective to go and speak to an expert in skin tightening, be it a board certified plastic surgeon or a board certified dermatologist, and you'll come up with a great plan that may even be less expensive than spending a lot of money on very expensive home systems that you're going to keep trying over and over again and trying different ones and using them in different ways to try to get a result. So there you have it. There's kind of the background on skin tightening, one of the most popular things that we're doing in our New York City plastic surgery practice.

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All photos are of models except before and after images.

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