5 Things You Should Know About Skin Tightening

Did you know that “skin tightening” is searched for on the web more than almost any other cosmetic topic? No wonder, our images of youth and beauty almost always include smooth, wrinkle free skin. The top actors and fashion models almost all have smooth beautiful skin. You never see an advertisement or commercial promoting a product that adds to your jowls or the bags under your eyes. Swimsuit models always have flat stomachs and smooth thighs. They never look like they’ve had a baby. Unfortunately, many things can cause us to have loose or wrinkled skin. Pregnancy, weight loss and aging all contribute to a lack of skin tightness. So how can you safely and effectively restore skin tightness after it is lost? This article will address the 5 things you should know about skin tightening and help you find the answers that are best for you.

# 1 – Can my skin really be tightened?

The short answer is yes; your skin really can be tightened in many ways. However, from a medical standpoint, there are only three underlying methods by which skin tightening occurs:

a. The first method of skin tightening is a process known as collagen remodeling. Collagen is a protein that provides much of the support of our skin. Collagen remodeling uses special techniques to tighten the collagen proteins. These techniques also stimulate the production of new collagen.
b. The second method of skin tightening only affects the skin indirectly using volume restoration. Much of the time our skin sags or is loose because it is no longer covering as much underneath as it did in the past. This is especially true on our faces like the cheeks or lips. We also see it in women’s breast after pregnancy. Other areas can be affected also. Restoring volume uses fillers to restore the volume and tighten the overlying skin.
c. The third method of skin tightening is the most direct and perhaps well known, surgical skin tightening. This method has been employed for many years with procedures like face lifts, breast reduction and tummy tuck. While surgery often gives the best skin tightening, it has other issues that should be considered before making this choice.

#2 – How does collagen remodeling perform skin tightening?

Much of your skin is made up of a protein called collagen. Collagen provides most of the support to your skin. A second protein called elastin combines with collagen to provide your skin with its elasticity. As you age, you lose collagen in your skin. The collagen you have remaining also stretches and becomes less organized. Other factors such as pregnancy or weight gain can also stretch or diminish collagen in a localized area. The loss and stretching of collagen results in loose and wrinkled skin.

Collagen remodeling addresses the loss, stretching and disorganization that collagen develops. Typically with collagen remodeling your skin is exposed to a substance or device that stimulates your body’s own healing properties and causes your body to lay down new collagen. The new collagen then tightens over time and results in skin tightening. Many different techniques like topical creams, acid peels, lasers, microderm abrasion and others have all been used to produce collagen remodeling. We will talk about some of the most important in current medical settings.

a. Acid peels and medical microderm abrasion have been used for many years. These techniques are good for exfoliating dead skin and can reduce the appearance of fine lines, wrinkles and even stretch marks. While these techniques can cause a small amount of skin tightening by collagen remodeling, they really cannot reach deep enough into the skin to stimulate significant collagen remodeling and skin tightening. We need something that can get deeper into the dermis or lower layer of our skin.
b. For many years the gold standard for skin tightening using collagen remodeling was full surface skin resurfacing using a carbon dioxide (CO2) laser. CO2 lasers are known as ablative because they completely vaporize or “ablate” the skin area treated. While full surface CO2 lasers give great results, the recovery is brutal (taking up to 6 months) and full surface CO2 lasers cannot be used off of the face. Today, fractional CO2 lasers have taken over for full surface CO2 lasers on almost all patients. Fractional CO2 lasers remove thousands of tiny dots of the skin and not the entire surface. Fractional therapy results in the great majority of the benefit with only a tiny fraction of the downtime. Fractional CO2 lasers such as SmartXide DOT have a down time that is only a few days to just over a week. Typically, most patients can return to work wearing make-up in 3-4 days. SmartXide DOT gives a new surface to the skin, much greater than the deepest exfoliation you have ever had. In addition, a large amount of collagen remodeling is stimulated, resulting in significant skin tightening over a few months to a year.
c. Over the last decade, numerous “non-ablative” lasers have been developed to promote collagen remodeling. These lasers produce a tightly controlled thermal injury to the skin that stimulates your body to produce new collagen. Some of these like Titan or Accent lasers leave the surface of the skin intact. These tend to be less effective and cannot address surface issues like pigment or fine wrinkles like lasers that do affect the surface. Other non-ablative lasers like Fraxel: Restore treat both the surface and promote collagen remodeling. Fraxel: Restore treats thousands of tiny dots resulting in skin resurfacing and collagen remodeling. Fraxel: Restore has only a day or less of downtime for most patients, so it can be a great choice for busy people.

All of the above techniques address collagen from the skin surface. While effective, they are not able to reach the collagen in the lower part of our dermis or into the supporting tissues below known as subcutaneous tissue. Two important recent developments have overcome this problem and can now take advantage of collagen remodeling throughout your skin and into the subcutaneous tissue.

a. Thermage Skin Tightening uses radio frequency energy to deliver the deepest collagen remodeling available today. During Thermage Skin Tightening therapy, energy passes from a special tip applied to your skin to a return pad placed elsewhere on the body. The tip is cooled to provide comfort. Thermage Skin Tightening is currently considered the “gold standard” technique for skin tightening. Thermage Skin Tightening can be done on almost any body area, including: face and neck, abdomen, thighs, buttocks, arms, hands and even eyelids and lips. Innovations Medical has done more Thermage Skin Tightening than almost any practice in America over the last three years, giving us the experience to give great results with the best comfort available.
b. SmartLipo is a laser used in liposuction that also provides collagen remodeling from a deep level. During office based liposuction, the SmartLipo laser fiber is placed through the skin into the zone below the subcutaneous tissue. While the laser does melt fat, its real advantage is promoting collagen remodeling. SmartLipo has been shown to result in up to a 25-30% reduction in the size of the skin overlying the liposuction area performed. This helps give smoother liposuction results and reduces the loose skin and rippling skin can occur with previous liposuction techniques. Since the SmartLipo laser is actually under the skin, it also is providing very deep collagen remodeling.

#3- How does volume restoration work for skin tightening?

As you age, we all lose tissue volume in certain parts of your body. For example, you have seen older people with sunken cheeks and creased lips. These same older people invariably also have facial wrinkles. The main cause of the sunken cheeks, lip creases and even the wrinkles is a loss of volume from these areas. The majority of the volume lost is fat. As we age we lose fat from certain areas of our bodies and gain it in others. Perhaps the most noticeable area you lose fat with age is on your face. Loss of fat is most prominent around your eyes, on your cheeks and in your lips. This loss of fat from the upper face causes much of the skin sagging and wrinkles that we associate with age. Restoring volume to the face, and occasionally other areas can result in significant skin tightening. Several techniques are used:

a. Implants were probably the first form of volume restoration to see widespread use. Implants can permanently restore volume and even add volume where you never had volume. However, many implants such as lip implants have dropped in popularity. While implants provide permanent volume restoration, many patients do not care for the feel and look that facial implants can give, so they not as popular as other techniques.
b. Collagen injections were one of the first widely used volume restoring therapies. Collagen worked well, but only lasted for about three months. Unfortunately, early users frequently liked to “overfill” to make the collagen last longer. This tended to cause a puffy look that many people still associate with facial volume restoring products. Over the years, collagen has been replaced with longer lasting volume restoration products. These products are commonly called facial fillers.
c. The most commonly used volume restoring products today are the facial fillers. Several are on the market in the United States. Restylane, Perlane and Evolence are all based on a substance known as hyaluronic acid (HA). These products are excellent fillers. They can be used in most areas of the face, but are especially popular in the lips. They give a natural look, take only a few minutes to inject and last for 6-12 months in most patients. Radiesse is another product made of microspheres. Radiesse works well in the folds running from the nose to the ends of the mouth (naso-labial folds), marionette lines and on the cheeks. Radiesse lasts for 9-15 months in most patients. Overfilling is rarely used in these products. In current use, you typically see these products used to restore volume that has been lost. Making the lips or cheeks larger than they were when you were young is no longer very popular.
d. Fat transfer is rapidly becoming the volume restorer of choice.Fat transfer hasa number of advantages over other options.

First, fat loss was the primary cause of volume loss in the first place. Restoring volume with fat transfer gives a very natural look and feel. Since fat transfer uses your own tissue, it has no chance of a tissue reaction. Fat transfer does not cause capsule formation of harden over time. Fat transfer is also available in much larger volume than facial fillers. Finally, volume replacement with fat transfer is believed to be permanent. Since the technology has only been used for 10-15 years, no one has results for longer than about 10 years. Fat transfer is commonly used on:

i. The face. Fat transfer can be used on the entire face to restore all the volume lost, or on localized areas like the cheeks or lips
ii. Breasts. Fat transfer can be used to restore lost volume after childbirth or weight loss. Fat transfer can also be used for Natural Breast Augmentation.
iii. Buttocks. Fat transfer can be used to lift the buttocks. Fat transfer can also be used to increase the size and improve the shape of the buttocks. This process has become known as the Brazilian Lift.
iv. Hands. Using fat transfer on the hands can improve wrinkling and cover the appearance of veins and tendons. It is said that you can really tell a person’s age from their hands. Fat transfer can make you hands look younger by 10 years of more.
v. Other. Fat transfer has been used to help depressions around scars, old injuries and even cellulite. These areas often require more than one fat transfer injection. Fat can be injected into almost any body area, but some areas survive better than other areas. Ask about your area of concern and be sure to inquire how well fat transfer cells survive in that area.

#4 – How does surgical skin tightening work?

Surgical skin tightening may be the most familiar form of skin tightening. Simply stated, loose skin is pulled tight, the excess skin is cut away and then the area is sutures together. In many situations, surgical skin tightening results in a tighter finished result than any other technique. Surgical skin tightening can be used on many body areas. Some common areas are face (face lift), abdomen (tummy tuck), arms (arm lift), and thighs (thigh lift). Patient satisfaction is typically high after these procedures. The primary advantage of surgical skin tightening is the impressive skin tightening. The disadvantages are the scar and some post operative recovery time. Newer techniques such as tummy tuck done under local anesthesia or Avelar Abdominoplasty reduce the recovery time. Fat transfer is having a significant impact on surgical skin tightening. Many face lifts are now done with fat transfer to help restore volume around the eyes and lips. Using fat transfer also helps keep a more natural look to many areas treated with surgical skin tightening. Some areas like the Brazilian Lift for the buttocks have replaced many surgical skin tightening procedures.

Avelar Abdominoplasty, otherwise known as an Awake Tummy Tuck is a great example of how surgical skin tightening has changed over time. Classic abdominoplasty is done under general anesthesia in a hospital or surgi-center. Awake Tummy Tuck is done under local anesthesia in the doctor’soffice. AwakeTummyTuckgoeslikethis:

a. Awake Tummy Tuck begins with marking your stomach for liposuction.Pictures are taken and you are taken into the procedure room.
b. Once in the procedure room, you are placed on the bed and the stomach is cleaned for surgery. You are then placed on a monitor for continuous monitoring during the procedure.
c. Next the entire stomach area is anesthetized using a technique known as tumescent anesthesia. Tumescent anesthesia pumps a solution containing a local anesthetic and a medicine that decreases bleeding, swelling and bruising into the area treated.
d. Liposuction of the stomach is the next step. The entire stomach area is liposuctioned to reduce the size of the stomach and free the skin. Aggressive liposuction is done to promote the best results.
e. After the liposuction, the entire area is cleaned again and a sterile surgical area is set up.
f. Next, the excess skin is marked for removal. This area is then removed
g. The skin edge above and below are sutured together using a special skin of stitch. This
stitch does not have any surface sutures and does not require any suture removal.
h. Finally, the wound is sealed using special skin glue that stays in place. The wound
requires no care or bandaging. Drains are left in place for 2-5 days that require small dressings.

#5 – How do I know what is best for me?

This may be the most important question and the best answer is: “it depends”. It depends on many factors such as your age, weight, desire for change and quality of your skin. Research (such as reading this article) can help you understand the treatments available and have some idea of what is best for you. Before making a final decision, you should speak with an expert consultant. Here are some you should ask yourself:

a. What areas of my body and face concern me? Many times the best treatment is determined by the body area of concern.
b. Can I afford any recovery time? If you can afford no recovery time your options are more limited than if you can afford even a few days of down time.
c. Do I want more volume? This applies to common areas like the lips or naso-labial folds, as well as less common ones such as around the eyes and on the buttocks.
d. Do I need help with color or skin texture in addition to lose skin? Color and texture tend to respond best to resurfacing.
e. Is my problem just loose skin or something more? This is particularly true on the body. Sometimes in order to get the changes we want, body shaping techniques such as liposuction are necessary.
f. How much do my problems improve when my face is relaxed? Sometimes muscular action causes issues that are best addresses with muscle products such as Botox.

It is difficult to help you to understand what is best for you without knowing your specific concerns. To help, some good general rules are:

a. Mild skin looseness on your body can usually be treated with collagen remodeling technologies. Thermage is probably the best choice. Thermage is probably the best treatment available for loose skin on the knees (tennis knees), stomach, arms or buttocks. An expert consultant can help you know what kind of results to expect.
b. Skin looseness on the face is more complex. Sometimes collagen remolding is a great answer when skin looseness is mild to moderate and volume loss is small. Other times, volume restoration becomes essential to get the look you want. The effects of muscle action are also important, so remember Botox especially around the eyes.
c. Consider your body shape and size as you begin. While Thermage can cut 1-3 inches off
your waist and an inch off your thighs, greater reduction is better achieved with SmartLipo.
d. As you consider shape and size, you may also want to consider fat transfer to areas like
your face, buttocks (Brazilian lift) or breast (Natural Breast Augmentation).
e. Botox and the facial fillers such as Restylane or Radiesse can produce immediate results.

A portion of Thermage results are also immediate. Most of the other procedures and the rest of Thermage results take several months to a year to achieve final results. Be sure to consider this in your planning.

Always talk to a consultant or physician before you make your final decision. Skin tightening works great and as a large number of happy, satisfied patients. It is important to understand how it works and have expert help determining what is best for your individual needs.

Dr. Bill Johnson MD, MMM Innovations Medical
Contact us with any questions or call our Dallas office at 214-420-7970.
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