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Can we offer patients a no-knife neck lift?

Article-Can we offer patients a no-knife neck lift?

There’s big demand for noninvasive neck tightening and contouring, and treatment options are expanding, according to dermatologist E. Victor Ross, M.D., who presented on what’s new in technologies and procedures to tighten and contour the neck this morning at the 36th Annual Conference of the American Society for Laser Medicine & Surgery, Boston, Mass.

While many patients in their 50s and older have taken steps to protect their faces and have had rejuvenating procedures like Botox and fillers, their necks still bear the signs of sun damage and time.

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This is evident at his Scripps Clinic Carmel Valley practice in San Diego, where he says almost all his patients have aging necks that they’d like to improve.  

“We can’t treat the neck as aggressively as the face … but I think we’re broadening the number of things we can do nonsurgically,” Dr. Ross told colleagues.

Skin tightening

Some of today’s most exciting new approaches for neck tightening involve the use of needles, including Infini by Lutronic, Intensif by Endymed and Factora by Inmode, he says. All of these devices, according to Dr. Ross, require that physicians apply the needles in skin from about a half millimeter to three millimeters deep and apply radiofrequency energy at the tip of the needles — in some cases, the entire length of the needles — to achieve skin tightening.

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“That approach continues to evolve. I think we’re still working out the best parameters to achieve the best tightening with needles,” Dr. Ross says.

Fat removal

Then, there’s the issue of submental fat removal. Dr. Ross says there are new, exciting devices in this space, too, including CoolMini (Zeltiq Aesthetics), which is the new attachment for CoolSculpting’s technology, as well as the newer Body FX-MiniFX (Inmode). The MiniFX, which is part of the BodyFX system, heats the skin under the chin to tighten the submental area.

“BodyFX Mini just came out, so I don’t think anybody has much experience with that,” Dr. Ross says.

But CoolSculpting’s Mini fared well for safety and efficacy in a study published January 2016 in Lasers in Surgery and Medicine.1 Researchers studied cryolipolysis for non-invasive reduction of submental fat using a prototype small volume CoolMini vacuum applicator to treat 60 subjects in the submental area. Among the patients, 83% reported they were satisfied with the treatment; 77% reported visible fat reduction and that they felt that their appearance improved post treatment. More than three quarters said the procedure was comfortable, and the researchers found no device- or procedure-related serious adverse events.

The evolution of applying heat

In addition to using needles to tighten the submental area, Dr. Ross uses ThermiTight (Thermi), which, he says, is a little more invasive.

“We have a radiofrequency cannula that sits several millimeters under the skin, parallel to the skin, and we go back and forth much like a liposuction cannula. But rather than sucking, you’re applying heat to the skin in a controlled fashion. You can use it on other body parts, too …,” Dr. Ross says.

ThermiTight, according to the dermatologist, offers sophisticated feedback on temperature during treatment.

“In the past, when people tried to heat the skin from inside out using these types of cannulas (whether the laser or radio frequency) they would just hold their hand on the surface or measure the skin temperature from the surface. Sometimes, patients occasionally would get blisters and scars as a result,” he says. “This device measures the skin temperature simultaneously under the skin with the tip of the cannula. It also measures the skin with a pretty sophisticated thermal camera from the surface. So, you’re getting a two-pronged view of the temperature. By simultaneously measuring these temperatures in real time as you perform the procedure, you’re much less likely to get into trouble.”

The newer devices are in addition to less invasive options, including Thermage (Valeant Pharmaceuticals) and Ultherapy (Ulthera), as well as more invasive surgery for severely aged necks with redundant skin. All continue as part of the armamentarium of treatments for the submental area, according to Dr. Ross.

Disclosure: Dr. Ross receives research support and is a consultant for Lutronic and Inmode. 


Kilmer SL, Burns AJ, Zelickson BD. Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat. Lasers Surg Med. 2016 Jan;48(1):3-13.

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