Noninvasive skin tightening is in demand. But there are many such devices and finding the best fit for a practice can be challenging.
Michael H. Gold, M.D., medical director of Gold Skin Care Center and the Tennessee Clinical Research Center in Nashville, Tenn., says his practice has offered skin tightening since it first came to market.
“The numbers don’t lie. Outside of neurotoxins and fillers, skin tightening is one of the most sought-after cosmetic noninvasive treatments out there,” Dr. Gold tells Cosmetic Surgery Times. “I do think that one needs to be honest with your patients. These devices work over time and multiple sessions may be needed for success. Maintenance… may be needed, as well.
Barry DiBernardo, M.D., director of New Jersey Plastic Surgery, in Montclair, N.J., says that he added skin tightening devices to his practice because patients want tighter, smoother skin, without having to go through with big surgeries or long recoveries.
“Noninvasive and invasive fat removal is very popular today, but if that fat is removed and there is loose skin, it is not a becoming result. Thus, the importance of skin tightening today,” says Dr. DiBernardo.
Skin tightening devices have come a long way but questions remain, says Chris Robb M.D., Ph.D., cofounder of the Skin and Allergy Center in Spring Hill, Tenn.
“The molecular mechanisms that lead to skin tightening are not entirely understood, so the effectiveness of any given device is still being worked out. That makes a direct device-by-device comparison very difficult,” Dr. Robb says. “Finally, some patients respond to this kind of treatment and some do not. Experience will guide who you select and make for a happy customer base.”
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Device Search 101
First and foremost, cosmetic physicians should look for a device that achieves true skin tightening, according to Dr. DiBernardo.
“Skin tightening has always been a mystery as a sole treatment,” Dr. DiBernardo says. “For years, we ‘tightened’ skin surgically by excising excess and pulling the remainder. But was that true tightening or just pulling?”
The answer lies in what makes skin tight. The two components to consider are plumpness and elasticity, or the lack of laxity, according to the plastic surgeon.
“If we know what makes skin tight, then we can explore devices able to reproduce the condition of tightness in aging skin,” Dr. DiBernardo says. “Originally, the work was done with lasers and more recently with radiofrequency devices. If we can control the heat to 47 degrees centigrade and measure it, this will enable fibroblasts to make more collagen and elastin, which can then be measured and seen as tighter, thicker skin.”
The optimal skin tightening device should (a) emit an energy form to achieve a temperature rise in skin, (b) measure that temperature and (c) for safety, monitor the temperature and shut off when needed to prevent injury, according to Dr. DiBernardo.
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My Top Device Picks
Dr. DiBernardo has two devices: the Smartlipo TriPlex (Cynosure), which is a laser delivered through a 1 mm fiber to breakup fat and tighten skin. The device monitors temperature with its ThermaGuide.
“This device, using these mechanisms, can treat body skin and fat, and also cellulite…,” Dr. DiBernardo says.
He also uses the ThermiRF (Thermi), which emits radiofrequency energy through a 1 mm probe. The device offers deep tissue and surface temperature settings via its thermal camera. It also stops energy emission once the “set temp” is reached, leading to a high degree of safety and efficacy, he says.
“This has been used in all areas of the body and breasts,” Dr. DiBernardo says.
Dr. Robb says he performs skin tightening with broad band light from Sciton, external radiofrequency and radiofrequency microneedling from Infini (Lutronic).
“And we have treated literally every part of the dermis that can have laxity. The areas that best respond are the lower eyelids, neck, abdomen, knees and labia,” Dr. Robb says. “We use the Sciton BBL (Skin Tyte II) the most. It's pain free and effective. We've also had very good experience with Infini and the results are very impressive.”
Boca Raton, Fla., plastic surgeon Jason Pozner, M.D., says his practice does quite a bit of skin tightening, and he gives a thumbs up to Infini by Lutronic among other devices.
Among the better devices on the market that head from the outside in, according to Dr. Pozner, are radiofrequency devices, like Thermi 250, VelaShape or long-pulse IPL devices, including Sciton’s SkinTyte. He also looks at the devices that heat from the inside-out. Winners in that category, he says, include the radiofrequency device ThermiTight, Precision TX laser by Cynosure and ProLipo by Sciton.
“Other devices cause a burn zone in the skin. These are either Ulthera (ultrasound) or microneedle radiofrequency, like Lutronic Infini,” Dr. Pozner says.
Dr. Gold uses many of the devices because he works with companies in the space and does research on the associated skin tightening devices.
“My favorites — in no particular order — are the Venus Legacy, EndyMed 3deep, Alma Accent (now called the V-shape), Invasix Inmode system, BTL Exelis and Syneron VelaShape,” Dr. Gold says.
3 Steps to Buying the Right Device
Dr. DiBernardo says he goes through these three steps before purchasing expensive devices:
- He makes sense of the physics and biophysics of the device.
- He needs to see very clear before and after photographs that are standardized and consistent from that technique.
- He needs to understand all the finances, including the costs to purchase and run a device, the return on investment in the procedure’s pricing and potential demand.
“If those three items are achieved, you will have made a wise investment for the practice and a terrific treatment for your patients,” Dr. DiBernardo says.
It’s important to ask the companies to show you evidence that the devices work, including peer-reviewed studies. And beware of promotional literature that poses as credible studies, according to Dr. Gold.
“Many laser companies like making white papers which in essence is a promotional piece and not scrutinized as a peer-reviewed paper,” Dr. Gold says. “One also wants to look to see how long the company has been in business, and what they have done to enhance the industry.”
Skin tightening device purchases make sense for cosmetic practices that are already doing the fundamentals, according to Dr. Robb.
“I wouldn't add one unless you already owned an IPL, for example. But if you have an established patient population, this is a good move,” he says. “I would focus my homework on market demand (in office questionnaires, etc), local pricing and competition. It's easier to brand yourself if your device is unique but also effective — not just one or the other.”
Skin tightening devices have come a long way but questions remain and patients should be educated about realistic expectations, says Dr. Robb.
“The molecular mechanisms that lead to skin tightening are not entirely understood, so the effectiveness of any given device is still being worked out. That makes a direct device-by-device comparison very difficult,” he says. “Finally, some patients respond to this kind of treatment and some do not. Experience will guide who you select and make for a happy customer base.”