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Research provides objective evidence of skin tightening using laser-based system

Article-Research provides objective evidence of skin tightening using laser-based system

Key iconKey Points

  • Laser procedures offer less invasive option to conventional skin tightening procedures
  • Best results in patients with mild to moderate skin laxity
  • Know whether patients will prefer noninvasive or minimally invasive procedures before purchasing devices

A recent study of the impact of laser lipolysis on skin tightening may be the first to provide objective evidence of successful use of this system for that purpose, according to a member of the research team.

Bruce Katz, M.D., clinical professor of dermatology at the Mount Sinai School of Medicine, director of the Cosmetic Surgery and Laser Clinic of the Mount Sinai Medical Center, and director of the Juva Skin and Laser Center in New York, and his team expect their research to be published within the next few months. The study is among the latest to examine outcomes of minimally invasive tightening techniques.

FACELIFT FLASHBACK The first rhytidectomy or facelift was performed more than a century ago, in 1901. German physician Eugen Hollander, at the urging of his patient, made a couple of small incisions, did a little snipping, pulled some skin and sutured a tight seam. Pleased with the success, Hollander immediately set about perfecting the procedure, a challenge taken up by others, as well.

Before (top) and after skin tightening using SmartLipo (Cynosure) on the neck.
By the middle of the 20th century, surgeons had improved facelift methods with the incorporation of more (and deeper) facial layers, such as the superficial musculoaponeurotic system and the deep-plane tissue layer. The facelift became the primary method for addressing facial skin laxity in aging patients; similar procedures were developed to reduce wrinkling and sagging in other body areas.

At the dawn of the 21st century, new technologies and philosophies were focused on the development of skin tightening methodologies outside of the operating room, with varying success. Solutions have ranged from cosmeceuticals to fillers to lasers, but, depending on the product and the use, evidence of validity varies — in part because regulation does, as well. For instance, the Food and Drug Administration does not scrutinize cosmeceuticals as closely as medical devices, under which injectables and lasers are cleared or approved. But even for those approved, success can vary from device to device and patient to patient.

LASER OPTIONS Lasers most often tighten epidermal and dermal tissue by shrinking the collagen under the skin's surface in some way. The devices can employ radiofrequency, optical or fractional technologies.

Before (top) and after skin tightening using SmartLipo on the stomach.
"The first one that was found to be somewhat successful was Thermage (Solta Medical)," Dr. Katz says, noting the device uses monopolar capacitively coupled radiofrequency (RF) energy to tighten and contour skin. The heating — intended to be deep, uniform and volumetric — targets the fibrous septae to effect tightening.

Thermage was followed by Titan (Cutera). Titan uses optical technology in the infrared spectrum to heat the collagen and cause it to contract. Alma Lasers introduced Accent Dual-layer Thermotherapy in the United States after 510(k) clearance was granted in 2007. The device uses both unipolar and bipolar frequencies to heat two depths of tissue, enabling treatment to occur at both surface and deeper levels.

Additional skin tightening technologies on the market include Harmony (Alma), an infrared device; Fraxel (Solta Medical), with single-wavelength, dual-wavelength and CO2 laser options; Pearl (Cutera), which operates in the 2,790 nm wavelength; and SmartLipo (Cynosure), a laser lipolysis system with varying wavelength options. Dr. Katz's team employed the unit that combines 1,064 nm and 1,320 nm wavelengths to target fat.

Using 4 cm by 4 cm tattoos (which were removed after the study was completed), researchers compared measurements before and after performing a laser skin-tightening procedure using the SmartLipo system. "We found the squares shrank about 20 percent," Dr. Katz says.

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