Skin Tightening Treatments
As we age, our skin loses its elasticity from sun damage, decreased collagen production, and aging. It can leave skin looking saggy and lifeless. The face and neck are the most noticeable areas of this loss of skin tightness, and a facelift has always been regarded as the remedy. However, there are a multitude of other less invasive options for tightening the skin.
The best candidates for skin tightening treatments are people between the ages of 40 and 60 who have mild to moderate skin laxity.
Patients should always discuss their condition with their treatment provider, but some with the following conditions may have to avoid skin tightening treatments entirely:
- active cancer
- inflammation of the skin
- uncontrolled diabetes
- autoimmune diseases
- broken blood vessels on the surface of skin
- active mental illness
- taking blood thinners
- women who are pregnant or breastfeeding.
Some laser therapies are considered safe for pregnant women, but they should be cleared by a physician first.
The categories of treatments available for skin laxity and sagginess are:
- dermal fillers
- non-invasive body contouring
- botulinum toxin
Each treatment approach has its own costs, expectations, effectiveness, and duration of effects. There is very little research evidence that evaluates or compares the effectiveness of the various approaches. (1)
Dermatologists, plastic surgeons, and other licensed providers have long used dermal fillers to “fill” the area under the skin of the face and hands in order to lift up wrinkled skin and restore fullness to the area. Dermal fillers are injectable gels that are based on natural compounds found in the human body, such as hyaluronic acid, and calcium hydroxyapatite (CaHA). (2)
These not only provide support for the overlying skin from their own volume, but they also work by stimulating natural collagen production, and draw in hydrating fluids from the body. (3) In skin tightening treatments, dermal fillers can be used in a number of body areas, including the face, neck, decolletage, upper arms, abdomen, upper legs, and buttocks. (3)
Procedure: The clinician may numb the area to be treated with a topical cream (some areas are more painful than others). Several treatments may be required, and it may take some time to see the full effect of the filler. The effects are temporary, lasting anywhere from 6-18 months, depending upon the specific filler used, the area injected, and the patient’s biological characteristics.
Side effects: bruising, redness, hypersensitivity, swelling, pain, and skin hardening around the injection site. (3) If the filler is injected too superficially in skin that is dark or thin, more serious adverse events can occur. (3) The person performing the procedure should be a licensed practitioner with experience in administering dermal fillers.
Cost: $500-$800 per syringe
Non-invasive body contouring
Also used for removal of fat for improved body appearance, non-invasive body contouring is a popular method of skin tightening. (4) The techniques typically use some form of heat to rearrange and renew collagen for creating firmer skin. The FDA-approved modalities for skin tightening are laser resurfacing, micro-focused ultrasound (MFU), and radiofrequency. (4)
Laser skin resurfacing
Laser treatments use heating of skin tissue to create a wound-healing effect, which causes skin to become tighter. Laser skin resurfacing can be performed through either non-ablative, fractional, or ablative (more aggressive) resurfacing. (5) Fractional resurfacing may be the most effective, as it targets the deepest tissue without risk of scarring. (5) Like dermal fillers, laser treatment stimulates new collagen formation, which gradually creates tighter skin.
Procedure: The medical team will either numb the area to be treated or sedate the patient, depending on the treatment size and type of laser. During the procedure, an intense laser beam penetrates the skin in the affected areas with either pulsed or sprayed light. The treatment process takes between 30 minutes and 2 hours.
Side effects: Redness, itching, swelling, acne, skin discoloration, infection, and turning of the eyelid (rare).
Microfocused ultrasound (MFU)
Ultrasound waves have been used for everything from healing injured tendons to imaging internal organs. Plastic surgeons can now use them to treat the “turkey neck” that results from age and sun damage.
MFU uses highly focused beams of ultrasound waves to briefly heat deep skin tissue in the face and neck to 140 degrees Fahrenheit. (6) The top layers of skin are not affected by the ultrasound beam. The heating of the deeper tissue causes collagen fibers to break apart and subsequently create new, fresh fibers. (6) The result is tighter, firmer skin with reduced wrinkles in the neck and lower facial region. Improvements continue over the first few months after treatment.
Procedure: A clinician performs the treatment in a clinical setting. After a cool gel is applied to the skin, a hand-held wand is used to deliver the sound waves to the target area through a specialized ultrasound head.
If patients find the procedure uncomfortable, they can take medication to dull the pain. It is a one-time, 90-minute procedure. People generally tolerate it well, although it is common to feel the pulsed bursts of energy. Occasionally, the clinician will ask the patient to return for a second treatment if necessary.
Side effects: tenderness, redness, swelling, and occasional bruising.
A popular type of MFU treatment is Ultherapy.
Radiofrequency (RF) uses an oscillating, electrical current to transform charged molecules and ions into heat. (7) It is thought to work by inducing inflammation in small areas, which promotes new collagen production. (7) When new collagen fibers mature, lax skin becomes tighter and smoother in appearance. Common areas of treatment are the face, abdomen, neck, upper arms, thighs, and buttocks.
Procedure: In an outpatient clinic, a practitioner will mark the areas to be treated, apply a cool gel to the skin, and roll a hand-held tool that delivers RF waves to the targeted region. While some heat may be felt, patients usually have no discomfort.
Side effects: Redness and increased sensitivity may occur temporarily after the session.
A popular type of RF treatment is Thermage.
Cost: One treatment runs between $200-$500 per session, and a patient can require up to 10 sessions.
Already a staple in the world of cosmetics, botulinum toxin (often referred to by one the the brand names: Botox) injections are well-known for their quick and effective treatment of wrinkles. Studies have shown recently that they can also improve skin laxity and reduce the need for lipolysis (fat reduction) when combined with microfocused ultrasound (MFU). (8)
Botulinum toxin works by inhibiting the muscle contractions under the skin that pull on skin and produce wrinkles. The effect is temporary, so treatments must be repeated every 3-4 months to maintain the effect.
Procedure: Tiny amounts of botulinum toxin are injected into the targeted area. When combined with MFU, the botulinum toxin injections are applied first, followed by the MFU treatment.
Side effects: Pain, swelling, and bruising at injection site. In rare cases, permanent paralysis of injected muscle can occur.
Cost: $200-$800 per treatment session.
The facelift procedure has been the gold standard for decades for the tightening of skin around the face and neck. There are a variety of options to choose from if opting for the surgical route, from submentoplasty to neck lift to full facelift.
The average price of facelift surgery can range from $3,000 to $12,000, which may not include additional costs of anesthesia, etc. Talk to your plastic surgeon about which one is right for you.
What type of results to expect
The length of time required to see maximal effects and the duration of the effects depend entirely on the specific treatment method, the severity of the skin laxity being treated, and on the patient’s biological characteristics. For example, in general more invasive procedures such as a facelift surgery will provide longer lasting results than less invasive treatment options.
To maintain results, it is important to have a good skincare regimen and protect the skin from the sun to prolong the lifespan of skin tightening treatments.
Most doctors agree that no lotions or creams can penetrate the skin deep enough to create substantial skin tightening effects. (9)
The ones that claim to be tighteners actually just plump the superficial skin. The result is moisturized, but not tightened, superficial skin.
Ready to take the next step?
- Gold, M. (2010). Update on tissue tightening. The Journal of clinical and aesthetic dermatology, 3(5), 36–41.
- Loghem, J. V., Yutskovskaya, Y. A., & Philip Werschler, W. (2015). Calcium Hydroxylapatite: Over a Decade of Clinical Experience. The Journal of Clinical and Aesthetic Dermatology, 8(1), 38–49.
- Casabona G, Kaye K. Facial Skin Tightening With Microfocused Ultrasound and Dermal Fillers: Considerations for Patient Selection and Outcomes. J Drugs Dermatol. 2019;18(11):1075-1082.
- Mazzoni D, Lin MJ, Dubin DP, Khorasani H. Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition. Australas J Dermatol. 2019;60(4):278-283. doi:10.1111/ajd.13090.
- Ortiz AE, Goldman MP, Fitzpatrick RE. Ablative CO2 lasers for skin tightening: traditional versus fractional. Dermatol Surg. 2014;40 Suppl 12:S147-S151. doi:10.1097/DSS.0000000000000230.
- Fabi SG. Noninvasive skin tightening: focus on new ultrasound techniques. Clin Cosmet Investig Dermatol. 2015;8:47-52. Published 2015 Feb 5. doi:10.2147/CCID.S69118
- Weiss RA. Noninvasive radio frequency for skin tightening and body contouring. Semin Cutan Med Surg. 2013;32(1):9-17.
- Cheng CKL. High-efficiency Combination Treatment of Submental Neck Fullness. Plast Reconstr Surg Glob Open. 2019;7(7):e2306. Published 2019 Jul 25. doi:10.1097/GOX.0000000000002306.
- Neill, U. S. (2012). Skin care in the aging female: Myths and truths. The Journal of Clinical Investigation, 122(2), 473–477.