Lifting, tightening, firming—these three words often tend to pique our interest, but can we really lift, tighten and firm the same skin that decreases collagen by 1 percent each year after age 20? Simple math says that by age 40, we’re producing a whopping 20 percent less collagen. As collagen and elastin fibers become thicker and looser with age, skin becomes less elastic and eventually starts to get lax—picture an old rubber band. “We have to start with the basics,” explains Delray Beach, FL dermatologist Dr. Janet Allenby. “Sunscreen, sunscreen, sunscreen! If you don’t do anything else, at least do that. It helps slow the degradation of collagen.” But once we start seeing sagging skin on our jowls, upper arms, thighs and knees, how do we counteract the forces of nature? Here, experts share the truth about tightening up and when the latest noninvasive means just won’t cut it.
Healing Injuries
When it comes to firming sagging skin, nonsurgical procedures that help stimulate collagen production are typically the first line of defense. “One way to tone and tighten skin is to use energy devices that injure the natural collagen, which then causes the rebuilding of new, thicker collagen that results in tighter skin,” says Scottsdale, AZ plastic surgeon Bryan W. Gawley, MD. Dr. Allenby adds, “It’s the same type of tightening effect that would occur if you skinned your knee and saw a contraction at the injury site as it healed and made new tissue.”
According to Louisville, KY plastic surgeon Chet Mays, MD, ultrasound, laser resurfacing, and radio frequency with or without microneedling are the most common skin-tightening modalities available. “The HALO laser has been a great tool for reducing fine lines and tightening skin. I also like the Lutronic Infini Genius, which uses radio frequency and microneedles to tighten skin and improve its texture.” “I often combine treatments like Ultherapy, radio frequency and Fotona laser skin resurfacing with fillers and neuromodulators for optimal results,” explains New York dermatologist Doris Day, MD. “We age in more than one dimension, so I find that results are the most long-lasting and natural-looking when we address aging in more than one dimension.”
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Head to Toe
While our faces get most of the attention, other visible areas of the body that are often treated are the hands, arms, elbows, knees and stomach. Any visible area is fair game, and doctors say the more you tighten, the better your results will be. “The more we do the treatments, the more we get out of them,” says Dr. Day. “I also recommend incorporating a body product with retinol when possible, which can help strengthen the dermis.” To tighten skin on the hands, Dr. Gawley often combines Restylane Lyft injections to plump thin, wrinkled skin with a Intense Pulsed Light (IPL) treatment to improve age spots and discoloration.
For other areas of the body, like the arms, knees, inner thighs and elbows, Englewood, NJ plastic surgeon Shwetambara Parakh, MD recommends radio-frequency microneedling or the minimally invasive BodyTite treatment, which heats skin tissue from the inside out. “We can use radio frequency pretty much anywhere on the body where there is loose skin. For someone who doesn’t have too much skin laxity and may not want an arm lift—it can leave a scar that extends from the armpit to the elbow—I often recommend lipo combined with BodyTite instead.”
For areas where the skin tends to crinkle faster than others, like the knees, elbows and thighs, the prescription is the same, with the addition of a little filler. “I do radio frequency on those areas too, but for an area like the knees, I can inject hyper-diluted filler to add volume back to the area as well,” adds Dr. Parakh.
“For a long time, Ultherapy has been a gold standard for noninvasive skin tightening and lifting,” notes Dr. Gawley. “However, we now have more options with radio-frequency microneeding devices that help tighten, stimulate collagen and improve overall skin health just about anywhere on the body with little to no downtime.”
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Surgical Solutions
Nonsurgical options continue to gain popularity, but when skin is too lax and cannot be tightened to a degree that shows improvement, the most effective form of tightening remains excising the skin via surgery. “Significant laxity of the lower face and neck to the extent of deep jowls or neck bands will be better served with a lower facelift,” explains Dr. Mays. “Fine lines, wrinkles and volume loss can all be treated nonsurgically, but I find the best results occur when you combine surgical and nonsurgical solutions to treat multiple modalities of the aging face: texture, volume and loss of elasticity.”
Dr. Parakh also recommends surgery to patients who will not benefit from energy devices. “Surgically, a tummy tuck will address sagging skin of the abdomen, a brachioplasty—arm lift— will address sagging skin of the arms, and a thigh lift can address sagging in the knees. However, treating these areas preventively can help patients get ahead of it and postpone the need for surgical intervention.”
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All of the nonsurgical and minimally-invasive treatments mentioned in this story may have some benefit in the appropriate patient with early signs of aging, but for some patients results can be unpredictable. We strongly stress seeing a board-certified doctor who practices within scope and has vast experience and knowledge on the treatments in question. Of course, all cosmetic treatments can have a potential risk which is why it’s important to see a properly board-certified doctor.
