Speaker offers insight on myths, realities of skin-tightening technologies

SAN DIEGO — Non-surgical total body rejuvenation has shown increasing popularity in recent years; however, the technology is still in the early stages of development, and several factors must be understood for success, according to a speaker here.

Neil Sadick, MD, FACP, FAACS, FACPh, FAAD, discussed the different types of technology and procedures available for, as well as the myths and realities associated with, non-surgical skin tightening during the American Society for Dermatological Surgery Annual Meeting.

Among the available types of non-surgical skin-tightening technologies are broadband light, radiofrequency, intense focused ultrasound and internal laser fiber. The technologies do not all perform equally, however, with each offering its own advantages and disadvantages with regard to results, costs and efficacy on different parts of the body. Additionally, not all patients show comparable responses to the different technologies, Sadick said.

Available technologies

Broadband light was the first technology used for skin tightening, according to Sadick. The procedure uses infrared light to reach relatively deep areas of the dermis.

“You can have excellent results,” Sadick said. “We use this with postpartum women who do not want to have abdominal surgery relatively soon after pregnancy.”

Radiofrequency technology encompasses four generations of technology, Sadick said. These include unipolar radiofrequency (first generation); bipolar radiofrequency and bipolar radiofrequency plus pulsed light (second generation); multi-generator, multi-polar and micro-needle radiofrequency (third generation); and multi-polar radiofrequency plus pulsed electromagnetic fields with and without suction, fractional radiofrequency and sub-dermal radiofrequency (fourth generation).

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Significant improvement can be seen with unipolar radiofrequency, according to Sadick. Additionally, most of the deeper-penetrating technologies can also provide fat reduction if used properly, he said.

Multi-polar radiofrequency plus pulsed electromagnetic fields with suction offers a fast, homogenous method of heating of the treated area and boasts a lower overall energy level, which yields high safety, according to Sadick. The combination procedure also increases collagen and elastin synthesis and reduces cellulite.

Intense focused ultrasound — a newer technology — allows dermatologists to vary the depth of ultrasound energy delivered to the skin and is commonly used for body contouring on the arms, thighs and knees, according to Sadick.

“On the face, this is the No. 1 technology I usually start with,” he said. “On the body, I usually use unipolar radiofrequency technology for skin tightening, as it can offer significant results after one treatment.”

Internal laser fiber, which Sadick described as the newest technology on the market, significantly increases skin elasticity, in addition to increasing dermal thickness and homogeneity.

Myths and realties

A common myth regarding the use of non-surgical skin-tightening is that maintenance programs are not needed. However, maintenance programs are necessary to maintain skin-tightening results, according to Sadick, who typically recommends patients return once a year for body treatments and twice a year for face treatments.

Another common myth — that temperature monitoring is unimportant — is perhaps one of the most important factors, he said. Sadick defined 55º C to 90º C in deeper tissue and 42º C to 46º C on the skin’s surface as the “sweet zone” in which optimal collagen contraction is achieved for long-term dermal maintenance remodeling.

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Among the factors dermatologists must understand is that the technologies have varied associated costs, with some systems ranging from $60,000 to $150,000. Sadick recommended test-driving the available technologies before committing to purchasing in order to see what works best for a particular practice’s patients and economic model.

One of the most important realities, according to Sadick, is that setting realistic patient expectations is essential, and photo documentation is of the utmost importance, as patients may not be able to fully appreciate the changes they have undergone after 6 to 12 months of treatment.

Little histopathologic documentation of results 6 to 12 months following a procedure exist; therefore, it is the physician’s responsibility to explain procedure success rates and methods, Sadick said.

Reference:

Sadick N. Evidence-based myth and reality of skin-tightening technologies. Presented at: American Society for Dermatological Surgery Annual Meeting. Nov. 6-9, 2014; San Diego.

Disclosure: Sadick is a consultant and trainer for and receives stock options, grants for research and honoraria from Venus. He also receives equipment for research from Solta and honoraria for Endymed.