I am asked all the time – by friends, family, patients, doctors, the dry cleaning lady, the person I just met at a wine tasting – about ways to tighten the skin without surgery. I finally have some great news for all interested parties – non-surgical skin tightening has come of age! Over the years, the tools that we have to tighten skin without surgery have expanded. One technology in particular has evolved – radiofrequency.

The first radiofrequency (RF) device to non-surgically tighten skin was the Thermage device introduced in 2003. 10 years later, Thermage treatments have been significantly enhanced and perfected and several other RF devices have been developed.

Radiofrequency devices deliver energy, in the form of heat, into different levels of the skin. This heat tightens collagen and stimulates collagen renewal. If you heat the skin consistently to a specific level – referred to as controlled bulk tissue heating – your skin’s collagen will respond in several ways. The first is a temperature induced immediate collagen contraction often giving some visible results right at the time of treatment. The other 2 ways are: collagen production which occurs over 3- 30 days increasing the thickness of skin; and lastly, collagen remodeling in the dermal layer of your skin which gives gradual tightening and skin enhancement initially over 1-6 months and possibly up to a year.

As a cosmetic dermatologist with a vast experience with a number of different lasers and devices over 15 years, I can tell you that I truly believe in radiofrequency technology. The ability to safely, consistently and gently heat tissue is revolutionary in how we treat aging skin. In the days of fully ablative CO2 laser resurfacing (think whole face burn), we were all amazed by the immediate collagen contraction induced by the heat spike from the laser impact; however, our enthusiasm was always buffered by the extreme downtime and side effects of the procedure. We saw the wonderful effects of the heat but we – and our patients – wanted an easier way. An easier way is now available and is continually evolving and is safe for all skin types.

Thermage was the first RF device to be used for non-surgical skin tightening. I have used this technology since it was first approved in 2003. The latest innovation of Thermage reflects 10 years of experience and ongoing research. The treatment tip now has many more pulses and delivers the heat more quickly and consistently to achieve more uniform tissue heating which results in 2 things – better collagen renewal and tightening and much less discomfort since there are not high peaks of heat.  Additionally, the treatment tip now vibrates during firing – this vibration “distracts” skin nerves, further minimizing any discomfort. If you have had a Thermage treatment in the past, this latest Thermage will seem entirely different – minimal or no pain and better results!

Exilis is a relatively new RF device that delivers RF energy in a continual, constant flow of energy through a handpiece that is moved over the skin. This technology avoids peaks of heat and thus the treatment is pain free and actually can feel quite good like a warm massage (careful – addiction alert! personal experience). Again the bulk heating of tissue is used to tighten and renew collagen as well as to increase local fat metabolism (with the body tip) to reduce circumference (like of thighs or arms for example). The Exilis can tighten skin of the face and neck and also of the arm, thigh, butt – with no pain and no downtime. The immediate results can be quite nice and so I also think of Exilis as a party or special event treatment – get a little tightening right before event.

Pelleve is another new RF treatment that utilizes very similar technology as Exilis but via a very much smaller handpiece so this is ideal to target smaller areas such as the eyes, décolleté, around the mouth and just under the chin.

A little note about rejuvenation around the eye area. This area is very challenging to treat with devices due to sensitive, thin skin which is subject to movement, dryness, irritation and increased lines. Laser treatments can be used but require multiple treatments – each with significant healing times. Persistent redness, up to several months, is not uncommon after more aggressive laser treatments and scarring can occur. The non-invasive RF treatments are a great option for the eye area – tighter skin and fewer lines with no downtime, no fuss, and no redness.

Radiofrequency treatments are safe for all skin types – tan or not – and all patients with only one exception – those with a pacemaker cannot have an RF treatment. You can do this treatment year round!

What does the future hold? Well, in radiofrequency, I believe the future to be very bright. First of all in the next few weeks we will be getting yet another RF device –Vanquish – which is able to treat a large area. The results of Vanquish in shrinking fat are remarkable – more to come… I also believe the future will include devices for home use. These devices will not have the power of the clinical devices but will be great for early or mild changes or for maintenance of results. I envision patients getting a treatment in the office that will be complemented and maintained with home treatments. Think about it…what a great way to keep your skin youthful, tight and resilient!

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