To fully understand your options when it comes to skin-tightening procedures, it’s important to know a couple of definitions. “Non-surgical” procedures are those that do not involve actually cutting into the skin, as one might experience when having a facelift to rejuvenate their looks. “Minimally invasive”procedures, on the other hand, are those that do not require a scalpel, but do permeate the surface of skin in one way or another.
For those who don’t feel they are ready for full cosmetic surgery, minimally invasive procedures have become increasingly popular. The procedures provide a significantly lower downtime, or recovery period, before resuming normal daily practices, with less bruising, swelling and pain involved. They can also be less expensive.
But considering that minimally invasive procedures may not provide the full results of cosmetic surgery and may have to be repeated, when possible, to achieve desired effects, cost may be less of an issue over time.
“It really starts with the patients, even before they get to my door,” says Dr. John Mancoll, plastic surgeon and owner of Mancoll Cosmetic and Plastic Surgery in Virginia Beach. “For many patients, it’s not a scenario where I see them once and then treat them. They really need to decide for themselves what they are unhappy with. When a patient comes to me and says, ‘Tell me what you can do for me,’ my initial response is, ‘Tell me what you don’t like’, rather than me giving them a laundry list of things I could potentially do. So, I ask them to make their wish list from number one to whatever. We then look at what’s realistic for what they want, given how much ‘time, energy and treasure’ they want to put into it. Patients should also research where they want to have their procedure done. All patients should be very comfortable with the person they choose to perform their procedure. It is also a good idea to look at their before and after photos to see the quality of their work—understanding that they aren’t necessarily going to show you their average results. They’re going to show you their best.”
As far as options available to rejuvenate the skin, especially of the face, there are a number of factors that determine which procedures may work for you. “During preoperative analysis, evaluation requires assessment of the deeper structures of the face, the skin elasticity, and skin texture,” says Dr. Lambros K. Viennas, chief of the Division of Plastic Surgery at EVMS Medical Group. “Non-invasive skin tightening techniques may not correct the changes of aging including fat that has descended to a lower position on the face, or fat that has lost its volume, causing areas of depression.” More invasive procedures may be necessary to restore fat volume and lift the underlying fat tissue for a more youthful appearance. Loss of elasticity of the skin due to aging, genetics, and environment such as smoking or chronic sun exposure may also require more invasive procedures to rejuvenate the face. If it’s just a matter of facial wrinkles of the skin, then minimally invasive procedures, including Botox injections, hyaluronic acid fillers or fat grafts may be an option for treatment.”
If your facial foundation and skin are in good condition, there are a number of different types of minimally invasive procedures medical professionals can provide, including fractional laser procedures, radiofrequency procedures and micro-needling. All of these procedures are designed to generate natural responses in your skin that can produce a more youthful appearance.
“Non-surgical skin tightening techniques work by triggering the skin’s repair process,” says Dr. Leslie Coker, dermatologist with Associates in Dermatology in Hampton. “The trick is to cause just enough damage so this repair process or regeneration is triggered—new collagen is formed, and the result is smoother, tighter skin. Too much damage, and you could end up with overly thick and scarred skin. In our office, we have had success with Ultherapy, which focuses ultrasounds energy at a depth below the skin without injury to the outer layer. It is optimal for tightening areas like the jawline and neck. When addressing fine lines and roughened skin, there is a method called micro-needling. Similar to aerating a lawn, hundreds of tiny punctures are delivered over any skin surface, triggering another repair response. With an immediate application of a serum of your own protein-rich plasma (PRP), you have the ultimate self-help session.”
Although many minimally invasive techniques are generally used on the face, there are other parts of the body that can benefit from skin-tightening procedures.
“Simply put, people desire to look the best they can, whether it’s by buying a new suit, getting a new haircut or style, or in this case, making their skin look more youthful and vibrant with skin-tightening procedures,” says Dr. Edward Prodanovic, assistant professor, director of the Cutaneous Cancer Center, and director of the Pigmented Lesion Clinic at EVMS Medical Group and Dermatology. “People often say they feel much younger than they look, and many spend time and money seeking treatments to reflect their inner age. The great thing about today is that there are several non-invasive treatments that one could consider for skin tightening without the need for surgery. Typically, people have sought various facial aesthetic treatments, but now it has progressed to include other body parts, ranging from tightening of the neck, upper arms, breasts, abdominal areas, buttocks and thighs.”
Dr. J. Marshall Green III, plastic surgeon at Coastal Aesthetic Facial Surgery, uses a combination of techniques in one tool that has provided great success for his patients. “I’m going to tell you, full disclosure, my favorite surgical procedure is facelift surgery,” he says. “However, there are patients I see every day that want to look younger, could benefit from a facelift, but are just starting to age and aren’t quite ready for a facelift. Or they know they need a facelift, but don’t want surgery, for whatever reason. These are the patients that bring up why we need a non-surgical option. The latest thing that I’m excited about is radiofrequency micro-needling. It takes a lot of the radiofrequency and delivers it deep down into the tissue. So you get lifting and tightening from deeper down, and there is only a day or two of downtime. Then they can watch the results over the next couple of weeks or months with no surgery at all.”
According to Dr. Eric Dobratz, EVMS/Sentara endowed chair for academic leadership advancement, associate professor, director of Facial Plastic and Reconstructive Surgery and Residency Program director at Eastern Virginia Medical School’s Department of Otolaryngology, there are also instances when patients may need skin-tightening procedures for non-cosmetic reasons.
“There are times when patients may suffer loss of facial volume due to medical conditions that cause atrophy of fat in their face, and the skin will become lax,” he says. “In these instances, we can replace the lost volume to tighten the skin and improve financial contour. There are other times when a trauma may cause loss of underlying volume, which can also be helped by adding back volume to improve contours and tighten the skin. Hyaluronic acid fillers have been around for many years and are very safe. They have the benefit of being well-tolerated by most patients with very few patients having allergic reactions to the filler. These have traditionally been used for filling lines around the mouth and lips. However, in the past few years, newer HA fillers have been indicated for deeper injections into the midface, near the cheek bones. These fillers allow us to replace the volume that is lost in this area as we age and can actually lift the skin of the cheek.”
All of the doctors agree that anyone considering any kind of skin-tightening procedure should consult with a medical professional first to review the patient’s wishes and expectations, assess the current condition of the skin and supporting tissues, then come up with the right course of action to achieve success.
“Minimally invasive procedures can be powerful in providing rejuvenation in the appropriately selected candidates,” says Dr. Dobratz. “However, there are a number of patients that would be best served with traditional ‘surgical’ techniques to tighten their skin. These patients will be underwhelmed and generally disappointed with minimally invasive procedures. So, appropriate patient selection is key, and patients should make sure they are counseled about all options—both surgical and non-surgical—to know what is appropriate for them.”
