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How To Tighten Skin Without a Face Lift

What makes a person’s face look younger or older involves a number of variables, from skin texture, tone, and color to wrinkles, loss of volume, and sagging. The last of those—sagging—happens because collagen, the structural support of your skin, diminishes over time. Collagen loss also contributes mightily toward volume loss and wrinkle formation; the very best way to stay youthful-looking is not to lose it in the first place, says New York dermatologist Dr. Robert Anolik, clinical assistant professor of dermatology at the NYU School of Medicine (he also advised us on our piece about lasers). “The ultimate is prevention,” he says. “There’s truly no substitute for regular sunscreen use and a good lifestyle—no smoking, low alcohol, and sugar consumption, exercise, keeping inflammation in general down. Do it and you won’t have as much visible aging to begin with, and any results you get with anti-aging dermatology will be better, and they’ll hold longer.

“But what’s revolutionary now in lifting/tightening/firming is the ability to stimulate multiple layers of skin remodeling, not just the surface layer,” he explains. “The surface layer reveals many signs of aging, like fine lines, discoloration, blood vessels, sun spots, acne scars, etc. But it’s the remodeling of deep to surface collagen layers that lift and tighten.”

While most dermatologists agree, they often disagree on which is the absolute best treatment—understandable, because there are now so many options. “We all have different patients and different techniques that we’ve seen work,” says New York dermatologist Dr. Doris Day, clinical associate professor of dermatology at New York University Langone Medical Centers. “Doctors also tend to like the devices that they have in their offices: Technology in tightening devices is always evolving, so ‘the best treatment’ is sort of a moving target.” (Day has some 16 different devices in her office and says she tailors each treatment plan depending on the patient.)

Until recently, the ways to tighten skin were either mild—stimulating collagen in the very top layers of skin with treatments like peels, retinoids, and certain kinds of lasers—or severe—CO2 peels or pulling the skin tight with a surgical facelift, both of which involve downtime and a greater amount of risk.

Many people who might’ve gotten a facelift in the past are now opting for dermatological treatments instead, or at least forestalling the need for one, says Santa Monica dermatologist Karyn Grossman: “A very detailed consultation is so important—you have to weigh so many considerations.” She mentions downtime, risk, cost, durability (how long the effects are going to last), severity (in terms of the resulting look), and potential scars as factors (Dr. Grossman also wrote this piece for us on aging well.)

Less invasive therapies are making huge strides, in any case. “I feel confident we are delaying the need for surgical tightening procedures, says Anolik. “This is not to say some people don’t need plastic surgery—I regularly recommend patients for it—but this is a way of looking and feeling younger with much less downtime.” Injectible fillers temporarily replace lost collagen a little deeper in the skin: Dermatologists inject a filler along, say, the cheekbone, and the volume it creates pulls up the skin below. This sort of lifting has its limits, and is easy to overdo, but can also really help. Another approach, threading, lifts with physical threads that bind to the tissues of the face and stimulate collagen growth there. “I’ve seen great results with the new threading,” notes Day. Grossman is excited about the new threads: “Reports from friends abroad have shown good results—the combination of threading with other therapies like Thermage [see below] will add a whole new frontier to minimally invasive procedures.”

The biggest non-invasive technological breakthroughs are in radiofrequency and ultrasound devices, which build collagen by sending energy to different layers of the skin, radiofrequency in a broad, diffuse way, and ultrasound in a deeper, targeted way. “Think of the collagen fibers as a loose-knit sweater, and these treatments tighten that sweater,” says Anolik. Both usually require skin-numbing but have no downtime because they work beneath the top layer of skin; significant results develop over a period of months as the body grows the new collagen. “Ulthera is the backbone of most of the tightening I do,” says Day, who supplements it with radiofrequency treatments like EndyMed and Thermage. “I find the EndyMed treatments make the effects of the Ulthera last longer.” Grossman considers Thermage her gold standard for tightening but feels Ulthera is equally effective; Anolik prefers Ulthera but uses Thermage in certain situations.

Grossman says she gets incredible upper-eye tightening results with Thermage treatments, and prefers another radiofrequency device called Forma, which requires multiple sessions, for fullness in the lower eye area. She also loves Thermage for the neck; Anolik likes combine Ulthera with Botox—done a week before or after the Ulthera. “If I’m trying to lift the brow or the neck, but see muscle pull that is countering an upwards direction, then combining the process with Botox can be very helpful,” he says. “It helps create an optimal environment for unencumbered lifting.” Day likes Thermage for tightening the stomach and hips, and prefers Endymed for lifting the eye.

Microneedling technology combines with radiofrequency in several new devices. EndyMed makes an Intensif version of its radiofrequency device that uses microneedles to help remodel and build collagen. “What’s great with the EndyMed device is I can dial up or down the depth of the needles depending on the patient,” says Day. “It’s not a bloody procedure—there’s very little downtime. It’s reliable, it works on skin of color, for smoker’s lines around the lips, and it really lifts around the eyes. I like it for acne scars, too.”

Another emerging device, Infini, combines radiofrequency that’s able to target specific points in the skin the way Ulthera does, with the collagen-enhancing action of microneedles. “It’s exciting, and new, but the results are also new,” says Anolik. “It looks really promising. The idea with microneedling is you’re triggering an immune response to stimulate collagen production—I love the theory, but I haven’t seen results that bowled me over yet.”

Grossman, too, is excited about microneedling: “It has beautiful results in the neck, and recent studies have shown it may also improve cellulite on the back of the legs.”

If the many options sound like too much, Day thinks about it differently: “I think you get the best results doing a little of a lot of things—skincare, neuromodulators, diet, exercise, fillers, devices. It isn’t about going big in one particular area. We age in many different ways, and so It’s better to do a little of one thing and a little bit of another. It’s no longer about chasing wrinkles: Now we investigate the wrinkle.”

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