- Skin tightening procedures can be noninvasive, minimally invasive or surgical.
- Noninvasive skin tightening procedures are effective for temporarily tightening loose skin.
- Minimally invasive procedures result in longer-lasting, yet still temporary, improvements to skin laxity.
- Surgical procedures such as facelifts offer immediate improvement, but require the most downtime.
Loose skin and wrinkles develop with age or as a result of overexposure to the sun. Sagging skin and fine lines may make you feel like you look older than you actually are.
Fortunately, skin tightening procedures can reduce skin laxity and encourage collagen production (a protein that gives your skin firmness and elasticity).
Choosing the right skin tightening procedure depends on how loose your skin has become, your comfort level with a given procedure and your tolerance for a procedure’s side effects.
“We are fortunate to now have a wide variety of powerful tools available to rejuvenate the face,” says plastic surgeon Steven Goldman, MD. Unfortunately, with so many options, choosing the right treatment for loose skin can prove difficult. “There is not much scientific data available to compare the devices,” says Dr. Goldman. “Doctors rely heavily on anecdotal observations, which is inherently limited.”
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Do Skin Tightening Procedures Work?
The effectiveness of a given skin tightening procedure depends on how loose your skin has become and on the intensity of your treatment of choice.
With the exception of a facelift (or similar procedures such as a neck or eye lift), skin tightening procedures work by causing mild trauma to the deeper layers of skin and subcutaneous tissue. This is primarily done by using heat to damage the skin beneath the epidermis. These mild injuries triggers the natural collagen production process resulting in a tightening of the skin.
In contrast, a facelift requires incisions to be made on the face, near the ears and along the hairline. A layer of muscle and tissue beneath the skin is then pulled up and secured to bones behind and in front of the ears. The incisions are then closed, excess skin is trimmed and loose skin on the face is tightened.
Other surgical procedures can also target loose skin in specific areas of the face.“There are multiple variations of the facelift and multiple adjunctive procedures—like eyelid lifts, fat injections and laser resurfacing—that can also be used in conjunction with a facelift,” says Dr. Goldman.
Noninvasive Skin Tightening Procedures
A noninvasive skin tightening procedure is nonsurgical and causes no damage to the skin. Noninvasive skin tightening is effective for those with mild to moderate skin laxity.
Before considering a noninvasive skin tightening option, it is important to know if you are an eligible candidate.
“Patients with lots of skin laxity are not usually good candidates, and these treatments also work relatively poorly on the neck and under the chin. They work best on the cheeks and jawline, and can work well around the eyes and forehead,” says Dr. Goldman. “Younger patients are usually good candidates; older patients are more likely to need a facelift, blepharoplasty or other procedure.”
Even if you are an eligible candidate, patients should be aware of the results that these noninvasive procedures offer and set their expectations accordingly. “All nonsurgical skin tightening treatments produce subtle, not drastic, tightening,” says Dr. Goldman.
Radio frequency (RF) skin tightening
During RF skin tightening, heat is used to stimulate new collagen production and contract existing collagen fibers.
| Efficacy | Side effects | Downtime |
| Visible results within 6 months; may require multiple treatments Effects last 2–3 years | Mild to moderate pain during the procedure Redness and swelling for up to 24 hours (or 1 week in some cases) | Essentially no downtime for the noninvasive RF skin tightening No time off work is needed, however numbness or a mild tingling sensation may persist for a few weeks following the procedure |
Ultrasound skin tightening (ultherapy)
Ultrasound skin tightening uses ultrasound energy to send heat deep into the skin to encourage new collagen production.
In general, Dr. Goldman prefers the results of ultrasound skin tightening to RF options. “I feel that Ulthera works better than noninvasive RF treatments. That said, it is more painful during the procedure, not after, than most noninvasive RF treatments,” says Dr. Goldman.
| Efficacy | Side effects | Downtime |
| Visible results within 2–6 months with results lasting up to 1 year; may require multiple treatments | Some pain and discomfort during the procedure Occasional redness, swelling and bruising after treatment | No downtime is needed except in rare cases when mild swelling occurs Numbness or a mild tingling sensation may persist for a few weeks following treatment |
Nonablative laser treatment
Nonablative laser skin tightening uses lasers to heat the tissue beneath the epidermis to stimulate collagen production without damaging the skin.
Dr. Goldman prefers the results of other noninvasive options to nonablative laser treatment.
“I believe that ultrasound and RF skin tightening work better than noninvasive laser treatments, probably because ultrasound and RF can penetrate deeper than noninvasive laser treatments, since the light waves of these lasers are absorbed more readily,” says Dr. Goldman.
| Efficacy | Side effects | Downtime |
| Tightening is visible immediately, but the full effect usually takes at least 6 months May require multiple treatments | Mild pain, discomfort and stinging during the procedure Some swelling, redness or superficial blistering after treatment | Varies by treatment Some treatments will cause a mild peeling effect that is noticeable for 4–5 days; others will cause a minor amount of redness and require little to no down time |
Minimally Invasive Skin Tightening Procedures
Minimally invasive skin tightening procedures offer quicker, longer-lasting results than noninvasive treatments and are the most effective nonsurgical solution.
However, when compared to noninvasive options, minimally invasive procedures require sedation and a recovery period.
Microneedling (collagen induction therapy)
Microneedling is a skin tightening procedure that uses small needles to puncture skin, triggering the healing process and encouraging new collagen production.
| Efficacy | Side effects | Downtime |
| Results visible after 90 days, with more significant results visible after 150 days Skin continues to improve for up to 1 year May require multiple treatments | Requires sedation Mild discomfort, swelling, redness and skin irritation | May require 1 day to recover and some postprocedure skin care Mild bruising may persist for a few days following treatment |
Ablative laser resurfacing
Ablative laser resurfacing removes the top layer of skin to heat the tissue beneath, stimulating collagen production, resulting in a smoother, more uniform appearance of the skin.
The results of ablative laser resurfacing are among the best available outside of surgical options. “Ablative lasers, especially fractionated CO2 lasers, are the gold standard for resurfacing, treating wrinkles, sun damage, pigmentary changes and thin, crepey skin.” says Dr. Goldman. “Nothing smooths the skin’s surface better.”
| Efficacy | Side effects | Downtime |
| Most effective nonsurgical treatment for severe wrinkles, skin laxity and other skin conditions | Requires sedation Patients may experience acne, oozing, bleeding, crusting, postinflammatory hyperpigmentation (darkening of skin), redness, swelling, scarring and infection | Requires between 10 and 21 days to recover and postprocedure skin care |
Surgical Skin Tightening Procedures
A facelift, or rhytidectomy, is a form of plastic surgery that tightens loose skin on the face. Facelifts can be done at the first sign of aging.
Facelifts produce the most dramatic, longest-lasting results. Improvements are immediate and still visible more than 5 years after treatment, although the neck may begin to sag slightly.
“Facelifts are the standard for lifting and tightening the face and neck,” says Dr. Goldman. “Heavy jowls, a large waddle—excess skin below the chin—and large skin folds can only be effectively treated with a facelift.”
Sedatives and anesthesia are used during the surgery, so pain is minimal.
Adverse side effects of a facelift include:
| Side effect | Frequency of occurring |
| Swelling, bruising and numbness | Likely after surgery; fades gradually |
| Hematoma | 1–15% |
| Large hematoma requiring surgery | 1.9–3.6% |
| Skin necrosis (secondary to untreated large hematomas) | 1.1–3% |
| Nerve injury | 1–7% |
| Hypertrophic scars (caused by too much collagen) | Generally occur in areas with thin skin; treated with triamcinolone |
| Hair loss | 8.4% |
| Permanent hair loss | 1–3% |
| Infection | <1% |
| Injury to the parotid gland | Rare |
| Postinflammatory hyperpigmentation | More common in patients with Fitzpatrick skin types IV–VI; fades after a period of months |
| Hypopigmentation | Affects patients of all skin types; more likely to develop if necrosis occurs |
| Changes to skin contouring | May occur from localized hematomas; fades after several months and can be treated with massages and steroids Major deformations occur if too much fat is removed and will require fat transfer to resolve |
| Deep vein thrombosis | 5% seen primarily in elderly, immobile or trauma patients |
After a facelift, patients can expect 2–3 three weeks of downtime and must maintain a skin care regimen and avoid excessive physical activity.
Alternative Skin Tightening Treatments
Creams and lotions can serve as an alternative to a skin tightening procedure. Effective skin tightening creams include anti-aging ingredients that hydrate the skin and encourage the production of collagen and elastin, increasing skin’s firmness.
A proper skin care routine not only serves as an alternative to skin tightening procedures, it can also be a precursor to these treatments and a supplement to them. “Skin care should be used by surgical and nonsurgical patients,” says Dr. Goldman. “It addresses surface issues like pigment, pore size and fine wrinkles.”
The best skin tightening creams are dual-purpose and include ingredients to protect the skin from exposure to the sun while tightening loose skin. “Retinoic acid is the most powerful topical cream, with the most science behind it,” says Dr. Goldman. “Retinol is less powerful, but may cause less irritation.”
Takeaway
Noninvasive and minimally invasive skin tightening procedures are effective, yet temporary, anti-aging treatments. The heat generated during these procedures stimulates collagen production and gradually tightens the skin within a matter of months. Results of these procedures typically last between 2–3 years.
Cosmetic surgery provides the most dramatic and longest-lasting results, but has the most side effects and downtime.
Skin tightening creams serve as an effective alternative to a procedure, with proven efficacy in combating mild skin laxity and no downtime.
Sources
- Neil Sadick, Tissue Tightening Technologies: Fact or Fiction, Aesthetic Surgery Journal, Volume 28, Issue 2, March 2008, Pages 180–188, https://doi.org/10.1016/j.asj.2007.12.009
- Sanan A, Most SP. Rhytidectomy (Face-Lift Surgery). JAMA. 2018;320(22):2387. doi:10.1001/jama.2018.17292
- Jones BM, Lo SJ. How long does a face lift last? Objective and subjective measurements over a 5-year period. Plast Reconstr Surg. 2012 Dec;130(6):1317-27. doi:10.1097/PRS.0b013e31826d9f7f
- Moyer JS, Baker SR. Complications of rhytidectomy. Facial Plast Surg Clin North Am. 2005 Aug;13(3):469-78. ncbi.nlm.nih.gov/pubmed/16085292