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What’s Important?

  1. Novel technologies in the aesthetic market continue to facilitate the growth of skin tightening procedures. This has led to improved patient experiences and clinical outcomes, while encouraging patients to further embrace cosmetic dermatology. Since skin tightening is a common cosmetic goal of many cosmetic patients, physicians should be familiar with the many devices and modalities available in order to optimize results.

What’s New?

  1. Newer RF devices have been equipped with subdermal probes and real-time monitoring to increase patient safety and reduce the potential for over-heating. Novel ultrasound devices have incorporated high-intensity, high-frequency, parallel ultrasound beams that bypass the epidermal layer and directs the thermal damage to depths of 0.5–2 mm, while avoiding injury to deeper anatomic structures. Patient interest in absorbable thread lifting is high, and newer absorbable threads have a favorable safety and efficacy profile compared to their predecessors.

What’s Coming?

  1. Thermomechanical fractional injury (TMFI) is a relatively new modality that combines thermal energy with motion. A current TMFI device focuses thermal energy on a titanium tip with a grid of pyramids, which, when heated, is pulsed to contact the skin surface and coagulate the tissue. The expansion of topical drug delivery via lasers and other energy-based devices may offer synergistic effects when combined with these skin tightening devices.


Lax and sagging skin is an inevitable sign of cutaneous aging. The onset and severity of crepiness is influenced by several intrinsic factors, such as fibroblast senescence with age, genetics, and ethnicity, as well as various extrinsic factors, such as ultraviolet radiation, environmental toxins, diet, smoking, and stress. On histology, lax skin shows dermal atrophy due to loss of collagen and elastin and decreased hydration.1 On the face, laxity can manifest as severe wrinkles, dermatochalasis or eyelid skin redundancy, and jowls. Areas on the body, such as the inner arms, abdomen, and upper thighs, may begin to show laxity in the mid to late thirties or even earlier in post-partum patients or those with a history of rapid weight loss. The gold standard for addressing skin laxity is rhytidectomy, which mechanically tightens the skin by excising redundant tissue and re-draping the underlying fascia and musculature. However, many patients find the risks associated with general anesthesia, extended recovery time, and unavoidable surgical scars unacceptable and instead opt for less invasive options.

Additionally, there has been a growing population of aesthetic patients who are younger individuals who exhibit mild laxity or desire preventive interventions. Young patients with mild to moderate laxity can be candidates for the less invasive modalities discussed below. Highlighting the demand for non-surgical approaches, in 2019, body-sculpting procedures, which include skin tightening procedures, saw a 62% increase, which was the largest increase of any cosmetic procedural category.2 Non-surgical approaches to tighten and lift sagging skin include microneedling, collagen-stimulating-soft-tissue injectables, laser and light devices, radiofrequency, intense focused ultrasound, thread lifting, cold atmospheric plasma, ...

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