As we age our skin loses collagen and elastin in addition to losing volume. The combination of skin laxity, fat volume loss and gravity all contribute to sagging and the loss of facial contours we once had. I am definitely a proponent of restoring volume as that makes a HUGE difference! Firming the skin can help quite a bit too.
There are a multitude of skin firming devices on the market. They all are used to create collagen stimulation (neocollagenesis) in the tissues by delivering a controlled dose of heat to create an injury to which your body responds by creating new collagen (collagen remodeling). There are numerous devices on the market that are utilized to deliver this tightening. More aggressive treatments that are ablative or sub-ablative (meaning the surface of the skin is affected helping with texture and/or pigmentation) are effective in stimulating collagen but have cosmetic downtime. The devices meant to create skin tightening alone have the benefit of sparing any injury on the surface and having little to no downtime. Familiar brand names in this category include Thermage® and Ultherapy®, amongst others. These are the two devices I have personal experience with.
Thermage® utilizes radiofrequency to deliver heat while Ultherapy® utilizes micro-focused ultrasound. Ultherapy® is the device Toccare offers for skin tightening. The ideal candidate for Ultherapy® has mild to moderate skin laxity, is a non-smoker and practices effective sun protection. Ultherapy® is not going to produce surgical results, therefore someone with more severe laxity should not be given any expectations that Ultherapy® will be able to provide adequate results. Managing expectations with Ultherapy® is key. The results are natural and subtle for the most part. Occasionally a really good collagen responder will have more dramatic results but that is not typical.
Ultherapy® is FDA approved for the noninvasive lifting of the eyebrow, neck and under chin. It is also approved for tightening the skin of the décolletage.
Ultherapy® IS uncomfortable. We have patients medicate to help take the edge off and get through the treatment. It is a treatment which takes anywhere from an hour to 3 hours depending on the area/areas treated. After a treatment there can be mild redness which is generally gone within a few hours. Some patients report feeling sore for a few days after the treatment. The results are seen 3-4 months after the treatment as the neocollagenesis takes time. Many patients report an improvement in the appearance of their skin in addition to the gradual tightening. For example, pores appear smaller.
After the age of 50 (or so) patients may find it beneficial to have a second treatment to obtain the results they are looking for. This is because as we age we just don’t generate the new collagen as well as when we are younger. This varies from patient to patient.
Ideally someone undergoing Ultherapy® (or any skin tightening) will also be on a supportive topical skin care regimen to optimize their results.