Laser skin tightening and much more!

Popular Esthetic Dermatology procedures include laser skin tightening via several methods:

The way I’ll do this “review” is to mix up the laser skin tightening procedures with the non laser procedures with similar results to that you can always say I’m making you an educated, sophisticated “beauty consumer.” I told you I would teach you how to look younger, right?

Carbon dioxide laser resurfacing.

For those desiring more drastic results, carbon dioxide laser resurfacing has been shown to be effective. You get nice, new skin, but it’s only recommended for those with lots of sun damage due to the long recovery process. It is thought of as a procedure to wipe out sun damage but is definitely also a form of laser skin tightening. But wow-is there a “recovery time!” It can be up to 6 months of facial redness. However do note that studies of the Lifeline ProPlus+ formatulation used after CO2 laser resurfacing, show a real shortening of recovery time.

Laser skin treatment before and after

The hour long procedure is usually done in an outpatient setting, and patients are sedated. As the laser is passed across the face, it sears through the paper-thin epidermis and into portions of the dermis—the skin’s thicker layer beneath the epidermis—to purge old, damaged collagen and generate four to five times more new collagen than retinoic acid does.

But be prepared: Your face essentially becomes an open, oozy wound that must be rigorously cared for until healed. That means virtual house arrest for two weeks, during which skin must be soaked with ice-cold water every few hours then slathered with a layer of ointment to avoid scarring and infection. During this time expect to take pain medications and lose some sleep. Once healed, skin may remain red for up to six months. However, again, the Lifeline ProPlus+ products shorten this time.

Lesser healing time – lesser “invasive” lasers which are also “ablatives”:

A newer generation of lasers (“fractionated ablatives”) are less invasive. They do indeed promote laser skin tightening but it’s more “gentle” than you just read with the CO2 laser. Instead of burning off the skin’s entire surface, microscopic beams of energy singe tiny plugs of tissue, leaving areas of untouched skin.

This promotes quicker healing. Patients are usually just red and swollen for a week or so and can usually resume their daily routine after that. While one carbon dioxide laser resurfacing session may yield results that last eight years, fractionated ablatives may require two or three sessions for best effects. The traditional procedure can cost between $5,000 to $8,000, and the fractionated ablatives, between $3,000 and $5,000 per treatment. Fraxel® is the best known and most widely used fractionated ablative laser.

Corrective Chemical Peels

Chemical Peel Before & AfterPeels, when properly administered, are one of the most powerful non-surgical skin improvements available. They remove cellular buildup, stimulate skin regeneration, and reduce wrinkles, fine lines, large pores and oiliness. They also aid in clearing blemishes, treating hyperpigmentation, and improving overall texture and tone.

Undergoing a chemical peel is a popular anti-aging non-surgical treatment because it’s considered an effective alternative to costly surgery. The procedure involves applying an acid-based solution to small areas of the skin, be it the face, hands, or neck.

The solution is typically washed away after two minutes, and to minimize discomfort, a small fan may be directed over the spot where the acid was applied. Depending on the strength of the formula used, it may take several treatments to see any noticeable results. With stronger peels, like phenol peels, the recovery time can be up to three months, because of the severely sunburned look the skin takes on.

The results of a phenol peel are close to the laser skin tightening results of a CO2 laser treatment at a fraction of the cost. But be careful-in un-trained hands chemical burns which leave scars are not all that un-common.

However light glycolic peels can be done as often as weekly with no “down time” and light TCA peels will work more quickly and be as little as 3-4 days of “down time”.


This is something new which is being used for fine lines, acne scarring and mild collagen-elastin stimulation. It is also showing great promise for stretch marks. The beauty of this is that hyaluronic acid mixtures are used to drive that product down into your dermis. This is where your own dwindling hyaluronic acid “lives”.

So this then gives you a radiant “several months” and there is only several days down time. This procedure is “thrown in here” because it is equivalent to having one Fraxel® laser skin tightening treatment at a much lower cost and less “down time.” Mesotherapy used to be used for a similar effect but has fallen out of favor due to very short improvement times and no real long term effects.

how to treat damaged skinDermapen® is a popular instrument being used. It looks pretty bloody but cleans up with minimal after effects, believe it or not!

Intense Pulsed Light (IPL): Intense pulsed light, or IPL, is an anti-aging non-surgical treatment that uses wavelengths of light to correct wrinkles under eyes, on foreheads and cheeks. It is another way to treat sun-damaged skin.

It is also used as a hair removal treatment. The procedure uses intense bursts of light applied to a small area via a handheld device. The process triggers a damage-control response in the skin, leading it to shed the old skin and take on a smoother, more youthful appearance. There may be mild pain and discomfort following the procedure. This is also often used for “age spots” with very good results. It too will stimulate collagen and elastin, although not to the extent that the other laser skin tightening methods will.

Now for my favorite laser skin tightening procedures!


GentleWaves LED photo modulation is part of the “non-invasives” which fall in the category of laser skin tightening which are the latest methods in the fight against aging. Unlike invasive surgical procedures or treatments that use harsh chemicals, GentleWaves uses low-intensity light-emitting diodes (LEDs) to stimulate the skin’s production of collagen, resulting in more youthful, rejuvenated skin. Alternately, it also suppresses the enzymes that breaks down collagen.

An LED device is applied to the area to be treated and only takes five minutes. No aftercare is required and the device is compatible with all skin types. It usually takes four to eight treatments to see results with this anti-aging non-surgical treatment, and the procedure is completely painless.


how to treat aging facial linesThermage® is indicated for those who want to address the visible signs of aging in just one treatment. It’s an anti-aging non-surgical procedure that’s clinically proven to safely treat fine lines and wrinkles on most body parts, including the face, eyes, neck, stomach, arms, hands, thighs, and buttocks. Thermage® has even been approved by the FDA for improving cellulite. (But it just doesn’t work – here is what does.) And here is a product that really reduces the appearance of cellulite.

Thermage® uses radio frequency to non-surgically tighten skin and lift problem areas on the body. It heats the deepest layers of skin to help tighten existing collagen and stimulate the natural renewal of collagen. Benefits of Thermage® as non-surgical treatment include the smoothing of wrinkly or uneven skin; better definition around the eyes, jaw, and neckline; and the smoothing and toning of dimples and wrinkles on the face and questionably the body.

Caution: Reviews of efficacy for everything written about vary widely so do your homework!


 infrared laser treatment Titan skin rejuvenation is an infrared laser treatment that uses light energy to stimulate new collagen growth deep beneath the skin’s surface. Titan has been shown to tighten skin on your face, arms, abdomen, and legs. A Titan procedure has also been shown to tighten pores and smooth away fine lines. While some patients report seeing results in as few as one or two months, the full benefits of the Titan procedure are not usually observed for at least three to six months.

Another caution: Reviews show best and most predictable results on face and neck only-but it does seem to predictably work in those areas.

Titan on steroids = Ultherapy:

This is the “rage” in the NYC and LA circuit: it does what Titan does but deeper and more effectively. A pain killer is recommended and so is a deep pocket as this effective annual treatment runs about $5000. The full benefits are seen at 6 months, as with the Titan. I have seen patients have excellent results with this one and I do not offer it in my practice so this is a totally unbiased endorsement.

Pulsed-Dye Lasers: Not a laser skin tightening procedure but I thought you’d like to know!

Pulsed-Dye Lasers (PLD) before and afterPulsed-dye lasers (PDLs) are a non-surgical treatment used for skin conditions such as port-wine stains, scars, spider veins, and more. Before the procedure starts, the dermatologist may do several test patches to determine the best strength for the laser. The laser will then be applied to the area being treated. The process sends short pulses to the area. There may be mild pain, but most of the time; a cooling spray will be applied to minimize any discomfort. PDL treatment only takes a few minutes, and it may require up to three treatments before any results are visible. Bruising is the most common side effect.

Fillers are another way to look younger

Cross-linked hyaluronic acid injections:

Hyaluronic Acid Injections before and afterFor an immediate fix, many people turn to “fillers.” A viscous hyaluronic acid is injected into facial folds and creases, plumping wrinkles from the inside out in about five minutes. Cells whose collagen production has waned are fooled into making more.

Cross-linked hyaluronic acid is one of many materials used and is particularly effective. How long such fillers last can depend on the amount used and wrinkle depth and can cost between $500 to $700 for each cubic centimeter injected. There is a great variation so be sure to “get it straight” so you get what you want. Botero is a thin, fine hyaluronic acid product, used for filling in around the mouth and under the eyes. The newest and longest lasting one called Volumina is used to not just augment cheekbones but to essentially “pull up” the face. There are others “in-between” these two.


naso-labial fold injections

This is a “creamy calcium” and often used for naso-labial fold injections. It tends to last a little longer than hyaluronic injections but the new Volumina might rival its staying power. It too stimulates collagen production. Between this and the hyaluronic “variants” injections of collagen have gone by the wayside.

Sculptra®: Not a filler but achieves similar results:

Approved by the FDA in 2009 for the correction of shallow to deep smile lines and other facial wrinkles, Sculptra® is not a wrinkle filler, but rather, a volumizer. Sculptra® works through a series of injections that fill the depressed areas of the face caused by aging (collagen loss). Sculptra® is made of a synthetic material known as poly-L-lactic acid, a substance that forms naturally in the body when you exercise. A full Sculptra® treatment consists, on average, of three sessions over a few months, and the results can last for more than two years.

If not over done these are serious skin care starter treatments:


Botox injections Before and After

Botox® is a popular anti-aging non-surgical treatment that involves injecting a diluted version of the botulinum toxin into muscles on the face. The toxin blocks the signal that tells the muscles to contract or cause the skin around the eyes or forehead to wrinkle.
Like many other anti-aging non-surgical treatments, Botox® is relatively painless and only topical anesthesia is used. Botox® is administered using a fine needle to minimize discomfort. Results typically appear within two weeks and last between four to six months.

But a disclaimer here – in “real life” results last 12-14 weeks according to most patients surveyed. Botox® is also used as a treatment for patients suffering from serious medical conditions, such as muscle disorders. The practice of 20 or 30-somethings using botox has been widely criticized. I’m not going to weigh in on that. However there is evidence that after 10-15 years of use in forehead lines, less and less is needed and it lasts much longer as the lines are possibly filled in with fatty tissue.


Reloxin® is an alternative to Botox® that achieves the same results. Like Botox®, it is derived from botulinum toxin type A. But unlike Botox®, the concentration of botulinum isn’t as high in Reloxin®; therefore, the results are reported to last longer. Like Botox®, Reloxin® is injected directly into the area being treated using a fine needle to minimize discomfort in the patient. The results reportedly last anywhere from five to six months. Note: according to most women surveyed, Reloxin® lasts the same amount of time as Botox®!

Thread Lift:

For those who don’t like the idea of going under the knife, but want the immediate benefits of a surgical neck or facelift, there’s the minimally invasive thread lift, also known as a suture lift or stitch lift. As the name implies, the procedure uses “threads” made out of specialized suture material to lift the skin of the eyebrows, mid-face, cheeks, and neck.

Unlike facelifts, thread lifts are minor surgery. Thread lifts are performed using a local anesthetic. Bandages are not required after a thread lift, and recovery time is just two to three days.

What they don’t tell you: These are advertised as Plastic Surgery alternatives at a lower price, but honestly, they don’t appear to last more than 18 months. So if you NEED plastic surgery “do it right” and I’ll tell you how.

First, let’s talk about the facial zones

Facial ZonesIf you have never looked at your face “this way”, if you are even thinking about Plastic Surgery you should.

Zone 1 is your forehead. Zone 2 is your eyes and temples. Zone 3 is your “midface”. Zone 4 is your jaw and just above it. Zone 5 is your neck.

The reason most total facelifts look just plain un-natural is actually a combination of things. Remember me telling you that you have to get your skin in shape, get rid of oxidative stress and inflammation and use great skin care products? Well that is step 1. The next step is to find a great Plastic Surgeon and make sure he/she is “up” on the latest procedures.

Now regarding the zones, when we cannot overcome sagging skin with ethocyn or botox or laser skin tightening and you can’t stand the sagging it’s time to judiciously pick “by the zone” and by the specific procedure.

Good Plastic Surgeons do surgeries just in one or two zones at a time and don’t insist that you have a full facelift under general anesthesia if you just need 1,2 or up to 3 “zones” attended to.

The secret that movies stars you see on this website know is to never have more than two adjacent zones “done” at the same time. Doing so is appearance altering and that is what you want to avoid- right? Who wants everyone saying “OH wow, you’ve had plastic surgery?” You want them to say you look great, look rested, seem to have more energy, whatever, but NOT THAT!

So as an example you can have an endoscopic brow lift (zone one) and a blepharoplasty (zone 2) but don’t go lower than that. However you can dip into zone 4 and 5 with a Z-lift and have your jaw and neck “done” at the same time if the surgeon is game. Get it?

Now let’s talk techniques:

Plastic surgery keeps evolving and evolving. An up-to-date Plastic surgeon should know how to do things like a forehead lift “endoscopically.” And he/she should be able to make 2 incisions behind the hairline so your scar is invisible.

Browlift B&AHe/she should know how to use lasers for things like jaw tightening and neck tightening-where incisions are tiny, lasers are inserted to basically “shrink-wrap” loose tissue. Gone are the days when plastic surgery will alter the tilt of your eyes or give you huge visible scars. Scars are now minute and become invisible within 3-6 months.

Now remember that each procedure, even if it’s called a “weekend XYZ” lift, means you are up and around but you still look like someone punched you in the eyes for a good 2+ weeks. So it’s down time and weighing the pro’s and cons. An example of one choice is what to do with upper eyelids drooping and eyebrows appearing to close to the eyes. A blepharoplasty will open the eyes but not fix the brows.

The choice could be getting an endoscopic brow lift or using Ultherapy treatments and Botox®. This is why you need a really good, board certified Plastic Surgeon who specializes in faces.

But no matter what, you need to keep your insides healthy and use amazing skin care products to optimize whatever procedure you have done.

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