Percutaneous Skin Tightening

This is part 2 of a 2-part series.

Part 1: Surgical vs. Nonsurgical Skin Tightening

The third category of nonsurgical skin tightening includes percutaneous devices: helium plasma (Renuvion), Smartlipo (Cynosure), Thermi (Thermigen), and Facetite (InMode).

Percutaneous devices put the energy where it’s needed, allowing multiple dimensions of lateral and vertical tightening and modification of the fatty tissue layer.

“When you heat those tissues, the amount of contraction you get in the fibroseptal network is markedly more than double what you get in the dermis and facia,” says Dr. Hamilton, referencing a study from Aesthetic Plastic Surgery.² “And so that's really where we want to be placing energy to get the maximum improvement. And percutaneous skin tightening devices do that.”

By comparison, the skin tightening effects with liposuction are no match for those possible with percutaneous RF.

“While you can expect 6% to 10% [skin tightening with liposuction], studies have shown that you can get about double that with laser-assisted liposuction, and then percutaneous RF in studies has been shown to be significantly [25% to 50%] more than laser-assisted liposuction,” he says.

Both Thermi (monopolar) and Facetite (bipolar) work well as percutaneous RF devices, says Dr. Hamilton, but his preference is for Facetite.

“Facetite is a little quicker procedure, a little easier for the surgeon… Temperature is measured both at the tip and externally, so you're getting both internal and external temperature, which allows you to protect the skin and also makes sure you're getting to the temperatures you want to get to,” he says.

But this device is also not without issues.

“Even with all this monitoring and safety, you do get occasional hotspots, especially if you're pushing the settings a little bit,” he cautions.

Another, more significant issue, says Dr. Hamilton, is temporary hair loss. He says he won’t use the device on men with facial hair who have any concerns.

Although Dr. Hamilton isn’t sure that he’s seen results that match those of published studies (13% to 47% skin contraction at six months and 35% to 60% at one year), “…there definitely is fairly consistent contraction with this device,” he says.

“I think radiofrequency is the most proven energy for skin tightening. It’s safe, effective, and relatively quick.”

Dr. Hamilton says to wait and see what happens with helium plasma for nonsurgical skin tightening in the months and years to come.

“They had a really nice recent study in November of 2019 in PRS,³ demonstrating safety. So I do think there's a promising future with this and I think it's something to watch.”

When evaluating nonsurgical skin tightening devices, Dr. Hamilton stresses the importance of also discussing surgical solutions.

“It's important to be honest with our patients that most of our devices offer very limited ability to consistently tighten the skin,” he says. “These radiofrequency devices, though, I do think offer the best option at this point for nonsurgical tightening. But always remember surgical results will still far outperform even the best skin tightening devices.”

References:

1. Alexiades-Armenakas M, Rosenberg D, Renton B, Dover J, Arndt K. Blinded, randomized, quantitative grading comparison of minimally invasive, fractional radiofrequency and surgical face-lift to treat skin laxity. Arch Dermatol. 2010;146(4).
2. Paul M, Blugerman G, Kreindel M, Mulholland RS. Three-dimensional radiofrequency tissue tightening: a proposed mechanism and applications for body contouring. Aesth Plast Surg. 2011;35(1):87-95.
3. Doolabh V. A single-site postmarket retrospective chart review of subdermal coagulation procedures with Renuvion: Plastic and Reconstructive Surgery - Global Open. 2019;7(11):e2502.