Before and After Two Titan™ treatments.Tissue tightening truly represents a revolutionary new method for non-surgical 3-dimensional rejuvenation. Tissue tightening is a non-invasive procedure meant to tighten and lift lax or sagging and wrinkled skin. It is based on the fact that medium to deep heating of the skin causes both immediate collagen contraction and new collagen production that occurs over a 4-6 month period. At Advanced Dermatology, we have all three of the leading tissue tightening technologies: the ThermaCool TC™, Titan™ and ReFirme™ST. The most common areas treated are the face and neck, resulting in firmer, tighter, and lifted jowls, cheeks, neck, and forehead. Newer indications include tightening of the eyelids (Eyes by Thermage™), hands (Hands by Thermage™), abdomen (Tummy by Thermage™), lips (Lips by Thermage™), arms, thighs, and buttocks (Body by Thermage™).
Before (left) and 2 months after (right) one Fraxel® SR1500 and one Thermage Tissue Tightening treatments for stretch marks and skin laxity. Photos courtesy of Advanced Dermatology.
Before and 4 Months After One Lower Face Thermage Treatment. Photos courtesy of Advanced Dermatology.
What is Tissue Tightening?
Scientists recently discovered that light and radiofrequency energy can be used to heat deeper layers of the skin while protecting the surface of the skin. This heating activates fibroblasts signaling new collagen to form and existing collagen to tighten over time. We currently have three devices that use this technology to tighten tissue: ReFirme™ by Syneron, Coolglide Xeo Titan™ by Cutera, and Thermacool TC™ by Thermage®.
The ReFirme™ combines infrared light (700-2000nm) with bipolar conducted radiofrequency. The Titan™ utilizes a pulsed broadband infrared source of 850-3000nm. The ThermaCool TC™ uses radiofrequency.
Thermacool TC™ has been studied in US clinical trials for treatment of wrinkles of the face. This system is currently cleared by the FDA for this indication and in 2006 gained clearance for the non-invasive treatment of additional areas that allow for Eyes by Thermage™, Body by Thermage™, Hands by Thermage™, and Tummy by Thermage™ to now be available at Advanced Dermatology.
Titan™ has been FDA indicated for the temporary relief of minor joint pain associated with arthritis, temperature increase in local circulation where applied, and relaxation of muscles.
Tissue tightening is not meant to replace surgical procedures such as face, eyelid, and neck lifts, but it is a good option for people who have mild-moderate changes and who understand that the results are noticeable but modest. These procedures represent an important and recent advance allowing dermasurgeons to achieve 3-dimensional rejuvenation of the face and body without surgery.
Who is a candidate?
Anyone who is looking to tighten and lift their jowls, neck, cheeks, and forehead is a good candidate. Also lax skin on the eyelids, a heavy brow, or upper eyelid drooping, as well as lax abdominal skin, upper arm skin, or lax buttocks or thighs may benefit from these treatments. In some cases we also find patients with superficial acne scars, rough skin texture, and mild to moderate superficial wrinkles can gain improvement with these treatments. You must understand the risks, costs, and time necessary to achieve the full benefit of the procedure(s) and have realistic expectations of the ultimate outcome.
You should not have treatment with any of these devices if you are pregnant or have been on Accutane within the past 3 months. If you have a pacemaker, internal defibrillator, or metal implants you may not have radiofrequency treatments, but you may be treated with the Titan™. If you are diabetic, have autoimmune disease, have recently been treated with chemotherapy, or are over 65, you may need more treatments to achieve less effect due to possible slow collagen production. You may not undergo Eyes by Thermage™ if you have recently had Lasik or eye surgery without permission by your ophthalmologist. Patients with a history of HSV (cold sores) may have a flare after a treatment. We can prescribe prophylactic medications prior to treatment.
What is Tissue Tightening like?
These procedures can be somewhat uncomfortable during but are not unusually so after. It can feel like a "hot pinch" toward the end of each pulse. You need to feel some warmth and a little bit of discomfort but not outright pain in order for the proper energy to be delivered. Occasionally oral pain pre-medication may be taken for someone who is especially fearful or intolerant of discomfort. Tissue tightening procedures are no down-time procedures. This means that you should be able to come for your treatment and go back to your activities of daily life the same day. Your skin may appear to be slightly red or slightly swollen after the procedure but makeup or sunscreen may be applied immediately. For Eyes by Thermage™ plastic ocular shields will be inserted onto the eye for protection during the treatment. One eye shield will be inserted at a time to reduce anxiety or claustrophobia that could result during this treatment.
How does Tissue Tightening work ?
Certain light energies and radiofrequency energy can be used to heat deeper layers of the skin while protecting the surface of the skin. This heating activates fibroblasts signaling new collagen to form and existing collagen to tighten over time.
What type of equipment is used?
We currently have three devices that use this technology to tighten tissue: ThermaCool TC™ by Thermage®, Coolglide Xeo Titan™ by Cutera, and ReFirme™ by Syneron.
The ReFirme™ combines infrared light (700-2000nm) with bipolar conducted radiofrequency. The Titan™ utilizes a pulsed broadband infrared source of 850-3000nm. The ThermaCool TC™ uses radiofrequency.
What desired results can be expected?
In most patients a definite but modest to moderate improvement in the area treated is expected. For facial procedures and depending on the treatment area you can expect improved jaw line definition (less jowling), a more toned central cheek area, and a firmer, less lax neck. For Eyes by Thermage™, expect less wrinkled eye skin, less hooding of the upper eyelid area, and a firmer contour around the eye. For Body by Thermage™, Tummy by Thermage™ or body tightening procedures with Titan™ you can achieve toning of the abdomen and reduction of laxity, toning and narrowing of upper arm or thigh. It is important that you understand that the results may take up to 6 months to be appreciated and that they are not expected to achieve the same degree of improvement as surgical procedures.
Some patients have significant results with just one Thermage® procedure, but one to three repeat treatments may be needed for others to achieve the same improvement. Improvement with Titan™ and ReFirme™ may be seen in two to six treatments. Although in some patients the results from a treatment are seen immediately, in most patients they will appear gradually over 2-6 months.
Are there any negatives?
The mild discomfort and lack of definite immediate improvement are the most commonly noted negatives for tissue tightening. The protocol methods for performing tissue tightening treatments have changed since the release of these devices. The discomfort has decreased with these changes and the chance for more immediate improvement has increased. To evaluate results, we have patients come in for follow-up evaluations visits six months following the treatments.
Short-term immediate risks include prolonged redness at the area being treated, although this usually dissipates before you leave the office or within a couple of hours. Swelling can occur and could last for a few days to a week. In some rare instances, swelling and redness have lasted several weeks. The treatment area may also become temporarily white (blanching) following a treatment. Blanching typically resolves within 24 hours.
Nobody is sure how long the effects last. We know that most people get at least 1-2 years of effect from their procedure but no definitive studies on long-term effect have been undertaken.
There is a very low chance (less than 1%) that other side effects may be experienced. The potential other side effects are bruising, skin wound, infection and scarring, hypo (too little) and hyper (too much) pigmentation, alter sensation, and surface irregularities.
Patients may also experience claustrophobia while receiving Eyes by Thermage™ procedure. We do our best to limit this side effect by using one ocular shield at a time while providing this treatment.
What happens after Tissue Tightening?
Immediately after the treatment(s), there may be some redness or swelling at the area being treated, which usually dissipates within the hour or by the end of the day but rarely persists for a few days. You should be able to apply makeup or sunscreen immediately after the procedure and go back to your daily activities.
For Eyes by Thermage™, it may take a couple of hours before your eyes do not feel sensitive to light and you may have some swelling for 1-2 days. We also do not recommend any eye makeup application for at least 2 days after this treatment.
Is there another way to get the same effect?
The main alternatives to tissue tightening are surgical (blephroplasty or eyelift, face-lift, tummy tuck, and other surgical skin tightening options), liposuction, injectable fillers, BOTOX® Cosmetic, and the Pan G™ Lift (muscle stimulation device).
How is this different than other procedures?
These treatments help to firm and tighten skin laxity by allowing for new collagen production and tightening. Alternative methods will help tighten and lift muscular atrophy (the Pan G™ Lift), plump and fill in lines and folds (injectable fillers), relax depressive muscles to achieve a brow-lift (BOTOX® Cosmetic). Surgical procedures cut through excess tissue and remove it, suturing the remaining back in place.
Can this be combined with other treatments?
These treatments may be combined with other treatment methods or may be done individually. BOTOX® Cosmetic and injectable fillers are commonly combined to achieve a more dramatic effect than by itself. Virtually any procedure (even post or pre-surgery) may be combined with tissue tightening. Also tissue tightening does not preclude you from having additional treatments in the future or undergoing surgery.
What is the cost of Tissue Tightening?
The cost of these procedures is based on the area being treated. Please call Advanced Dermatology for a consultation and the Cosmetic Coordinator will develop a personalized treatment protocol with you.
