How Skin Tightening Procedures Works ?

Plain and straightforward, laser skin tightening is tightening the skin on the face, neck, or body using good old fashioned heat. According to New York-based dermatologist Dr. Marnie Nussbaum, it's one of the most effective methods for tightening the loose, crepey skin.

"After the age of 30, we slow down our production of collagen and elastin—the two proteins that help our skin stay firm, plump, and toned," she explains. "What non-surgical skin tightening with lasers does is target energy in the layers of the skin to stimulate that collagen and elastin production, which will gradually improve the texture and tone."

Do you find yourself gently pulling back the skin on your face when you look in the mirror and wishing it would stay there? Does the jiggle in your upper arms bother you?

A surgical lift, such as a facelift or eyelid surgery, will give you the most dramatic results, but you'll find plenty of other skin-tightening options. These alternatives offer less downtime and lower cost. Another perk: Many can be used on just about any part of your body that needs a lift.

Ahead, hear more from Nussbaum on how it works, how long it takes, how much it costs, and whether or not tightening hurts.

Non-surgical skin tightening procedures are cosmetic treatments to change the look of your face and your stomach. These procedures are far less invasive than surgical options, like facelifts and tummy tucks, and some people claim they can produce similar results. There are also fewer complication risks, it's less expensive, and recovery is simple.

These treatments are based on newer technologies. That means that there's still a gap in research to understand how effective they are and the long-term side effects.

skin tightening cream

Many factors contribute to sagging skin: age-related loss of collagen and elastin, UV damage, dehydration, and, well… 2020, which makes all of us feel like we're aging faster, even if we're not. Although limited access to dermatology treatments might mean an in-office Ultherapy pick-me-up isn't on the cards just yet, there are effective at-home skin-tightening remedies that can address everything from under-eye bags to a softening jawline without lasers, surgery, or other invasive interventions.

"We have so many potent activities that really can change the quality and health of our skin," says leading dermatologist Dr. Dendy Engelman. "And new ingredients are being discovered daily!" Here, she and New York dermatologist Dr. Whitney Bowe share some of their favourite home devices, rollers, creams, ingredients, and treatments that work to firm up the skin's face, neck, and body.

What Is Skin Tightening?

Skin tightening refers to various devices, products, and procedures that make the skin tighter by actually causing some degree of shrinkage and lift or by creating the appearance of tighter, more youthful-looking skin. However, the term "skin tightening" can be confusing. "Many skincare products, medical devices, and surgical procedures advertise how effective they are in tightening skin, but results can vary dramatically," says Alexis Parcells, MD, board-certified plastic surgeon and clinical instructor at RWJ Barnabas Health.

Why Does Skin Get Loose In The First Place?

In a word: Aging. Some sagging and loosening of the skin is a normal part of the aging process. Many factors play a role in the look and feel of your skin as you age. Time, gravity, genetics, exposure to smoke and air pollutants, diet, and radiation from the sun all contribute to your body's ability to restore or replace damaged skin cells. Additionally, as you age, your body's supply of collagen, elastin, and hyaluronic acid—the essential building blocks of skin—diminishes. At the same time, your ligaments, which provide the support structure that keeps these building blocks in place, start to weaken, resulting in thinner, saggy looking skin.

"It's important to understand the aging process and how different our bodies are because this influences what will be effective for you and why your results may differ from someone else's," she explains.

Why Consider Non-surgical Skin Tightening?

As we age, the production of collagen and elastin—two proteins that help our skin stay plump, firm and smooth—slows down, resulting in areas of lax, sagging skin on the face, neck and body. If you are bothered by skin laxity, non-surgical skin tightening can temporarily halt this process and restore a firmer, smoother, more youthful appearance with little to no downtime.

Benefits of non-surgical skin tightening

  • Tightens mild to moderately loose skin on the face, neck, or body without surgery or scars
  • Many treatments can provide a noticeable "lifting" effect
  • Little to no downtime is needed
  • Very low risk of adverse effects when performed by a qualified provider
  • Treatments can be performed in-office, typically in 1 hour or less
  • Results can last up to 1 year


  • Results appear gradually over several weeks or months following treatment
  • Multiple treatments may be needed to achieve desired results
  • Treatment will need to be repeated periodically to maintain results
  • Not effective on more advanced skin sagging, such as pronounced jowling or stretched skin following pregnancy or weight loss

Skin Tightening Procedures

Laser Skin Tightening

Lasers offer targeted treatment, and lasers that target collagen and water will thicken these structures and reduce fine lines and sun damage, Dr. Cassileth says. These non-surgical procedures are non-invasive, office-based, and have little to no downtime. While these are popular, the lift effect is usually minimal, and for best results, you'll need multiple treatments.

These work better for making your skin look younger by improving skin texture than they do for actually lifting it.

Lasers Can Tighten Skin Almost Anywhere On The Body.

According to Nussbaum, lasers can treat loose skin on the face, neck (and chin), décolletage, stomach, thighs, and anywhere else on the body you want to improve. Not all lasers are made equal, though—what might work magic on the butt isn't going to be the best option for tightening your under eye area.

Laser Tightening Is Non-invasive, Non-surgical, And Not Very Painful.

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Phew! Other than slight discomfort from the heat produced by lasers during the procedure, tightening your skin is practically painless. You might even enjoy the feeling of the heat, which Dr. Nussbaum compares to that of "a hot stone massage."

Radiofrequency (Thermalift, Thermage, and Exilis)

Thermalift was the first technology to use the concept of "waking up" or restoring lost collagen. Thermalift uses a device to apply controlled radio waves to the area of your skin that you would like to tighten. The procedure is done with topical or no anesthesia, and no recovery time is required.

Thermage requires one treatment session, but some people benefit from multiple sessions. Other types of radiofrequency treatment usually require multiple sessions to see results. Whether you get one treatment or several, results are only slightly noticeable right away and typically take 4 months to take full effect.

What is Radiofrequency Skin Tightening?

Radiofrequency (RF) therapy, also called radiofrequency skin tightening, is a non-surgical method of tightening your skin.

The procedure involves using energy waves to heat the deep layer of your skin, known as your dermis. This heat stimulates the production of collagen.

Collagen is the most common protein in your body. It creates the framework of your skin and gives your skin its firmness.

As you age, your cells produce less collagen, which leads to sagging skin and wrinkles. Skin laxity occurs around age 35 to 40 when the quantity and quality of your collagen begin to decline.

RF therapy has been used since 2001 to fight against sagging skin and signs of aging. In this article, we will look at how this cosmetic therapy works and what potential benefits it has for your skin.

Radiofrequency also uses a handheld device to heat the skin for a tightening effect. "With radiofrequency, we heat the skin at a more superficial level to trigger collagen production. There's little to no downtime. As with ultrasound treatments, it can feel really hot—it's like a hot stone massage. It's also a gradual process, so while you can be in and out of the office in under an hour, you'll need two to six treatments usually (depending on the size of the area you're treating, delivered 7-10 days apart," Nussbaum explains. As far as the most popular modalities go, you'll hear your doctor talk about name brands like Thermi and Therma, which both use the radiofrequency method.

How Radiofrequency Therapy For Skin Tightening Works

Thermalift was the first type of RF available for skin tightening, but now many companies offer similar technology.

Some of the most common types of systems in the United States include:

  • Exilis
  • Profound RF
  • Thermage
  • Thermi

Each type of technology works the same way. RF waves heat the deep layer of your skin to between 122 and 167°F (50–75°C).

Maintaining a temperature over 115°F (46°C) for over 3 minutes causes your body to release heat-shock proteins. These proteins stimulate your body to create new collagen fibres.

The procedure normally takes less than an hour and should be nearly painless.

What are radiofrequency waves?

RF waves are a form of radiation. Radiation is the release of energy in the form of electromagnetic waves.

It can be classified as low energy or high energy, depending on the amount of energy released. X-rays and gamma rays are examples of high energy radiation, while RF waves are considered low energy.

Radio waves, WiFi, and microwaves are all forms of RF waves.

The form of radiation used in RF skin tightening releases about 1 billion times less energy than X-rays.

Radiofrequency Micro-needling

Radiofrequency microneedling treatments are the hottest new thing, as it allows doctors to target heat to a specific depth and personalize it to the patient, Dr. Cassileth says. "These come in different strengths and powers, from a 'lunchtime lift' with a mild freshening effect to a heavy treatment that causes swelling for a week but produces more pronounced results," she says. "The more powerful treatments are often used by people who have sagging but want to avoid surgery, and a good treatment can take years off your face."

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RF energy heats the collagen under the skin's surface, causing it to contract as well as to create more collagen naturally, says Hardik Doshi, MD, a facial plastic surgeon at Discreet Plastic Surgery in New York City. "We tighten skin from the inside out and the outside in, sandwiching it between two wands," he explains. "One wand goes on top of the skin, causing collagen to contract and tighten, and the other goes underneath the skin where it liquefies the fat." The process is known as radiofrequency-assisted lipolysis.

A tiny puncture in the skin is needed to access the deeper level. Results appear gradually within six weeks to three months, he says. RF treatments can be used on the face and neck, or there are types formulated for the body. More than one treatment may be needed if the skin is extremely lax.

Microneedling With Other Technologies

Some newer procedures combine multiple technologies in one device to tighten skin. For example, Vivace is a new treatment that starts with micro-needling and adds radiofrequency and laser light. "It is the first device to use a robotic motor to gently push the needles into the skin, allowing smooth, precise control, no downtime, complete comfort, and the optimal delivery system post-treatment," says Sejal Shah, MD, founder of SmarterSkin Dermatology in New York City.

"Both the micro-needling and the radiofrequency components stimulate collagen, resulting in skin tightening," she says. "I use the treatment primarily on the face, neck, and chest but have used it in other areas of the body as well, such as hands, knees, abdomen." And so far, so good. "Most people have noticed immediately that skin appears more radiant and even tighter. Over time, the skin should appear smoother and firmer, with improved texture and reduced fine lines and wrinkles," she says. Some people also notice improved tone and more even pigmentation. The number of treatments needed varies but typically ranges from three to six. 

Nope, not the micro-needling you're thinking of. Rather than going full-Hemingway with a micro-needling pen, Nussbaum says the radiofrequency micro-needling tool is actually more comparable to a stamp. "It's not your typical microneedling with the pen. It's actually a motorized stamper with 37 gold plated needles," she explains. "So you're not destroying the epidermis and creating micro-tears like with micro-needling, you're actually stamping the skin to create microscopic holes, that then—once the needles are in—emit radiofrequency to tighten the layers." Like most laser treatments, radiofrequency micro-needling is a quickie, but the trade-off is that you need multiple treatments. Nussbaum says three to four sessions spaced four to six weeks apart usually does the trick.

Intense Pulsed Light/Radiofrequency (Velashape)

Velashape is a device that claims to target and shrink fat cells. It uses a handheld device to send infrared waves into your skin layers to break apart fat deposits.

Radiofrequency waves are also used. This procedure doesn't require anesthesia. Several appointments are usually recommended to get the most visible results. 

Ultrasound Skin Tightening

Ultrasound treatments are newer and are still being refined but show a lot of promise, Dr. Cassileth says. "Ultrasound can pass harmlessly through skin, heating and tightening deeper tissues. The handheld devices employ sound waves to boost collagen stores under the skin's surface, firming skin," she says. "However, we have noticed that this doesn't work for everyone, and sometimes these deep treatments are not enough. They seem to work better for heavy skin with more fat, as it will shrink and tighten up these structures that can cause sagging and jowling."

Ultrasounds aren't just for expectant mothers, apparently. According to Nussbaum, ultrasound laser treatments (Ulthera being the most popular brand name treatment) are extremely effective for those patients seeking a heavy-duty lift. "[The ultrasound method] focuses ultrasound energy to heat the skin at a deeper depth than the other modalities, so that you're tightening and lifting from deeper under the skin," she says. "The treatments are delivered by a handheld device that delivers ultrasound waves, and usually you really can do just one or two treatments spaced apart—based on how much plasticity you have."

During the procedure, your doctor will use ultrasound technology to look at the deep layers of skin that they're heating to ensure you're getting lift exactly where you want it. Do it on your lunch break, because it only takes 45-90 minutes. Fair warning, though, you'll need to be patient: "You really start to see the best result from that after 3 months," adds Nussbaum. "You get an immediate lift, but it takes three months to see the best result."

Surgical Alternatives For Skin Tightening

The alternatives to non-surgical skin tightening are much more invasive procedures. Facelifts and tummy tucks do provide dramatic results, but they require extensive recovery time. If you're looking for permanent and immediately noticeable results, surgical treatment might be more in line with your expectations.

Surgical alternatives also carry different risks. Non-surgical methods of skin tightening don't require any downtime, but surgery requires significant recovery time. Non-surgical methods also carry no risk of infection, whereas infections and complications are a possibility after surgery.

Another alternative for your midsection is liposuction. Liposuction is technically a type of surgery, but it generally has fewer risks than a tummy tuck. Liposuction can flatten your tummy, but it can also make your skin look wavy or saggy in the areas where fat was removed.

Skin Tightening As A Side Effect

With some procedures, firmer skin is more of a bonus than a goal. The results are not as dramatic as what can be achieved with procedures specifically designed to tighten skin. Still, these benefits may be enough for the right person to make a meaningful difference, Dr. Doshi says. Procedures that target fat loss (liposuction, Kybella, Coolsculpting), facial fillers (injectables like Juvaderm, Restylane), and products for wrinkles (Botox) all provide some degree of skin tightening as a happy side effect, he says.

How To Get The Most Out Of Skin Tightening Treatments

What you do in the doctor's office can only help so much; what you do at home will make all the difference in how well the treatments work and how long the results last. "I tell my patients they need three things: Compliance, a good skincare routine, and sunscreen," Dr. Parcells says. Ensure you complete your whole treatment program, follow all your doctor's directions, and then maintain your results by babying your skin and protecting it with a daily 30+ SPF sunscreen.