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Laser Facial Skin Tightening

Non-surgical skin tightening procedures are continuously growing in popularity. The idea is to apply a specific amount of heat from a laser device to cause the skin to contract and to induce a collagen production response.

The standard for skin tightening was full beam Erbium or CO2 lasers where the top layer of skin was removed while simultaneously applying heat to the deeper layers of the skin. Although consistently successful at improving the appearance of skin, long healing time and complications like scarring, skin pigment changes limited who would be a good candidate for this type of procedure.

New methods using the Erbium and CO2 lasers in a fractional or fractionated method have made these procedures more convenient. Fractional technology can be customized to spare the top layer of skin, or the epidermis, by using columns of laser energy to reach the dermis (the backbone of the skin) for the desired effect. The dermis is where collagen is generated, and where the skin contracts and tightens.

Although more safe and predictable, fractional lasers need to be done by trained and experienced physicians who know how to apply the right amount of laser energy to be effective and minimize risks and complications which often occurred with full beam lasers when used by inexperienced practitioners.

collagen response of fractional laser treatment illustration
LASER SKIN TIGHTENING INVOLVES A LASER PENETRATING THROUGH THE OUTER SKIN LAYER (EPIDERMIS) TO THE BACKBONE
OF THE SKIN (DERMIS) TO HEAT IT, WITH THE BODY RECOGNIZING IT AS AN INJURY. THE BODY’S REACTION TO THE INJURY IS TO
GENERATE MORE COLLAGEN TO HEAL THE SKIN AND TIGHTEN IT, GIVING IT A MORE YOUTHFUL QUALITY.
Collagen Response of Fractional Laser Treatment illustration
LASER SKIN TIGHTENING INVOLVES A LASER PENETRATING THROUGH THE OUTER SKIN LAYER (EPIDERMIS) TO THE BACKBONE
OF THE SKIN (DERMIS) TO HEAT IT, WITH THE BODY RECOGNIZING IT AS AN INJURY. THE BODY’S REACTION TO THE INJURY IS TO
GENERATE MORE COLLAGEN TO HEAL THE SKIN AND TIGHTEN IT, GIVING IT A MORE YOUTHFUL QUALITY.

Fully Ablative Laser Skin Resurfacing

Fully ablative laser skin resurfacing is frequently used for skin renewal and tightening of facial skin. The laser is used to take off the top layer of skin, or the epidermis, so a new, fresh layer of skin will come in. In addition the laser treatment induces skin contraction and additional collagen formation in the dermis.

The collagen response results from heating the dermis (the deeper skin layer below the surface layer called the epidermis) so the bonds that hold collagen together breakdown in a process called collagen denaturing. The body responds to the breakdown of collagen as an injury, so it reacts by generating new collagen, which once healed, gives skin a more youthful quality.

laser skin tightening before and after
FULLY ABLATIVE LASER TREATMENT REMOVES THE TOP LAYER OF SKIN (DERMIS) FOR REPLACEMENT WITH A FRESH, NEW LAYER OF SKIN,
WHILE STIMULATING COLLAGEN PRODUCTION AND CONTRACTION/TIGHTENING IN THE SKIN’S BACKBONE (DERMIS).
before and after Ablative laser skin resurfacing on face
FULLY ABLATIVE LASER TREATMENT REMOVES THE TOP LAYER OF SKIN (DERMIS) FOR REPLACEMENT WITH A FRESH, NEW LAYER OF SKIN,
WHILE STIMULATING COLLAGEN PRODUCTION AND CONTRACTION/TIGHTENING IN THE SKIN’S BACKBONE (DERMIS).

Risks of Complications Reduced with Gradual, Controlled Heat, and Adjustable Laser Beams

Dr. Amiya Prasad performing Non-surgical laser facial skin tightening on female patient
DR. PRASAD PERFORMING NON-SURGICAL LASER SKIN TIGHTENING FOR JOWL TREATMENT WITH GREATER TEMPERATURE AND BEAM CONTROL,
MAKING IT A SAFE, COMFORTABLE, AND FAST PROCEDURE FOR THE PATIENT, WHILE GIVING LASTING RESULTS.

While risks were reduced with the transition of full beam lasers to fractionated lasers, complications were still persistent with improper and overuse of fractionated lasers, especially when lasers are used in an attempt to replace cosmetic surgeries. The next generation of medical lasers took another step to provide the practitioner more control, and provide more comfort to the patient by limiting heat and the discomfort associated with high skin temperature. Lasers such as the new SP Dynamis Pro features Nd:YAG and Erbium lasers that reduce risks even further with:

  • greater temperature and energy control
  • more gradual heating of the skin layers
  • more options in controlling beam wavelength for precision
  • customized treatment without overheating
  • multiple modes to adjust levels of skin peeling, ablation, tightening, and resurfacing.

Non-Ablative Laser Facial Resurfacing

before and after Non-ablative laser facial resurfacing on older female
NON-ABLATIVE LASER CAN TIGHTEN FACIAL SKIN AND EVEN JOWLS WITHOUT ABLATING THE TOP LAYER OF SKIN (EPIDERMIS).
THE BACKBONE OF THE SKIN (DERMIS) IS PENETRATED WITH HEAT AND TIGHTENED,
AND STIMULATED TO PRODUCE MORE COLLAGEN, BUT WITH LITTLE TO NO RECOVERY TIME LIKE A FULLY ABLATIVE PROCEDURE.

Non-ablative laser facial resurfacing is a major step in quick recovery skin rejuvenation. Patients can recover with virtually no downtime and no redness. Non-ablative skin tightening can be performed using the FRAC3 setting of the ND:Yag laser in the SP Dynamis laser. FRAC3 uses short pulse duration with high power to contract skin and trigger a collagen response – without downtime.

FRAC3 non-ablative skin tightening works by focusing its energy on “islands” of the epidermis and dermis, so the surrounding skin tissue of the treatment area is not heated or ablated. The skin is still heated to induce a collagen response which results in tightening of the dermis at the same time avoiding affecting the protective layer of the skin (epidermis) so extended downtime and prolonged recovery are avoided.

Ablative vs Non-Ablative Laser Resurfacing

before and after Ablative laser facial resurfacing / facial skin tightening
ABLATIVE LASER SKIN TIGHTENING LEAVES MORE TEMPORARY REDNESS AND EXPOSURE DUE TO THE ABLATION
OF THE TOP LAYER OF SKIN, BUT IS MORE THOROUGH IN SKIN (EPIDERMIS) RENEWAL, AND MAXIMIZES COLLAGEN
STIMULATION AND TIGHTENING OF THE DERMIS. FULL ABLATION REMAINS THE STANDARD OF LASER SKIN SKIN TIGHTENING.

Generally, ablative laser skin resurfacing is the most thorough skin tightening method, and provides the best results for firmer, smoother, and tighter skin. However, ablation means that the protective layer of the skin, the epidermis, is temporarily compromised while healing and new collagen formation is ongoing, which leaves the skin looking pink to a light red during the recovery/ collagen formation process. The general rule of laser treatment is the deeper it penetrates the dermis, the better the results, but recovery time is also increased.

before and after Ablative laser facial resurfacing / facial skin tightening results
NON-ABLATIVE LASER SKIN TIGHTENING IS EFFECTIVE FOR WRINKLE TREATMENT AND INCREASED COLLAGEN IN
THE SKIN, WITHOUT REDNESS OR PROLONGED RECOVERY AS THE TOP LAYER OF SKIN IS NOT ABLATED.

Non-ablative laser skin resurfacing is often recommended during summer months when sun exposure is higher, or when someone wants to tighten skin close to a social deadline, like a wedding. Non-ablative laser treatment is also useful for skin imperfections such as pigmentation. If people want little to no downtime, then non-ablative skin tightening is still an effective option as heat still tightens the dermis and generates collagen, but the outer layer of skin (epidermis) doesn’t have the same prolonged redness as the ablative option.

Can I have laser treatment for wrinkles but without the downtime?

Since the mid-1990s laser treatment has become well established as one of the most

effective ways to treat wrinkles of course the term laser evokes

science-fiction imagery which implies immediate results with no downtime in

reality there are different ways that lasers can be used to help improve the

appearance of wrinkles based on principles which determine how the skin

heals after light energy is absorbed by different parts of the skin and how

different forms of energy interact with these parts of the skin one approach for

example is using a laser like the co2 laser which is absorbed by water to

remove the top layer of skin so afterwards a new smoother and more

youthful layer of skin can come in this is known as ablation in addition to

removing wrinkled and discolored skin the heat generated by the co2 laser can

cause the skin to contract and stimulate cells called fibroblasts to produce

collagen another laser technology which can improve the appearance of wrinkles

without any downtime is a non ablative laser when you learn about the existence

of these two very different options how do you decide what to do at a time when

a lot of lasers are aggressively marketed to be the best laser for

wrinkles every other day it’s helpful to understand some principles of laser

treatment so you can see past the noise and the hype if your goal is to improve

the appearance of wrinkles I’ll discuss how I apply customized strategies which

include lasers to help my patients improve their wrinkles without downtime

every day in my practice I’m Dr. Amiya Prasad I’m a Board-certified cosmetic

surgeon and Fellowship-trained oculofacial plastic and

reconstructive surgeon have been in practice in Manhattan and Long Island

for over 20 years I’ve been performing laser treatment since the mid 1990s with

the first fully ablative co2 lasers as technologies changed I continue to

integrate newer technologies such as fractional co2 and erbium laser as well

as more recent technological advances such as long pulse erbium and nd-yag

laser in addition to non ablative technology such as q-switch laser I also

perform radiofrequency treatments like peleve particularly for darker skin

types who are not laser candidates I was also among the first proponents of using

platelet-rich plasma or PRP for improving skin quality when the first

fully ablative co2 lasers were used in the 1990s the outer layer of facial skin

would be removed leaving the skin raw the aftercare was essentially burn

management downtime was for several weeks with intense redness lasting for

months once the new layers of skin came in and the wrinkles improved the

patients were mostly happy with their results this prolonged downtime as well

as conspicuous appearance in the first week to two weeks kept a lot of

potential patients away from this treatment fractional laser technology

allowed for shorter healing times for partially ablating the top layer of skin

and allow the skin to heal faster fractional laser treatments such as co2

and erbium are very effective in improving skin quality and texture as

well as stimulating collagen but they still require some downtime although

much less than fully ablative laser treatment so how can we apply the

benefits of laser technology without any downtime by first understanding the

underlying problem the skin we’re trying to address I look at it this way the

skin which is about two millimeters in thickness is made up of two

the dermis and the epidermis the dermis is the backbone or foundation of the

skin this foundation is supported by cables made of collagen aging health and

environmental factors caused breakdown and loss of collagen loss of collagen in

the skin has an effect on the skin like the brakes and the foundation of a

structure that would be like a building lines or wrinkles which are present at

rest refer to as static lines can be the result of loss of support caused by loss

of collagen a universal goal in the claim of superiority for every new

technology in the stimulation of the skin to produce collagen if you look at

the claims made by technologies such as laser or radiofrequency and micro

needling they all list the stimulation of collagen production as being a

significant benefit much of this stimulation of collagen is based on the

physiologic response of the skin to a medically induced controlled injury the

skin recovers from injury by producing collagen there is however a limit on how

much collagen can be generated by your skin regardless of the technology this

concept is something that I have observed as being generally ignored by

practitioners it is common in our practice to see a patient

after they had several different laser treatments by several different

practitioners over the course of a few years I often find the skin to be

scarred or thinner than I would expect this is the result of over treating I

compare this injury to the skin to be comparable to the type of injury which

occurs if you force someone with weak muscles to lift weights that are too

heavy this means that a strategy for wrinkle treatment needs to be well

thought out before being implemented to improve the appearance of wrinkles laser

treatment can be used to stimulate collagen in the dermis to restore

support and new the top layer of skin to restore

even texture and color during my assessment I look at what my patient

wants to improve and determine the level of severity of the fine lines they’re

interested in treating I explained to my patients that as a general rule the

deeper the lines the more aggressive the laser treatment needs to be practically

speaking I find that unless I’m doing a surgical procedure such as eyelid

surgery or facelift surgery when people are already taking a week or so off so

they have a period of time they will not be seen my patients generally prefer to

avoid procedures where the skin is ablated and they have to be out of

commission even for a few days for minimal to moderate depth wrinkles laser

treatment can be performed without ablation and without the downtime one

laser I use is a non ablative 1064 YAG laser the outer layer of skin is

preserved but the heat of the laser can penetrate into the dermis to induce a

collagen response and remodel the skin since wrinkles are often associated with

Sun induced skin discolorations I also treat these discolorations refer to as

solar disk crummiest and solar lenta goes I use the q-switch laser to treat

pigment at this level without ablation of the top layer skin in our office we

use the same q-switch laser for tattoo removal I then deliver platelet-rich

plasma or PRP to induce maximal collagen production within the body without using

heat PRP is a concentration of wound healing and growth factors present in

your blood PRP is prepared by drawing a patient’s blood and then spinning the

blood in a centrifuge to separate the platelets the skin can benefit from PRP

with collagen stimulation improvement in blood supply increase in skin thickness

which ultimately results in a nice glow and luster to the skin which is fairly

unique to PRP while PRP is often injected into the skin or applied

topically after micro needling I find that a treatment we call skin boosting

by using a specially designed device effectively delivers PRP directly into

the skin without causing swelling bleeding or bruising PRP can also be

mixed with hyaluronic acid to provide a scaffold for the fibroblasts to place

collagen more effectively as well as adding hydration to the dermis to

improve the skin surface or epidermis without downtime we help our patients

with a procedure called HydraFacial HydraFacial uses water for the same

effect as microdermabrasion to remove dead skin cells from the outer skin

layer while avoiding irritation often associated with traditional

microdermabrasion glycolic acid and hyaluronic acid is often used during the

HydraFacial session which provides maximum benefit to the epidermis Hydra

facial also involves no downtime and the skin can look really good right after

the procedure more aggressive lasers have an important role in wrinkle

treatment as skin improvement fractional and partially a blade of lasers like co2

erbium and Andy AGG are still highly effective for combined treatment or

improvement of the dermis and epidermis although downtime is required anytime

the outer skin layer is partially ablated it can be for a limited time in

my practice I strive to help my patients with minimal to moderate wrinkles with

combined combinations of technologies such as non ablative laser PRP and Hydra

facial to get maximum results with no downtime I provide my patients with

perspectives and a strategy for maintenance consumers our bra

with aggressive messaging from companies who pay celebrities to claim that the

secret to their youthful appearance is the technology that the celebrity was

paid to endorsed you can potentially avoid getting your skin cooked and

damaged by finding an ethical and highly experienced doctor to be with you for

the long-term so you can achieve your goals and look your best

I hope you found this information helpful thank you for your question

Caution with Thermal Energy Devices

Excessive use of heat or prolonged exposure to thermal energy devices can result in inadvertent loss of fat below the skin which creates youthful volume. Other complications include skin burn, blistering, scarring, and prolonged redness. Laser manufacturers recommend a doctor with extensive training with lasers perform these procedures to minimize these potential risks.

Eye Lift Surgery – before & after patient photos
damage skin layers from laser device illustration

LASER SKIN TIGHTENING WORKS BY PRIMARILY HEATING THE DERMIS TO TIGHTEN AND INCITE A COLLAGEN PRODUCTION RESPONSE. 

PROLONGED EXPOSURE OR EXCESSIVE HEAT CAN “COOK” THE ESSENTIAL FAT BENEATH THE DERMIS, AND DAMAGE THE SKIN LAYERS.

Why did I lose facial volume after laser radio frequency treatment?

We are continuously seeing people who are distressed by facial volume loss after

treatment with thermal energy devices this reflects a growing trend in the

aesthetic field I feel that thermal or skin heating devices such as the various

branded laser and radiofrequency technology are often aggressively

promoted as substitutes for surgical procedures such as facelifts and neck

lifts although these devices can modify the

skin through collagen stimulation and remodeling which can be beneficial for

facial aging they are not in any way replacing surgery I’ve observed the

effects of these devices being overused for people who are not candidates for

this type of technology yet these devices continue to be aggressively and

deceptively marketed as alternatives to surgery in the state of New York people

who perform lasers and radio frequency device procedures do not have to be

licensed physicians or nurses this means that unlicensed individuals can perform

procedures which can permanently change and even damage your skin regardless of

who uses these devices improper and overly aggressive use can cause facial

volume loss I’ll discuss the role of laser or radiofrequency technology in my

practice and how you can understand the indications for this technology so you

don’t overcook your skin I’m Dr. Amiya Prasad. I’m a Board-certified cosmetic

surgeon and Fellowship-trained oculofacial plastic and reconstructive

surgeon I’ve been practicing in Manhattan and Long Island for over 20

years I started using fully a blade of co2 lasers in the early 1990s since that

time I’ve continued to use light and radio frequency based technology in my

practice to help people improve the appearance of their skin prior to the

introduction of the co2 laser the gold standard for treatment of lines wrinkles

and skin discolorations was chemical peels with chemical peels whether

superficial medium or deep there is an ablation of different levels of skin

with regeneration of new skin a certain amount of collagen was created in

response to the peel which then improved the skin texture quality and color the

benefit that co2 lasers have over chemical peels is a skin tightening

effect caused by thermal energy delivered to the skin by the laser

the idea behind laser treatment is to apply a specific amount of heat from a

laser device to cause the skin to contract and to induce collagen

production through a controlled injury response these principles are relevant

when treating the skin which is about two millimeters in thickness there is a

general perception that facial aging only affects the skin which is why

anti-wrinkle creams and skin procedures are so popular the reality is that

facial aging is more significantly associated with bone loss and weakening

with sagging of the supporting soft tissue in clinical practice I’ve often

seen people in their 40s and 50s who feel that they may need some type of

tightening procedure this is because they pull upwards on the cheeks and show

me how they look better the basis for this perception is that soft tissue

volume is being repositioned through this action and improving the appearance

of areas where volume has been lost in my opinion

neither surgical lifting nor heat in skin-tightening is the optimal approach

to this type of situation if there is volume loss you restore volume however

it’s important to restore volume in the most anatomically beneficial way volume

loss is managed by the placement of injectable fillers in my practice I

prefer the hyaluronic acid fillers such as the Restylane and Juvederm family of

products traditional place where the fillers is within the skin at the level

of the dermis or just below the skin I approach facial volume loss differently

since a significant amount of volume loss is at the bone level I perform a

procedure called Structural Volumizing this method is based on applying the

principles used for the placement of facial implants such as cheek and chin

implants these implants are routinely placed on the bone and below the facial

muscles as a surgeon I’ve performed many of these procedures and I’m familiar

with this space I place long lasting fillers such as Juvederm Ultra Plus or

Juvederm Voluma to restore volume at the cheeks chin and jaw angle this method of

restoring volume lost by aging is much more impactful than any thermal energy

procedure once you understand this principle

you’ll recognize why heating up the skin makes no sense when the underlying issue

is the facial bone volume loss for people who are in their 50s and older

sagging of the supporting tissue called the smash and platysma muscle results in

gels and loose neck skin the optimal procedure for this type of situation is

a facelift or face a neck lift surgery this group of people is particularly

susceptible to the false promises of thermal based non-surgical face lifting

in addition at this time of your life your skin is thinner and the layer of

youthful fat under the skin continues to diminish in my practice I help many

people over the past two decades overcome their

fear of facelift surgery by performing these procedures and my certified office

operating facilities under local anesthesia with light intravenous or IV

sedation by avoiding both general anesthesia and institutional facilities

such as hospitals where you can feel like a number

my patients are able to undergo more definitive surgery with quicker recovery

the science behind thermal induced collagen remodeling as well as thermal

induced fat reduction is sound and can be effective the problem is that people

who are looking for a solution for volume loss and deeper tissue sagging of

being sold procedures which don’t deliver an often result in making you

look worse than you did before it is often the case that after thermal

treatment is not successful the practitioner will often dial up the heat

intensity or prolong heat exposure to the skin excessive use of heat or

prolonged exposure to thermal energy devices can result in loss of fat below

the skin a layer of fat under the skin is important for the appearance of

smooth and youthful skin this means that the treatment makes the skin end up

looking older other complications include skin burns blistering scarring

and prolonged redness during consultation it’s routine for patients

to ask me about different devices which they hear about I suggest to them to

first take an overview of the problems which concern them before determining

the options which suit their needs I take an

inside-out approach this means understanding the presence and extent of

one bone volume loss too soft-tissue volume loss three support

tissue and skin sagging and four skin quality in terms of wrinkling

discolorations and vessels based on understanding of the potential benefits

of thermal energy devices in improving skin thickness and smoothness I

developed strategies to achieve these goals with significantly lower risk we

use a variety of lasers in our practice such as fractional co2 fractional erbium

nd AG Q switch as well as radio frequency devices such as peleve when it

comes to aging skin there is usually a combination of issues such as wrinkles

and discolorations if we focus on the typical objectives of a therapy which is

to both stimulate the production of new collagen and improve the arrangement of

the collagen bundles skin looks younger and thicker and more even than we could

look at all the ways these objectives can be achieved

we should also factor in what is the potential capacity of a person’s skin to

produce collagen this capacity to produce collagen will be limited by

factors such as age sun damage smoking and previous treatments for many people

who come in for consultation they’ve previously had chemical peels lasers and

radiofrequency treatments this means there may be no effect or benefit from

thermal energy treatment or even potential breakdown of the skin’s

integrity this is why a proper examination by a highly experienced

physician is important before signing up for a treatment in my practice I

routinely combine technologies to improve the skin let’s consider a common

situation such as skin affected by chronically excessive sun exposure and

aging for the fine lines I use fractional and fully ablative RB

co2 laser for discolorations I use a q-switched laser for dermal thickening I

will use limited heating with long pulsed erbium as well as nd-yag laser

technology the technology used with long pulsed nd YAG can be used for both skin

remodeling and tightening as well as fat reduction for many patients I will also

do a procedure called skin boosting this is where I combine PRP or platelet-rich

plasma combined with hyaluronic acid and use a device to deposit this mixture

directly into the dermis and this is done without any bleeding or bruising

this combination will stimulate the collagen production and improve the skin

without heating many people who come to our office upset and angry about facial

volume loss from overuse of a thermal energy device performed elsewhere are

relieved to have a rejuvenated appearance by a rational approach from

the inside out most often a combination of structural

volumizing with skin boosting and an epidermal treatments such as hydro

facial results in a natural and improved appearance deceptive and high-pressure

marketing in the aesthetic field is not going away anytime soon the key is to

find a doctor you can trust and who you feel understands your cosmetic concerns to help you look your best

I hope you found this information helpful thank you for your question

 

Nd:YAG Laser Treatment

The Nd:YAG laser and other therapies can be performed for non-surgical fat loss. In the face, fat loss should be minimized as a small layer of fat gives facial skin a youthful volume and the fat layer also provides physiologic functions for skin for general health and a visible glow. The Nd:YAG laser technology can be focused to improve undesirable fat collection in the face such as the area under the chin and the jowls.

Facial Skin Tightening as a “Lunchtime Procedure”

Skin tightening is a quick, outpatient procedure that can be done during lunch hour. A whole cheek can be tightened to treat wrinkles in just a few minutes. Skin tightening for the whole face can take less than 30 minutes.

Contact us today for facial skin tightening at our Manhattan, New York City location or Garden City, Long Island by filling out the contact form below.

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