Are Energy Based Devices Effective to Tighten Loose Skin?

Skin tightening devices in liposuction – do they really work?

Many women want to have areas of fat removed from their bodies but are afraid of what might happen to the tightness of their skin once that fat is removed. Fears about loose skin, fears about wrinkling, and most importantly, fears about needing skin removed with resulting scars (tummy tucks, arm lifts, neck lifts and thigh lifts) is a real issue for patients thinking about liposuction.

That is why the skin tightening treatments that are currently available out there are so appealing to patients! Everyone wants tighter skin without surgery, right? Devices like J- plasma which market themselves as tightening skin after liposuction get a lot of attention from patients. Every day in our practice, we get questions about whether we do J-plasma or Body Tight. The answer is a resounding “yes” but remember, that old saying:

“if it sounds too good to be true it probably is”

While we currently use energy-based devices it must be pointed out that there is no clear-cut evidence that these devices actually do anything, except heat up the subcutaneous tissue, and in some cases, cause severe burns. There may be a tightening effect but it is not scientifically conclusive. Simple liposuction – just removing fat alone will cause the overlying skin to tighten extremely well in many patients. Some patients have thinner collagen in their skin due to age, child bearing or massive fluctuations in weight. In such patients their skin will never tighten – no matter what non-surgical treatment is done to their skin. In such patient’s skin removal surgeries are required to tighten skin.

In our New York City Liposuction and BBL practice, we advise our patients regarding their relative likelihood of needing a tummy tuck following abdominal liposuction, as follows:

• Age > 40: 33% risk
• One child or more: 33% risk
• 20 Pound Weight Loss: 33% risk

These risks are additive.

In the 15th century Leonardo Da Vinci drew picture of a helicopter but wasn’t aware that it required a motor in thrust. The concept was there but the technology hadn’t caught up to the concept.

DaVinci’s concept of the “Air Screw” was put to paper 500 years before the helicopter could be developed.

The idea of heating the subcutaneous fat and melting it to tighten the skin from destruction of collagen is a concept that has been around for over 30 years. Like Shrink-Wrap™ on a boat, heating collagen to denature it will result in tightening, shrinkage and internal scarring. In the 1980s and 90s ultrasonic liposuction was the energy used to apply heat to damage tissue and tighten it. Patients and surgeons experienced horrible scarring and burns with this technology and it was largely abandoned. In other words, there is a “fine line” of a perfect treatment zone – not enough heat and you will get no tightening of skin, too much heat and you will get burning of skin. It is the pursuit of this “fine line” that supports the continued research into this type of technology.

Recently, using radio frequency energy, the company Inmode has come out with a whole series of body tight devices: face tight, body tight, and many others. This is the most promising technology because of its enhanced safety features: these devices determine the temperature not only in the subcutaneous tissue but also on the outer level of skin – where burning would be visible. Indeed, there are excellent results with experienced surgeons leading the way using this modality. However, proper training is necessary. In the hands of less experienced surgeons, or non- surgical practitioners who buy these expensive devices to help market their practices, we will continue to see more unfavorable burns and results with energy-based devices.

Just as the helicopter is here today, unfortunately there remain crashes. And with energy-based devices, we will see a gradual improvement in the margin of error and hopefully some scientific proof that the actually do tighten the skin. Realistically, we will always experience some level of complications as we do in any surgical procedure that we perform, but the goal is to minimize these complications with the best technique, best patient selection and the best instrumentation. At the end of the day patients are best served by seeing an experienced surgeon who is unbiased and most importantly – trustworthy.