Multiple Skin Tightening Devices in NYC: Why Matching Technology to Your Skin Matters

You may be looking for a New York City practice with multiple skin tightening devices because you worry that a single-device office will recommend whatever it owns. Still, the number of machines matters less than whether the recommendation came from examining your skin. I'm Dr. Debra Jaliman, and that examination is where I start.

Two people can have very different skin. One has thin, finely lined skin on her cheeks and almost no sagging. The other has thicker skin that has started to sag along the jawline. Each goes to a different office, and each is offered the device that happens to be in the room, so in each case the recommendation followed the equipment.

In my Manhattan dermatology practice, I recommend the treatment that fits your skin, because loose skin isn't one condition and no single device treats every form of it.

Four patterns behind loose skin

Skin that feels loose usually has one or more of four patterns:

• Crepey skin: the skin is thin, slightly loose, and finely lined, with little sagging.
• Sagging skin: the skin has lost its ability to spring back, and tissue is starting to drop.
• Volume loss: the tissue beneath has lost fullness with age, so the skin has less underlying support.
• Muscle pull: a muscle pulls on the skin and changes the shape of the area, as with the vertical bands some people see when they tense their neck.

Many people have a mixture. Muscle pull calls for Botox, lost volume for filler, and crepey or sagging skin for radiofrequency skin tightening. Crepey and sagging skin both involve the dermis, the layer beneath the skin's surface that holds collagen and elastin. Treatments can stimulate new collagen, but improving skin texture is usually easier than correcting very loose skin.

Before I recommend a treatment, I evaluate what's causing the change. Common causes include sun damage, hormonal change, and recent weight loss. Sun exposure can age skin early, and daily sunscreen helps prevent that. If your concern is crepiness on your arms, chest, or legs, our crepey skin treatment guide covers each area separately.

What each treatment is best at

Each treatment does a different job, so they aren't interchangeable, and FDA clearance is specific to each device. Thermage CPT, a radiofrequency system, is cleared for wrinkle treatment, for example.

Radiofrequency works in different ways. Monopolar radiofrequency sends current from one treatment tip through your skin to a pad placed elsewhere on your body. That lets heat reach deeper than with devices that keep the current near the surface. Botox relaxes a muscle by blocking the nerve signal to it. Fraxel is a fractional laser, which delivers heat through thousands of tiny columns and leaves the skin between them untouched.

Thermage CPT

• What it does: delivers deep heating in a single treatment.
• What it usually suits: lifting and shaping, when you want one session.
• What it usually won't do: restore lost volume.

TempSure Envi

• What it does: delivers gentle, even heating over four monthly sessions.
• What it usually suits: fine lines, the jawline, and the neck, when you prefer no pain.
• What it usually won't do: lift skin that has sagged a lot.

Exilis Ultra

• What it does: combines radiofrequency with ultrasound over several sessions.
• What it usually suits: tightening and shaping on the face and body.
• What it usually won't do: replace surgery for very loose skin.

FlexSure

• What it does: uses wrap-around pads over a series of sessions.
• What it usually suits: larger body areas such as the abdomen, thighs, and flanks.
• What it usually won't do: treat the face.

Fraxel

• What it does: heats tiny columns of skin to improve the surface.
• What it usually suits: sun damage, uneven texture, and fine lines.
• What it usually won't do: replace surgery for very loose skin.

Dermal fillers

• What they do: replace lost volume directly.
• What they usually suit: hollow areas where fullness has been lost.
• What they usually won't do: correct loose skin on their own.

Botox

• What it does: relaxes a specific muscle.
• What it usually suits: shape changes caused by a pulling muscle.
• What it usually won't do: help thin or loose skin.

CoolSculpting

• What it does: freezes fat cells.
• What it usually suits: fullness from fat, such as a double chin.
• What it usually won't do: tighten loose skin.

We use radiofrequency for crepey or sagging skin. Our radiofrequency options are Thermage CPT, TempSure Envi, Exilis Ultra, and FlexSure, which is designed for the body. For sun damage and uneven texture, we use Fraxel and other laser treatments. Fraxel sessions are typically scheduled four weeks apart, and you can expect redness, mild swelling, and rough texture for 2 to 5 days. Exilis Ultra sessions usually last 20 to 30 minutes, and most people resume their usual activities right away. Because CoolSculpting removes fat, it can make existing loose skin more noticeable. At your consultation, I determine the best treatment based on your anatomy, needs, and goals.

Why treatments are often combined

When you have more than one of the four patterns, I usually plan treatments one at a time instead of all at once, and the order depends on your skin.

A single-device plan can disappoint. Take someone with mild sagging along the jaw and significant sun-damaged texture on her cheeks. She's treated with a tightening device alone. Her firmness may improve slightly, but the texture she sees every morning looks much the same, so she concludes the treatment failed. The texture that bothered her most needed a different treatment.

For her, a laser chosen for the sun damage is usually part of the plan. I space treatments over months and reassess before each step. If you're weighing radiofrequency against laser, I determine which fits at your exam. Radiofrequency usually firms skin, and a laser usually improves its surface.

The questions to ask at any consultation

Four questions show how a recommendation was made:

• "Which technologies do you use?" A short list is fine if the practitioner can explain what falls outside it.
• "Why this one for me?" A good answer refers to your skin, including its thickness, how much it has sagged, and what you notice most in the mirror.
• "What if I had thinner skin or more sagging?" This shows whether the recommendation would change with your skin. If the answer stays the same, the plan may depend on what the office owns.
• "What will this not fix?" A practitioner who can name a treatment's limits has usually thought about what it can do for you.

The warning sign is a vague answer to that last question.

Does skill matter more than having multiple skin tightening devices?

Often, yes. A device can't assess your skin, so the plan depends on the person who examines you and the person who treats you.

Having multiple skin tightening devices helps only when the assessment comes first. Ask who examines you and who performs the treatment before you book. In our office, I evaluate your skin and determine the plan. I do every injection myself, and my medical assistant, who has 13 years of experience, performs radiofrequency and laser treatments.

Some skin is looser than any skin tightening device can address. Non-surgical tightening results develop gradually and are more modest than surgery. For advanced sagging, a facelift or neck lift performed by a board-certified plastic or facial plastic surgeon is commonly the better option.

We'll go over exact pricing for skin tightening at your consultation, once we know which treatments fit your skin. The consultation fee is credited toward same-day treatment or a future appointment.

FAQ

Can you combine skin tightening treatments?
Yes, in many cases. A common plan pairs a laser for sun-damaged texture with radiofrequency for firmness, or dermal fillers for lost volume with tightening for firmness. When a plan includes Fraxel and injections, Fraxel usually comes first. Injections can be done the following week.

How do I know which device is right for me?
It depends on which of the four patterns you have, and many people have more than one. I evaluate your skin at your consultation and recommend what fits.

Is one treatment enough?
It depends on the device. Thermage CPT is designed as a single treatment, while TempSure Envi is given as a series of four.

What the first visit involves

Your consultation covers your whole face, not only the concern that brought you in. I evaluate your skin, and I explain which of the four patterns I see. Then I recommend only what fits your skin and tailor your plan.

How to start your skin tightening plan

I've injected Botox in New York City since 1992, and I still begin every plan with an examination before naming a treatment. You'll know what I found, which treatment I recommend, and why. To have your skin checked at 931 5th Ave on the Upper East Side, request an appointment with Dr. Jaliman or call (212) 517-8855.