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Skin Tightening & Resurfacing

Treatments designed to refresh your skin, such as microdermabrasion, chemical peels and laser skin resurfacing.

By Zeel Editorial Staff, Last updated: May 18, 2020

Want tighter, firmer skin? There are two basic methods - remove the outer, damaged layers of the skin (thus allowing the fresher inner layers to emerge in all their glory) or swell the tissues under the skin, stretching and tightening the skin as the underlying tissues gain volume (much like adding air back into a balloon).

The great thing is that much skin tightening and resurfacing methods do both to varying degrees - a double-barreled beautifying effect.

Skin Tightening

Skin tightening treatments swell and tighten the tissue underneath the skin, smoothing out the skin's surface.

Radiofrequency treatments: Currently, two major radiofrequency treatments are available in the United States: Thermage and Pelleve. While both Thermage and Pelleve use RF to tighten skin, Thermage is more expensive and requires fewer treatments to take effect.

Ultrasound: Ulthera, a new skin tightening treatment, uses ultrasound energy to tighten skin on the face and neck. During treatment, the Ulthera hand piece heats the underlying tissues of the skin to promote collagen growth, while leaving the surface unaffected. The amplification of collagen both lifts and tightens the treated area.

Non-ablative lasers: Non-ablative lasers target the deep layers of skin, increasing its collagen production by causing controlled damage under the skin's surface. The resulting increase in collagen (a byproduct of healing) plumps the skin and softens wrinkles.

Non-ablative lasers used for collagen growth include Fraxel re:fine and Fraxel re:store, the Smoothbeam laser and longer wavelength Nd:Yag lasers. Non-ablative lasers can also be used to treat cosmetic issues beneath the surface of the skin like scars and veins.

Skin Resurfacing

Skin resurfacers peel off the damaged top layers of skin.

Chemical peels: Chemical peels work by removing the top layers of skin, so skin cells unaffected by surface aging and damage can emerge. Peels range from very light peels (like the AHA peel) which can be purchased over-the-counter, to the very deep phenol peel, which involves general anesthesia and a hospital stay. Light peels are useful for treating dull or rough skin, enlarged pores, sun damage, and to keep acne under control. Deeper peels can reduce wrinkles and age spots.

Dermabrasion: Dermabrasion is a straightforward mechanical skin-resurfacing technique. Essentially, it involves the application of a sanding device to the face to smooth and level the surface. Dermabrasion takes away more layers of skin than microdermabrasion, making it deeper, more painful, and more effective.

Dermabrasion typically revives skin affected by acne, sun exposure, wrinkles and precancerous lesions. It can also be used as a last resort for laser-resistant tattoos.

Microdermabrasion: Microdermabrasion is a mild mechanical exfoliation which removes the top layer of dead skin cells, revealing the fresh, healthy cells beneath. In microdermabrasion, the skin is sprayed with tiny abrasive crystals, which are then vacuumed off of the skin's surface.

Microdermabrasion can reduce superficial skin damage like superficial scars, stretch marks, age spots and acne. It is gentle enough to perform on the neck. (The neck's skin is among the thinnest on the body - about as thin as that of the eyelids.)

Ablative laser skin resurfacing: Ablative lasers directly affect the surface of the skin, peeling off wrinkles and spots along with the top layer of skin. The most common types of ablative lasers are C02 lasers and erbium YAG lasers. Laser skin resurfacing, or the "laser peel," is the use of lasers to treat skin blemishes like wrinkles and age spots.

Ablative lasers can be either fractional or non-fractional. The light in fractional lasers is split into separated pixels, something like a checkerboard. This means that not every patch of skin is affected, which shortens healing time without significantly impacting the effectiveness of the laser.

Photodynamic therapy: Photodynamic therapy (PTD) can clear problematic skin concerns like acne, acne scars, broken capillaries, warts, rosacea, wrinkles, sun damage, and enlarged pores. How? By activating a topical liquid or creamy drug with a special red or blue light, spurring a chemical reaction that destroys damaged skin, promotes collagen growth, and shrinks oil glands by destroying pore-dwelling bacteria. Photodynamic therapy includes blue light and red light therapy, which are effective treatments for acne.

Vein, Spot and Hair Removal

Colored marks and hair follicles can be targeted by lasers, removing blemishes and hair alike.

Laser hair removal: Zap! Your hair's gone. Sounds like a dream, and indeed, laser hair removal can be a very effective method of semi-permanent hair removal. Lasers deliver intense heat to individual hair follicles, damaging, and in some cases eliminating, the ability of hair to grow back.

The best choice of type of laser hair removal depends primarily on your skin tone. The darker the skin tone, the more likely it is to absorb laser energy, because laser energy tends to be attracted to colored molecules. Hence, it's important to treat darker skin tones with lasers with longer wavelengths. The longer the wavelength, the deeper the laser energy travels into the skin - bypassing the vulnerable surface skin. Shorter wavelength lasers are typically used for fairer skin. (Read more about your skin tone type.)

Lasers commonly used for hair removal are the diode laser, alexandrite and Nd:Yag. (Lasers are usually named after the type of material that the beam is focused through, which affects the wavelength of its light.) IPL treatment, while not technically a laser (because it combines multiple wavelengths of light, while lasers have only one wavelength) is also an effective hair removal treatment.

IPL treatment: Intense pulsed light (IPL) is a popular variety of non-laser, light-based treatment. It is one of the few treatments that reliably reduces the appearance of rosacea, broken blood vessels, and skin redness. There are many brand names for IPL, but they all do pretty much the same thing - shoot pulsed (that is, not a continuous beam) light at the skin to heat the underlying tissues.

Unlike lasers, which by definition travel along one wavelength, IPL devices emit light at different wavelengths. Hence IPL treatments are capable of targeting cells of different colors at one time, unlike laser treatments which target only cells of one particular color. (When the colored cell absorbs the laser, it is converted into heat energy and disappears.)

Tattoo and birthmark removal: Tattoos and birthmarks are removed in much the same way -- lasers of a specific wavelength are used to target cells of a certain color. That's because different lasers are attracted to different colors. For example, some lasers are attracted to reddish hues, so they are best for targeted red discolorations, like spider veins and port wine birthmarks. Correct use of a laser means that the colored molecule will be dissolved into heat energy.

Typically, alexandrite lasers are used for greenish colors, ruby lasers for black and blue colors and Nd:Yag lasers for brownish colors. Cafe au lait spots are best treated by a q-switched Nd:YAG laser, which is typically effective on brown pigmentation. (Q-switched means that the laser is able to emit very high-powered pulses.)

Treatment of reddish vein, marks and spots (vascular lasers): The term "vascular" refers to the body's network of blood vessels. Vascular lasers target malformed blood vessels that can leave discolored marks on the skin. The lasers target the red color in blood and transmit a focused beam of light on blood vessels, heating and destroying selected vessels.

Because they target red-hued molecules, vascular lasers can be used for red-blue spider veins, red-purplish birthmarks, red ink in tattoos and other red marks. For example, port wine stains (purplish-red birthmarks like Gorbachev's) should be treated with vascular lasers.

Most vascular lasers emit a wavelength of 500 to 1064 nm, the range which is required to penetrate the reddish cells. One such laser is the pulsed dye laser (PDL), which was introduced in 1989 with a wavelength of 585 to 595 nm. Other vascular lasers/light sources, from shortest to longest wavelengths, include the intense pulsed light (500-1200 nm), the potassium titanyl phosphate (simplified as KTP) laser (532 nm), diodes (940 nm), and the Nd:YAG (simplified as neodymium-doped yttrium aluminum garnet) laser (1064 nm).

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