How to Choose Which Skin Tightening Treatment is Right for You
Much like there are many resurfacing laser options for treating skin texture, there are several options for skin tightening, including Ultherapy, Thermage, Sofwave, Exilis, and Emface. These skin tightening methods all have the same goal of lifting sagging skin and work by activating the production of collagen, some by ultrasound, others by radiofrequency, and some with the help of both. And Emface even goes beyond just your skin and builds muscle.
As a collective, these methods have no downtime, are typically safe for all skin types, and results are best seen after at least 3 months to ensure your body has ample time to build collagen. However, results for all of these skin tightening treatments are dependent on the body’s ability to make collagen and how well the skin responds - which can be frustrating as the outcome is unpredictable.
Because the treatments heat the deeper layers of the skin, as stated above, there is no down time. You will leave the procedure with a healthy flush. After a skin tightening treatment at Modern Dermatology we cleanse the face, apply my Face Cream, and zinc based sunscreen. We encourage our patients to stay well hydrated and skip their treatment steps until their skin feels normal again, often just 24 hours.
Let’s break down these skin tightening techniques so you can hopefully determine which one may be right for you. Spoiler alert - I have a favorite!
Ultherapy
Ultherapy uses microfocused ultrasound energy to target the deeper layers of skin, including the dermis (1.5-3 mm) and the underlying connective tissue, specifically the SMAS layer (up to 4.5 mm). The ultrasound energy creates controlled thermal energies at precise depths which triggers a natural healing response for the body to build collagen which can tighten the skin. While this is not like a browlift, for the people who respond well to Ultherapy, it can create a subtle lift. The forehead, jawline, neck, and decolletage are the most commonly treated areas for Ultherapy.
Pros: Suitable for non-invasive lifting and tightening and requires no downtime. What’s also nice about Ultherapy is you only need one treatment to see results if it works for you. It is often recommended to repeat every one to two years to lift and maintain a raised forehead and eyebrows.
Cons: This treatment is the MOST painful of the bunch as it penetrates deep into the skin. There are even rare cases of atrophy (divets) from destruction of fat from the deep ultrasound. It’s also very expensive, not effective on fine lines and wrinkles, and results can be unpredictable.
Thermage
Thermages uses Monopolar radiofrequency (RF) energy to treat the dermis and subcutaneous tissue (up to 3 mm) and is less painful than Ultherapy. When it works well, it’s not as effective as Ultherapy. Multiple treatments are required and are typically repeated every 3 to 6 months, or once a year.
Pros: Has multiple hand pieces so can be done all over the body, face, eyes and neck. It improves fine lines and wrinkles, and can help with crepey skin. People typically experience less discomfort than with Ultherapy.
Cons: Does not address deeper lifting like Ultherapy or Emface, and some experience pain with the treatment.
Sofwave
Sofwave is a newer technology which uses high-frequency, focused ultrasound to build collagen in the mid-dermis (1.5 mm) on the face, neck, and body, similar to Thermage. What’s interesting is it uses parallel beams to hit the target areas. I have experience with Sofwave, and it hurts more than Thermage, but less than Ultherapy and I think the results are better than Thermage. It is recommended to have 1 to 3 treatments, spaced 2 to 3 months apart to maximize results, followed by annual maintenance.
Pros: Improves fine lines and wrinkles, provides mild lifting, and is a relatively quick treatment.
Cons: Second most painful treatment to Ultherapy, and does not address deeper lifting like Ultherapy or Emface.
Exilis
Exilis is probably the most tolerable of the treatments, but you have to do it in a series of at least four treatments. It combines monopolar radiofrequency with ultrasound to target the dermis and subcutaneous fat layers to build collagen. Studies show a significant increase in collagen in treated areas. The treatment uses a wand, so can be done anywhere, most commonly, the eyes, lips, face, and neck.
Pros: Painless; and improves fine lines, wrinkles, and the appearance of crepey skin.
Cons: Does not address deeper lifting like Ultherapy or Emface, and requires a series of at least 4 treatments apart followed bi-annual maintenance.
Emface
Emface is another technology that is newer on the market, and is my favorite. It’s different from the others discussed as it combines High-Intensity Focused Electrical Stimulation (HIFES) with radiofrequency (RF) energy and goes after your dermis by heating it, and also stimulates your muscles to contract. What’s nice about Emface, is you can see the muscle building results faster, but as usual, collagen takes at least 3 months to build. It doesn’t hurt very much, but does require a series of at least 4, followed by maintenance every 4-6 months to maintain the muscle mass and continue building collagen. A study showed that Emface lifts cheeks and decreases jowls. It also can lift eyebrows and now has a newer attachment that lifts the fat underneath your chin.
Pros: While I think Emface gets you the best results, the results are still unpredictable - but the least unpredictable of the treatments. The treatment is well tolerated, requires zero downtime, and offers better results by strengthening facial muscles for tone and lift, plus increased collagen production for skin tightening.
Cons: Likely the most expensive of the treatments. Requires a series of 4 treatments, spaced 1 week apart, followed by biannual maintenance.
Despite being the most expensive, Emface is my favorite of the technologies because I find the results consistently the best and most predictable. In fact, I do this treatment on myself twice a year. As a group, any of them will build collagen, but a common frustration with these treatments is some may only slow the sagging of skin, but not lead to visible lifting improvement. The bigger question is how much and will it be enough for you to see the results? In general, better results are seen in healthier people with thicker skin. If you have the interest and money to spend on procedures, then these are all good options as they’re well-tolerated, typically safe for all skin types and can help defy gravity.
Want to learn more? Check out this Cosmopolitan article featuring insights from Dr. Rogers on skin tightening treatments.
These recommendations are not sponsored. They are the result of Dr. Heather D. Rogers, MD evidence-based research and extensive clinical experience.
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