closeup of a woman's neck and chin, pink lips

4 Ways to Tighten Your Skin - No Surgery Necessary!

There's an analogy for facial aging that goes something like this:

You've had your beautiful couch for a few years. As time passed, you've watched it change. The cushions have started to sag. They're not as comfortable as they used to be. The slipcover looks more worn and loose over the seat. You can feel the odd spring poke you when you sit in the wrong spot.

In some ways, your face is like that couch.

You lose bone density - and the framework of your couch starts to break down. Your eye sockets widen making your eyes look sunken. Your jawbone shrinks.

The sagging couch cushions are analgous to your shrinking facial fat. The fat underneath your skin is divided into compartments by connective tissue called fascia. The fascia is essentially a retaining system for your face. As your skeleton changes, the soft tissues of your face dramatically shift. You develop smile lines called nasolabial folds and the corners of your mouth turn down.

Your couch is shrinking.

The lost fat and bone density in your face causes your skin - the slipcover - to become loose. And it gets worse as the skin on your face loses elasticity and starts to sag - like the lycra in an old bathing suit or the slipcover on your couch.

Your slipcover is becoming larger.

Dr. Van Dyke, from Paradise Valley, Arizona explains it really well in an article for Dermatology Times:

"What we know is happening is that we've got fat that is not only descending with gravity, but it's also thinning out."

Facelifts used to be the best answer - BUT because we didn't know as much about how faces age, they didn't always work. Fortunately, we've learned from our mistakes.

Dr. Van Dyke, explains more:

"We used to take that slipcover and pull it really tight, which never looked good. That was the wind-tunnel effect."

I remember seeing a lady on a plane like that. She was flying in first class and her dark hair was up in a bun. She was probably in her 60s. Her face looked younger than 60, but her neck looked older. The skin on her face was drawn tight back to her hairline. To be quite honest, it looked uncomfortably tight. And then there was her neck. It was sagging and wrinkled. It created a very noticeable contrast - one that was hard to miss.

Now we try to shrink the slipcover AND plump the couch. So instead of surgically stretching your skin to tighten it, we use a combination of nonsurgical techniques. (Facelifts are better now and can tighten skin beautifully, but in this article, I'll be talking about nonsurgical skin tightening.) Skin tightening is combined with fillers or fat grafting to get a very natural looking result. Most of Dr. Van Dyke's patients get a combination of nonsurgical procedures:

"When you fix one thing, it's not going to look normal. In my practice, patients want to look like themselves. They don't want to look like somebody else."

And she elaborates on skin tightening:

"We want to tighten in all three dimensions. To that end, we know that heating collagen (which gives your skin structure) causes it to contract. And there are significant amounts of collagen in the skin, the dermis and underlying structures including the superficial muscular aponeurotic system (SMAS) and the platysma. Additionally, there's a lot of collagen in the fibrous septae (fascia) that connect the skin to the underlying structures. We need those connections. We just need to tighten them up a little."

Besides aging, is there anything else that causes loose skin?

Yo-yo diets, weight loss and gain - especially in large amounts - have a huge impact on your skin.

“The skin stretches to accommodate excess weight so a large quantity of weight gain and loss is more likely to cause skin laxity than smaller weight changes.”  - Dr. Jessica Weiser, Dermatologist, New York City

“Rapid weight loss is more likely to lead to sagging than slow, steady weight loss.”  - Dr. David E. Bank, Dermatologist, Mount Kisco, New York

“Most patients will lose the buccal fat pad (aka apple of the cheeks). That will result in lose skin and jowls. Interestingly, it may be just a few pounds that make a difference.” - Dr. Gary Goldenberg, Dermatologist, New York City

Whatever the cause, it's clear that sagging skin bothers people.

“Last year, alone, if you look at RealSelf data, there was over a million page views for nonsurgical neck lift topics, like Ultherapy (Ulthera), Thermage (Valeant Pharmaceuticals), ThermiTight (Thermi)…,” - Dr. Jason D. Bloom, Facial Plastic & Reconstructive Surgeon, Ardmore, PA

So how do you treat loose, sagging skin - without surgery?

Skin tightening uses heat to tighten the skin on your face, neck or body. Each method works a little differently. Older devices heat skin from the outside in. Newer devices heat skin from the inside out.

"It's all about getting to collagen and heating it to a certain temperature. When you do that, it will shrink like a wool sweater in the dryer and trigger more collagen production."  - Dr. Van Dyke

Dr. Marnie Nussbaum, a dermatologist in New York City, explains it like this:

"After the age of 30, we slow down our production of collagen and elastin—the two proteins that help our skin stay firm, plump, and toned," she explains. "What non-surgical skin tightening with lasers does is target energy in the layers of the skin to stimulate that collagen and elastin production, which will gradually improve the texture and tone.”

You'll hear about many different kinds of skin tightening treatments - no surgery necessary. They all fall into 3 major categories:

  1. ultrasound
  2. radiofrequency
  3. radiofrequency microneedling
  4. microinvasive radiofrequency
hand holding tape measure
Photo courtesy of Jennifer Burk & Unsplash.
woman wearing grey tank top


Ultrasound uses sound waves to start new collagen production and tighten your skin. Ulthera / Ultherapy is the big dog in the room.


Radiofrequency uses a hand held device to heat the superficial layers of your skin and create more collagen. The more collagen made, the tighter your skin becomes.

smiling man looking up at his girlfriend
Beautiful woman doing abdominal exercise
Photo courtesy of Pixabay & Pexels.

Radiofrequency Micro-Needling

This kind of skin tightening uses a motorized stamp full of tiny, very short needles. Once the needles are in your skin they emit radiofrequency that heats and tightens the layers of your skin.


Microinvasive radiofrequency skin tightening uses a cannula (that looks like a long needle) to deliver heat below the skin's surface. Because it heats tissue below the surface, soft tissue and muscle can be treated using higher temperatures - and you get a better result more quickly.

woman in flowered dress walking on beach
Photo courtesy of Unsplash & Pete Bellis.

Does skin tightening without surgery work?

The answer really depends. The noninvasive (NO needles or cannulas involved) methods of skin tightening don't work as well as the invasive ones (needles and cannulas).

Let's talk about noninvasive skin tightening first: Radiofrequency & Ultrasound.

NONINVASIVE | RADIOFREQUENCY SKIN TIGHTENING DEVICES send radiofrequency through your skin to create heat (It's called transcutaneous or external contact radiofrequency). They use lower energy and multiple passes to heat large volumes of tissue and create new collagen and elastin. Some of the names you'll hear are Thermage (Solta Medical), Exilis (BTL Aesthetics), ThermiSmooth (Thermi) and Pellevé (Cynosure).

NONINVASIVE | ULTRASOUND SKIN TIGHTENING like Ulthera uses micro-focused ultrasound to bypass the epidermis (the top layer of skin) and work on the deeper tissues. Dr. Bloom feels Ultherapy produces a nice change in the neck  of the right candidate (meaning not everyone will get a good result). "People who need it the least do the best." Some of the device names you'll hear are Ultherapy (Merz), Venus Legacy (Venus Concept), and VaserShape (Sound Surgical Technologies).

NONINVASIVE RADIOFREQUENCY & ULTRASOUND SKIN TIGHTENING WORK BETTER WHEN COMBINED WITH OTHER SKIN TREATMENTS - which is why doctors like Dr. Van Dyke combines these treatments with fillers and fractional resurfacing.

Dr. Naissan O. Wesley combines skin resurfacing with noninvasive skin tightening (if needed) to give her patients the best result. By using fillers and resurfacing treatments first, her patients see results quickly - and are happy:  "In my practice, I choose fractional resurfacing treatments first. If patients want additional tissue tightening, radio-frequency is used as an adjunct treatment. This keeps costs lower, patients happier, and results more attainable."

While traditional skin rejuvenation treatments like fractional resurfacing lasers & IPL do tighten skin, they're better at improving your skin's color and texture. They work from the outside in.

Infini radiofrequency micro-needling device

This is the handpiece for the Infini radiofrequency micro-needling device.

FaceTite Cannula by InMode.

This is the FaceTite cannula by InMode. It uses microinvasive radiofrequency.

Now let's talk about invasive skin tightening:  Radiofrequency Micro-Needling & Micro-Invasive Radiofrequency.

INVASIVE | RADIOFREQUENCY MICRO-NEEDLING uses micro-needles that are inserted into the skin where they create radiofrequency energy / heat. Some heat the tip of the needles, while others heat the entire length of the needles. The advantage of radiofreqency micro-needlng is that the energy levels and depth can be changed so there is "significant new collagen and elastin and generally happy patients," says Dr. Bloom. There are several different devices:  Infini (Lutronic), Profound (Syneron Candela), Fractora (InMode), and Intensif (EndyMed).

INVASIVE | MICROINVASIVE RADIOFREQUENCY is the most recent advance - and Dr. Bloom's nonsurgical method of choice for neck tightening. These devices deliver the radiofrequency vial a single cannula that looks like a long needle. So the heat completely bypasses the top layer of skin. "You can tighten the soft tissue and muscle of the neck at higher temperatures, without getting a burn because you're pushing that energy deeply. I've gotten some amazing results with these devices. And people love it because it's one treatment and done," says Dr. Bloom. There are several devices in this category as well:  ThermiTight (Thermi), PrecisionTx (Cynosure), and BodyTite and FaceTite (InMode).

To give you a basis of comparison, Dr. Bloom sees a 10 - 15% improvement on neck tightening with Ulthera (ultrasound), but a 30 to 40% with ThermiTight (microinvasive radiofrequency). "Then, I tell them that neck lift surgery or lower face and neck lift surgery is 100%, so I price [ThermiTight] at about 30 to 40% the cost of my neck lift."

So surgical neck lifts and facelifts still get the best result. BUT the new nonsurgical technology is getting better and better results.

Am I a good candidate for nonsurgical skin tightening?

"In general, good candidates for non-surgical methods are patients who have skin that is not pendulous (hanging) or redundant (excess or folding over on itself)."  - Dr. Bruce Katz, Dermatologist, New York City

"Sun-damaged skin, for example, is harder to work on. But skin that is in good condition responds better to treatment." - Dr. Bruce Katz

“If you lost 100 pounds, your skin won’t contract enough with this technology, but for those who may not be candidates for liposuction, this is an impressive alternative.”  - Dr. Christopher T. Chia, Plastic Surgeon, New York City

If you're pregnant or breastfeeding, you're not a good candidate for skin tightening. For more specific information, refer to each kind of skin tightening using the buttons above. Thanks!

How about dark skin? Is skin tightening safe?

I found this answer from Dr. Brandith Irwin, a dermatolgist in Seattle on her website, Skintour:  "Any technology that involves laser/light/optical energy is almost always going to be riskier for darker skin types." And she continues. "A better/safer choice would be a tightening device with pure radiofrequency or ultrasound energy like the Thermage, Exilis, and Ultherapy. If it were me, for the face, I’d pick either the Exilis or Thermage. Ultherapy gives similar results but is significantly more painful."

Are people happy with the results?

Skin Tightening gets an 85% "Worth It" rating on RealSelf based on 33 ratings over the last 2 years.

How much does it cost?

The average cost for "all locations" is $2,125 with a range of anywhere from $125 - $8,000 based on 116 reviews on RealSelf.

Find a good provider!

The bottom line with this type of procedure is this:  the device is only as good as the person operating it. The looser your skin, the more invasive the treatment you'll need. And you'll need to find a provider who knows the difference. So look for someone who has lots of experience doing skin tightening. The more devices they have, the more options you will have. Check their credentials. Go in and talk to them - make sure they understand your expectations. And remember, if you have a lot of loose skin, surgery may be your best option! Thanks for reading & good luck!

If you have any questions or comments, please email amy {at} masterpieceskinrestoration {dot} com. I'd love to hear from you!


Amy Takken, RN


Masterpiece Skin Restoration is your online resource for all things medical aestheticsskincarebeauty, and wellness. We keep you up to date on leading edge technology and the services available to help you restore your natural beauty.

We have all the information you need to restore your skin.

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References:  The Science and Theory behind Facial Aging The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments.



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