The future of skin tightening: Mechanical or biological?


Journal Article


Diane Irvine Duncan, MD


Introduction. Not too long ago, the concept of nonexcisional skin tightening was a field of dreams. Currently, the field of nonexcisional skin tightening is heavily device dependent.

Though great strides have been made in both minimally invasive skin tightening and totally noninvasive devices, will these be in use for decades? Advances in biological research and development have been rapid. Consumer demand for regenerative solutions is high, despite the warnings from the Food and Drug Administration (FDA) noting that benefits are unproven and that instances of charlatan practice are high. While genetic modification of food is frowned upon, the use of biomarkers in medicine has become a standard of care.

Energy based devices. Current devices that have retained value in the skin tightening arena include transcutaneous radiofrequency (RF) and microfocused ultrasound. Laser resurfacing can improve mild skin laxity but its best use is wrinkle removal and pigment and textural improvement. RF‐based subdermal tightening consistently achieves a higher measured skin surface contraction than alternatives such as ultrasound‐assisted or laser‐assisted liposuction. Highintensity electromagnetic field (HIFEM) improves that framework that supports the overlying skin, as well as reducing diastasis recti. HIFEM can generate a 17.9% skin surface area contraction. A combination of transcutaneous RF and targeted pressure energy significantly reduces skin surface irregularities, cellulite, and striae while measurably thickening the dermis.

Injectables and biologiocals. Biologically based entries into the field include mechanically processed adipose‐derived stem cells, nanofat, and exosomes. Intradermal injection of nanofat and topical application of exosomes following microneedling can “resurface” skin by reversing many age related changes. A recently approved collagense drug can correct skin surface depressions such as cellulite, deformities following liposuction, and other areas of fibrosis.

Conclusion. Surgical skin excision has largely been replaced with minimally invasive and noninvasive alternatives. While energy based devices still dominate this field, biologicals are rapidly gaining ground. Substances that induce cell signaling can target cell senescence. The future of skin tightening will include treatment options that offer tightening, smoothing, dermal thickness improvement, hydration, and overall skin quality improvement.


The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. No funding was received for this article. Drs DiBernardo, Bharti, and Kortesis are paid consultants for Apyx Medical, and Dr Duncan is a member of Apyx Medical’s Medical Advisory Board. The opinions contained herein are those of the authors and do not necessarily represent the official position or policies of Apyx Medical, Inc.

Apyx Medical manufactures and owns the Renuvion®/J-Plasma® technology discussed in this article.


    • The Renuvion APR Handpiece is intended for the delivery of radiofrequency energy and/or helium plasma for cutting, coagulation, and ablation of soft tissue during open surgical procedures.
    • The Renuvion APR Handpiece is indicated for use in subcutaneous dermatological and aesthetic procedures to improve the appearance of lax (loose) skin in the neck and submental region.
    • The Renuvion APR Handpiece is intended to be used with compatible electrosurgical generators owned by Apyx Medical (specifically BVX-200H, BVX-200P, APYX-200H, APYX-200P, APYX-RS3, and APYX-JS3).
    • Apyx Medical wants to present you with current scientific discourse. Specific usage outside of the cleared indications may not be safe or effective.
    • The use of Renuvion with liposuction has not been approved or cleared by the FDA.


    • As with all energy devices there are inherent risks associated with its use. Risk associated with the use of the Renuvion APR may include: helium embolism into the surgical site due to inadvertent introduction into the venous or arterial blood supply system, unintended burns (deep or superficial), pneumothorax, temporary or permanent nerve injury, ischemia, fibrosis, infection, pain, discomfort, gas buildup resulting in temporary and transient crepitus or pain, bleeding, hematoma, seroma, subcutaneous induration, pigmentation changes, increased healing time, scarring, asymmetry and/or unacceptable cosmetic result.

As with any procedure, individual results may vary. As with all energy devices there are inherent risks associated with its use, refer to the IFU for further information.

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