• Dry Cracked Skin
  • General Dermatology
  • Impetigo
  • Eczema
  • Alopecia
  • Aesthetics
  • Vitiligo
  • COVID-19
  • Actinic Keratosis
  • Precision Medicine and Biologics
  • Rare Disease
  • Wound Care
  • Rosacea
  • Psoriasis
  • Psoriatic Arthritis
  • Atopic Dermatitis
  • Surgery
  • Melasma
  • NP and PA
  • Anti-Aging
  • Skin Cancer
  • Hidradenitis Suppurativa
  • Drug Watch
  • Pigmentary Disorders
  • Acne
  • Pediatric Dermatology
  • Practice Management
  • Inflamed Skin

Cutting-edge Rejuvenation: Injectables + Energy Devices


The subtle results of long-wavelength devices combined with the more dramatic results of injectables can last for years and deliver more natural results than those of injectables alone.

Many of our peers consider skin tightening and lifting with injectables alone to be a little old-fashioned.

When used as a combination therapy, however, nonsurgical tightening and lifting with injectables and energy devices is currently trending at cutting-edge aesthetic practices all over the nation.

Just as injectables made a splash in the aesthetic industry in the early 2000s, ultrasound and radiofrequency (RF) devices have been game-changers over the last decade. They’ve advanced the way we practice and, most recently, the combination of injectable strength and energy device longevity have resulted in achieving what I believe are the best nonsurgical facial lifting and tightening results we’ve seen yet.

Injectables are powerful aesthetic practice tools, but they are limited when it comes to lifting or tightening facial skin. In the past, we might have used a filler to literally “tent” the skin in areas such as the cheeks or the corners of the mouth to pull inferiorly sagging skin upward. While fillers and neuromodulators offer a close-to-instant gratification for wrinkle reduction, injecting the face to get a lifting or tightening effect wasn’t ideal. As patients age, they often need higher dosing of neuromodulators and fillers to do the job, which results in their faces looking more and more unnatural.

Today’s RF and ultrasound devices present a new opportunity to achieve a consistently natural-looking nonsurgical lifting and tightening result, as well as enhance and prolong the wrinkle-reducing, volumizing and lifting effects of injectables.

We are fortunate that in the last decade manufacturers have perfected devices that deliver focused beams of longer wavelength energy (i.e., radio and ultrasound) deeper into the skin than before — bypassing the epidermis and going directly to the dermis and beyond. RF delivers energy to the reticular dermis, while ultrasound can deliver thermal energy to the dermal-subcutaneous junction, the subcutaneous fat and even into the fat-muscle junction and superficial muscular fascia.

When used correctly, these devices can tighten and/or lift skin and soft tissue without delivering heat to the skin, which explains their minimal recovery time and ability to treat different skin types.

While I use the Viora Reaction device, there are many good brands in this niche. Ultherapy (Merz) appears to remain the gold standard for lifting sagging soft tissue and muscle, but there are newer aesthetic ultrasound devices on the market that I have not used but show promise.

NEXT: How I Decide Which Combination Is Best

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