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Skin-tightening technologies need more rigorous evaluation


National report — As baby boomers get older, they are fighting a valiant battle against aging. But while they want to look younger, they are often too busy to give up weeks for recuperation, they don't want major side effects, or to spend $10,000, and they really don't want to wait until their faces are sagging so much that only a major facelift will help.

They are looking for an easier, faster and less expensive way to get that revitalized look. Resurfacing can smooth the skin, but it doesn't adequately address sagging - so many are looking for methods that accomplish that goal.

Intense pulsed light (IPL), radiofrequency and laser light are all minimally invasive techniques currently growing in popularity - but they may not come without a price.

"It is the technology that has been out there the longest and has the most clinical and histologic research showing not only how it works, but how well it works." Dr. Zelickson, an assistant professor at the University of Minnesota and medical director of the Cosmetic Care Clinic in Edina, Minn., is on the medical advisory board of Thermage®. He says it is an excellent alternative for patients who want mild skin tightening and do not want to go through a surgical procedure.

"There is no truly good objective way to measure skin tightening of the lower face, so we try to make the studies as objective as possible, looking at before and after photos and grading the lifting and tightening.

"We know that histologically we can see definite changes within the deep dermal collagen, and in the fibrous septae of the fat," he explains.

Dr. Zelickson says that even though Thermage® is the gold standard by which other treatments are judged, it still doesn't work for everyone.

"Although we can demonstrate histologic changes in every person being treated, there are a handful of patients who only see mild clinical improvement." A consensus group for Thermage® (Thermage, Inc.) recently presented a consensus algorithm to delineate the best practices on how to use Thermage® and how to get the best results.

A number of other companies have introduced skin-tightening technologies which may offer advantages in the future, but Dr. Zelickson says the biggest drawback they all share is that it's too soon to tell how well they will work; they all need more rigorous clinical studies and evaluation.

A researcher for a number of the manufacturers, including Candela, Luminous, Laserscope and Syneron, Dr. Zelickson has experience with most of the equipment.

Tightening technology status

Titan is an optically based system from Cutera.

"There is anecdotal evidence that it works. Some engineering is needed on the handpiece - it's cumbersome, slow and difficult to use. But I think the company has identified those problems and the next generation will correct that," Dr. Zelickson says.

Other potential drawbacks with the optically based system is that it can't be used close to the eyes, and it doesn't have a temperature sensor on the tip, which may result in more injury to the skin.

An advantage is that it is a multi-platform system so different heads can be used on the same machine.

Polaris by Syneron is a bipolar intense pulsed light system.

Dr. Zelickson says anecdotal studies show some tightening and histological studies also show some changes - but, again, more clinical studies are needed.

One possible advantage of a bi-polar IPL system is that it may address pigmentary dyschromia and redness at the same time.

Candela GentleYag laser system has early studies that show some effect on tightening.

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