Means to achieve facial rejuvenation fall within a wide spectrum. Cosmetic surgery and other invasive procedures lie at one end. Injectables, minimally invasive treatments, take up a wide band in the middle of this spectrum. At present, they are the most popular facial rejuvenation treatment worldwide. At the far end are non-invasive facial rejuvenation and skin tightening procedures. These are popular with people who don’t consider cosmetic surgery or injectables to be acceptable options. What are these treatments? Do they really produce results their marketers claim that they do?

Gwyneth Paltrow’s cosmetic facial rejuvenation method, Thermage, recently made it into the news. Thermage is just one brand of the many non-invasive cosmetic treatments that use radiofrequency technology. Other non- or minimally invasive facial rejuvenation options include ultrasound and laser technologies.

We all know that ageing changes the face. So do photo-damage and gravity. These three together account for most of the undesirable effects that show on our faces over time. True facial rejuvenation can’t just repair skin damage, because skin is not the only place where the damage occurs. Our neuro-muscular systems and our facial skeletal structure also change with ageing. This is why facial rejuvenation should take a gradual and planned approach rather than a piecemeal one.

What cosmetic treatments are right at your age?

According to Columbia University Health Center’s Department of Surgery Newsletter, healthpoints, “Staging age maintenance procedures through adulthood provides superior results”. This is why Robert T. Grant, Plastic Surgeon in Chief at the New York-Presbyterian Hospital/Columbia University and Weill Cornell Medical Centers in New York recommends different treatments for different age groups.

In an interview published in healthpoints, he recommends minimally invasive skin treatments such as dermabrasion, laser hair reduction and spider vein treatments be combined with commitment to fitness and weight control for those in their 20s. Medical approaches such as acne control, sun block and topical creams and ointments containing retinols and vitamin C are also suitable. He does not mention surgery or injectables as appropriate for this age group.

For people in their 30s, he recommends the following treatments to help maintain a youthful appearance:

  • Minimally invasive and non-surgical treatments, including fillers and anti-wrinkle injections in the face.
  • Surgical correction of the abdomen, breast, or other tissues after pregnancy.
  • Discreet surgical procedures for the eyes, face, and neck, which can prolong the period of time that a woman looks her best.
  • Light-based facial treatments including laser resurfacing, intense pulsed light or plasma.

In his opinion, when people reach their 40s, 50s and beyond, the physiologic age is more important than the chronological age. It all depends on how your skin and body respond to ageing. This group can benefit from cosmetic surgical procedures such as facelifts and neck lifts, not for any preventive purpose, but for their corrective benefits. He also stresses the importance of daily maintenance routines, lifestyle, rest and stress management, as they are “essential to looking one’s best.” Medical skin care, filler injections and the judicious use of wrinkle reduction injections are considered suitable.

Invasive, minimally invasive and non-invasive treatments

If you are in your 20s and follow Dr Grant’s advice, the only options open to you are non-invasive treatments. If, like Gwyneth Paltrow, you prefer to stay away from cosmetic surgery, neurotoxins and dermal filler treatments even in your 30s and 40s, your choices are limited to a few minimally invasive and non-invasive treatments.

The many technologies at your disposal—regardless of their brand names—employ lasers, ultrasound or radio frequency technologies to improve skin quality and tightness. They mostly focus on bringing about changes in various layers of the skin and the subcutaneous fat layers that lie beneath it. A few systems address the deeper muscle and tissue layers. None of these technologies claim to bring about changes in the underlying bone structure of the face. At present, changes in muscle mass and underlying bone structure have to be achieved through injectables and bone reshaping cosmetic surgery.

Let’s take a look at the wide range of non-invasive cosmetic treatments that are available for facial rejuvenation.

Radio frequency technologies

Radio frequency skin rejuvenation was used in medical applications long before it found a use in non-wounding skin rejuvenation.

When the electric current generated by radiofrequency (RF) devices using electromagnetic radiation passes through a tissue layer, it produces heat. Some tissue, like the subcutaneous fat tissue below the skin, generates a lot of heat. The resulting heat damages the dermis (the skin layer beneath the epidermis), a layer containing blood vessels, nerves, sebaceous glands and hair follicles.

Collagen fibers in the dermis contract and thicken in response to the heat produced. Some of the contraction is immediately noticeable after an RF treatment. This process continues for a number of weeks, and the inflammatory response of the skin to the heat damage leads to additional collagen synthesis.

Branded radio frequency devices that use pure RF energy include Accent, Pelleve and Thermage. These are mainly used to correct skin laxity and are best suited for those with mild or moderate sagging in the forehead, mid-face, neck and jaw line and around the eyes. People of any skin colour can be treated with these devices.

With current RF technologies, most people see at least mild improvement in skin tightness. Compared to cosmetic surgery, RF treatments have minimal risks and downtime.

Read Radio Frequency Rejuvenation for more information including the treatment process, risks and complications.

Laser treatments

Lasers produce intense and orderly beams of bright light at varied intensities. They can be used for various medical purposes, as well as treating the skin and stimulating collagen activity. Facial rejuvenation with lasers can improve skin tightness; treat wrinkles, scars and a number of other skin blemishes.

Laser treatments can be broadly divided into two categories: ablative and non ablative.

Ablative lasers works by removing the outer layers of skin in order to promote the growth of new and healthy skin. This allows laser resurfacing to treat a broad range of cosmetic issues, including wrinkles, facial scarring, age spots or sunspots and acne marks.

First generation ablative lasers damaged the outer skin layer, often resulting in redness, swelling, discolouration of skin, infections, eczema, scarring and eruptions. The next generation of lasers, such as pulsed and scanned carbon dioxide lasers and Erbium:YAG lasers, have better efficiency and cause far less heat damage to skin tissue. Both these systems are ablative, wounding the top skin layer and also treating the tissue underneath.

Non-ablative lasers, on the other hand, penetrate the surface skin without damaging it and reach tissue beneath the skin’s surface. The controlled thermal energy produced by the non-ablative lasers allows them to stimulate collagen remodelling in the skin. The resulting changes in collagen, including new collagen growth, help tighten the skin, improve skin tone, remove fine lines and repair mild to moderate skin damage. Non-ablative systems are popular among those who seek non-invasive facial rejuvenation options.

Non-ablative laser treatments, though not as effective as ablative lasers, require little downtime. They are increasingly finding a market among consumers who prefer non-wounding methods of rejuvenation.


Ultrasound skin tightening is still another option for facial and body rejuvenation that needs no without downtime and leaves no surgical scars. Ultrasound uses sound waves with frequencies above what humans can hear. Ultrasound technology has been used in medical applications for a long time and is valued for its ability to literally see through deep layers of tissue in the body. Among many other medical applications, ultrasound is used in breast exams and for examining the foetus during pregnancy.

Non-surgical skin tightening systems use intense-focused ultrasound, which can bring about both immediate changes and longer lasting results. Ultrasound can cause thermal and non-thermal effects on the tissue layers it targets.

The heat and vibrations from ultrasound can be fine tuned to produce thermal effects at various depths of skin and in the tissue below. Thermal effects can increase blood flow in the skin and stimulate new collagen production, helping the skin rejuvenate itself. Ultrasound waves are also used to selectively injure skin tissue, triggering a natural healing process. These combined effects cause the skin lifting, tightening and firming that is experienced after ultrasound therapy.

Ultrasound energy can also improve the superficial skin layer, exfoliating and smoothing it.

Exposure to ultrasound energy can temporarily change the structure of the outer skin layer. Such changes can last up to 12 hours, making it easier for topical applications to reach into inner tissue layers. Exploring these effects will, in the future, lead to new frontiers in combined therapies.

The best candidates for ultrasound skin tightening are those between the ages of 35 and 65, who have some level of skin looseness in the face and the body and wish to postpone or avoid cosmetic surgery and invasive procedures. Most people opt for ultrasound treatments because of its convenience, safety and non-invasive skin tightening abilities. Ultrasound skin tightening focuses on the same tissue layers that are addressed during a standard facelift, although the effects are much more subtle than a facelift would deliver.

Ultrasound therapy has been proven safe and effective in tightening the skin on the face and neck, including the forehead, eyelids, cheeks, chin and jaw areas. It can also be used for improving the texture and contour of the upper arms, knees and mid-thighs. Ultrasound has also found uses in treating hyper-hydrosis, or excessive sweating in the underarms.

The most widely known ultrasound skin tightening system is the Ulthera System which has gained clearance from the TGA as a facial treatment for specific use in achieving a non-invasive eyebrow lift and as a non-invasive lift for loose tissue under the chin and on the neck.

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