WHAT IS SKIN TIGHTENING?
Skin Tightening is about increasing collagen production within the skin such that skin becomes more elastic and therefore drapes better over the face. Inelastic skin hangs loosely as folds and droops as jowls.
As people age, their skin tends to lose collagen and elastin, two proteins responsible for maintaining skin structure and resilience. Additionally, factors such as sun exposure, genetics, and lifestyle choices can contribute to the loss of skin elasticity.
The are other factors that include fat pad atrophy, and bone resorption, causing a loss of internal support to the structure of the face. Fillers using the DL Lift method or fat grafting help these underlying causes. These are discussed in other pages on our website.
TIGHTENING SMAS
The face is not made of skin alone. Under the skin, and pretty much in continuation with it, are the fibrous tissues that surround the fat pockets, the muscles of the face, as well as ligaments. Together they make up the fibromuscular layer, also called the SMAS. Skin tightening is therefore about contracting not just the skin, but also the fibromuscular layer of the skin in the face such that the skin envelope of the face becomes more taut.
The SMAS is one of the layers which surgeons tighten during an open-surgical-facelift. It is also the layer which Facetite, a slightly invasive procedure, targets. And with reasonably comparable results to a surgical facelift, at least for the lower face and neck.
With Ultherapy, we can target the SMAS non-invasively.Having a built-in ultrasound scan, Ultherapy can accurately locate the SMAS and deliver a very precise dose of energy to it. This results in the collagen regeneration, increased elasticity and lifting of the face. Because it is non-surgical, there is no recovery-time.
With the DL Lift (a filler injection technique named after Dr David Loh), fat compartment atrophy is systematically addressed to restore internal support to the SMAS. While this filler injection technique does not directly tighten skin, it complements the various skin tightening procedures we offer.
TYPES OF SKIN TIGHTENING TREATMENTS
FACETITE
Facetite is a mildly invasive procedure that tightens not only the skin but the fibrous septae around the fat compartments below the skin.
Procedure
During a Facetite treatment, a local anaesthetic solution is first injected into the fat layer under the skin. This is called tumescent anaesthesia as it distends the fat layer facilitating the second step, which is to insert a thin probe that delivers the radiofrequency underneath the skin. The energy then contracts the fibrous septa around the fat compartments, as well as the skin.
MORPHEUS8
Morpheus8 is a noninvasive procedure (but with a slight recovery time) that tightens the skin through radiofrequency delivered by microneedles penetrating the skin at different depths.
Procedure
During a Morpheus8 treatment, a local anaesthetic is applied to the skin for comfort. Arrays of sterile microneedles are then deployed at different depths, delivering RF energy, to contract the layers under the skin. Several sessions are needed for optimum results. Morpheus8 can treat the face and neck, the decolletage, arms and even reduce the appearance of cellulite.
ULTHERAPY
Ultherapy is a totally external and non-invasive procedure designed to tighten and lift sagging skin on the face and neck.
Procedure
During an Ultherapy session, local anaesthetic is applied to the skin for greater comfort. The micro-focused ultrasound are directed to specific depths beneath the skin’s surface, targeting the foundational layers that are typically addressed in surgical facelifts. The focused ultrasound energy triggers a natural healing response, promoting the production of new collagen. This, in turn, tightens and lifts the skin over time.
THE DL LIFT
In 2018, Dr David Loh published The DL Lift in The Prime International Journal of Aesthetic and Anti-Ageing Medicine, a medical industry journal, detailing this filler injection technique for other doctors.
Procedure
One of the fundamental reasons why we sag when we age is because of sequential and progressive fat compartment shrinkage. Dr David Loh demonstrated that by selectively restoring volume in certain fat compartments that have begun to atrophy, we can restore tension in that layer under the skin that supports the face. He uses high density HA fillers, autologous fat, or CAHA to achieve this Liquid Facelift.
RECOVERY PERIOD
| Treatment | Recovery Period |
| Ultherapy | Totally external treatment. No downtime, no recovery period |
| Morpheus8 | Minimal downtime, slight redness of 1-3 days. |
| Facetite | Slightly invasive treatment. About 7-14 days of swelling and sometimes bruises. |
| The DL Lift | Depending on the extent of the fillers used, there may be no recovery time, or a few days of bruising and swelling. If autologous fat is used, then there will be slightly more recovery time. |
COST OF SKIN TIGHTENING
The cost for Ultherapy, Facetite, Morpheus, The DL Lift or combinations can vary depending on factors such as the treatment area, the original condition, and which combination. For a breakdown of the costs at David Loh, you can refer to our price list. It should be noted, though, that only after a thorough consultation that we can give you the most accurate quote.
COMPARISON OF SKIN TIGHTENING METHODS
For completeness, we have included treatments not mentioned above. If you have come this far, you should know that these are the personal opinions of Dr David Loh, based on his experience with these treatment modalities. They are solely intended as educational pieces.
Thermage and Sofwave are skin quality treatments in that they reduce the appearance of fine lines and wrinkles. Expect mild improvements, like with all external non-invasive treatments. They are more like preventive treatments than anything else. Even Ultherapy is likewise.
With Ultherapy, however, one can expect some degree of sculpting of the face. So for heavy set faces, the results appear more dramatic. But still these non-invasive external treatments like Thermage, Sofwave and Ultherapy are all mild treatments that are better viewed as preventive or maintenance treatments rather than ones with dramatic “wow”results.
We have no experience with other HIFU devices so we will not comment on them.
Morpheus-8 is slightly invasive in that gold coated needles penetrate the skin to deliver RF energy to contract the depths of the skin. You can expect skin changes, and some contraction of the deeper layers. More than of course with totally external devices.
Facetite delivers RF energy directly to the subcutaneous fat compartments to contract the fibrous septae around the compartments and the skin as well. Facetite works particularly well in the lower face and neck.
The DL Lift is a filler injection technique that selectively restores supports to the SMAS, by reinflating fat compartments that have atrophied. The technique uses HA fillers or CAHA where appropriate.
Fat grafting is an alternative to fillers, and can be performed with The DL Lift techniques for similar results. Just that the procedure is more elaborate involving harvesting fat from the patient.
Thread lifts are a bit overrated. The fine PDO threads that stimulate fibrosis reactions are not any better than Thermage or Ultherapy in terms of final results. Meaning very mild. The cogged or bard threads are operator dependent, and suboptimal results are very hard to correct.
And then there are combination treatments to create a non-surgical facelift. Our favourite with minimal recovery time is Ultherapy combined with The DL Lift.
DR DAVID LOH
Dr David Loh
Founder
Dr David Loh founded David Loh Surgery back in 2002 when Aesthetic Medicine as a field was still in its infancy. He obtained his basic medical and surgical degree from the National University of Singapore. He has 30 years of working experience, 18 years of which were in aesthetics. He is MOH-accredited to perform office -based Liposuction. He is perhaps best known for being a trainer for B*tox and Fillers in the region. He is the President of The Society of Aesthetic Medicine in Singapore.