Clinical Relevance of Skin Tightening with Minimally Invasive Subdermal Energy-Based (EB) Technologies.

[BACKGROUND] Skin retraction and tightening are essential cornerstones of facial rejuvenation and body contouring. Retraction depends on skin recoil secondary to volume reduction, while tightening results from active contraction of dermal and subdermal collagen fibers and activation of the healing process promoting neocollagenesis and neoelastinogenesis. Use of energy-based (EB) technologies including lasers, ultrasound, monopolar and bipolar radiofrequency (RF), and plasma/RF is becoming increasingly frequent for aesthetic interventions. The current review is intended to critically analyze their reported outcomes and determine their clinical relevance regarding skin retraction and tightening.

[METHODS AND MATERIALS] A systematic literature search was conducted across the MEDLINE, PubMed, and EMBASE databases.

[RESULTS] A limited number of clinical studies about each of percutaneous EB technologies were identified. Studies provide low-level evidence for skin tightening, and very few describe objective measurement with supporting documentation. Furthermore, most studies do not differentiate retraction due to volume reduction from actual improvement in skin biomechanical characteristics.

[CONCLUSION] Although histologically significant outcomes have been demonstrated, clinically evident skin tightening with EB devices remains poorly measured and documented. Effective skin laxity correction and true long-term skin tightening are the result of reparative healing of a superficial dermo-subdermal injury, be it thermal or mechanical. Further studies are needed to determine the most effective device or modality able to induce a superficial injury capable of triggering the most intense flat scar contracture. Determining maximal potential of this natural biologic phenomenon is also necessary for selection of patients that would benefit most from minimally invasive interventions.

[LEVEL OF EVIDENCE III] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .