In this episode, Dr. Elizabeth Roche defines skin tightening as treatments that stimulate collagen, the framework that keeps skin firm. She describes two paths. Ablative laser peels remove a thin surface layer to trigger repair. She favors precise Erbium:YAG over older CO2 for better control and broader skin type safety, with recovery from a two day nano peel to about a week for deeper passes. Non ablative options heat the dermis without peeling to spark collagen over weeks. These include Ultherapy ultrasound, SkinTyte infrared, broadband light that also treats reds and browns, and the fractional MOXI. Choice depends on goals, downtime, and steady maintenance.
John Maher: Hi, I am John Maher. I’m here today with Dr. Elizabeth Roche, founder of the Elizabeth Roche M.D. MedSpa in Bergen County, New Jersey, a medical aesthetics center committed to providing people with the most advanced procedures available to restore youth while preserving the beauty and functional health of your skin. Today our topic is skin tightening technology. Welcome, Elizabeth.
Dr. Roche: Thank you, John.
What Does Skin Tightening Mean?
John: Elizabeth, tell me a little bit about what skin tightening means. What do we mean by that term?
Dr. Roche: So, skin tightening is a way to stimulate collagen, and collagen is so important in preserving and keeping your skin tight. It’s the scaffolding to our skin, and we have a couple of different modalities that hopefully we can talk about in terms of how to preserve collagen and how to correct collagen. It’s a really exciting field and I’m glad we’re here talking about this today.
John: Yeah. So, tell me a little bit about some of the different types of treatments that you offer to achieve that goal of skin tightening.
Dr. Roche: Sure. We have devices such as Ultherapy, SkinTyte, Broadband Light, and MOXI. These are all considered non-ablative treatments. And then we have stronger treatments such as laser peels, and these are ablative treatments. So, it kind of falls into two categories. Then there are other skin tightening modalities that are injections or PDO threads, but that’s a whole other discussion, but we’ll talk about the devices today.
Choosing A Skin Tightening Treatment
John: Okay. So, how do you determine what type of skin tightening device that you choose for a particular patient?
Dr. Roche: So, when a patient comes in, we usually do a consultation and I get a feel for what their goal is and look at their skin. Are they preserved? Are they younger? Have they been protecting their collagen? Do they just need some treatments just to keep that youthful appearance going? Or maybe they fall into a later age group and they’ve never done anything to their skin, so we have to do some rejuvenation of the skin. So, it depends on also what the patient is comfortable with in terms of downtime. Some of the ablative procedures, like the lasers, have more downtime, meaning that they may be a little bit red, whereas someone who is looking for no or minimal downtime, that may be the non-ablative procedures that we do.
Getting Results Fast
John: Does it matter how quickly they want to see the results as well? Maybe they’ve got a particular event coming up or something like that and they want something done right away?
Dr. Roche: Yeah, absolutely. That’s very common. We have people who have a wedding on the calendar or their son’s or daughter’s wedding, and they are like, “I need to do something”. So we may say, okay, let’s take the path of doing something a little more aggressive, like one of our laser peels. And I don’t mean to use the word aggressive, but there is a little bit, it’s more heat. It’s peeling of the skin.
That’s what ablative means, that we’re actually peeling the skin, and then because of that, there is downtime, meaning that you’re going to look red. Your skin’s going to take maybe a week or so to heal. So if they’re really gung-ho on doing something like a strong treatment and one treatment, we may suggest to do a laser peel.
The other category are the non-ablative treatments. These are treatments that send the heat and energy into the skin, but we’re not damaging the surface of the skin. So, everything goes down into the dermis and it causes the micro injuries beneath the skin. Those micro injuries, your body responds to by stimulating fibroblasts, and fibroblasts are the cells that make collagen and elastin, and once they start doing their work over weeks to months’ time, you get tightening of the skin because you have new collagen there.
What Is An Ablative Technology?
John: So, tell me a little bit more about the ablative technologies and again, what that means and what devices are available on the market today and what you offer at the Elizabeth Roche M.D. MedSpa.
Dr. Roche: Sure. So, there are many different types of lasers, fractionated, and then CO2 lasers, we have an Erbium:YAG laser, and then there’s all the different brand names too, but I’m just going to keep it really pretty simple. What some people consider the old gold standard is the CO2 laser, and it does a good job, but it sends heat everywhere, so there could be a lot of collateral damage, meaning not just specifically targeting those skin cells that we want to target.
It’s targeting other tissues and soft tissue fat cells and everything else that’s underneath the skin there. So yes, it does its job. But you’re limited on what skin types you can treat. You have to be careful when you get into the darker skin types because you can cause hyper or hypopigmentation and there can be scarring that can occur too. Not that every time a CO2 laser is done that that occurs, but it’s not as forgiving as the Erbium:YAG laser.
The Erbium:YAG laser is more precise. It has a wavelength, all lasers have a certain wavelength of light and energy. It has a wavelength of 2940 nanometers, and that’s the same wavelength as the water in the skin cells. So, it specifically targets that water in the skin cells and vaporizes those skin cells. So, we’re very precise on where that heat and energy is going. When we vaporize the skin cells, you get that ablative procedure where the skin is actually gone from the surface and over maybe three days, four days, five days, a week, maybe even sometimes two weeks depending on how deep I set the laser. Your skin is going to then regrow back.
The laser peel, the Erbium laser, is really nice because I can set the depth. So if someone says, “I only have two days, I want a laser peel”, I can set the depth so that they’re probably recovered in two or three days. It’s called a nano peel. But if you do that, you’ll have to do repetitive treatments to equal one deeper peel. But that’s okay if someone has the time to do repetitive treatments and they want that laser peel. We do that all the time, and if someone just wants that one peel, deep peel, and has a weak or so to recover, we also have done that. We do that all the time as well. So, it’s nice that we have a choice of recovery time for the laser peel with the Erbium:YAG laser.
Learn About The Non-Ablative Procedures for Skin Tightening
John: Right, so, tell me a little bit more now about the non-ablative procedures that you offer and the devices that are used for that.
Dr. Roche: Sure. So, just to review, non-ablative means that we’re not peeling the skin. All the heat penetrates the surface of the skin and it goes down into the dermal layer. It’s creating micro injuries in that layer, and then the cells respond to that micro injury or stress by creating new collagen and healing. It’s all about causing the slight damage and then healing. So these devices are either Ultherapy, SkinTyte, Broadband Light and MOXI. Those are the four that we offer in my office here.
John: So, tell me a little bit about each one of those. Let’s start with Ultherapy. What is that?
Dr. Roche: Sure. So, Ultherapy is ultrasound therapy, so it’s not laser wavelength at all. So, Ultherapy sends ultrasound waves in the form of a thermal coagulation point past the skin. And with Ultherapy, unlike lasers where we’re treating [only] in the dermal layer, [with] Ultherapy, we treat actually that collagen that’s on top of the muscle and we treat the collagen that’s in the dermal layer. So, you’re getting two layers of tightening. So it sends this heat in the form of the ultrasound wave or the thermal coagulation point causing that little injury, and then the body responds over time by creating new collagen.
So, it’s usually in four months, we have patients come back to see the results, and it’s really a popular treatment because we get amazing results with this machine. The treatment can be uncomfortable, so if people read about it online, they can see like, “oh, it was so painful”, but I’ve created, and I have a protocol and I have some really great strong numbing cream to help.
And we have you come in earlier, relax, we put the numbing cream on. And if somebody’s really sensitive, then I can do some injections of local anesthetic to make it almost no pain, no feeling at all. So, the Ultherapy treatment’s good [because] you can go back to your routine, you could even go swimming afterwards. There’s no peeling of the skin, there’s no redness, there’s no special creams or ointments that you have to put on afterwards, just your sunscreen. And it’s a very, very nice one-time treatment. We wait four months, look at the results, and then we can repeat it at that time or do it just yearly.
Layers Of the Skin
John: Right. When you’re doing these types of treatments that are affecting the collagen, like you said, that’s right on top of the muscle layer or into the skin layer, does everybody have the same depth of skin and where their muscles are, where that collagen layer is? Or do you need to adjust that patient by patient?
Dr. Roche: Ultherapy comes [with]…we’re looking at an ultrasound screen. There are different…you put this transducer in the handpiece and there are different depths. If someone has thicker skin or a fat layer in between that’s thicker, we want to make sure we’re hitting the appropriate levels there. Someone who has very thin skin or doesn’t have that fat layer in between, we may use two different transducers because if we’re looking at the screen, we can see, okay, I’m not reaching that level or I’m below that level that I want to be at. So, the person doing the procedure really needs to understand how to read the depth of where they’re at. But there are adjustments that we can do within that parameter, and most people fit within those three different transducers.
What Is SkinTyte Therapy?
John: Right. The next device that you mentioned was called SkinTyte. Tell me a little bit more about that.
Dr. Roche: Sure. So, SkinTyte is using an infrared light wavelength, and it too stimulates the collagen by causing a little thermal injury under the skin. So, similar to Ultherapy, but using, instead of ultrasound waves, we’re using light waves. The difference between SkinTyte and Ultherapy is that with Ultherapy, we’re treating two layers where with SkinTyte we’re treating the surface. But [there are] amazing results with that as well. Some people may start off with Ultherapy and then they use SkinTyte as their maintenance treatments, but it’s really, it’s very relaxing actually, the treatment.
It’s a sustained heat that goes into the skin and we’re measuring the temperature. We want to make sure we get it up to 40 degrees Celsius. but It’s just gliding this transducer back and forth over the skin area and that heat, once again, it causes micro injuries and stimulates your body’s collagen. So that’s a nice treatment. Similar to the SkinTyte – it’s actually the same machine — there’s a treatment called broadband light, BBL.
What is Broadband Light?
John: So, the next treatment that you offer is called broadband light or BBL. Tell me a little bit more about that.
Dr. Roche: Sure. BBL is an amazing treatment that is probably the most popular treatment in our office. And broadband light is a wavelength of light, the infrared light, and it’s actually adjustable. We have different wavelengths that target collagen, but we’re targeting also browns and reds. So, what broadband light does, we’re correcting the surface, whether you have fine capillaries, red spots, you have hyperpigmentation freckles.
So, it’s treating those chromophobes by…we select a wavelength of light that targets those, but we also are getting that heat in and that heat is going to stimulate the collagen similar to what the SkinTyte did. So, it’s nice because you get two treatments in one, and some people actually will have the broadband light, the BBL treatment, and finish with SkinTyte. And that’s a beautiful combination of treatments. So, it’s light therapy that helps with the pigmentation, it helps with the surface complexion, but we’re also getting the skin tightening component of it as well.
What is Intense Pulse Light?
John: There’s another thing that’s called IPL or intense pulse light. Does that differ from BBL?
Dr. Roche: That is an excellent question because a lot of people think they’re similar. They’re similar on the surface in that it is light, light waves that can target pigment or red vessels. But IPL is a big bang or flash of light and you are getting the surface treatment, but you’re really not getting that sustained heat. The fibroblasts react better to sustained, controlled heat than the big blast of the light that comes from the IPL.
So, IPL was like the older technology, BBL is a newer technology. It’s more specific, it’s a quicker treatment, and you’re getting a different depth. You’re getting the browns, the reds, the collagen, so newer technology and better results overall.
What is a MOXI Treatment?
John: And then there was another non-ablative treatment that you mentioned that you called MOXI. Tell me a little bit more about that as well.
Dr. Roche: Yeah, so MOXI’s a great treatment. It’s a non-ablative fractionated resurfacing treatment. So what does that mean? Non-ablative we talked about – it’s not going to peel the skin. Fractionated in that it does it in…think of a shower head instead of a hose. So, it’s doing the skin in little bits instead of completely. And once again, the heat and energy is under the skin. You’re making that little stressor, little injury, and the body’s responding. But what MOXI also does is that you’re going to get a slight shedding of the epithelial cells in about three days. It’s called MENDs – microscopic, epithelial necrotic debris.
Remember I talked about the nano peel from the other laser? It gives you that resurfacing, that nano peel will, but you’re also getting nice heat in energy deeper down in the dermal layer. We often combine the BBL and the MOXI, and that’s an amazing treatment combination by putting those two modalities together.
John: And why is that? Is that just because that BBL really is, again, treating the pigmentation on the skin and evening out your skin tone, as well as doing a little bit of skin tightening under the surface, and then the MOXI is really, really working on that skin tightening and you’re just, you’re getting all of the layers of the skin that way.
Dr. Roche: And the MOXI really helps shed the surface of the skin. So, it helps with the fine lines and wrinkles and the BBL will bring that brown pigment to the surface and it’ll stay on the surface of the skin for a week or two, not as a scab, but just a little darker. But when you combine it with the MOXI, you’re really getting the dead skin cell turnover. You can have one treatment and you come back in a couple of months and you can see the difference of the tightening of the skin and you get a beautiful glow.
So, that would be one treatment for someone who maybe is younger and is taking care of their skin or doesn’t have a lot of damage. But somebody who comes in who has a lot of sun damage, a lot of wrinkles, a lot of laxity, we may recommend a series of three to six treatments. [We] get them at a level where they’re really happy with their skin, and then put them on a maintenance program where they come in two, three times a year to have the treatment.
Consultations with Patients
John: What would you do in terms of talking to a client who’s maybe confused about all of this? There’s so many different technologies, so many different types of devices that can be used. So, somebody who’s just looking for a little skin tightening, looking to maybe fix up their complexion a little bit, remove some wrinkles, make sure that their skin is more tight moving forward, how do you sort of summarize this for them and pick a recommended treatment or multiple treatments for each patient depending on what their needs are.
Dr. Roche: So, once again, getting a feel and really talking to the patient and listening to what they feel comfortable with. Because I tell patients, you can [consider] each…there’s different roads you can take to get to the end point, so we’ll pick one. But what’s really important is I tell them to think of the office as the gym for their skin. You have to consistently stimulate the collagen just as you go to the gym to help your body. You don’t go once and then say, okay, I never have to exercise again. You have to go regularly.
Same with stimulating your collagen or building your collagen. You need to have a consistent plan. So we may have the front end treatments back to back a little more, but once they get to that goal, then we go on a maintenance program. And if they’re younger, it’s probably easier just to maintain. If they’re older, then we come up with a plan to get them to that point, and then consistency of exercising your skin, coming to the “skin gym”.
John: That’s great advice. Alright, thanks Dr. Roche for speaking with me today. I appreciate it.
Dr. Roche: Thank you, John, for having me. Good to see you.
John: And for more information about all of these different skin tightening treatments or other treatments that are available at the MedSpa, visit the website at elizabethrochemedspa.com or call 201-505-1020.