As we age, both intrinsically and extrinsically, the skin loses its natural, youthful firmness and begins to appear loose and saggy. This is because of the loss of collagen, elastin and aminoglycans in the dermis, as well as the fatty tissue in the subcutis, thereby the whole structure of skin thickness seems to lose support. These changes have been mentioned under Skin Aging.

Loose skin due to aging can occur anywhere on the body : face, eyelids, neck, arms, thighs, and tummies, though lax facial and neck skin is often the most noticeable. Other cases of skin laxity are seen not from skin aging, but after liposuction of the tummies and breast reduction. There are just too many non-surgical treatments to improve skin laxity these days. One can be really confused by them, even a lot of physicians do not know them all, and there are a lot of debates on their relative effectiveness.

Apart from the efficacy of each of them, one needs to consider also the potential side effects, length of downtime, cost etc. They are all expensive treatments and there have been many cases of dissatisfaction after having paid out a large sum of money without getting the results as promised by the physicians.

All of the non-ablative treatment modalities achieve skin tightening via delivering heat energy into the deep dermis, causing controlled damages to the collagen and dermal matrix, which then undergo repair and remodelling. These include those delivering light ( Laser ) and electric current ( Radio-frequency ). However, although offering a low downtime, they have not delivered the optimal results as promised.

There are also the ablative treatments using CO2 laser or erbium laser. CO2 laser has been the gold standard in skin resurfacing and tightening, but it was limited by the long downtime for up to 1 month and the potential to leave marks ( post-inflammatory hyper-pigmentation ) in Asian skin. Now by employing a fractionated mechanism with a low downtime of several days, yet achieving results close to the traditional one, it is regaining great attention.

An example of Facial Skin Tightening with the Fractional CO2 Laser :

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