LOOSELY SPEAKING…… The skinny on the evolution of non-incisional skin tightening

Andrew Kornstein, MD

Split Rock Surgical Associates

Greenwich and Wilton, CT

The Retreat at Split Rock

Twenty-five years ago plastic surgeons had only one tool, the scalpel. All “rejuvenative” options involved cutting and redraping of the skin. There was no Botox®, fillers or lasers. Today we are inundated with minimally- and non-invasive options. What is fueling the demand for these technologies? In my opinion, two things: the increase in life expectancy and the focus on quality of life, including exercise and diet. But no matter how we exercise and diet, we cannot control skin laxity and excess. Whether due to pregnancy, weight loss or the aging process, controlling skin quality and quantity has become a major focus for my patients.

Despite the promises and dashed hopes, there has never been a reliable way to tighten skin without excision and the requisite scars until now. The revolution, and evolution, began in 2011 when I purchased Ultherapy®. I saw something unique in its ability to reliably deliver energy just beneath the skin, as opposed to penetrating the skin like most technologies. By establishing a close relationship with the scientists at Ulthera®, I learned what they knew about their device and combined this with my knowledge of anatomy and the aging process. This is when I began using Ulthera® on the body. It worked well in some candidates, especially on the arms, abdomen, knees and male and female chest (www.kornstein.com/procedures/body-procedures/ulthera-for-the-body/ ). It also led to my discovery that Ultherapy® could non-surgically melt silicone injected into lips as well as shrink post rhinoplasty nasal skin.

My results with non-invasive body contouring brought Syneron, the makers of Profound® to my door in 2015. I began working with Profound® and found that it was remarkably successful and consistent at rejuvenating facial skin, restoring elasticity and hydration while delivering an overall tightening. I discovered that certain facial muscles, the ones that create forehead wrinkles, crow’s feet and lip lines, can also be successfully targeted and reliably treated. Profound® has a 96% satisfaction rate on the face while delivering clinical results equivalent to 35% of a facelift that lasts for five years. A deeper applicator melts neck fat as well as fat elsewhere on the body (youtu.be/cS0nkOEYMyg youtu.be/GWx5qcSpriA www.facebook.com/DrKornstein/). We are now working on achieving the same success with the body’s skin.

When it comes to controlling neck and body skin laxity and redundancy there is nothing like J-Plasma®, now known by the name Renuvion®. Its skin tightening capability was discovered by a colleague while using it on the deep surface of excised upper eyelid skin as opposed to the superficial surface for the purpose of resurfacing. Based on its excellent safety profile when used for delicate intra-abdominal surgeries, I was the first physician to use J-Plasma®/Renuvion® on body areas. J-Plasma/Renuvion® has maintained its excellent safety track record over the last two to three years and is by far the most consistent means of skin tightening available today. The back, hip, waist, abdomen, arms, buttock, thighs, knees and calves have all been successfully treated although results can vary from patient to patient depending on a number of factors, some known and some unknown.

J-Plasma®/Renuvion® is unique in its mechanism of action. Unlike most, if not all other modalities, it does not simply use various forms of energy to generate heat, which in turn contracts collagen. Heat related devices are limited by temperature, rising temperature leads to tissue destruction including burns. Instead J-Plasma®/Renuvion® employs cool helium plasma which cools any heat generated (preventing burns) as it biologically rejuvenates the skin’s underlying supportive structures. This may leave tissues not only tighter but rejuvenated as well. What is plasma? It is the fourth state of matter. Solids (ice) are melted to liquids (water); liquids are vaporized to gas (steam), and gas is energized to a plasma state of matter. Some examples include neon signs, plasma television and lightning. Medically, its unique properties have been successfully employed to remove tumors from delicate intra-abdominal organs. Moreover it has the ability to target bacteria and cancer cells. Other surgical specialties are presently investigating its special talents. The generated plasma biologically repairs and rejuvenates the tissues as it shrinks skin.

Combination therapy with the aforementioned technologies further enhances our ability to deliver the results patients are looking for, all with very limited downtime consistent with our busy lives. J-Plasma®/Renuvion® may be the beginning of a quantum leap in the treatment of skin redundancy, much like liposuction changed the way we removed fat from the body in the 1970s. It took 20 years for liposuction to become mainstream and the Lipoplasty Society of North America organization was founded to research and advance the predictability of this new technology.

J-Plasma®/Renuvion® is much safer than liposuction was in its early days. By virtue of its cold helium plasma technology it cannot burn the skin or indiscriminately melt subcutaneous fat, destabilizing and deforming the overlying skin like other devices presently on the market. As with liposuction’s evolution, further scientific studies will light our path to more predictable non-surgical skin shrinkage, from person to person as well as body area to body area. Will it ever completely replace the need for incisional surgeries? I doubt it. However, it has already dramatically reduced their number in my practice. Despite the obvious changes in how medicine is presently practiced, I believe that good medicine will always be predicated on sound scientific studies and the individual physician’s skills. The right prescription for a given clinical situation will always lead to the best long-term outcome. Liposuction’s results are much more consistent today but still very much depend on the person holding the cannula.

J-Plasma®/Renuvion®’s mechanism of action and safety profile has enabled us to move forward much faster so that we can achieve what was not possible only a short time ago, skin tightening (skintighten.net). And this in turn, has translated to better quality of life for my patients.

Dr. Kornstein is Board certified by the American Board of Plastic Surgery. He is an active member of the American College of Surgeons, the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery and The Rhinoplasty Society. For more information, visit www.kornstein.com