As discussed in our article on skin retraction after liposuction, the quality of skin retraction and redraping is an important part of achieving the best Vaser lipo result. As this depends mainly on the skin’s thickness and elasticity, treatments to improve skin quality are an option that some patients may want to consider before surgery. In some cases this can also be helpful after surgery (for example, using HIFU).
This article discusses the mechanisms that allow the skin to improve in quality, and the treatments that can be used to trigger this. The diagram below illustrates the key elements of this process. When comparing younger and older skin, we can see that there is an important difference in the amount of collagen and elastin.
The treatments used for revitalizing and improving the skin work by stimulating it to produce more collagen and elastin. This is achieved through a process of controlled injuries. The skin then works to repair the injury, and by doing so, it creates more of these two keys skin components, while also stimulating the increase in connective tissue and blood vessels. The overall process thickens the skin, and increases its elasticity. It also generally improves the smoothness of the skin’s surface, reducing wrinkles, and rejuvenating its appearance. A variety of methods can be used to achieve this, and these are discussed in the following sections.
Micro-needling
A well-known method for inducing controlled dermal injuries is through the use of micro-punctures. Devices such as derma-rollers and derma-stamps can be used to create a matrix of small punctures to the skin. This, in turn, stimulates bio-chemical signals that trigger the mechanisms of skin repair such as neocollagenesis. This is a non-surgical method that is inexpensive. For good results multiple applications over a period of six weeks are needed per area treated, and results can last up to a year.
Gold thread skin rejuvenation
Similar to micro-needling, but longer lasting is the technique of gold thread rejuvenation. This is the implantation of fine threads made of surgical grade, pure gold. These are deployed in a mesh fashion in a pattern that depends on the area of the skin requiring improvement. The method can double skin thickness, improving its elasticity and suppleness. It also promotes growth of new capillaries, so not only does the skin become thicker, it is also better nourished and oxygenated. This is a low-impact surgical method that produces results that can last up to five years. The treatment is required only once per area treated and the threads can be implanted in a few hours.
Recosma laser skin tightening
Various laser technologies have been used to improve skin quality and tightness, but often with variable results and, sometimes, adverse reactions. Newer technologies such as the Recosma laser have been shown to deliver skin improvement results faster and also with fewer side effects.
This type of laser produces a more controlled injury to the skin, keeping power levels low. The method relies on mechanical stimulation of the skin instead of thermal. Several applications are typically required with recovery periods of five to seven days in between to achieve good results.
In addition to improving the skin, the Recosma treatment is also a very effective laser scar removal treatment that can be used to improve the aesthetic aspects of acne scars, general scars, and stretch marks.
High energy focused ultrasound (HIFU)
HIFU is an ultrasound-based technology that creates a focused beam of acoustic and thermal energy and applies it at various skin depths. It has been successfully used to facilitated retraction and stimulation of soft tissues.
Radio frequency (RF)
Similar to HIFU, but using radio waves instead of ultrasound, RF delivers focused energy to target tissues.
Medical grade topical skin products
It has been shown in many medical studies that retinol, concentrated alpha- and beta- fruity acids, anti-oxidants, anti-inflammatory, and pigment-stabilizing agents are all valid as topical preparations for improving the cellular metabolism of skin and promoting neo-collagenosis. To be effective they must be used in a compounded, prescription doses, and applied daily. Long-term use is required to achieve good results.
Surgical redistribution with anchoring threads
For some cases, satisfactory skin retraction can’t be achieved by any of the previously described methods. In this case, a surgical redistribution of the skin can be made in a manner similar to what is done for mini-facelift procedures. That’s to say, the skin is stretched with use of threads under the skin, and the excess skin at the perimeters is then trimmed. The incisions are positioned so that scars are optimally hidden in the natural creases of the body.
Summary
For some patients it will be possible to improve the body’s contours while simultaneously achieving good skin retraction. For others there will be a clear trade-off, as the skin will not retract sufficiently for some ambitious body contouring goals. For this latter case, it is up to the patient to decide the balance they wish to achieve. The surgeon’s responsibility is to assess the skin, and provide the patient with advice on likely outcomes, and ways to further improve the skin’s appearance.
