Drs Discuss Skin Tightening Treatments

today we’re talking about skin
tightening treatments hi guys welcome back to the channel I’m here again today
with a lovely doctor Kishan and dr. Euan and to talk to you about skin tightening
treatments which is a topic we get asked about an awful lot in the clinic you
know patients come in they’re like my skin feels like it’s down here near the
nipples what can I do to really snatch everything back up and in again I’m
gonna go first this time because it’s my channel and
you know that’s just how it works sometimes and I’m gonna talk to you guys
about doing ultrasound treatments so in the clinic we use a machine called ultra
cell which has got radiofrequency and ultrasound on it and the ultrasound
portion is sort of similar to that of Ulthera do you guys have any
comments mmm I’ve you suppose so definitely one has benefit over the
other in terms of visualization of the area you need to treat so Ulthera has
a scanner where you can see this mass layer which is the layer sitting on top
of the muscle that you want to contract that’s what the ultrasound is targeting
isn’t it contract that promote collagen and provide a kind of non-surgical
facelift mm-hmm I would say that Ulthera is more
painful I find when have you used a bit before I did not find that like for
myself I had both I’ve had both have you had majority not have it but I’ve got
experience with all theatres and it is a thing I mean patients will say it’s more
painful most of the clinics I know that use it
actually apply anesthetic beforehand and there’s and also the other treatment
that I have come across as ultra former and I think that’s better for the body
it’s really popular in Brazil but I think the Ultracel is quite a nice
gentle it’s much gentler sort of a feeling treatment
yeah I am going to go and have a look at the new ultrasound machine tomorrow I
think it’s called Ultracel Q plus so perhaps that will be slightly different
I don’t know there’s a price point difference as well between having
ultrasound and Ulthera as Ulthera significantly more expensive because the
consumables are a lot more expensive so having had both myself in my opinion it
wasn’t all painful either of them I put it as solid zero to one out of ten just
so unusual yeah I don’t think i’m particularly hardcore no she’s not I genuinely just
didn’t feel anything I did see slightly more of an
improvement when I had that all Sarah over the ultrasound but I like I said
with both I’m not sure whether or not that extra expense is worth it or not I
think it depends on how much you value your time like would you have two
ultrasound done instead of one else I don’t know I’m not sure I’m someone that
I would say though about doing the ultra cell is even though you can’t get the
direct visualization so you’re not exactly 100% sure if you doing in
the smas layer or not in practice I’m not sure whether or not that actually
makes that much of a difference because even if you’re in the fact if you’re
doing it on a patient with a full of face who maybe needs to slim the face a
little bit that’s probably a good thing because you’re gonna get a little bit of
fat loss as well when you do it so certainly when I have it done I noticed
that I I look slimmer and I do think an element of that is going to be from fat
necrosis element of skin tightening as well yeah which though they do look a
little bit sharper and much more elegant as well I think yeah I like a great word
yes fantastic word so with the ultra cell we’ve got four different
transducers that target different depths so it doesn’t have to go down to the
Smas layer you’ve got 1.5 millimeters and two millimeters which are much more
superficial so they’re much better for perhaps crepey skin I’m using them for
example on the decolletage or areas where somebody’s got a lot of
fine lines and it seems to work quite well for that so in a treatment will not
only target the deeper structures but also the most superficial ones as well
depending on what that particular patient needs so how does it work well
with the ultrasound you’re targeting the heat energy at a focal point underneath
the skin so you’re heating it up to about a sixty to seventy degrees so
cause new collagen formation in that region it’s kind of a repair response
and similar to how you would have with micro needling for example it’s
localized trauma so we pair our tissues through a little bit of trauma to them
promote the healing response Korean collagen at the level that we choose to
so there’s no burns on the surface of the skin even though it’s sixty degrees
or 70 degrees it’s focused diving into the tissues so you don’t see anything on
the surface that skin other than like a little bit of redness maybe I think
that’s the great thing about these treatments because somebody can just
have it done and then go to dinner or whatever straight away afterwards and
there’s literally no downtime at all but it’s not an instant result either
because it takes your body some time yeah to produce that collagen so we’re
thinking what three to six months down the line you’ll start to see some really
nice improvements a little bit on the day yeah but you’ve gotta wait have you
guys ever seen any bruising breeze any man I mean that machine always warns us
doesn’t it you know you will get a red mark you will get a bruise then you have
to reset it but I’ve never had any patients with any downtime in fact the
patients are the ones who asked me like do we need to do anything different
after this treatment and actually no I have had patients who’ve said that
they’ve been brusing from Ulthera yeah um but I’ve never seen it from
ultracel ever as a with Ulthera did you see those sort of don’t know how to
describe it almost like bars whether whether transduce transducers sort of
been sighted no it’s like a step that’s very temporary but that’s what I’ve seen
off just redness do you mean? it’s just it’s very temporary but it’s
just literally where the transducers made contact with the skin get a bit of
a step and then it’s gone by the afternoon
if you’ve done in the morning I think with ultrasound it’s really important to
be realistic about what you’re going to get from it so it’s not going to be an
overnight change it’s not gonna be as a hugely significant difference as well
that you get from it and personally I would only treat people who have got a
fuller face so I prefer treating slimmer patients using a combination of maybe
fillers or bio stimulators not using ultrasound for them Thank You areas that
patients I’ve had have really liked it’s tightening than that because that’s
where fit examine the healthier machine has an FDA approval for proven lifting
of the neck so people with that kind of crepey skin or needing some lift it
is good for that and the other area I’ve had people say they really liked was
above the eyebrow so if you’ve got a bit of a drop in the tail to bribe that
happens at aging you can revolumise with fillers you can lift with toxins
but some people don’t want to use those things they just want to use their own
body’s natural healing response so you use a little bit of focus ultrasound
there and you can get a nice lift in the tail of the frame I have I’m unconvinced
that’s our basic yeah patients like it so this is what I meant in the previous
episode about how if you ask different doctors the same question they’re gonna
give you a whole bunch of different results um I think it’s just a case
selection yeah if you do the wrong treatment on the wrong patient it’s just
not gonna work so it’s just okay this what so many things to choose from
you need to make sure we slip our options down to things we think are
gonna do a good job for you I think that’s the art isn’t it just sort of
case selection and seeing what’s going to work for someone and having that
experience to select exactly what you think will work and then the rest is
obviously nature the patients on repair processes and a bit of luck as well okay
so let’s move on to your topic ah so again so talk about case selection one
of the treatments that I think has been really popular over the last four or
five years has been plasma soft surgery so there have been some devices on the
market such as flexor plasma and there’s other treatments available and even in
your local salon or other aesthetic skin centers where the treatment isn’t
genuine plasma so plasma is technically this the fourth state of matter you have
solid liquid and gas and plasma is the fourth state of matter and this
particular machine that we use is called Plasmage
it generally basically generates a micro current and as the tip of the device
gets close to your skin it generates plasma and the plasma vaporizes a small
island of skin and then we go on to do lots more and then you get a gradual
tightening of the area I mean you get an immediate tightening and then you get
progressive tightening over a period of three to six months and it’s similar to
what you said it’s it’s a controlled injury and we’re relying on the body’s
natural repair processes and hormones to affect a tightening and although the
company recommends you that you can use it for acne for wrinkles for general
tightening of the facial skin I found it most useful for the laxity of the upper
eyelid let’s talk about that so how far around the are you going are you doing the
eyelid you just do it on top of the bone what are you treating so I’ll treat
first of all this is the area which most patients complain complain about in
patients over 50 or 60 typically with quite crepey skin maybe there’s been a
history of sun damage or genetically they’ve just got this laxity of the skin
there it’s called dermatocollasis and it’s
really common and but if it’s if the component is mainly thin crepey skin
this treatment is really good so that’s where I find the case selection is
really important so what was your question first of all I just want to
point out to you guys at home that when we say what the patient complains about
we don’t mean that your mosn it’s a medical term so we mean the patient
comes in complains of x y&z it’s not they’re coming in
it’s just what we say right between ourselves we’re now sharing with you um
so my question was are you actually treating on the eyelids itself yes so
first of all this is this area here is the most common area and then second of
all I’ll treat under the eye as well if there’s crepey
skin here as well and I’ve had quite good results with that as well and then
finally above the brow technically you’re supposed to be able to get a bit
of a brow lift but again it’s quite subtle haven’t seen it happen with
everyone but I think if I’m treating this area as well I tend to do this area
it’s such a politician he didn’t answer the question I’m sorry about three
things directly on top of the eyelid are you doing like that but there yeah
absolutely yeah this is number one this is number one area but how far down are
you going to the lash okay about two millimeters from the lash line okay so
you’re doing that section as well and what about numbing the person up so I
used to treat patients with just topical anesthetic applied over the eyelid
maybe sat there for about twenty to thirty minutes now I’ll use injected
local anesthetic into really key points to give a bit of a block and that way
patients can tolerate the treatment better yeah interesting I mean the cream
worked quite well for patients before I mean there tolerate it I mean okay
downtime so this is important so you are left with carbon crust sitting on the
skin and it looks like a strange tattoo particularly if I’ve done on the upper
eyelid above the brow it can look a bit like one of those Marvel comic heroes
with a mask and it’s quite difficult to hide so that’s the other thing too just
to let our patients know about that you know you’ve got to allow for a little
bit of maybe even a bit of a social exclusion you might want to sort of keep
away from you know school events or things like this you can cover with
makeup after about three days so and then you have to be really really strict
with yourself not to pick at the carbon crusts because now I can lead to
scarring and next it’s big problem have you ever seen anybody
whose ik had extended redness afterwards not with our machine so with the other
machines that we’ve mentioned I have seen you know our friends have have
talked to us our colleagues have talked to us about extended periods of era see
of redness which has lasted two months I think hasn’t it and you have to be
careful with your skin types as well so patients with slightly darker skin types
that are more prone to post inflammatory pigmentation problems after trauma need
to be really careful and if you do get any pigmentation you’d want to use
something like a hydroquinone to lift that out what we generally do is we if
we if we are identified patient wants the treatment and they have got that
risky skin type which is above Fitzpatrick three we would pretreat with
a with it with it with some sort of treatment that prevents more melanin
being made in the skin so actually one of the patients that we were talking
about was a Fitzpatrick one and she had extended redness yeah I’m so that’s
quite a few people yeah because they just the skin is traumatized and then it
takes some time to heal and need to wear SPF don’t they really because if you
don’t we rescue have the redness persist and they can go pigmented so it’s really
important that everyone wears their SPF after the treatment
so actually you and I would be perfect for this treatment but of course we
don’t need it so let’s move on and what is your treatment of choice so I’m gonna
talk about intracel which is kind of like a sister to get ultra cell device
that you were talking about it uses micro needling so 49 little needles in a
square and then through those needles goes a current of radiofrequency
so you can get the benefits of micro needling and radiofrequency within one
device which is quite unique there are a few in the market but by far in my
experience Intracel is the best one so it’s
called focus radiofrequency micro needling the needles go into the skin
you can choose the depth to which you do it and then the tips
needles are where the current flows so the rest of the needle is insulated so
anything on the surface of the skin doesn’t receive that my radiofrequency
it’s only the deeper layers the radiofrequency was it for well it’s for
collagen stimulation so basically the needle goes in causes some local trauma
like you would get with normal microneedle ink so you’re going to
promote collagen stimulation in that way but by delivering the radio if we can
see it heats the tissues so you’re gonna get more collagen stimulation so you’re
getting a double whammy basically any sense uh yes so why do we do it
various reasons as the machine that really can be a benefit for anyone that
wants just to improve the appearance of their skin new collagen tighter skin
help with fine lines wrinkles but it’s really really good as well for people
that have got like acne scarring where you’ve got pits and depressions Microneedling can help slightly subcision fillers can help but really I find that
the best treatment to start with is about three brands of intra so because
it breaks the scar tissue up it untangles the collagen that’s tightly
bound in the scar I lift the scar up and then you form new collagen from beneath
and it lists that’s go right that makes any further treatments a lot easier it’s
quite nice for pores as well yeah I definitely get a reduction in pore size
after it hmm what about downtime so there’s not really downtime as such they
can be a bit red for a couple of days that’s really about the extent of it
sometimes if you’re prone to like bleeding during treatment you can get a
few small scabs mmm yeah where the tissue is a bit thinner perhaps you
could scalp it it’s really not too bad again you need to wear your SPF after
the treatment you need to wear that every day even in winter for a good
couple of months mean you should be wearing every day anyway but if very
focused wearing the treatment you need to work for at least a couple of months
after the treatment um pain pain yeah it’s painful if you if you put I think a
good topical on it’s not painful I I still don’t think is
painful you can wipe tend to be so hard core today it’s a little bit low it’s a little bit
painful so you pick very strong an anaesthetic on and I’d leave that on for at
least half an hour ideally an hour I think so since it down the clinic have a
cup of tea wherever it’s stayin however make sure
that’s really working well yeah and it does take a lot of the pain out of it I
find that it gets a little bit more painful in your second path because you
do one pass with something called monopolar radio frequency which kind of
stimulates collagen throughout the tissues and a second pass with that
bipolar which focused the energy right at the tips of the needles and I find
that whatever setting you put it on I am on a puller or a bipolar the second pass
is definitely a lot more painful because you’ve already traumatized the area once
so towards the end of the treatment you get a little bit tired it takes about
half an hour to do but people love the results so they come back two three
times and it works really well I’m a big fan
have you ever heard anybody say that they got some flaking afterwards yeah
yeah yeah with a scab to the scatter some dry skin for a few days but you’re
putting on a moisturizing SPF and it really doesn’t say three or four days
later just falls off and you just use you notice the difference drained away
results were pretty quick I mean the collagen stimulation again it gonna take
a few weeks to kick in but the instant results that you’d get with normal
magnet needling it’s pretty quick okay so any wild cards that we want to
discuss as well like pee do for example when you saving up Sarah I’m not saving anything up you know I just I’m mindful that we haven’t talked about
that either yet I used to use PDO the short PDO threads in the neck and in the
lower face for skin tightening we’ve had some regulatory changes over here in the
UK which means that unfortunately we can’t use them anymore at the moment and
I well I think it’s that in one of my previous videos I was showing you using
the longer threads which I do feel are a bit more chew than they’re worth the
squeeze is not worth the juice in my opinion
I don’t know maybe they’ve got something different to say about that but the
short ones I thought were very good for this section here the jawline and the
lower part of the face thoughts comments I like the short ones for here you know
that’s sort of the that’s my line yeah exactly yeah and they’re quite they’re
sort of fairly straightforward to put in patients don’t often need numbing for it
either hardcore l I think the threads I was always using they were they were quite
sort of straightforward under the chin you can get some fat dissolving property yes
from the PDO threads been shown in studies so be take a section of the
tissue not from a human it can dissolve fat and promote collagen so quite nice
under here I don’t like using this base but I’ve used them under the eye as well
and that’s a really different technique because you’re presumably you’re sort of
putting them laterally so perpendicular to the skin so this technique is
different it’s from Korea and from that doctor I told you about and basically
you’re going sort of perpendiculars in the skin so the needles coming in at you
in super shot right underneath the eyelid and it is terrifying in patients
neutral you’re going backwards they think I would be a fun but as if by
magic and it just stays like that you did a lot of stuff for then Korea don’t
they and nose threads maybe that will come to UK at some point I think the penetration stay inside South Korea so I think
that’s it yeah yes that’s it for this week if you’ve got any questions or
comments or let us know in the comment section below and we will see you again
next week for more of the same joy you you

18 thoughts on “Drs Discuss Skin Tightening Treatments

  1. Ultrasound, terrifying that’s done to babies. It is bad for them, am still guilty I had one for my baby. Now doctors are giving every month to babies, pure sadism.

  2. Such interesting topic, I saw you went on a confrance for the newest products, technologies and other,
    1. Could the team talk about newest products, technologies or procedure (that are new or not on the market) that you and the boy are excited to see and use the future???
    2. Dr. Euan would you kindly talk about your background in dentisrty and how it helps you in your aesthetic practise? ?
    Love from Iceland

  3. had some troubles with lidocaine cremes as a topic or such procedures. Super allergic, skin scabbed because of that. Any other cremes I can use instead?Thank you for the video🌻

  4. I’m curious about Forma RF, but I was also told that the collagen/affects it builds isn’t long lasting if u stop treatments. But it sounds like it’s less riskier when it comes to volume loss.
    I love your video’s!

  5. I was not warned about the potential fat-reducing effect of Ulthera, and I lost too much volume in my face and neck. Be careful about unintended consequences!

  6. Great video! Can you talk about approximate costs of the treatments as well? Just ball park amounts would be helpful for those of us saving up for treatments. Really enjoy the content!

  7. Are the threads permanent or do they dissolve after time passes? Incidentally, you kids all look incredible. I am so jealous…

  8. hi dr sarah , iam 42 and have lost allot of volume in the face , temples , eye area , nose , the volume seems to have decended to down under my chin and jaw . The clinic i went to advised the best option would be a facial fat graft using facettite , so harvesting the fat from under my chin and injecting back into my upper face , they would then use morpheus 8 after , it is pretty costly and i just wanted to get you're thoughts on this , as this treatment wasn't discussed …thanks

  9. hope this video was pre-recorded as otherwise you are not following government rules- stay 2m away!; essential work; work from home!

  10. I've had HIFU 3 times now, ultraformer twice and ultracel once, both very effective and amazing treatments. ultracel was more painful but it really wasn't bad at all just a bit prickly.

  11. I had Ultherapy, a little over 2 and a half weeks ago. I had Thermage years ago and that killed. The Ultherapy was only done on my lower face, chin and upper neck. Very little discomfort, redness afterwards but faded quickly. The technician said that she found it was painful you let the part that touches your face get too overheated. She took her time and I was never uncomfortable. Its supposed to take 3 to 6 months for results. My plan is to do this and then follow up in a couple months with the new light filler that hasn't been approved in the US yet. I'm fortunate, my fiance is a primary care doctor and has agreed to take the course for injectables so he can do mine. This way I can have him do my temple area, like you do Sarah. He isn't about to purchase an Ultherapy machine, so I had do so that elsewhere.

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