Skin Tightening

Nonsurgical skin tightening refers to treatments that use focused energy, such as ultrasound (US) or radiofrequency (RF), to gently heat the deeper layers of the skin. This controlled heating process stimulates collagen and elastin production, which are the structural proteins responsible for skin’s firmness and resilience. Additionally, fractional lasers can also be used to build collagen and contract the skin.

Unlike surgery, these treatments do not require incisions or general anesthesia. Instead, they work gradually over time, allowing the skin to remodel itself from within. Most procedures are performed in-office and take under an hour. Energy-based devices (RF, US) involve little to no recovery time, whereas laser treatments can require more significant downtime.

Dr. Hibler frequently combines multiple treatment modalities to maximize outcomes. For example, a patient may undergo Fraxel laser resurfacing to improve surface texture (e.g. pores, acne scars and fine lines), followed by Sofwave® to address deeper tissue laxity. He carefully evaluates each patient’s skin, facial structure, and goals during consultation to create a customized plan that delivers natural, balanced results.

Treatments largely fall into two categories: laser treatments (which produce heat columns or vaporize tissue and require downtime), and energy-based devices (which bypass the top layers of the skin to reach the deeper dermis and do not require any downtime).

Lasers

Lasers are widely considered the gold standard for nonsurgical skin tightening, with effects emerging gradually as collagen rebuilds and the skin repairs itself.

• Non-Ablative Fractional laser resurfacing (Fraxel® Dual) – One of Dr. Hibler’s most effective tools for skin tightening at the surface level is Fraxel Dual, a fractional non-ablative laser that delivers controlled thermal energy deep into the skin to target wrinkles, texture and pigmentation. Over time, this leads to smoother, firmer skin with improved tone and texture. This is best performed in a series of treatments when used for tissue tightening.
• Ablative lasers (e.g., CO₂ or Erbium) remove microscopic skin columns, promoting intense collagen remodeling. These devices can also be used to fully vaporize the outer layers of skin, resulting in longer recovery but delivering dramatic firmness and resurfacing.

Energy-based treatments

Energy-based treatments include radiofrequency, RF microneedling, and ultrasound devices. These devices deliver gradual yet natural-looking improvement, with lifting and skin-tightening effects emerging over two to three months. Sessions usually last under an hour and require no downtime.

• Radiofrequency, RF microneedling – For deeper collagen stimulation and more significant tightening, Dr. Hibler often recommends radiofrequency or microneedling/RF devices. Radiofrequency treatments like Thermage® use heat energy to remodel collagen deep within the skin. Thermage is a popular choice for smoothing and firming the skin around the eyes, face, and jawline in a single treatment session.
• Morpheus8 – Morpheus8 is an advanced radiofrequency microneedling device that combines microneedling with RF energy delivered into the deeper layers of the skin, triggering robust collagen remodeling. Because this device incorporates microneedles that stamp through the skin, there is more downtime than a standard RF device.
• Ultherapy® and Sofwave® (Ultrasound Technology) – Ultherapy is FDA-cleared to lift the brow, neck, chin, and décolletage. It uses micro-focused ultrasound to deliver heat deep into the dermis and superficial muscular aponeurotic system (SMAS), triggering collagen regeneration and resulting in a natural-lift effect

Sofwave uses non-invasive ultrasound energy to heat the dermis at optimal depth, promoting collagen and elastin production. Patients benefit from firmer, lifted skin on the face, neck, chest, and upper arms, with no downtime. In addition to treating skin laxity, this device is also FDA approved to improve the appearance of cellulite and acne scars.

Often times, skin laxity is exacerbated by a loss of volume (fat) in the face due to aging, weight loss, and other factors. Additionally, bone resorption and loss of structure can accentuate loose tissue. As a result, Dr. Hibler often uses dermal fillers to restore lost volume in the face and provide structure and lifting strategically to augment the results of laser and energy-based tissue tightening. Dermal fillers can help lift tissue in the midface (restoring cheek contours) and can be used at the angle of the mandible enhance jawline contour and lift the jowls. A combination approach using devices and injectables often reduces the overall volume of dermal fillers necessary and provides the most natural, refreshed appearance.

In addition to in-office procedures, Dr. Hibler emphasizes the importance of maintaining skin firmness through medical-grade skincare. He often recommends products containing retinoids, peptides, and antioxidants to support collagen production and protect the skin from environmental damage. These topical therapies can enhance and prolong the effects of energy-based treatments.

During your consultation, Dr. Hibler will assess the degree of skin laxity, review your medical history, and discuss realistic expectations. Based on your skin type and concerns, he will recommend the most appropriate treatment or combination of treatments. The treatment choice will depend upon your skin type, areas requiring tightening, and tolerance for downtime. Results develop gradually over weeks to months as new collagen forms and skin becomes firmer and more lifted.