Don't get us wrong: Injectables will always have a place in the world of cosmetic treatments. They're easily accessible, reasonably predictable, mostly free of side effects, and an amazing alternative to cosmetic surgery. Yet, attempting to fill every fine line or wrinkle with temporary facial filler can be costly and tedious. The maintenance appointments not only rack up quickly, but they are also time-consuming and, obviously, painful (hello, needles to the face). Many patients are left wishing for alternatives to rejuvenate their skin.
As the evolution of technology in the aesthetics realm has soared, laser treatments and other skin-care devices have luckily followed suit with less downtime and discomfort than injectables. Many even tout longer-lasting results that are instantly visible while working behind the scenes deep down in your skin to boost collagen production for months after each treatment.
With the latest in-office treatments, "we're advancing and refining technologies and finding better ways to utilize the radio frequency and microneedling procedures to get more efficacy and reduce side effects," New York City-based board-certified dermatologist Blair Murphy-Rose, M.D., tells Allure. With that in mind, we asked dermatologists to break down the next generation of non-invasive cosmetic treatment options.
Sofwave for Tightening
Starting in our 20s, the building blocks of our skin's composition, such as collagen and elastin, begin to break down, causing sagging, fine lines, and wrinkles. Genetics, sun exposure, or unhealthy lifestyle choices can speed up this deterioration, too. No matter the cause, one of the newest in-office devices promises to pause this process and rebuild collagen via ultrasound waves, which penetrate skin approximately 1.5-millimeters below the surface to tighten and tone loose, crepey tissue, says Dr. Murphy-Rose.
In less than a week, you'll see results without experiencing any redness and irritation. The device’s waves skip over the top layers of superficial skin, leaving it completely unharmed, Dr. Murphy-Rose points out. With the help of slathering of numbing cream beforehand, you'll just have to sit through 30 to 40 minutes of minimal discomfort with a warm feeling skimming your skin throughout the treatment. Without numbing, "it definitely does come with a bite," New York City-based board-certified dermatologist Shereene Idriss, M.D., mentions. "It's not a painless procedure by any definition of painless."
With Sofwave, dermatologists can pinpoint where they want the waves to make the procedure as noninvasive as possible — most popularly, the eye and neck areas. They can even target the "nooks and crannies that other devices wouldn't let you go into," Dr. Idriss says, listing off the rims around the eyes and the front of the neck as examples.
Even better, doctors can also control how deep underneath the skin the energy goes, so it only heats up specific tissues without affecting the muscle, nerves, or fat tissue around it, which won’t benefit from the ultrasound waves. In the process, "that heating causes a coagulation [in the tissue], which tightens the skin by bringing the fibers closer together," Dr. Murphy-Rose explains.
The Sofwave can be compared to Ulthera, a beloved older ultrasound-based machine that has gained popularity for its tightening, wrinkle-reducing effects, Dr. Murphy-Rose says. However, Ulthera comes with significant discomfort throughout the procedure, as well as some swelling and longer-term redness because it penetrates skin at a deeper level. "With Sofwave, you have none of that," Dr. Murphy-Rose adds. In fact, Sofwave has zero downtime.
Sofwave is also an amazing option for preventive maintenance, as it stimulates collagen even if you don't need any tightening. "It's really for everything and largely anyone," Dr. Murphy-Rose notes. Whether "it's just some early laxity that someone in their thirties is starting to notice" or significant looseness and fine lines in the face or neck of a more mature patient, she adds.
Regardless of your skin type or age, though, Murphy-Rose recommends only getting Sofwave once a year. Priced at about $6,500 per treatment, the results are so discernable and long term, you won't want to return to the dermatologist for a second round. Within a week, you'll be able to notice your skin tightening. After a month or so, your skin's collagen production will continue to ramp up to strengthen your skin at a cellular level to keep future lines at bay. The three-month mark is when your skin will start showing significant results — and your skin will only get better from there.
Lutronic Genius for Fine Lines
The Lutronic Genius is what Dr. Murphy-Rose calls "the next-gen radio-frequency microneedling procedure." Unlike its counterparts of the likes of Morpheus8 and Vivace, this treatment has more impressive results with fewer side effects and little to no downtime.
Radiofrequency microneedling is the go-to procedure of Marie Hayag, M.D., a New York City dermatologist, for speedy results and recovery. "It's a simple and quick non-surgical procedure," she says. "No one wants downtime."
The first phase of the treatment is microneedling to create microscopic, quick-healing wounds deep in the dermis. "When you put needles in the skin, it induces a cascade of events for your skin to respond to produce more collagen and elastin," Dr. Hayag explains.
Then, Lutronic Genius takes skin plumping and tightening one step further by pairing up the painless pinpricks with radiofrequency to heat up the skin and create thermal damage. As a result, the whole process "expedites the production of collagen and elastin," causing skin to contract, tighten, and improve fine lines, wrinkles, and sagging, Dr. Hayag says. Best results appear after a series of three treatments, timed one month apart.
On the day of the procedure, you can expect your face to be covered in some "point marks of blood" and minimal scabbing, Dr. Murphy-Rose says, while Dr. Hayag recommends patients skip wearing makeup for 24 hours to let the needle wounds heal. In the three to five days following, redness and a bit of peeling may occur, too.
Dr. Idriss also loves microneedling with heat — so much so she performed three treatments a month apart on herself. Two months into the series of procedures, "I remember looking at my eyes, thinking, 'Wow, those fine lines under my eyes are so much better,'" she recalls.
In general, radiofrequency microneedling devices offer "the best bang for someone's buck" — about $1,500 to be exact — as their results pack very little downtime and maximum efficiency without causing "an enormous amount of trauma" to skin, says Paul Jarrod Frank, M.D., a board-certified cosmetic dermatologist in New York City.
Clear + Brilliant Touch for Texture and Discoloration
Another newer, noninvasive innovation Dr. Murphy-Rose recently added to her device lineup is the Clear + Brilliant Touch laser, which she considers a safer, more low-key alternative to the laser gold standard, Fraxel.
With a typical Fraxel treatment, patients are sedated for the procedure, which resurfaces skin to diminish sun damage, discoloration, and fine lines, followed by wound care for the first 24 hours. Fraxel notoriously requires serious downtime, complete with redness, peeling, and discomfort for at least a week. Also, it’s pricey — starting around $7,500, depending on the area you're addressing
Clear + Brilliant Touch, on the other hand, offers up the same resurfacing effects for reducing hyperpigmentation, roughness, and fine lines, though. "Clear + Brilliant is kind of like a baby Fraxel, I tell my patients," Dr. Hayag says. "You're making little microthermal zones, like Fraxel, but it’s not as intense and not as powerful, so there’s not as much downtime."
Starting at about $1,000, Clear + Brilliant is much more affordable than Fraxel's hefty price tag. You'll still experience slight redness and some peeling, but these side effects are much more manageable and heal up in about a week. "At the two-week mark, most people have a nice glow to their skin," Dr. Murphy-Rose notes.
All the peeling isn’t just for the astonishing radiance-inducing results, though. For up to a year, your collagen will also be stimulated enough to help ward off new wrinkles. "Basically, you're improving the quality of your skin so it's able to bounce back a little bit more like it did when you were younger," Murphy-Rose says.
Hayag often recommends Clear + Brilliant Touch to her younger patients looking for preventative care for the healthiest, smoothest, brightest complexion. Typically, the treatment will be done in a series of three, a month apart, in this case. "It wouldn't be my go-to [procedure] for my older patients who have more sun damage, [though]," she adds. In that case, Hayag suggests Fraxel instead, as Clear + Brilliant Touch is not as strong for decreasing discoloration like that.
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ArrowPlatelet Rich Fibrin (PRF) for Radiance
Like its sister treatment, PRP (also known as the Vampire Facial), a doctor draws blood and purifies it before reintroducing certain components from your blood into your skin to help it heal faster and expedite collagen and elastin production for complexion rejuvenation.
PRF collects platelet-rich fibrin, which has more cells, growth factors, and stem cells than PRP, which is powered by platelet-rich plasma. As a result, PRF decreases dark spots, improves texture, and provides a longer-lasting luminescence on the skin.
This treatment is also considered to be more natural. Reason being: When blood is collected for PRP, it fills a tube that already contains coagulants and preservatives to keep the blood from clotting too quickly. PRF, however, utilizes completely empty tubes, says Dr. Hayag. Without those additives, the entire skin-regeneration process speeds up. Blood converts to fibrin by thrombin in the early stages of clot formation, causing the platelets to activate faster. As a result, a slow, constant release of growth factors occurs over a longer period of time to accelerate tissue healing.
The fibrins collected from your blood can later be reintroduced to your skin through topical application after microneedling, which is Dr. Hayag's preferred route. Alternatively, PRF can be injected with shallow shots directly into your skin like Skin Botox. Either way, your complexion will be infused with a powerful dose of nutrients and growth factors. Barely any downtime or side effects comes along with it. If anything, your complexion may appear slightly flushed for the day, but the redness should resolve overnight. At Dr. Hayag's office, one round of treatment begins at $1,050.
Layering for Personalized Results
Combining several noninvasive treatments into one dermatologist visit is also trending for patients who want a little bit of everything for a completely customized approach to skin care. In fact, Dr. Hayag says many devices are ideal for pairing with other treatments, like microneedling with PRF, she says. You can even add a laser to the mix. Consult your dermatologist to find out which treatments work best together in one visit for your complexion concerns.
On The Horizon
Stem Cell Face-Lift for Plumping
Another up-and-coming procedure is a stem cell face-lift, which all of the doctors that Allure spoke to had heard of, but only one has actually performed: Dr. Frank.
When doing so, Dr. Frank extracts fat cells from one area of the body before purifying them and injecting them into a patient's face to plump up hollow areas. He compares the process to a fat transfer. The fat cells, in this case, provide skin with stem cells, which have regenerative properties, Dr. Idriss adds.
Dr. Idriss isn't fully sold on the treatment, though. Before she offers it at her practice, Dr. Idriss would like to see studies on the long-term effects of stem cell face-lifts. "You're adding weight that, over time, is going to drop and sag more," she explains. "I don't believe everything new is great. Everything great was once new, but not everything was great. I’d like to see how some of these patients progress before I jump on the bandwagon."
Downtime for a stem cell face-lift is typically about a week to allow inflammation, bruising, and swelling to subside. Then, results should be in full effect after a month. At Frank's New York City office, the price for this treatment is around $10,000.
More Chemical Peels
Many dermatologists, Dr. Frank included, aren't fans of chemical peels because they burn several layers of skin for unpredictable results. "Different areas of the skin may penetrate differently than others," he adds. For those reasons, Frank prefers lasers.
Despite the drawbacks of peels, Dr. Idriss predicts their comeback in the next two years, especially for patients with melasma. In fact, she's seen an uptick over the past five years of patients dealing with this kind of hormonal hyperpigmentation. Unfortunately, lasers and heat-based devices aren't always the best options in this case because "you can indirectly trigger [the discoloration] to come up to the surface," Dr. Idriss, therefore, worsening the dark spots.
Chemical peels, on the other hand, effectively resurface the skin's texture without a heat component, making them a safer option for patients who want to decrease the appearance of fine lines and wrinkles without causing a melasma flareup.
Several different chemical peels are currently available as in-office treatments. Jessner, which unclogs pores with equal parts salicylic acid, lactic acid, and resorcinol, an antiseptic exfoliant, and trichloroacetic acid (TCA), which helps brighten dull skin, are the most popular options. Each peel's concentration of acids can be adjusted based on your skin's needs and goals.
Lighter ones (aka superficial peels) only work on the surface, outermost layers of your skin to make it smoother. Typically spiked with a glycolic or salicylic acid solution, these have the easiest recovery with minor flakiness, redness, and sensitivity.
More intense peels, on the other hand, usually take about four to 10 days to recover from to allow any scabbing to heal and flake off to reveal a more radiant and even complexion. They work deeper down in the dermis to help correct sun damage, fine lines, and dark spots. You're likely to feel an intense burning sensation with these ones.
You can expect to spend about $250 for a low-key peel, while stronger ones usually ring up at around $750 to $1,000.
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In 2022, you're sure to hear a lot about a device recently approved by the Food and Drug Administration (FDA) for moderate to severe fine lines called Ellacor, Dr. Frank says. "That's going to be transformative," he adds.
Like lasers, Ellacor works in a fractional manner, meaning it makes innumerable "punch excisions" — in other words, microscopic hole punches across the skin's surface. Unlike the needle pricks of microneedling, this device removes skin tissue via a process called microcoring to tighten skin and reduce fine lines and wrinkles, Dr. Frank explains. The downtime and side effects are drastically more minimal than lasers, though. Studies show this treatment typically requires about three days of downtime and minimal to no risk of scarring, he adds.
By snipping off these less-than-a-millimeter-sized sections of excess skin, fine lines are literally be cut out, and skin tightens by binding together and stretching to cover the newly formed openings via thermal energy. "I think this is going to be a huge, cutting-edge technology and a new category of treatments," Dr. Frank says.
The pricing for Ellacor with likely range from $1,500 to $2,500 per treatment, Dr. Frank shares. Keep in mind a series of at least four treatments will likely be recommended for optimal results.
Even with all the advancements newly available and on the horizon, expectations must be set individually between a patient and their dermatologist, cautions Dr. Idriss. "Improvement is such a subjective word," she explains. "I always had lines under my eyes. So for me, even having a 20 percent improvement, I was so happy… so it depends, you have people who have really deep-set etched lines that a 20 percent improvement might not do much for them."