The best skin tightening options for mild, medium and severe skin looseness

How to tighten loose skin on thighs, stomach and arms, for different levels on skin looseness severity

We are pleased to share our experience in cellulite and skin tightening from our clinic in London with everyone in the world. Check all our articles here. And if you do live in London, feel free to book a treatment or consultation with us here.

• What are the best procedures to tighen skin: surgical / non-surgical options

• What causes skin looseness?

• Inactivity and skin looseness

• Low protein diet and skin firmness

• Yo-yo dieting and saggy skin

• Ageing, genetics and loose connective tissue

• Weight loss and loose skin

• Pregnancy and skin looseness

• Ok, now that I know what causes skin looseness, What can I do to tighten up my skin? What are my options?

• You don’t necessarily need to do anything about it - skin laxity (or cellulite) doesn’t kill

• Can diet and exercise help tighten up my skin?

• How about skin firming creams?

• Skin tightening treatments: the good, the bad and the ugly

• The strongest SAFE skin tightening treatment: deep-acting, high-power radiofrequency

• Bipolar or low power RF is a waste of time for skin tightening

• HIFU skin tightening: low/medium power doesn’t work, high power is dangerous

• Skin tightening with infrared/red light: too superficial, too weak

• EMS for skin tightening: good luck with those…

• Microneedling radiofrequency (fractional RF): too dangerous

• Fillers for skin tightening: temporary and dangerous

• Strong, deep tissue radio frequency - the only skin tightening technology worth considering

• I have extreme skin looseness - what are my options?

• I have a lot of skin looseness and don’t like surgery, what should I do?

• Surgery for extreme skin looseness

• How about skin looseness in the buttocks area? What about bum lift - surgical or non-surgical?

• Summary of options, according to severity of skin looseness

• What would I do if I had skin looseness?

• Check our professional consultancy in cellulite, skin tightening, ultrasound and radiofrequency

What are the best procedures to tighen skin: surgical / non-surgical options

There is a lot of misinformation and hype when it comes to skin tightening.

Especially for severe skin looseness things are even more complicated, as there is the dilemma between surgery and non-surgical skin tightening and the inadvertent marketing hype, misleading claims and truth concealing, all for the pursuit of unethical profit.

Here we examine this issue in detail based on science and two decades of experience and present the best options for each case.

What causes skin looseness?

Skin looseness is the same, regardless of where it is found in the body - stomach, arms, legs, buttocks, waist, neck or face.

It is the result of:

• low collagen levels

• damaged collagen fibres, due to glycation, inflammation and oxidation

• overstretched collagen fibres

• and, quite often, reduced elastin

People who have lost a lot of weight, gave birth or who have had liposuction, also have an overall excess length of skin - “too much skin” that hangs.

Several things can cause skin looseness, but the seven most important ones are:

• Lack of movement / inactivity

• Low protein diet

• Yo-yo dieting

• Ageing, especially if genetically you are prone to having loose connective tissue

• Weight loss, especially extreme weight loss

• Pregnancy

• Fat removal / cellulite surgery, such as liposuction, vaser, smart lipo, cellfina, subcision etc

Let’s look at those factors in detail.

Inactivity and skin looseness

The more you move, the more you stimulate your fibroblasts (collagen cells) to produce collagen and elastin and thereby keep your skin firm and elastic.

Inactivity has the opposite effect and leads to loss of collagen and elastin, i.e. looser, less elastic skin - and cellulite.

Low protein diet and skin firmness

Your skin is made of protein. Collagen, which gives your skin its firmness, and elastin, which provides elasticity, are proteins.

Following a low protein diet, as most women do, for one reason or another, deprives skin of its necessary aminoacids (building blocks for collagen and elastin) and leads to skin laxity.

Yo-yo dieting and saggy skin

Skin stretches when you put on weight, while when you lose weight you inadvertently lose some collagen (protein), with the skin becoming thinner.

The next time you put on weight the already thinned and damaged skin stretches even more. When you lose weight you lose more collagen and your skin becomes even thinner…

In summary, yo-yo dieting obliterates skin firmness.

Furthermore, when you put on weight you put on some cellulite fat too. When you lose weight, only a small amount of that cellulite fat is lost, as it is a “stubborn” type of fat, which tends to be absorbed but not be releesed.

With repeated cycles cellulite multiplies.

Ageing, genetics and loose connective tissue

Some people have naturally lower levels of collagen to begin with and with age they gradually suffer from looser skin - and looser connective tissue overall.

This also means more cellulite.

Weight loss and loose skin

When gaining weight skin is stretched to accommodate the extra fat.

When weight is lost you are left with excess skin, plus you lose some collagen as a result of the diet (lack of protein) that caused the weight loss. The end result is loose and creppey skin.

Moreover, due to the loss of firmness the pre-existing cellulite becomes more evident.

Pregnancy and skin looseness

During pregnancy skin is stretched to accommodate the extra fat and water, which both tend to accumulate, especially in the last few months of pregnancy.

Stomach skin is further stretched and cellulite appears too.

After pregnancy you are left with excess skin, fat and cellulite.

Ok, now that I know what causes skin looseness, What can I do to tighten up my skin? What are my options?

You have five options for loose skin:

• Do nothing about it

• Improve your diet, exercise more and perhaps take some supplements

• Have a skin tightening treatment

• Apply a skin firming cream

• Have surgery

You don’t necessarily need to do anything about it - skin laxity (or cellulite) doesn’t kill

Obviously that’s the easiest option. Nobody has ever died of skin looseness or cellulite and you can live a happy and fulfilling life, regardless of the firmness of your skin, so you do not necessarily need to do anything about it.

However, if you are reading this article you may love and accept your skin as it is now but you would also like to tighten it too. One does not exclude the other.

Please note that although you can improve your skin firmness quite a lot, you cannot become 18 again or turn back the clock by 20-30 years, with any method or any kind, no matter how expensive or painful. Managing your expectations is quite important.

And please do not believe those Instagram fraudsters that promise “face / body transformations” in one, two or even three sessions of their miracle treatments, complete with fake “before and after” photos. Miracles do not exist in real life.

Can diet and exercise help tighten up my skin?

In the long run (we are talking about months, years and decades) healthy eating and exercise are absolutely essential to prevent/maintain skin looseness and even to slowly improve skin firmness.

• Swimming, running, fast walking, weight training, power plate training and all vigorous exercise classes can help provide faster/more pronounced results than Yoga, Pilates, slow walking and the like

• As mentioned above, protein is very important, so don’t be scared of lean meat choices (lean red meat, poultry, eggs, low fat cheese etc) and pulses. Nuts also have a high protein content, but they also have a very high fat content.

• If you are vegan consider using one of the many high quality vegan protein powders available in most health food stores to supplement your low protein intake - there are so many chick peas and nuts one can eat to get enough protein

• Vegetables and berry fruits are also important to protect collagen and elastin from damage and to also help boost collagen and elastin synthesis by fibroblasts (collagen cells)

• Some supplements, especially vitamin C and polyphenols, as well as collagen powder supplements, can also be of help, but don’t expect fast or impressive results. It’s all about maintenance and background work, which will keep your skin firm and healthy over the decades. It is not about instant results within days or weeks - regardless what the 22-year Instagram bikini model with the perfectly young skin claims in her posts and stories. That collagen drink will not make you like her in a day, month, year or decade.

In summary, diet, exercise and nutritional supplements are absolutely important for prevention, maintenance and SLOW improvement, for both skin firmness and cellulite.

However, for faster results with skin tightening you may have to consider something faster acting, such as a skin tightening treatment and - please do it only in extreme cases! - surgery.

How about skin firming creams?

A highly concentrated cream with multiple skin firming actives (usually peptides or herbal extracts) can offer some nice, gradual results, so they are a good idea - if you can find a good one.

While some good creams exist for the face, not many such creams are available for the body.

Most body firming creams are very diluted in terms of active ingredients (with the void being filled with fluffy hype and marketing).

Unfortunately, facial firming creams are just not good enough for the body - besides being too expensive for 10-20x times larger the application area.

Also, I have to make it crystal clear that a skin firming cream will not be of much help for severe skin looseness.

However, for moderate and especially for mild skin looseness - and definitely for prevention - a good skin firming cream can prove very helpful and can actually offer much better value for money than a skin firming treatment.

The same applies to cellulite creams vs cellulite treatments: a quality cellulite cream offers much better value for money than a quality cellulite treatment - it just acts more slowly.

For example a good skin tightening/cellulite) treatment costs about £300/session for one body area, thereby costing £1,800 for a course of six sessions in six weeks. It does indeed work faster and much better than the best skin firming / cellulite cream, but then again with £1,800 you can use enough skin firming / cellulite cream for 18 months, for the same body area and get far better value for money.

So for prevention and mild improvement a good skin firming/cellulite cream can make a lot of sense. For faster results a good skin tightening/cellulite treatment is the best choice - with a good cream still being useful in boosting the results of the treatment.

Skin tightening treatments: the good, the bad and the ugly

There are dozens of purported skin tightening (and cellulite) treatments, yet very few are worth your while. Everyone and their cat promise skin tightening / cellulite removal, yet very few deliver.

The strongest SAFE skin tightening treatment: deep-acting, high-power radiofrequency

Over the last two decades I have examined, researched and tried hands-on all the major skin tightening (and cellulite) treatments/technologies. My conclusion is that for body/face skin tightening and cellulite there is only one technology that really WORKS and IS SAFE: deep-acting, high-power radio frequency.

There are plenty of other treatments, many of them touted as miraculous and commanding hefty prices, to the tune of up to £3,500/session. Even those don’t really work.

Bipolar or low power RF is a waste of time for skin tightening

For starters, any type of RF, other than deep-acting AND high-power RF, is just not good enough for body treatments.

To tighten skin (and reduce cellulite) you need to work deep in the skin, in the hypodermis, dermis and the different fascia layers inbetween and around them.

So bipolar RF (and the so called “tripolar” RF) just don’t cut it, as they are too superficial. Neither any low power machine (the majority of machines on the market) or any home devices.

(For face you would be forgiven for using a shallow acting / low power RF equipment, as the area is smaller and skin is thinner, but still the stronger/deeper machines do a better overall job.)

HIFU skin tightening: low/medium power doesn’t work, high power is dangerous

HIFU (high intensity focused ultrasound) has been used for about 15 years for skin tightening and fat loss and although it is kinda OK for facial skin tightening, it does’t really work for the body.

The problem with HIFU is that:

• at low intensity nothing happens

• at high intensity it is dangerou

• and at an optimised medium intensity (good luck achieving that), deep-acting, high-power RF is way more effective and safer

It’s good money for those who offer HIFU though, so at least someone benefits…

Skin tightening with infrared/red light: too superficial, too weak

Then there is the option of infrared/red LED treatments, which again may have some utility in facial skin tightening, but for the body it is just too little and too superficial.

It is very easy to penetrate 0.1 mm of facial skin with an infrared/red LED to stimulate some (mild) skin tightening, but for body skin tightening (and cellulite) up to 25x times deeper action (i.e. up to 25mm) may be needed.

For the face, low power is usually enough, and this is especially true for the under-eye area, where very low power may be needed. For body treatments, however, 5x, 10x or even 20x more power may be needed, and again most machines are just not strong enough.

And still, the infrared/red light treatments that are strong enough and work, on either face or body, are too slow: they require dozens of sessions over months to create the results obtained by just 6x deep-acting, high-power RF sessions. No comparison.

EMS for skin tightening: good luck with that…

Then we have those electrical muscle stimulation (EMS) which, according to marketing, also stimulate skin tightening.

But that’s just theory. In practice this technology falls far short of expectations, regardless of what the Instagram smooth operators claim with their fake “before and after“ pictures.

EMS is a total waste of time and money. It just doesn’t work at all for skin tightening.

Microneedling radiofrequency (fractional RF): too dangerous

And then we have microneedling or microneedling combined with radiofrequency (fractional RF). The problem with microneedling, with or without RF, is has to be very superficial, if it is to be provided safely.

And it is just very unsafe when it is provided deeply (e.g. 2-3 mm for the face, up to 7mm for the body) and especially so when combined with high intensity RF (see ‘destructive radiofrequency’), in order to offer some real skin tightening (plain microneedling of up to 1.5mm is not that effective for skin tightening for all the drama that comes with it).

And still the deep and strong microneedling RF is neither deep enough nor it is effective enough, for either skin tightening or cellulite reduction, despite the side-effects, the drama and the complications.

For example, the deep-acting, high-power RF we use at the clinic:

• can focus the RF energy up to 25mm deep in the skin, affecting the subcutaneous tissue and the fascia on the body (on the face up 5mm is enough)

• with higher power (which we use wisely and safely)

• with pinpoint accuracy (which few people can offer)

• and without needles and bleeding (thank God!)

No comparison.

As is the case with HIFU, with microneedling RF:

• at low intensities nothing happens, except from irritation from the needles

• at medium intensity the little benefit is not worth all the complications

• and at high intensities, it is dangerous, with high rate of complications; and still offers skin hardening / scar tissueing - not real skin tightening

Fillers for skin tightening: temporary and dangerous

And finally we have collagen-stimulating fillers, which are very temporary, way too expensive, too superficial, with very high rate of complications and overall too ineffective for body skin tightening.

You cannot “fill” the entire thighs for example: that would require dozens of injection sessions with a huge rate of complications.

For the face, collagen stimulating fillers are effective but if anything goes wrong it’s a disaster - in contrast to deep-acting, high-power radiofrequency with 99.5% safety or better (at least at our clinic).

So I am not even discussing fillers as a serious/safe skin tightening option.

Strong, deep tissue radio frequency - the only safe and effective skin tightening technology worth considering

All in all, when it comes to non-surgical skin tightening (and cellulite removal), strong, deep tissue radiofrequency is the only game in town.

Strong, deep tissue RF does not provide overnight miracles, but then again even surgery does not provide overnight miracles. Surgery takes months to display its full benefits, typically three months for some results and one year for final results.

On the other hand, RF typically requires anything between 6-12 sessions for best results in most cases (again don’t believe the fake stories that “only 1-4 sessions are needed”).

But it is the best SAFE technology currently known for skin tightening (and cellulite) and for this reason this is what we use at the clinic.

We look at skin tightening and cellulite technologies ALL - THE - TIME and if there was anything stronger we would buy it IMMEDIATELY, regardless of cost. But at the time of updating this article (October 2023), nothing better than strong, deep radiofrequency exists for skin tightening (and for cellulite).

Plus, if provided properly, high power, deep tissue RF is super safe: at the clinic we have already done more than 11,000 sessions with nothing more than minor temporary irritation occurring every only 250 sessions or less (0.4% or less).

Compare that to complications/reaction by things such like RF microneedling which can reach up to 10% or more.

I have extreme skin looseness - what are my options?

For extreme skin looseness, which usually follows extensive weight loss (e.g. 20-30kg of weight loss), things are a bit blurred.

This is because in some cases only surgery can help (more on that below), while in some other cases a large number of deep, strong RF sessions are needed, anything between 12-24 sessions (quite often 24, rather than 12).

Of course the numbers “12” and “24” are not set in stone, they could easily be “10-15” or “20-25”, respectively.

I put an upper limit on 24 sessions for treatment of extreme skin looseness, even when treated with the best technology in the world. I believe that if more than 24 are needed, then surgery makes much more sense, both in terms of results and in terms of cost.

Again, if you suffer from extreme skin laxity, don’t believe those who claim results in 1-4 sessions, regardless of:

• pain (some people think if it is painful it must work better)

• cost (some people think if it’s expensive it must work better)

• amazing fake “before and after” pictures (some people are just too naive)

• and celebrity/influencer hype (celebrities and influencers are the last people to trust)

You will be disappointed.

I have a lot of skin looseness and don’t like surgery, what should I do?

Many women just do not like surgery, in which case there is only one option: that of 12-24 sessions of deep tissue radiofrequency.

In that case, my advice is, do your research, find a good clinic with a knowledgeable therapist, have 6x sessions first and if you’re happy continue with 12-24x.

Some people have very fast results, while others respond more slowly. If the treatment is good enough, you should see SOME results in six sessions (quite often good results actually), which will motivate you to continue to 12, 24 or whatever is needed.

Trying only 3x sessions of a specific treatment will most probably not show much difference if you suffer from extreme skin looseness, apart from revealing the competence / professionalism (or lack thereof) of your chosen therapist/clinic. This is still helpful though, if you are unsure about them and do not want to initially commit to six sessions.

By the 12th session results should be clear and perhaps even enough for some people with severe skin looseness. For some people, 12x sessions will not be enough, in which case a few more may be needed for satisfactory results, perhaps a total of 18, 20 or 24. Again everyone is different, there is no magical number and nothing is set in stone.

Please remember again that with extreme skin looseness we are not talking about achieving perfection, even with the best technology in the world. We are talking about a good improvement.

On the other hand, surgery does not provide perfection or amazing results either in the vast majority of cases either, and a whole lot of things can go wrong. Plus you have to live with the - quite often extensive - scars.

Surgery for extreme skin looseness

Firstly, for anything else than severe/extreme body skin laxity, surgery is not recommended, as the potential complications, downtime, swelling, fibrosis, scars, pigmentation or just a “bad job” being done outweigh the benefits of surgery.

But if body skin looseness is severe/extreme then only surgery (thigh lift, tummy tuck etc) can improve it. I quite often turn away clients in those cases and recommend surgery, as even the best non-surgical skin tightening technology in the world can not help those cases.

In that case, my advice is to pay a bit more and have the absolutely best surgeon in your area/country: have consultations with at least three surgeons before choosing one.

And under no circumstances you should consider cosmetic surgery tourism. You do not want to be in a foreign country, thousands of miles away from home and not speaking the language if something goes wrong or if you simply are not happy with the results and need a revision.

Revisions (and revisions of revisions) are very common with plastic surgery.

For the face, things are much more straightforward, as face lifts are routine these days and although they do not usually offer a very natural result, at least they are quite safe, effective and scars are well hidden behind the hair/ears.

How about skin looseness in the buttocks area? What about bum lift - surgical or non-surgical?

For skin laxity in the buttock area and for information on butt lift surgery, non-surgical butt lift, and Brazilian butt lift (BBL), we have three separate articles, where we analyse everything in detail:

• Non-surgical bum lift: 17 things you need to know before you book any treatment

• Brazilian butt lift (BBL) surgery: the controversy won't go away

• 24 words for non-surgical bum lifting: all you ever wanted to know, minus the marketing hype

Summary of options, according to severity of skin looseness

• For light and medium skin looseness cases, surgery has no place. High-power, deep acting radiofrequency is the best option (typically 6-12 sessions). A course of three sessions may still give a nice result for some, especially in mild cases. A good skin firming cream can also help at a relatively low cost.

• For borderline cases, 12-24 sessions of deep tissue RF may offer good results without surgery for some people, while for some others surgery would make more sense. Consult both a few surgeons and a few non-surgical skin tightening specialists and make an informed decision. Creams will not offer any significant benefit in these cases.

• For the more severe cases of skin laxity, non-surgical treatments are usually a waste of time and money, and only surgery makes sense. Again, visit a few surgeons and make an informed decision.

In all cases, if the promise of the surgeon / non-surgical specialist sounds too good to be true, then it is too good to be true. Don’t fall for hype, gimmicks and fake pictures and remember miracles do not exist (at least not outside the realm of religion).

Healthy eating and exercise are important in all cases, both for prevention and for moderate, gradual improvement.

What would I do if I had skin looseness?

If I had skin looseness, and with the experience and knowledge I have after 20+ years in practice, I would definitely have the appropriate course of deep-acting, high-power radio frequency according to severity, and then I would continue with monthly or bimonthly treatments for maintenance.

Just to clarify here that I offer and recommend strong, deep radiofrequency because I strongly believe in it: both theory and practice makes sense and I see the results of this work on my clients every day.

I do not say it is the best choice just because we offer it at the clinic. It’s the other way around: we offer it at the clinic because it is the best SAFE choice.

Just to clarify here that I am not stuck up or in love with radiofrequency or any other specific technology, method or specific machine. If something new and more effective comes up, I am happy to embrace the new thing and forget the technology we use now.

But at the moment, properly applied RF is the only game in town when it comes to skin tightening and cellulite.

For prevention:

• I would definitely use a quality skin firming cream once or twice a day

• I would take a few nutritional supplements (collagen, vitamin C, flavonoids, polyphenols, other herbal extracts)

• I would make sure I exercise as much as I could practically do

• and I would try to eat as healthy as possible

I am not against surgery, but I would only consider it as a last resort, if my skin was excessively loose - and I would believe half of what the surgeon promised.

Check our professional consultancy in cellulite, skin tightening, ultrasound and radiofrequency

If you are a therapist or clinic owner and are interested in our professional consultancy/teaching, via Zoom or at our London practice, please contact us here.