Skin tightening occurs with the use of fractional lasers, radiofrequency, and Smartlipo. The fractional lasers Fraxel (1550 nm; Solta Medical, Inc., Hayward, CA) and Affirm (1440 nm, 1320 nm) (Cynosure, Westford, MA) when used in combination tighten skin and lessen solar keratoses, and improve acne scars. With radiofrequency, further tightening occurs. Smartlipo (Cynosure, Westford, MA) (1064 nm or the newer MPX with combined 1064 nm and 1320 nm) results in skin tightening and has been very helpful in improving skin tightness and smoothness on the neck either singularly or in combination with the above procedures; and with the addition of the Affirm fractional CO2 laser (Cynosure, Westford, MA), further skin improvement and tightening occurs.
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