Titan-ing Up the Droop

Titan-ing Up the Droop

The Beauty Doctor explains the science behind laser technology

Debs is excited. She has been reading about the “Titan laser procedure” and naturally, she is wondering whether it is worth her consideration. Her question really deserves several separate discussions to do it justice, but it provides a great opportunity to tell you more about non-ablative skin tightening.

Over the past few years this segment of aesthetic medicine has been steadily growing. Understanding why is easy; as soon as anyone notices the third D of aging: the dreaded ‘droop’, they naturally start searching for the ‘cure’.

‘Titan’ is one of many contenders in this area. Which particular solution is more suitable for Debs depends entirely on the outcome she desires.

Let’s start with a couple of important concepts.

First, non-ablative skin tightening is not surgery, which is good if you want to avoid the risks and complications that come with the knife. It is less effective if you are looking for the dramatic kind of improvements that surgery can provide. Simply put; surgery physically removes the unwanted skin. No tightening procedure that merely rearranges things can hope to approximate that directly.

Second, we are not talking about body shaping here either. That is an exciting and hot topic in its own right, using technologies like ultrasound and various new methods of liposuction.

So what is it? I hear you ask.

The idea is that heat causes collagen (the fibres that form the scaffold of our skin) to contract, and by applying heat to the skin, we make it contract too. This idea is as old as the use of cautery. As surgeons, we clearly see the tissue contracting in front of our eyes when we use cautery during open surgery.

Making use of this effect has been problematic though.  When such power is applied directly to the skin it causes burns, scars and severe pain. So the problem has been to find a way to deliver the heat to the scaffolding under the skin (where we want the tightening to occur), without harming the skin itself. In search of solutions, our science has met with varying success.

Presently, we believe that the bulk of the improvements caused by these devices actually occurs on account of collagen remodeling. Heat application breaks some of the collagen strands and this is recognized as a problem by the body. It responds by activating the repair process to replace the broken parts with fresh new product. Voila! Fresher, improved skin.

Knowing this will make it easier to understand why all these solutions have results that develop over weeks and months after treatment, instead of instantaneously like the effect we originally observed.

Titan is a machine made by Cutera Corporation. It is not a laser; but flashlamp, or intense pulsed light technology. This means that it produces less intense, less focused and more scattered light than a laser does. The Titan device produces non-coherent light with wavelengths between 1100 and 1800 nm infra-red light, not unlike those red bulbs you see in the supermarket that keep the rotisserie chicken warm. Only the Titan’s light is not visible to the naked eye.

Competing technologies in this area include RF(radio frequency) devices like Thermage and Refirme and many other infrared devices, both flashlamp and laser all of which produce light in the same (specifically 1000 – 1400 nm) part of the infrared spectrum.

Heated (no pun intended) debates about the efficacy of these different solutions is a hallmark of many aesthetic conferences, meetings and ‘friendly discussions’ between physicians.

Only one of these devices is backed by peer-reviewed scientific studies of its effect, and that is the monopolar radiofrequency device of Solta; Thermage. These are not studies of the effect you see when using the device; only of the actual physics of its implementation. The fact that the competitors have not published such findings outside of internal whitepapers leaves us less than convinced of their effectiveness.

About the Titan in particular, there is little positive mention anywhere.

Since this device produces light that cannot penetrate your skin deeper than 1-2 mm, it is not possible for it to effect the deeper collagen. As a result, we can only expect it to affect very superficial skin – that crepiness that many of us develop in time. Many devices can achieve that though. Actually addressing The Droop is beyond its capacity.

It is actually interesting that people use the Titan for ‘skin tightening’ whatsoever, since even Cutera does not claim that it can do that! On their website, they advertise it for heating of the skin only. The US FDA has only cleared the device for skin heating too. Of the 20+ before and after photos in Cutera’s non-ablative gallery, there is not one set on Titan.
All of that should tell you something.

So back to Debs wondering whether this was worth her while.

Determining that is quite simple. She needs to consider two sides of the question; what effect she desires, and what costs she is prepared to put up with.  Any thoughts of surgery, however remote in Deb’s mind, creates expectations of noticeable improvement – a touch of Wow!

NONE of these devices can create Wow! changes.  All of them produce some improvement, but most of it is only evident when comparing meticulous before and after images. If you are looking for a Wow!, then Non-Ablative Skin Tightening could be a NASTy disappointment for you.  That said, if you are looking for subtle improvements that no-one will be able to put their finger on — the kind of thing about which folks will say; “You’ve changed your hair, haven’t you?” — then  these technologies may be just what your doctor should order.

At A Glance

These techniques all have zero downtime, meaning you can essentially go straight back to work after treatment. There may be a little redness, but no more than vigorous exercise would cause. That is a decent benefit.

Delayed results
All these procedures give results that develop slowly, over weeks and months. No instant gratification here.

Multiple treatments
Like all infra-red treatments, Titan procedures require repetition. Patients should not expect improvement in less than 4 – 6 sessions.

Regardless of what some providers claim, this procedure is not comfortable. It is not so severe as to stop treatment in most cases, but the discomfort is certainly noticeable when enough energy is applied to make a difference.

Facial treatments average around $500 per session, so a full treatment will be $2000 to $3000. And no, you should never anticipate getting away with fewer treatments unless you are prepared to walk away with even less results.

And don’t be tempted to compare these figures to surgical intervention like a facelift.  That is not even an apples and oranges comparison; it is more like comparing a monkey to a wrench. Don’t do it.

About Dr G.:

Dr Gerrit Velthuysen lives in Canada with his wife and two children and is a specialist in Aesthetic Enhancement.

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