Vivace and Ultherapy with no improvement - what can help with skin tightening?

Question

I have had at least 3 treatments with vivace with zero improvement. I have also had Ultherapy with no improvement My main concern is skin tightening. I am 65 and world like to know what procedures other than a facelift is effective in skin tightening. As a side benefit I would like improvement in overall skin clarity and texture, pores etc. I have spent a lot of money with no improvement

Anna Chacon, MD, FAAD · Answer

At 65, it’s understandable to feel frustrated after investing in multiple RF-based treatments like Vivace (RF microneedling) and Ultherapy without visible improvement. The key issue is that device-based tightening relies on your skin’s collagen-producing capacity. If there is significant laxity and collagen depletion, these treatments may produce only subtle or delayed changes.

If you want meaningful tightening without a facelift, options to consider include:

- Combination laser resurfacing (fractional CO2 or erbium) – This can improve fine lines, texture, pores, and stimulate collagen more aggressively than RF alone. It offers both tightening and surface refinement.
- Deep chemical peels (e.g., phenol or TCA-based, carefully selected candidates) – Can significantly improve texture, pigmentation, and fine wrinkling.
- Biostimulatory injectables (Sculptra or hyperdilute Radiesse) – These stimulate gradual collagen production and can improve mild laxity over time.
- PDO or PLLA threads – Provide modest lift and collagen stimulation, though results are variable and temporary.
- Lower-energy plasma or RF tightening devices with higher depth settings – Sometimes technique and energy levels matter; not all treatments are equal.

However, it’s important to set expectations: non-surgical options cannot replicate the degree of tightening achieved with surgery. For moderate-to-severe laxity, devices may improve texture and firmness but won’t reposition descended tissue.

If your goals include tightening plus clarity, pores, and overall rejuvenation, a combination approach—laser resurfacing + biostimulation + medical-grade skincare (retinoids, growth factors, pigment modulators)—often produces better results than repeating single-modality treatments.

The most important step is an in-person assessment to determine whether the primary issue is skin quality, volume loss, or structural descent—because the treatment must match the anatomy.

Nelson Lee Novick, MD · Answer

I am truly sorry for your disappointment and frustration with all the expensive device treatments you have unsuccessfully undergone. But I am not at all surprised at their lack of success. I have been cautioning my regular followers for years already that the hard science to support the use of these often "here-today-gone-tomorrow" gizmos lags woefully behind the heavy marketing hype and social media buzz to hawk them. Really so sorry for your frustration, disappointment and loss of time and money.
Without photos, it is extremely difficult to address your concerns specifically. Generally speaking, however, robust HA volumizing fillers work well for addressing cheek volume deficits that give rise to sagging cheeks, loss of the feminine Ogee Curve and hollows, tear troughs under the eyes, and loss of the smooth cheek-lid transition. Robust HA lifting fillers work well for addressing deep smile lines around the nose, as well as the sad, marionette lines around the mouth. Robust HA contouring fillers work well for defining and straightening a droopy, jowly jawline, and low viscosity cohesive HA fillers work well for use under the eyes and for "lipstick bleeding lines "around the mouth. 
Finally, a series of superficial peels, either with high concentrations of glycolic or salicylic acid, Jessner's Solution or low concentrations of TCA have a many decades' long track record for efficacy and safety for treating all kinds of skin texture and pigmentation issues. 
You would be wise to make sure to consult with a board certified cosmetic dermatologist injection expert. Hope this helps and best of luck going forward.

Vivace and Ultherapy with no improvement - what can help with skin tightening?

Answers (2)

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