Board-certified dermatologist Dr. Julie Del Cruz has noticed a significant shift in her practice lately.
Demand for fat-loss procedures has declined, but requests for skin tightening treatments have surged.
The culprit? GLP-1 medications, pregnancy, aging—all factors contributing to skin laxity that leaves people searching for solutions.
In a recent episode of the Glow Lab podcast, Dr. Del Cruz sat down with host to break down everything from at-home prevention strategies to advanced in-office procedures that actually work.
Jump to:
- Understanding Skin Laxity: It’s Not Just About Loose Skin
- The GLP-1 Effect: A New Challenge
- Prevention Strategies: What You Can Do at Home
- The “Pinch an Inch” Rule
- Dr. Del Cruz’s Top-Down, Bottom-Up Approach
- Treatment Frequency: Patience Pays Off
- The A-C-E-D Predictive Framework
- Minimal Downtime Options
- Emerging Technologies: Korean Innovations
- Safety Considerations and Contraindications
- Options for Melanin-Rich Skin
- The Bottom Line on Skin Tightening
Understanding Skin Laxity: It’s Not Just About Loose Skin
Dr. Del Cruz explains that skin laxity falls into two main categories: skin quantity and skin quality.
Skin quantity refers to having more skin than needed to cover underlying structures. Skin quality involves both internal and external factors affecting how skin looks and functions.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
Internal Factors: The Aging Timeline
After age 40, collagen production takes a dramatic hit.
Actually, after 40, we lose 1% of our collagen every year.
Dr. Del Cruz points to several scientific mechanisms behind this decline: cellular senescence, telomere shortening, estrogen decline, and oxidative stress. These processes gradually degrade collagen and elastin, the structural proteins that keep skin firm and elastic.
Bone resorption also plays an underappreciated role. As facial bones lose density—particularly in the cheekbones, jawline, and chin—skin loses its underlying scaffolding, creating sagging and prominent nasolabial folds.
External Factors You Can Control
UV exposure, smoking, nutrition quality, and resistance training all significantly impact skin quality over time.
The GLP-1 Effect: A New Challenge
GLP-1 medications effectively promote fat loss throughout the body, but that systemic effect creates visible laxity—especially in the face, neck, arms, abdomen, and thighs.
You’re going to lose fat everywhere when you’re taking a systemic medication, and one of the places that you see it the most is going to be the face because you look at your face the most.
Dr. Del Cruz emphasizes that muscle atrophy from GLP-1s compounds the problem. Without adequate protein intake and resistance training, users lose critical support structures beneath the skin.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
Prevention Strategies: What You Can Do at Home
Before considering procedures, Dr. Del Cruz recommends optimizing lifestyle factors.
Skincare Basics
- Daily sun protection remains non-negotiable
- Retinoids offer level A evidence for stimulating collagen topically
- Proper hydration supports overall skin health
Resistance Training: The Anti-Aging Secret
Recent studies confirm resistance training provides genuine anti-aging benefits beyond aesthetics.
I mean, it’s not just the muscles. It’s and the anti-aging. I mean, it’s the bones, too. Like women get osteoporosis so much more than men. And we need to keep that bone mineralization as much as possible.
Dr. Del Cruz encourages patients to prioritize weights over cardio-only routines for maintaining muscle mass and bone density—both critical for supporting skin structure.
The “Pinch an Inch” Rule
How do you know if you need a dermatologist or a plastic surgeon?
I usually like to say that if you can pinch an inch or less, then you’re in my wheelhouse. If it’s more, then you’re in the plastic surgeon’s wheelhouse.
This simple test helps determine whether non-surgical skin tightening will achieve desired results or if surgical intervention becomes necessary.
Dr. Del Cruz’s Top-Down, Bottom-Up Approach
For patients with time and appropriate skin types (Fitzpatrick I-III, some IV), Dr. Del Cruz employs a comprehensive strategy addressing multiple layers simultaneously.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
Top-Down: Ablative Lasers
CO2 lasers remain Dr. Del Cruz’s first choice for skin tightening, though erbium lasers also deliver excellent results. For deeper skin tones that can’t tolerate ablative treatments, she recommends non-ablative options like 1550 nanometer lasers.
Patients with Fitzpatrick V-VI skin typically require strict hyperpigmentation prevention protocols or alternative approaches entirely.
Bottom-Up: Radiofrequency Microneedling
After ablative laser treatment, Dr. Del Cruz reaches for radiofrequency devices—specifically the Secret Pro distributed by Cutera.
Why this device? Precision depth control.
Understanding anatomy proves critical here. Dermal thickness varies dramatically across the body:
- Eyelids: Less than 1mm
- Cheeks: 1-2mm
- Abdomen: 2mm
- Back: 3-4mm
Some monopolar RF devices penetrate 20-25mm deep—far beyond dermal tissue. This explains reports of unwanted fat loss from radiofrequency treatments.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
The Physics of Fat Melting
Dr. Del Cruz explains the science using Ohm’s law and Joule’s law: heat generated depends directly on tissue resistance.
Skin has approximately 200 ohms of resistance. Fat has roughly 2,000 ohms. When identical energy current passes through both tissues, fat generates dramatically more heat—hence the melting effect.
So you put that same energy current, which is what you’re going to control from your device, into the skin versus into the fat, and you’re going to have a hugely greater amount of heat generated in the fat. So of course it’ll melt.
Injectable Support: Building the Scaffolding
Depending on individual needs, Dr. Del Cruz may recommend hyaluronic acid fillers, fat transfer, biostimulators like polylactic acid, or PRP to restore volume and support skin structure from within.
Treatment Frequency: Patience Pays Off
Many providers recommend repeating treatments monthly, but Dr. Del Cruz takes a different approach.
Your results for all of these collagen remodeling interventions, they’re going to be 6 months down the line.
She recommends spacing treatments at least 6 weeks apart, though waiting the full 6 months to assess peak results often makes more sense. This allows proper collagen remodeling and prevents over-treatment.
The A-C-E-D Predictive Framework
Dr. Del Cruz uses a mnemonic to predict skin’s ability to bounce back naturally: A-C-E-D.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
- Age: Under 35 with less than 30-pound weight loss? Wait 6-12 months before interventions
- Collagen quality: Studies show bariatric surgery patients produce less collagen than age-matched controls
- Elastin recoil: The pinch test reveals elastin reserves (1.5 seconds or less indicates good recoil)
- Duration of stretch: How long skin remained stretched significantly impacts recovery potential
Between ages 40-55, fibroblast activity measurably declines. After 55, natural bounce-back ability decreases further.
Minimal Downtime Options
For patients unable to tolerate significant recovery periods, several effective options exist:
- Fractionated picosecond lasers
- Laser genesis treatments
- Non-invasive monopolar RF
- Microwave devices (like Onda Pro)
- Ultrasound treatments
- 1064 nanometer lasers
These modalities heat the dermis to 55-75°C, causing collagen contraction without affecting the epidermis. Cooling mechanisms protect surface skin while deeper tissues undergo remodeling.
Emerging Technologies: Korean Innovations
Several Korean-developed devices have gained popularity, including Density by Jeisys, Oligio, and Everus—all operating at 6.78 megahertz.
ZERF offers dual frequencies (6.78 megahertz and 2 MHz), marketing this as first-of-its-kind technology. While Dr. Del Cruz acknowledges these devices likely work, she emphasizes choosing practitioners over specific equipment.
I think it’s more important to go to someone who has experience in skin tightening more so than shopping for a specific device.
Safety Considerations and Contraindications
Energy-based devices aren’t suitable for everyone. Patients with metal implants—IUDs, pacemakers, defibrillators, cochlear implants, neurostimulators—should avoid radiofrequency, microwave, and ultrasound treatments.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
The most critical factor? Choosing providers who can handle complications.
Options for Melanin-Rich Skin
Deeper skin tones have excellent options despite ablative laser limitations.
Dr. Del Cruz frequently uses non-ablative fractional lasers for the top-down approach. For bottom-up treatment, radiofrequency microneedling works well because energy deposits in deeper layers, protecting the epidermis from heat damage.
With appropriate post-treatment care and strict post-inflammatory hyperpigmentation prevention protocols, patients with more melanin can safely achieve excellent skin tightening results.
The Bottom Line on Skin Tightening
Modern dermatology offers numerous effective solutions for skin laxity, from lifestyle modifications to advanced combination treatments.
Success depends on accurate assessment, appropriate treatment selection, and—most importantly—choosing experienced practitioners who understand both the science and the artistry of skin tightening.
If you want something simple that actually works, this is one of the most effective tools I’ve used to build strength, conditioning, and endurance without needing a full gym setup.
- Full-body training with one weight using swings, squats, and presses
- Solid cast iron build that feels stable and lasts for years
- Comfortable grip that makes high-rep workouts easier to handle
Dr. Del Cruz practices at Miami Dermatology and Surgery in Coconut Grove and shares educational content on Instagram at Skin and Sweat.
