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Unwanted fat, cellulite and flaccidity are three of the top reasons for consultation in aesthetic medicine in relation to body contouring. After the age of 30, the production of collagen and elastin decreases, so our skin starts to loose firmness and tone. Skin tightening is defined as the improvement of skin laxity.

There are several energy-based devices that can produce significant skin tightening without surgery, both on and off the face. The mechanisms of action involve collagen denaturation, resulting in collagen shrinkage and tissue tightening, as well as a wound healing response that generates new collagen and elastin.

The main advantage of lasers is that they are the only tool in medicine that give us the possibility of being selective. Since lasers target a specific structure in the body, we can reach the crucial (optimal) temperatures minimising the risk of burns in contrast to any other energy-based device system. In my personal opinion and experience (after having used many different technologies for this purpose) safety comes first, and this is the only reason why all radiofrequencies available on the market may not meet patients’ expectations, since the crucial temperatures needed to achieve a good result are never reached in general, due to pain or risks of burns. The Fotona V-SMOOTH® with the T-Runner with its super-long pulse duration results in a “dual-tissue remodeling” mechanism of action and represents an extremely effective and safe solution for non-ablative tissue regeneration and tightening. The Er:YAG laser has been found to stimulate neo-collagenesis, improve elasticity and shrinkage of the tissue.

There are two effects of treatment with V-SMOOTH:

  • An immediate effect with high temperature (yet safe) thermal contraction of collagen, shrinkage and tightening, accompanied by slight erythema.
  • A delayed effect with improvement of the surface appearance of the skin due to the complete restorative reaction after four weeks and longer.

A robotic scanner (Fotona T-Runner) is used for optimal delivery of V-SMOOTH pulses with controlled speed, accuracy and most importantly, the possibility of targeting either superficial or deep skin laxity, thus optimising the collagen regeneration process.

Using this product enables the achievement of critical temperatures and the precise depth of penetration needed for optimal regeneration procedures, minimising the risk of burns and making the procedure reproducible.


Before and after photos.


The procedure

Indications include skin flaccidity (body and face), flaccid cellulite, chronic stretchmarks, post-bariatric surgery or after lipolysis, pregnancy and severe weight loss. The results and benefits are improved skin elasticity, firmness, surface appearance and stimulation of microcirculation (flaccidity and cellulite). All body areas can be treated with no or minimal discomfort and no adverse effects with 85-100% patient satisfaction. It is important to highlight that there are no consumables using this technology.

Any area can be treated. The procedure lasts between 15 to 45 minutes, depending on the area. The settings for superficial heat shocking are 3,5-4,5 J/cm2, 3 stacks, 500ms, 1-2 pass and for deep heat pumping and 10-13 J/cm2, 25-30 stacks, 625ms, 1 pass. It is important to recruit the appropriate patient. This protocol targets the skin. It is ideal for skin tightening and the management of loose skin. In the case of very dry skin, since Erbium:YAG targets water, apply any cosmeceutical first, to resume the skin hydration. The complete protocol consists of four sessions (one weekly session).



Declaration of competing interests: The author has received honorarium and reimbursement for speaking at conferences about laser treatments and for taking part in educational workshops worldwide by Fotona.



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Adrian Gaspar

Board certified in Aesthetic Medicine and Cosmetic Surgery; University Associate Professor, Faculty of Medicine, Mendoza University; Director, Espacio Gaspar Clinic, Mendoza; Director, Sens Medical, Buenos Aires, Argentina.

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