We have learned that heating skin can result in collagen tightening, and there are many modalities used to achieve this. Typically heat is applied to the surface of the skin and may require repeated treatments to achieve a clinical or visible result. The skin’s ability to shrink or tighten will vary from one patient to the next, with age, genetics, laxity, and cumulative sun damage all influencing the final result. To date, the heat has typically been introduced from the surface of the skin, with the goal of reaching the deep layers which need to be tightened. This can be uncomfortable, and results have been inconsistent.