Dermal contraction for the purpose of cosmetic improvement can be induced by the application of heat at adequate intensity and for adequate time. The first technology to achieve this was nonablative radiofrequency. Heat was produced by the passage of electrons flowing from an active electrode into the skin and, ultimately, into a passive electrode or grounding plate. This monopolar radiofrequency device spared the epidermis from thermal injury using a concurrent squirt of cryogen fluid applied onto the back side of the treating electrode. The cryogen would be sprayed immediately before, during, and immediately after the emission of radiofrequency. This device had two inherent problems: one was the electrical quality of the energy pulses, which were unpleasant; second, the intensity of those pulses were quite painful. To mitigate such pain, a topical anesthetic was applied for at least an hour prior to the procedure, but even then, the intensity (up to 150 J/cm2) combined with a short delivery time (1–2 s) made for an experience hard to forget for the patient.

Titan (Altera Inc.) is an alternative device, which uses infrared light (1,100–1,800 nm) as the energy source, and also combines it with cold before, during, and after the energy pulse. This device has been used effectively to achieve skin contraction, but because it uses a multisecond pulse, the energy does not cause the same degree of pain as the radiofrequency device.