Do nothing about your appearance because critics claim "nothing works", or do something to reverse sagging skin, excess body fat build up and cellulite dimpling?

Are dimpled thighs, double chins or sagging loose skin around your stomach really going to miraculously "tighten up" due to treatment by any of the new high-tech and highly marketed skin rejuvenation therapies?

Scientists and skeptics will argue that cause-and-effect relationships between alleged skin tightening therapies like laser dermabrasion or the radio frequency based Thermage or Titan are simply too weak to demonstrate conclusively across a wide population.

Not surprisingly, the real story is complex with some wrinkle reduced "winners" and some sagging skin "losers" arguing strongly about these New Age saggy skin therapies.

What The Smoother Skin "Winners" Say - Voting With Their Pocketbooks. The current crop of baby boomers are individually putting out thousands of dollars for skin rejuvenation treatments, and combined are spending almost $4.3 billion dollars in 2006 for the full spectrum of body shaping procedures. Big trend setters are those non invasive non surgical body contouring "devices".

Clearly, lasers and their satisfied customers agree that this cold-light technology can stimulate collagen production, tighten loose saggy skin. Otherwise, the market wouldn't pay out these sort of monies, like $2,500 for a Thermage face lift and neck sagging skin treatment.

The "Winners" also point out that these non surgical therapies benefit customers through lower costs, no surgical health risks, no down time and loss of salary or vacation time.

What The Sagging Skin "Losers" Think. Here's the straight talk from industry skeptics. Insufficient clinical evidence exists to show the sort of predicted result claimed by the medical device promoters. "Results" in terms of reducing sagging skin are variable and random, rather than straight-line and predictable.

Worse, these critics tout that the alleged skin tightening "results" reflect swelling or inflammatory response rather than actual collage stimulation, or repairing skin laxity.

Their further argument is that the laser and other light-energy device makers rely on selective before-and-after photos, "cherry picking results" from the "success" end of the therapy spectrum rather than showing the miniscule "typical" candidate.

And patients, who are trying to reduce sagging skin? What's their beef? Any number of personal variables may contribute to poor or negligible performance...health, weight, family heredity, amount of excess loose skin. Also, realistic expectations are the big "bargaining chip" when dealing with an emotional issue like "how do I look?" People expect a lot, get a little, then complain.

The Conflicted "Money" Interests Of Some Cosmetic Surgeons. The "jury is out" as to the full results potential of these non surgical therapies for loose skin. Perhaps the "ideal" candidate, showing modest lines and saggy skin, will become the poster boy encouraging future candidates to try it. "Improvements" of 5%, 10%, 20% or more can seem small, yet become significant when applied to your face or body contour.

Meanwhile, surgeons trained in "invasive" surgery can get paid significantly higher fees, plus know that results will be physically dramatic when a patient rolls into the operating theater. Medical devices, on the other hand, do not attract the same high fees, and results tend to be incremental, experienced over time.

So, is money the real factor? Reducing a surgeon's income by removing surgery is unlikely to attract votes from either surgeons or their spouses.

Where's The Government's Role In The Sagging Skin Controversy? In general, most of the body contouring device makers have plenty of market "running room" since the FDA does not directly comment on or regulate these "off label" uses of prior-approved technologies. Most devices get a 510K clearance by demonstrating similarity to an existing approved device, independent of issues of effectiveness. Basically, the FDA doesn't get into the business of risk-assessing low risk devices.

Here's the catch-22. The device manufacturers can't promote "off label uses"...however medical professionals and clinics can, and do, promote the benefits. "Revolutionary collagen stimulant and skin tightening" claims rapidly gain traction with or without the government's review, and certainly without the direct support of device manufacturers.

In order to exploit a FDA approval, device manufacturers must submit their claim to rigorous research, where reliable measurements and repeatable results are necessary. To date, measuring tools are not sufficiently accurate and no company can create a research study that generates "repeatable results".