The Ultimate Technology to Treat Sagging Skin.

What is Attiva?

Attiva S.I.H. (Subdermal Induced Heat Technology) is a new, FDA-approved device to tighten the deepest layers of skin and soft tissue by reorganizing existing collagen and stimulating new collagen production. Via a small cannula introduced under the skin, precise radiofrequency energy is applied to the various layers of tissue, including the sub-dermis, to create controlled heat stimulation of the collagen and elastin layers. The results are both immediate and gradual as existing collagen fibers are tightened and new collagen is formed.

Plastic Surgery of Westchester is proud to be the first in New York to offer this technology to patients.

Attiva Benefits

Attiva is both safe and effective in improving the appearance of wrinkles, skin laxity, and contour to all areas of the face, breasts, buttocks, and body.

Attiva Candidates

Attiva works well for almost anyone who is interested in obtaining the benefits of tighter, more contoured skin. The ideal candidate should have realistic expectations. The procedure is not intended to replace surgery and thus may not be suitable for a patient looking to address severe skin laxity or aging skin. The treated areas should be free of infection or wounds. Any medical conditions which may affect wound healing or interfere with the transmission of radiofrequency energy (i.e., pacemakers, metal implants) should be discussed with your provider prior to treatment.

Attiva Techniques

Subdermal radiofrequency heat energy is applied through a small needle / cannula site and tunneled under the skin of the area to be treated. This is usually well-tolerated with just local anesthesia and can be done completely awake, in the office setting.

Attiva Videos

Procedure Types and Comparison

Attiva S.I.H subdermal RF skin tightening is different than but complementary to RF Microneedling, both of which are offered at PSW. The difference is in the mode of delivery. RF Microneedling applies heat energy and stimulates collagen through the top layer of the skin’s surface via a pen-like device fitted with a panel of insulated gold-plated needles. The Attiva RF device applies precise, monitored, heat energy subdermally and in the deeper layers of connective tissue through a sterile cannula tunneled and passed under the skin. The RF Microneedling can be performed by our licensed aesthetician in the spa setting, whereas Attiva will be performed by either your plastic surgeon or trained provider in our office-based procedure area. A treatment plan utilizing the two technologies is quite effective and can be provided by your plastic surgeon upon consultation.

Treatment Areas

  • Brows
  • Lower Eyelids
  • Face (Brows / Lower Eyelids / Cheeks / Nasolabial folds / Marionette lines /Jowls / Jawline / Lips)
  • Neck
  • Arms
  • Knees / Elbow
  • Thighs (Inner, Front & Back)
  • Abdomen
  • Flanks / Sides
  • Back
  • Breasts
  • Buttocks & Banana Rolls

Attiva Patient Case Study

Your Initial Attiva Consultation

An analysis of your skin and suitability for Attiva begins during either a spa treatment with one of our licensed aestheticians or a consultation with one of our plastic surgeons. The desired treatment area(s) will be examined and your health history will be reviewed by your provider. Photos will be taken for your chart. An Attiva treatment session can be performed during the same consultation session or scheduled for a future visit. To ensure adequate time for your appointment, please inform us if you plan to undergo the treatment at your visit.

Attiva Pre-Procedure Preparation

As with most procedures, there is some basic precautions that you should observe. If you take NSAIDs (aspirin, ibuprofen, naprosyn, celecoxib, etc.) these should be withheld for at least 5 days prior to your procedure. Regular use of certain supplements can also pre-dispose you to more bruising and swelling and should be withheld for at least 2 weeks prior to the procedure (fish oil, garlic, green tea, etc.). Please disclose any changes in your health history, including changes to medications or supplements you take, with your provider prior to the procedure.

What to Expect During the Procedure

At your Attiva visit, you will be positioned comfortably reclining in a procedure chair. The area(s) to be treated will be marked out and cleansed with a topical skin solution. The cannula insertion site(s) will be numbed with local anesthetic. Sometimes a nerve and / or field block will be administered for more comfort. In cases of certain larger body parts, an anesthetic tumescent solution may be used. The cannula is then painlessly inserted and tunneled through the entire treatment area until the target tissue temperature and retraction are achieved. Each area takes between 20 and 60 minutes to complete. There is no need for sutures or drains, and the treated area(s) are sometimes dressed with a compression garment.

Attiva Procedure Recovery

Mild bruising and swelling can be expected for several days. Discomfort after the procedure is usually minimal and managed by over-the-counter anti-inflammatories or plain acetaminophen. There are no medical restrictions to activity as long as you feel well and are ready to resume more regular activity.

Attiva Results

The effect of tissue tightening begins immediately and improves over the next 45 – 60 days. At this point, you may desire a treatment with RF Microneedling or another Attiva session to augment your results and prevent some recurrence of laxity that occurs during the first phase of collagen regeneration. The results continue to improve over the next 6 months. Maintenance treatments may be desired every one to two years thereafter depending on your lifestyle and rate of aging.



Attiva is done under local or tumescent anesthesia in our office-based procedure room. Depending on the extent and location of the treatment, you may drive yourself home or choose to have someone escort you for maximal comfort.

Attiva Complications

Swelling and mild bruising can be expected. More serious complications such as bleeding / hematoma, infection, burns, tissue loss, numbness, or adverse healing are rare.

Attiva Cost & Financing

Each area costs between $1500 and $4500 per treatment. 10% off an RF Microneedling or second Attiva procedure is applied when performed within the first 3 months to the same treated area(s). The treatment includes bilateral or both right and left sides, where applicable. Unfortunately, there is no financing available for Attiva treatments.

Attiva FAQ’s

How does Attiva differ from RF Microneedling, PDO threadlifting, Sculptra, or a LaseMD profractional laser treatment for facial rejuvenation?

Attiva®, Genius® RF Microneedling, PDO Max® Threadlifting, Sculptra®, and a profractional LaseMD® treatment all work in slightly different ways to improve your appearance.

Genius® RF Microneedling stimulates collagen production through radiofrequency heat energy delivered deep into the skin’s dermis via a penlike device fitted with 49 insulated, gold-plated needles. This procedure improves skin’s texture, enlarged pores, wrinkles, and laxity.

PDO Max® threadlifting is a non-surgical procedure that uses specialized barbed sutures (“threads”) to non-surgically lift and reposition loose, hanging skin. The threads dissolve over time leaving new collagen tissue in their place.

Sculptra® (poly-L-lactic acid) is an injectable treatment that stimulates your body’s own ability to make new collagen. This process is known as “biostimulation” and works to build the soft tissue cushioning under the skin’s surface naturally.

LaseMD® laser is a quick and relatively painless profractional laser to improve skin quality. The laser targets the many layers of the skin’s epidermis, improving cellular turnover, pigmentation, fine lines, and wrinkles with little to no downtime.

Attiva® complements these different treatment options through radiofrequency induced collagen reorganization and reformation. Results are immediate and progress over time, with skin and soft tissue that appears tighter and more lifted.

All these modalities together or in desired combinations create a comprehensive, non-surgical approach to skin rejuvenation.

Who is a good candidate for Attiva?

Attiva is appropriate for anyone 18 years of age or older who desires to tighten their skin. The procedure simulates the body’s own healing and regenerative process to produce new collagen; therefore, overall good health and reasonable expectations are important requirements.

How long does the procedure take?

The size and number of areas to be treated determine how long the procedure may take. Each treatment site takes between 15-20 minutes to complete. An entire face and neck can take between one to two hours to complete.

How many treatments with Attiva are needed?

Most patients plan to have one Attiva treatment followed by a session of RF Microneedling between 6 and 8 weeks; however, a second Attiva session or different skin rejuvenation modality may be indicated. The results will improve over the course of about 6 months at which point they will stabilize. The process of aging for some may make yearly maintenance procedures beneficial.

How do I prepare for my Attiva treatment?

Please disclose to your provider a complete health history with particular attention to a history of slow or adverse healing, metal implants / pacemakers, prior surgery, use of blood thinners or NSAIDs, and prior treatments to address skin rejuvenation. For no less than 5 days prior to your procedure, we ask that you refrain from taking NSAIDs (i.e., aspirin, ibuprofen, naprosyn, celecoxib, etc). Certain supplements may predispose you to more bruising and swelling and should also be held (i.e., fish oil, green tea, garlic). You may also be asked to avoid the use of topical retinoids or oral tretinoin before and after the treatment.

What can I expect during the procedure?

The procedure is well-tolerated completely awake. The treatment area may be anesthetized with local nerve or field blocks but some areas do not necessitate any local anesthesia. Tumescent fluid may be used in certain larger or more sensitive areas. Your provider will ensure the procedure is safe, effective, and comfortable for you.

What care or precautions will I need to follow after an Attiva treatment?

There is very little aftercare or restrictions after an Attiva treatment. There may be some mild swelling and / or bruising along with very mild discomfort. Bruising can be treated with topical or oral Arnica montana, and any pain or discomfort is managed with over-the-counter pain medications such as acetaminophen or ibuprofen. The treated area(s) may be gently cleansed in usual fashion with soap and water and kept hydrated with a topical cream. Plastic Surgery of Westchester recommends their own restorative hydrating moisturizer especially after treatment to the face and neck. If your provider recommends a post-procedure compression garment, this will be provided to you. Most patients are well enough to return to work and their regular activity immediately.

I am preparing for a special event. What is the timeframe if I wish to do other skin rejuvenation procedures after Attiva?

If Attiva is part of your skin rejuvenation plan then this treatment is usually performed first, followed by another Attiva or RF Microneedling session at 6-8 weeks. Fillers and / or Sculptra can then be performed 2-3 weeks thereafter. For the best results, we recommend that you plan to start with Attiva at least 3-4 months prior to your event.

Facilities & Hospital Affiliations

Our surgeons have privileges at White Plains Hospital, New York Presbyterian – Lawrence Hospital Center, Montefiore – New Rochelle Hospital, Westchester Medical Center, and Jacobi Medical Center. They also perform procedures in their fully accredited operating room in Harrison, NY. Our state-of-the-art facility is professionally designed and decorated for your comfort. We are always interested to know if there is anything we can do to enhance your experience. We appreciate your suggestions and pledge to work as a team to make your time here a rewarding experience.

  • White Plains Hospital
  • New York Presbyterian – Lawrence Hospital Center
  • Montefiore – New Rochelle Hospital
  • Westchester Medical Center
  • Jacobi Medical Center

Accreditation and Associations

We maintain an AAAASF accredited surgical suite, equipped like a hospital operating room with the privacy and ease of an office setting, offering full general anesthesia for more complex procedures as well as sedation and local anesthesia for other procedures. We enjoy a strong relationship with some of the finest hospitals in the area, offering overnight and extended post-operative stays if medically advisable. This is ideal for our out of town patients, those with little post-operative help, or those desiring a more private recovery. We can also arrange your recovery with a nurse at a luxury hotel located within minutes of our facility.


Contact Us

Schedule your Attiva Consultation

Please contact us with any questions or if you would like to setup a time for a one-on-one consultation with one of our surgeons.

Your Name (required)

Your Email (required)

Your Phone (required)


Your Message

Please enter the following text in the box below

Dr. Nicole Nemeth

Plastic & Reconstructive Surgeon

American Board of Plastic Surgery


Dr. Vadim Pisarenko

Plastic & Reconstructive Surgeon

American Board of Plastic Surgery
American Board of Surgery


Back to Top