Radio-frequency skin tightening

Radio-frequency skin tightening is an aesthetic technique that uses radio frequency (RF) energy to heat skin with the purpose of stimulating cutaneous collagen, elastin and hyaluronic acid production in order to reduce the appearance of fine lines and loose skin.[1][2] The technique induces tissue remodeling[3] and production of new collagen and elastin.[4][5] The process provides an alternative to facelift[6] and other cosmetic surgeries.

By manipulating skin cooling during treatment, RF can also be used for heating and reduction of fat. Currently, the most common uses of RF-based devices are to noninvasively manage and treat skin tightening of lax skin (including sagging jowls, abdomen, thighs, and arms), as well as wrinkle reduction, cellulite improvement, and body contouring.[7]

Several companies manufacture RF devices, including D-Finitive Thermage by Solta Medical, Evo by Beco Medical V-Form by Viora, Venus Freeze Plus, Venus Legacy by Venus Concept, VelaShape by Syneron, Exilis by BTL, and 3DEEP by Endymed. Microneedle radiofrequency is the latest form of delivery and devices include Profound by Candela lasers, Fractora, Intensif, Thermia Ablative RF Fractional by Melorin Group and Genius by Lutronic. Alternative techniques include Laser Resurfacing and certain Ultrasound alternatives. Novel non-invasive versions of radiofrequency delivery include tripolar devices such as Tripolar by Lumenis and Triactive by DEKA. Devices have different penetration depths depending on the number of electrodes (monopolar, bipolar, or unipolar).

The ideal target temperature in the dermis for inducing dermal remodeling and wrinkle and laxity reduction was shown to be 67 °C. By delivering radiofrequency power until this target temperature is attained, clinical outcomes are optimized.[8]

Microneedle radiofrequency has also been FDA-approved for cellulite reduction using vertically penetrating needles that target the subnormal plane.[9][10]

Side effects

Due to radiation of high-energy radio frequency, several patients have reported pain requiring sedation during the procedure. The process also requires extreme care in its execution. Improper application may result in dents on the skin surface due to uneven healing responses on the skin. Many effects including fat necrosis and atrophic scarring have also been reported, although several new techniques have overcome this obstacle. With the application of a vacuum at the point of application, the burning and crusting was reportedly reduced.

References
  1. Alexiades-Armenakas, Macrene; Rosenberg, David; Renton, Bradley; Dover, Jeffrey; Arndt, Kenneth (1 April 2010). "Blinded, Randomized, Quantitative Grading Comparison of Minimally Invasive, Fractional Radiofrequency and Surgical Face-lift to Treat Skin Laxity". Archives of Dermatology. 146 (4): 396–405. doi:10.1001/archdermatol.2010.24. PMID 20404228.
  2. "Update on tissue tightening". The Journal of Clinical and Aesthetic Dermatology. 3 (5): 36–41. May 2010. PMC 2922712. PMID 20725568.
  3. Alster, Tina S.; Lupton, Jason R. (September 2007). "Nonablative cutaneous remodeling using radiofrequency devices". Clinics in Dermatology. 25 (5): 487–491. doi:10.1016/j.clindermatol.2007.05.005. PMID 17870527.
  4. Hantash, Basil M.; Ubeid, Anan Abu; Chang, Hong; Kafi, Reza; Renton, Bradley (January 2009). "Bipolar fractional radiofrequency treatment induces neoelastogenesis and neocollagenesis". Lasers in Surgery and Medicine. 41 (1): 1–9. doi:10.1002/lsm.20731. PMID 19143021.
  5. Zelickson, Brian D.; Kist, David; Bernstein, Eric; Brown, Douglas B.; Ksenzenko, Sergey; Burns, Jay; Kilmer, Suzanne; Mehregan, David; Pope, Karl (1 February 2004). "Histological and Ultrastructural Evaluation of the Effects of a Radiofrequency-Based Nonablative Dermal Remodeling Device". Archives of Dermatology. 140 (2): 204–9. doi:10.1001/archderm.140.2.204. PMID 14967794.
  6. El-Domyati, Moetaz; El-Ammawi, Tarek S.; Medhat, Walid; Moawad, Osama; Brennan, Donna; Mahoney, Mỹ G.; Uitto, Jouni (March 2011). "Radiofrequency facial rejuvenation: Evidence-based effect". Journal of the American Academy of Dermatology. 64 (3): 524–535. doi:10.1016/j.jaad.2010.06.045. PMC 6541915. PMID 21315951.
  7. Weiss, RA (March 2013). "Noninvasive radio frequency for skin tightening and body contouring". Seminars in Cutaneous Medicine and Surgery. 32 (1): 9–17. PMID 24049924.
  8. Alexiades, Macrene; Berube, Dany (May 2015). "Randomized, Blinded, 3-Arm Clinical Trial Assessing Optimal Temperature and Duration for Treatment With Minimally Invasive Fractional Radiofrequency". Dermatologic Surgery. 41 (5): 623–632. doi:10.1097/DSS.0000000000000347. PMID 25915628.
  9. Alexiades, Macrene; Munavalli, Gilly; Goldberg, David; Berube, Dany (October 2018). "Prospective Multicenter Clinical Trial of a Temperature-Controlled Subcutaneous Microneedle Fractional Bipolar Radiofrequency System for the Treatment of Cellulite". Dermatologic Surgery. 44 (10): 1262–1271. doi:10.1097/DSS.0000000000001593. PMID 30222637.
  10. Weiss, RA (March 2013). "Noninvasive radio frequency for skin tightening and body contouring". Seminars in Cutaneous Medicine and Surgery. 32 (1): 9–17. PMID 24049924.
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