No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Noninvasive Radio Frequency for Skin Tightening and Body Contouring
Abstract
The medical use of radio frequency (RF) is based on an oscillating electrical current forcing collisions between charged molecules and ions, which are then transformed into heat. RF heating occurs irrespective of chromophore or skin type and is not dependent on selective photothermolysis. RF can be delivered using monopolar, bipolar, and unipolar devices, and each method has theoretical limits of depth penetration. A variant of bipolar delivery is fractional RF delivery. In monopolar configurations, RF will penetrate deeply and return via a grounding electrode. Multiple devices are available and are detailed later in the text. RF thermal stimulation is believed to result in a microinflammatory process that promotes new collagen. By manipulating skin cooling, 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.
... Although this is an exciting advance in the field of cosmetic rejuvenation, a full discussion of combination laser treatment is outside the scope of this paper. Depth of penetration is greater than bipolar counterparts [12,31] High voltage and low current system [28]. It creates less skin tightening than its biterminal counterpart ...
... It creates greater skin tightening than its monoterminal counterpart. Depth of penetration is greater than bipolar counterparts [12,31] Greater depth of penetration is associated with greater pain and risk for burns and scarring [12] Bipolar radiofrequency Separate deep and superficial passes are unnecessary [3]. Minimal or no in treatment bleeding [3]. ...
... Biterminal instead uses a grounding pad on a patient's back or leg to absorb the RF energy, creating a more powerful skin-tightening system that operates with a higher current and lower voltage compared to monoterminal devices [4•, 12, 31]. The main advantage and disadvantage of monopolar RF systems are the depth of energy penetration [12,31]. Although significant skin tightening can be achieved, monopolar RF systems are often limited by significant pain during treatment and risk side effects including burns and scarring [12,36]. ...
Purpose of Review
The skin laxity component of facial aging has been traditionally addressed with surgical intervention. However, demand for alternative treatment options with less associated risk, scarring, downtime, and cost have driven advances in non-surgical tightening techniques. This article explores the recent advances in these non-surgical technologies for skin tightening including microcoring, hydroxyapatite fillers, and energy-based devices (lasers, ultrasound, radiofrequency, and plasma).
Recent Findings
Advances in non-surgical skin-tightening devices allow for effective skin tightening. Although fully ablative laser resurfacing devices are often considered the gold standard for non-surgical rejuvenation, important advances in this technology include fractionated energy delivery to decrease risk and shorten treatment recovery. In addition, studies have shown that optimal treatment temperatures for skin tightening are lower than those achieved with CO2, favoring radiofrequency devices as a more optimal choice for tissue tightening in terms of treatment results, skin types amenable to treatment, risks, and downtime. Ultrasound technology has the unique advantage of allowing for real-time tissue assessment and tailored heat delivery. Microcoring and hydroxyapatite treatment stimulate skin tightening without heat production. Advantages and disadvantages of various non-surgical skin tightening are reviewed and summarized in this article.
Summary
A wide array of non-surgical skin-tightening techniques provide an attractive alternative to surgical intervention for modern cosmetic patients.
... As mais utilizadas são de 0,5 a 1,5MHz 4 . Porém, são encontrados no mercado equipamentos com outras frequências, como 3,4 e 4MHz 5 . ...
... A água é o principal alvo para esse processo, independente de qual o fototipo de pele. A profundidade de penetração da radiofrequência é inversamente proporcional à frequência, consequentemente as frequências mais baixas são capazes de penetrar mais profundamente podendo chegar até ao tecido adiposo subcutâneo 5,7 . ...
... A aparência da derme, Figura 02-B, demonstrou claramente os efeitos desta termólise. Segundo as referências, os efeitos térmicos da radiofrequência promovem a desnaturação do colágeno, com contração das suas fibras e posterior ativação dos fibroblastos, com neocolanogênese das fibras colágenas ao longo do tempo, devido a uma resposta de cicatrização secundária à lesão térmica 5,13,14 . ...
Abstract: Background: Radiofrequency is a noninvasive treatment method sought in aesthetics, has few complications and gives the patient the possibility to return to a routine after application. Objective: To Analyze the effects of radiofrequency on the morphological structure of the skin (epidermis and dermis). Methods: Experimental study case, having as sample a participant with indication for abdominoplasty. The region for the application and collection of biological material was the lower abdominal region. In which the rigth side received radiofrequency treatment, the opposite left side was not treated and was used as a control. In the first 2.30 minutes a power of 120W was used and in the last 2.30 minutes 80W. During abdominoplasty, the treated tissue samples were removed as they would be discarded for programmed aesthetic reduction. These samples were stained with HE and are available by microscopy. Results: In the epidermis, the radiofrequency region maintained the organization of the keratinized stratified epithelium, the same was observed in relation to the untreated region. In the dermis there was evident disorganization in the arrangement of the recutular and papillary layers, especially the collagen fibers were contracted in relation to the área not treated wioth radiofrequency. There was no increase in the number of fibroblats of neovascularization. Conclusion: Radiofrequency treatment of the lower abdominal region of the skin does not affect epidermis, while alterations in the connective fibers were found in the dermis.
Keywords: Radiofrequency, Dermis, Epidermis
... RF is a minimally invasive, nonablative technique that is commonly used for body contouring, skin tightening, and cellulite reduction. 1 The electromagnetic technology is based on the use of an oscillating electrical current that generates and delivers thermal energy to the deep dermis and subcutaneous fat that stimulates the production of collagen, elastin, and hyaluronic acid, resulting in skin tightening and lifting, while causing minimal damage to super cial structures of the skin. 1,2 Several modalities, both invasive and noninvasive, exist for the treatment of skin laxity of the arms and legs. ...
... 1 The electromagnetic technology is based on the use of an oscillating electrical current that generates and delivers thermal energy to the deep dermis and subcutaneous fat that stimulates the production of collagen, elastin, and hyaluronic acid, resulting in skin tightening and lifting, while causing minimal damage to super cial structures of the skin. 1,2 Several modalities, both invasive and noninvasive, exist for the treatment of skin laxity of the arms and legs. Cosmetic surgery is the classical approach to reducing thigh skin laxity; however, there is a risk for linear surgical scarring using this method that some patients might nd aesthetically unpleasing. ...
... 3 Ultrasound, RF, and cryolipolysis have emerged as nonsurgical alternatives for the treatment of skin laxity; however, though these modalities require less down time by the patient compared to surgery, typical results using these methods have not yet achieved the same level of e cacy as surgical techniques. 2 RF can be delivered at a frequency ranging from 3GHz to 24GHz using monopolar, bipolar, or unipolar devices, which allows for varying levels of depth penetration. 1 To achieve greater e cacy, a new device that combines fractional RF (a subset of bipolar delivery) with microneedling has been developed as a nonsurgical means to reduce skin laxity, primarily on the face and neck. 4 We present a case in which this new RF microneedling device was successfully used to treat thigh skin laxity, secondary to weight loss, and dimpling in an adult female patient. ...
Radiofrequency (RF) microneedling has been used to reduce skin laxity, due to aging, on the face and neck. Our objective for this case study was to evaluate the use of RF in combination with microneedling to nonsurgically improve skin laxity, a result of significant weight loss, on the thighs of a 39-year-old woman. Two sessions of subcutaneous RF microneedling were performed five months apart on the patient's bilateral medial thighs. Laxity was graded before the first session and two months following the second session using the Hexsel and Dal'Forno Severity Scale of Cellulite. Upon visual evaluation, the appearance of cellulite and skin laxity was improved, with a five-point improvement on the Hexsel and Dal'Forno scale at two months after the second treatment. Laxity and depth of depressions showed the most improvement. Our patient reported satisfaction with the results. RF microneedling might offer an effective alternative to surgical correction of skin laxity. Further research is needed to explore the expanding applications of RF microneedling in aesthetic medicine.
... Application of radiofrequency (RF)-induced thermal effects based on electrical systems is a minimally invasive treatment method used in various medical fields. Radiofrequencies are commonly used to treat tumors in the liver, lung, pancreas, and kidney, as well as to induce fat reduction and cellulite improvement [12][13][14][15][16]. Because RF is used to increase the temperature of a target point from 42 ∘ C to 46 ∘ C for hyperthermia therapy [17,18], or for ablation therapy (in which temperature changes ranging from 50 ∘ C to 102 ∘ C are applied), skin can be simulated using RF devices to increase the temperature [10,19]. ...
... Specifically, cold exposure is a strong inducer of beige adipocyte induction that functions by increasing mitochondrial biogenesis [25]; however, the detailed mechanism responsible for beige adipocyte induction by heat stimulation has yet to be clearly identified. A previous study indicated that heat stimulation by RF may result in fat reduction and cellulite improvement and that heat stimulation may also cause minor inflammation and promote collagen formation [15]. Another report suggested a unique effect of bipolar RF in enhancing fat metabolism, which may contribute to treating cellulite. ...
... Moreover, heat treatment and activation of heat shock proteins have been shown to improve insulin sensitivity of skeletal muscle, as well as to reduce plasma triglyceride and free fatty acids of genetically obese mice in conjunction with a decrease in WAT mass [48]. Traditionally, only cold exposure was associated with formation of beige adipocytes [24,25,42]; however, previous reports have shown that heat stimulation can also induce beige adipocyte formation [15,47], which led us to test the effects of RF heat stimulation in WAT browning. Consistent with the results of a previous report [47], our results demonstrated that heat stimulation by RF treatment can induce elevation of FGF21 in the serum and WATs. ...
Background
Obesity is a pathological condition associated with various diseases including diabetes, stroke, arthritis, infertility, and heart disease. Moxibustion is widely used to prevent and manage obesity in traditional Asian medicine. We tested our hypothesis that moxibustion-simulating bipolar radiofrequency (M-RF) can suppress total body and white adipose tissue (WAT) weight gain via induction of WAT browning in a mouse model of diet-induced obesity (DIO).
Methods
We designed an M-RF device that could accurately adjust the depth and temperature at which heat stimulation was administered into the abdomen of DIO mice. High-fat-fed male C57BL/6 mice were treated with the M-RF device every two or three days for three weeks. We then harvested WAT and serum from the mice and measured total body and WAT weight, size of adipocytes, mitochondrial contents, features of the dead adipocyte environment, and levels of uncoupling protein 1 (UCP1) and fibroblast growth factor 21 (FGF21).
Results
Heat stimulation by M-RF in DIO mice resulted in precise temperature adjustment in the mice abdomen, with variance less than 1°C. Additionally, M-RF stimulation inhibited body and WAT weight gain, resulting in increased formation of beige adipocytes, increased mitochondrial content, and decreased formation of dead adipocytes in WAT. Moreover, treatment of M-RF induced expression of UCP1 and FGF21 in serum and/or epididymal WATs in DIO mice.
Conclusion
Heat stimulation by M-RF treatment induced upregulation of UCP1 and FGF21 expression in serum and/or WATs, which was correlated with reduced total body and WAT weight gain in DIO mice.
... However, one of the disadvantages of using microwaves in skin-tightening hyperthermia therapy is the likelihood of burns owing to the high temperatures involved. To mitigate this risk, most therapies utilize a cooling tip or cooler to prevent skin burns while maintaining a high temperature beneath the skin surface (Weiss, 2013;Shin et al., 2019) [8-9]. Another drawback is its high cost and wide effective area. ...
... Electrodes for electromagnetic-field generation are advantageous in the design of compact handheld devices. However, many of these designs do not consider impedance matching, which leads to impedance mismatch issues requiring higher power or longer treatment times to achieve the desired skin-tightening temperatures (Hurwitx and Darren, 2012;Weiss, 2013;Gongalsky et al., 2019;Prasad et al., 2019;Tanaka, 2019). ...
Radio frequency (RF) hyperthermia focuses on raising the target area temperature to a value exceeding 45°C. Collagen is stimulated when the temperature rises to 45°C at the dermal layer, resulting in skin tightening. However, most studies on RF hyperthermia have focused on tumor ablation or using electrodes to radiate an electromagnetic field, which is highly inefficient. This study proposed a non-invasive RF hyperthermia skin-tightening system with a compact metamaterial-filled waveguide aperture antenna. The proposed RF system increased the temperature by 11.6°C and 35.3°C with 20 and 80 W of 2.45 GHz RF power, respectively, within 60 s and exhibited a very focused effective area. Furthermore, a metamaterial was proposed to reduce the size of the waveguide aperture antenna and focus the electromagnetic field in the near-field region. The proposed metamaterial-filled waveguide aperture antenna was compact, measuring 10 mm × 17.4 mm, with a peak gain of 2.2 dB at 2.45 GHz. The measured hyperthermia performance indicated that the proposed RF system exhibited better power- and time-efficient hyperthermia performance than other RF hyperthermia systems in the cosmetic skin lifting commercial market. The proposed RF hyperthermia systems will be applied into a new generation of beauty cosmetic devices.
... Radiofrequency devices are currently the most popular noninvasive body contouring devices used in practice. Although initially used for treating periorbital wrinkles, rhytids, and skin laxity [8,9]; RF is now widely used for body contouring, skin tightening, and cellulite reduction [10]. This method is based on the difference in water and impedance between skin (low impedance) and fat tissue (high impedance) [3]. ...
... Among the different non-invasive techniques used currently for body contouring, RF and US have become increasingly popular [3,10,15]. Adipose tissue is highly influenced by thermal changes. This fact, in combination with the development of new non-invasive ultrasound technologies, has led to the use of ultrasound as a strategy for thermal fat tissue destruction [13][14][15][16]. ...
Objective
To assess the efficacy and safety of a new non-invasive body contouring device in patients with localized fat in abdomen or in abdomen and hips. Additionally, we also evaluated the patient satisfaction with the procedure.Methods
Prospective and non-randomized open label study. The patients underwent four sessions, separated by 1 week each, with the Alma PrimeX, a non-invasive body contouring device that combines pulsed non-focus ultrasound and a Unipolar radiofrequency. The primary end point was the mean change in fat tissue thickness, assessed by diagnostic ultrasound, from baseline to 3-months after the last treatment-session.ResultsFifteen subjects were evaluated. As compared to pre-treatment thickness, Hodges-Lehmann median difference (95% CI) was − 85.3 (− 107.5 to − 62.0) mm, p = 0.0001; − 70.3 (− 95.0 to − 48.5) mm, p = 0.0001; − 100.0 (− 140.5 to − 49.5) mm, p = 0.0039; and − 71.8 (− 132.5 to − 23.0) mm, p = 0.0078 in infraumbilical, supraumbilical, right hip, and left hip, respectively. Pretreatment fat volume was significantly reduced from 32.9% to 31.2%, p = 0.0006. The median (interquartile range) degree of patient satisfaction was 4.0 (1.0–5.0), with 13 (86.7%) patients being “Highly satisfied” or “Satisfied” with the treatment results. The most common adverse event was discomfort, followed by erythema. All the adverse events were mild and were successfully resolved without treatment.Conclusions
Combine therapy of a Pulsed non-focus ultrasound and Unipolar radiofrequency using the non-invasive device Alma PrimeX was an effective and safe treatment for reducing fat tissue thickness in abdomen and hips in patients with localized fat. Patients’ satisfaction with the procedure was high.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... The controlled heating of the dermis leads to the denaturation of the helical structure of collagen and an inflammatory response with subsequent activation of fibroblasts. As the collagen undergoes repair and remodeling, the dermal health improves with decreased skin laxity and increased elasticity [4][5][6][7] . ...
... In this way, RF produces thermal injury in the dermis, while preserving the integrity of the epidermis [4,5] . The controlled heating of the dermis induces immediate collagen denaturation and subsequent fibroblast activation, leading to synthesis of new collagen and elastin fibers [4,6,7] . The heatinduced contraction of the dermal layer tightens the skin while also increasing skin elasticity. ...
As people live longer and stay healthier, many want to look as youthful as they feel. The general population continues to explore nonsurgical options to augment and possibly delay traditional rhytidectomy. Herein, we present a unique nonsurgical option to enhance our current modalities of neuromodulators and fillers commonly used on the face and neck. In addition, we discuss the ideal application of this technology including treatment times and intervals between treatments.
... Furthermore, PTT has been investigated in pain management, where its ability to provide localized heating offers a novel approach to alleviating pain without systemic side effects [93]. In the realm of cosmetic procedures, PTT has gained attention for non-invasive fat reduction and skin tightening, offering patients cosmetic benefits with minimal recovery time compared to traditional surgical methods [94,95]. These diverse applications highlight the versatility and potential of PTT as a multifaceted therapeutic tool in modern medicine. ...
Basal cell carcinoma (BCC) is the most common type of skin carcinoma worldwide. BCC development is the result of a complex interaction between environmental, phenotypic, and genetic factors. While conventional treatments such as surgery and topical therapies have demonstrated variable efficacy (some of them with limited efficacy), they are not free of adverse side effects, most of them debilitating. Thus, there is a notable gap in the literature regarding alternative and non-invasive therapeutic options. This review aims to address this gap, exploring the potential of photothermal therapy (PTT) combined with metallic nanoparticles, namely gold nanoparticles (AuNPs), as a minimally invasive treatment approach. Through a comprehensive review of the literature in the period from 2014 to 2024, using experimental investigations, this review seeks to elucidate the intricate interplay between genetic factors, environmental influences, and the tumor microenvironment in BCC disease progression, with PTT as a potential therapeutic strategy. Those studies confirmed an enhanced targeting of cancer cells and selective ablation of tumor tissue, using emerging technologies like PTT. A significant tumor reduction, often exceeding 50%, was observed, with some studies reporting complete elimination of the tumor. The main adverse effects noted were localized skin irritation and transient hyperpigmentation, but these were generally minimal and manageable, highlighting the promise of PTT as an effective treatment. Thus, by leveraging the unique properties of AuNPs to enhance the effectiveness of PTT, the targeting of cancer cells can more precisely occur, reducing collateral damage to healthy tissues. This approach not only aims to achieve better clinical results, but also contributes to the broader knowledge base in the field of BCC research. Continued research and clinical trials will be crucial in refining those techniques and validating their efficacy, ultimately paving the way for more effective and less invasive treatments for BCC.
... Additionally, increased blood flow delivers more oxygen and nutrients to the skin, promoting healing and regeneration. 2,7 The combined effects of collagen production induction, fat reduction, improved circulation, and lymphatic drainage make RF a comprehensive technology for body contouring. The treatments are well-tolerated by most patients and can be tailored to individual needs and clinical goals. ...
Background
Excess body adiposity and skin irregularities represent a major problem in today's society. Currently, radiofrequency‐based devices constitute an increasingly popular medical‐aesthetic application and a powerful non‐invasive method to combat this problem.
Objective
This study aims to determine the efficacy and safety of the high‐frequency device Zionic™ (Termosalud, Inc., Gijón, Spain) in reducing body contouring and improving skin appearance in the abdomen/flanks or thighs.
Materials and Methods
Thirty nine individuals were treated with the Zionic™ device in the abdomen/flanks or thighs. A total of 8 sessions of 40–50 min each, 72/96 h apart were performed. At baseline, body measurements were taken including photographs, body contours, and ultrasound scans to assess dermal thickness, dermal echogenicity, and subcutaneous fat thickness. The measurements were repeated after the eight sessions for comparison and analysis. Quantitative data was complemented with a customized survey to evaluate participants satisfaction level.
Results
At the follow‐up visit, a significant average reduction of 3% in abdomen/flanks circumferences and 2% in thighs contours was noticed. Abdomen/flanks and thighs subcutaneous fat layer thickness was significantly reduced by 8% and 6%, respectively. Dermal echogenicity changes, related to skin collagen content and organization, showed non‐significant increasing tendencies of 7% for abdomen/flanks and 8% for thighs. Thighs dermal thickness was significantly increased by 6%. Results were associated to a high satisfaction level (80%) and no severe adverse events.
Conclusion
Zionic™ treatment is a safe, effective, and well‐tolerated noninvasive procedure for body contouring and improvement of skin properties in abdomen, flanks, and thighs.
... The needles deliver the radiofrequency energy to heat up the deep tissue safely while also resulting in overall skin tightening and a rejuvenated appearance [3,4]. RFMN has shown excellent efficacy in rejuvenation, skin laxity and rhytides in multiple studies [5][6][7]. ...
... Fourth-generation MRF devices use a highfrequency generator that produces a 400 W, Fig. 2 Patients' assessments of the improvements immediately after the treatments, and 1, 3, and 6 months following the treatments 6.78 MHz monopolar current signal. MRF devices stimulate volumetric tissue heating, with dermal temperatures reaching between 65 and 75°C [16]. Our study used an MRF of 6.78 MHz, a power of 400 W, a 4-cm 2 disposable tip, and a coupling fluid to generate 40-60°C tissue heating. ...
IntroductionMonopolar radiofrequency (MRF) is a valuable modality for tightening and contouring mild-to-moderate facial skin laxity. Few studies have evaluated new-generation MRF devices for lower facial laxity in Asians. This study aims to evaluate the efficacy and safety of MRF for treating lower facial laxity in Asians.Methods
This prospective cohort study enrolled 30 volunteers with Fitzpatrick Skin Types III–V and mild-to-moderate skin laxity. Subjects received a single MRF treatment. Self-assessments and adverse events were recorded. Two blinded dermatologists graded improvements (6-point scale) after treatment and 1, 3, and 6 months later.ResultsAll subjects completed the study. Treatment energy levels ranged from 2 to 4. The average number of shots was 412 ± 49, delivered in 3–4 passes with 15–30% overlap. All patients reported improvement in lower facial laxity immediately after treatment. Most patients had mild-to-moderate improvement over the 6-month follow-up. Continuous improvement was observed at the 1-, 3-, and 6-month follow-ups (P < 0.01). Significant improvement was seen at the 6-month follow-up compared with the 1-month follow-up (P < 0.01). Subjects tolerated the procedure well: the average pain score was 3.13 out of 10, and no serious adverse events were observed.Conclusions
The new-generation MRF device we tested was effective and safe for mild-to-moderate lower facial laxity in Asian skin. The latest MRF technology offers improved safety to prevent complications. Appropriate patient selection, setting, and protocols are mandatory to achieve optimal clinical outcomes.The Trial Registration NumberTCTR20210326002.
... Radiofrequency devices utilize electrical energy to transfer heat energy to the dermis from an increase in tissue temperature at relatively low temperatures (14). These devices are typically not intended to resurface the skin but rather to induce thermal damage to dermal collagen while sparing the epidermis (15) . ...
Increasingly, there is an attempt to minimize expression lines through esthetic procedures, and radiofrequency (RF) is one of the therapeutic modalities. This article aims to systematically review the literature on the different types of RF treatment in clinical trials and in variables related to the aging process. This systematic review included 21 articles that treated 354 people with different physical characteristics. The most used RF was the fractional followed by the non-ablative RF. There was a large discrepancy in relation to the types and parameters. A parameter that did not show so much divergence was the temperature, which was between 38°C and 44°C. The main temporary adverse reactions reported by the authors were as follows: discomfort, pain, erythema, hyperpigmentation, crusting, swelling, edema, and purple and acneic appearance of the skin. Finally, our study concluded that non-ablative and ablative RF was reported to rejuvenate and improve the features of skin in all skin types.
... Notably, minimally or noninvasive cosmetic procedures have grown in popularity due to their minimal pain and recovery time, ease, procedural speed, exceptional biological responses, and positive effect on self-image [2,3]. For minimally invasive body contouring, a variety of energy-based [4][5][6] and injectable materials [7][8][9][10] are commonly utilized. Notably, biostimulatory fillers have the potential to add volume to volumetrically-deficient tissues and concurrently drive endogenous extracellular matrix (ECM) regeneration [11,12]. ...
For decades, aesthetic medical procedures have sought to improve patient appearance, comfort, and self-confidence. In more recent years, a growing interest in body contouring cosmetic procedures has emerged, in large part due to increased transparency in procedures and improved outcomes with minimally invasive procedures. Notably, several biostimulatory fillers have emerged as a suitable treatment modality due to their relatively low cost, low pain, short downtime, high tunability, and sustained biostimulatory effect. One volumizing biostimulatory filler, Radiesse® (Merz Aesthetics, Frankfurt, Germany), consists of calcium hydroxylapatite microspheres suspended in a carboxymethyl cellulose gel. When injected, Radiesse immediately volumizes the injection site and initiates neocollagenesis and neoelastogenesis. One technique, the Bella Vida Instant Brazilian Butt Lift (BBL)™, is a fast, safe, and minimally invasive alternative to surgical gluteal augmentation that accomplishes morphological remodeling, increases volumization, and improves shape and patient satisfaction. This technical report provides the clinical basis, materials, and methods for implementing the Bella Vida Instant BBL™ in aesthetic practices.
... The circumference of the targeted regions has been demonstrated to be considerably reduced by this method. One of the most notable differences between ultrasonic cavitation and liposuction is the absence of the disadvantages that come with surgical treatments 11 12 .The radiofrequency is established on an electric charge between particles, that is ultimately converted to thermal energy 13 . Radiofrequency causes electric fields to be transmitted through skin, causing old collagen to be rebuilt, fibroblasts to produce new collagen, and lipolysis to be stimulated 14 . ...
Objective: To investigate cryolipolysis versus ultrasound cavitation radiofrequency on hunger level, waist-hip ratio, skin fold, body weight, subcutaneous fat and visceral fat thickness in adolescent with abdominal obesity. Material and Methods: Sixty adolescent central obese whose age ranged from 13 to 16 years were allocated randomly into 3 groups. Each of them was 20 participants. Subjects in study group (A) underwent cavitation radiofrequency plus dietary regimen, subjects in the second study group (B) underwent cryolipolysis in conjunction with the same diet program, and subjects in control group (C) received the same diet program only. Patients in all groups were evaluated on height, weight, skinfold, waist-hip ratio, hunger level and MRI were carried out shortly before to the start of the intervention techniques and again two months afterwards. Results: After two months of intervention, there were no statistically significant differences in BMI, weight, or visceral adipose tissue (VAT) between groups. However, there was a significant difference between the three groups in Suprailiac skin fold, waist-hip ratio, subcutaneous adipose tissue (SAT) and hunger level (P= 0.001) with the Cavitation and radiofrequency group (A) showing better reduction than the Cryolipolysis group (B) and the Cryolipolysis group was better than the diet group (C). Conclusion: Cavitation radiofrequency have a favorable effect compared to Cryolipolysis on reduction of skin folds, waist-hip ratio, subcutaneous adipose tissue and hunger level. However, there is no difference between groups on BMI, body weight and VAT.
... Fourth, another treatment method of noninvasive fat reduction by using Radiofrequency, RF is commonly used for increasing deeper skin temperature without any epidermal or dermal ablation. It is not only used as an efficient method for contracting or inducing skin tightening but also as an effective method for reducing fat [24]. Based on the principle of volumetric heating and the varied impedance of different skin layers, radiofrequency energy is used to generate heat that selectively targets the collagen-rich tissue layers to contract and denature collagen fibers, which results in immediate skin improvement. ...
A Non-invasive hyperthermia ablation technique of adipose tissue using a microwave is proposed. It uses dielectric heating to heat the adipose tissue using a rectangular Horn antenna. A selection of operating frequency 5.8 GHz, as an industrial, scientific, and medical radio bands (ISM band), for concentrating electromagnetic (EM) power radiated from the external antenna to the adipose tissue. To protect skin from heat, a silicon layer is used on the surface of the skin instead of water bolus to reduce the percentage of burns on the skin surface. The performance of this antenna is applied in three biological tissues (skin, fat, and muscles), using the simulation of computer simulation technology (CST) microwave studio. The main feature in this antenna is the centralization of the Specific absorption rate (SAR) at the fat tissue more than other tissues. Finally, results achieved good matching of the return loss (S11), and linear SAR value became high at fat tissue more than other tissues, and also the temperature distribution inside fat tissues became 42.7 °C while keeping the temperature inside the skin and muscles below 40 °C after 30 minutes.
... 45 Additionally, RF elds can be used for hyperthermia and drug release, [46][47][48] and non-invasive body fat reduction. 49,50 Other notable applications include soil decontamination and drying of brickwork, 51,52 adsorptive catalytic off-gas, 51 oil recovery, 53 sterilization of vacuum-packaged food, 54,55 and non-chemical pest disinfestation. 56 Localized or targeted heating Various methods have previously been developed for localized or targeted heating. ...
Carbon nanomaterials have been shown to rapidly evolve heat in response to electromagnetic fields. Initial studies focused on the use of microwaves, but more recently, it was discovered that carbon nanomaterial systems heat in response to electric fields in the radio frequency range (RF, 1-200 MHz). This is an exciting development because this range of radio frequencies is safe and versatile compared to microwaves. Additional RF susceptor materials include other carbonaceous materials such as carbon black, graphite, graphene oxide, laser-induced graphene, and carbon fibers. Such conductive fillers can be dispersed in matrices such as polymer or ceramics; these composites heat rapidly when stimulated by electromagnetic waves. These findings are valuable for materials processing, where volumetric and/or targeted heating are needed, such as curing composites, bonding multi-material surfaces, additive manufacturing, chemical reactions, actuation, and medical ablation. By changing the loading of these conductive RF susceptors in the embedding medium, material properties can be customized to achieve different heating rates, with possible other benefits in thermo-mechanical properties. Compared to traditional heating and processing methods, RF heating provides faster heating rates with lower infrastructure requirements and better energy efficiency; non-contact RF applicators or capacitors can be used for out-of-oven processing, allowing for distributed manufacturing.
... The earliest RF devices were monopolar and bipolar, and they were applied for improving skin wrinkles and laxity. However, due to severe pain, relatively high risk of burn or superficial effect, they were not delightfully accepted by some beauty seekers [15][16][17]. Afterwards, the constant diversification and refinement of RF devices have improved their applications in esthetic treatments. Recently, techniques of microneedling in combination with RF were developed to enable deeper penetration and specific tissue targeting. ...
Large-scale long-term retrospective study of noninsulated microneedle radiofrequency treatment on neck rejuvenation is lacking. We conducted a 3-year retrospective observation of subjects treated with noninsulated microneedle radiofrequency (NIMNRF) for neck rejuvenation in Chinese subjects. Of all subjects, 28 subjects (28.6%) received only 1 session of treatment. About 50% subjects achieved ≥ 50% improvement, and average improvements were 37.0% at 3 months follow-up (M3) and 41.6% at 6 months follow-up (M6). Seventy subjects (71.4%) accepted 3 sessions of treatments. The neck aging scores were 3.57 ± 1.28 at baseline, and significantly decreased to 1.10 ± 0.84 at M3 (p < 0.05), 1.04 ± 0.86 (p < 0.05) at M6, separately. The average improvements were 73.3% at M3 and 75.1% at M6. It showed a trend of better efficacy with the increasing number of sessions (p < 0.05). Among of 6 subjects who was followed up for 1 year, 5 subjects who received 3 sessions of treatment achieved about 70% improvement after final session, and another 1 subject who received 1 session remained the improvement up to 40%. The results demonstrate NIMNRF treatment has significant and long-lasting effect on neck laxity and wrinkle reduction with minimal discomfort and downtime.
... RF is capable of forming micron-sized aqueous conduits in the SC and therefore it is considered as a promising technique which has wide applications in different fields such as electrosurgery, removal of malignant tissues, and in cosmetics for skin rejuvenation, skin tightening, and body contouring [77,78]. RF-assisted thermal ablation involves the placement of an array of micro-electrodes directly onto the skin which is capable of generating an electric current into the skin in RF range of 100-500 kHz [52,63,79]. ...
Traditionally, the skin is considered as a protective barrier which acts as a highly impermeable region of the human body. But in recent times, it is recognized as a specialized organ that aids in the delivery of a wide range of drug molecules into the skin (intradermal drug delivery) and across the skin into systemic circulation (transdermal drug delivery, TDD). The bioavailability of a drug administered transdermally can be improved by several penetration enhancement techniques, which are broadly classified into chemical and physical techniques. Application of mentioned techniques together with efforts of various scientific and innovative companies had made TDD a multibillion dollar market and an average of 2.6 new transdermal drugs are being approved each year. Out of various techniques, the thermal ablation techniques involving chemicals, heating elements, lasers, and radiofrequency (RF) are proved to be more effective in terms of delivering the drug across the skin by disrupting the stratum corneum (SC). The reason behind it is that the thermal ablation technique resulted in improved bioavailability, quick treatment and fast recovery of the SC, and more importantly it does not cause any damage to underlying dermis layer. This review article mainly discussed about various thermal ablation techniques with commercial products and patents in each classes, and their safety aspects. This review also briefly presented anatomy of the skin, penetration pathways across the skin, and different generations of TDD.
Graphical abstract
... Cryolipolysis utilizes cold temperature which triggers apoptosis of adipocytes and initiates inflammatory response leading to slow digestion of fat tissue by surrounding macrophages [7,8] while HIFU quickly raises local temperature leading to immediate death of fat cells via coagulative necrosis [9][10][11]. The use of RF is based on an oscillating electrical current which generates heat [12]. As concerns LLLT, the mechanism of its action on fat is controversial and probably affects several intracellular targets [13]. ...
BACKGROUND
Non‐invasive body shaping is becoming a growing demand. The aim of this study was to investigate the efficacy and safety of the combined treatments of 1064nm Nd:YAG and 2940nm Er:YAG in non‐invasive lipolysis and skin tightening.
MATERIALS AND METHODS
10 females were enrolled, all women’s side of the waist or the lower part of the abdomen were treated. In the first step, the 1064 nm Nd:YAG was used. As a second step, the 2940 nm Er:YAG laser was applied. Each woman was treated four times, once every two weeks. The effects were determined by comparative photo documentation, waist circumference measurement, 2D B‐mode ultrasonography and low‐dose native CT, whereas body fat was monitored with bioelectric impedance. The tissue firmness was measured by ultrasound shear wave elastography.
RESULTS
Combined laser treatment significantly reduced waist circumference and total body fat. Ultrasonography has revealed that the treatment considerably decreased fat thickness and improved skin stiffness in the treated region. Subcutaneous fat volume, measured by low dose CT, displayed a moderate decrease in the waist region.
CONCLUSION
The combined 1064nm Nd:YAG and 2940nm Er:YAG laser treatment results in the reduction of fat tissue and tightens the skin as confirmed by objective measurements.
This article is protected by copyright. All rights reserved.
... RF and ultrasound are the most recent technologies that have been reported as useful methods for mobilizing stored fat. RF is based on an electrical current between molecules and ions, which are then transformed into heat [7]. RF lead to the transmission of electromagnetic waves on texture and is reconstruction of old collagen, increased production of new collagen by fibroblasts stimulated, improve the quality of fibrotic septa of the adipose tissue, increased blood flow to the tissues and stimulates lipolysis. ...
Background:
Obesity and overweight are major public health problem. Different-strategies have been developed for body contouring including Radiofrequency(RF) and Ultrasound(US). The aim of this study was to investigate changes in serum-leptin as a potential-modulator of food/energy intake, in overweight-women receiving RF/US and diet-therapy as well as the effect of therapy on modulation of lipid-profile and body-fat-mass.
Methods:
Fifty overweight-females were enrolled in current randomized-clinical-trial and randomly divided into two groups. The case group received RF/US twice a week for 5 weeks with a low calorie diet whilst the control-group received just a low calorie diet. Demographic, biochemical markers as well as serum-leptin were determined.
Results:
The level of leptin was reduced from 1.29 ± 0.32 ng/ml to 1.14 ± 0.34 ng/ml in case group, before and after therapy, respectively, whilst no significant differences were observed in the serum leptin levels of subjects in the control group. The combination of RF and US decreased the leptin-level. In particular, the mean reduction of abdominal-circumference and waist-circumference was significant (P < 0.05) after therapy. This reduction was inversely correlated with LDL levels. Weight was reduced in case and control groups and in both was significant, but no statistically significant differences were detected for weight between the groups(P < 0.93).
Conclusion:
Our findings demonstrated the reduction of the leptin after treatment with the combination of Radiofrequency/Ultrasound cavitation, which was associated with reduced body-fat-mass.
... Ongoing research has led to the development of numerous energy-based technologies, such as cryolipolysis, 7 laser and light therapy, 8 and radiofrequency and ultrasound, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] that have been successfully used for the noninvasive reduction of unwanted fat deposits. These modalities for fat reduction and improvement in body contouring represent a potential treatment alternative for patients in whom surgical procedures are contraindicated or in those who desire minimal downtime. ...
Objective: Noninvasive fat reduction has become increasingly popular. This study evaluated the outcomes of multiple treatments with a nonthermal focused ultrasound device for the noninvasive removal of excess abdominal fat. Design: Participants underwent a total of three pulsed, focused ultrasound treatments spaced two weeks apart. Setting: This study took place in an outpatient dermatology office in a suburb of a major city. Participants: Ten healthy female subjects between 18 and 60 years of age with an abdominal thickness of at least 0.6cm and body mass index between 22 and 30kg/m2 were included. Measurements: Fat layer thickness was measured by ultrasound imaging and skin caliper and was compared with baseline at the four-, eight-, and 12-week follow-up visits after the final treatment session. Results: The study subjects underwent a total of 30 treatment sessions. Ultrasound imaging of the targeted fat layer decreased significantly by 13, 16, and 13 percent at the four-, eight-, and 12-week follow-up time points, respectively, while measurements of the fat layer as performed by skin caliper decreased by 12, 10, and 13 percent, respectively. All subjects noted improvement, while investigators noted significant improvement and expressed high satisfaction from the ultrasound treatment outcomes at the final visit. Treatments were well tolerated and no adverse events were recorded during the study period. Conclusion: Nonthermal pulsed focused ultrasound appears to be a safe and effective treatment option for the noninvasive removal of unwanted abdominal fat deposits. ClinicalTrials.gov: NCT02700152.
... Suboptimal treatment outcomes and limitations of past approaches and techniques have spurred continued research in this cosmetic niche, and led to the development of novel technologies that can be used for the non-invasive reduction of unwanted excess fat deposits including laser, cryotherapy, radiofrequency, and ultrasound (7)(8)(9)(10)(11)(12). Previous studies have shown the therapeutic benefit of a focused ultrasound system, used for the treatment of unwanted excess adipose tissue and improvement of body contours (7,(13)(14)(15)(16)(17)(18). ...
Introduction:
Energy-based cosmetic devices offer an in-office treatment option, with minimal downtime, to non-invasively remove unwanted fat. We evaluated focused, pulsed ultrasound treatment to randomized flanks, compared to corresponding non-treated contralateral flanks.
Material and methods:
Subjects were enrolled at three sites for a series of focused ultrasound treatments to a single flank, with the contralateral flank remaining untreated throughout the study. Success criteria included measureable fat thickness reduction on ultrasound imaging in the treated areas at 16 weeks after the final treatment session, and correct identification of the post-treatment photo and treated flank in at least 80% of evaluated images, as assessed by two blinded evaluators.
Results:
The post-treatment flank photo and treated flank side were correctly identified in 82% and 93% of cases, respectively. All study subjects demonstrated significant fat reduction in their treated area, as measured by ultrasound and skin caliper. Subjects expressed a high satisfaction from treatment outcomes. There were no complications with treatment.
Conclusion:
A series of three ultrasound treatments resulted in significant fat reduction in treated flanks. Although treatment results are more modest than with liposuction, non-invasive ultrasound treatment may provide an attractive alternative for patients seeking an in-office, nonsurgical procedure for fat reduction.
... Diabetes, hypertension, heart disease, and early death are obesity complications that are often connected with extra abdominal fat. [1][2][3][4][5] The fat cell destruction technologies are very important not only to fight against obesity [6][7][8][9][10][11][12][13][14][15][16][17] but also to treat cancer (e.g., breast cancer). [18][19][20] Adipose tissue usually surrounds the tumor; therefore, it is important to remove fat tissue accurately to ensure optical access to the tumor. ...
The goal of this study is to quantify the impact of the in vivo photochemical treatment of rats with
obesity using indocyanine green (ICG) dissolved in saline or dispersed in an encapsulated form at NIR
laser irradiation, which was monitored by tissue sampling and histochemistry. The subcutaneous injection of
the ICG solution or ICG encapsulated into polyelectrolyte microcapsules, followed by diode laser irradiation
(808 nm, 8 W∕cm2, 1 min), resulted in substantial differences in lipolysis of subcutaneous fat. Most of the morphology
alterations occurred in response to the laser irradiation if a free-ICG solution had been injected. In such
conditions, membrane disruption, stretching, and even delamination in some cases were observed for a number
of cells. The encapsulated ICG aroused similar morphology changes but with weakly expressed adipocyte
destruction under the laser irradiation. The Cochran Q test rendered the difference between the treatment alternatives
statistically significant. By this means, laser treatment using the encapsulated form of ICG seems more
promising and could be used for safe layerwise laser treatment of obesity and cellulite.
... Application of radiofrequency (RF) current to the skin is supposed to be able to modulate its mechanical properties, inducing immediate and long-term effects and consequently leading to improvement in the skin condition [4]. Immediate effects are mediated by heat disruption of hydrogen bonds in the triple helix collagen structure, leading to partial protein denaturation [13]. RF can increase local blood flow, upregulating local adipose metabolism, and is capable of stimulating lipase-mediated degradation of triglycerides or even adipocytes apoptosis [4]. ...
Skin aging is a gradual process that leads to wrinkle formation, laxity, and overall changes in skin appearance. In recent years, the demands to noninvasive treatments for facial rejuvenation increased, along with a variety of technologies and devices, such as radiofrequency. The present study aimed to evaluate the clinical effects of a multipolar radiofrequency and pulsed electromagnetic field treatment for face and neck rejuvenation. Eleven patients with mild to moderate grades of photoaging underwent eight radiofrequency and pulsed electromagnetic field treatment sessions, once a week. Clinical photographs were taken before and a week after the end of the treatment, and improvement of facial skin parameters was evaluated by two different investigators. Significant improvement in skin laxity was observed in all eleven patients (100%). Improvement in facial contour was noted in 73% and 100% of patients when analyzed by investigators A and B, respectively. The score for overall improvement in skin condition was 3 ± 0.78 for investigator A and 3.6 ± 0.67 for investigator B. All patients were satisfied with the procedure and noted significant improvement in the skin. The combined multipolar radiofrequency and pulsed electromagnetic field device is effective and safe for treatment of aged skin in Brazilian patients.
... The radiofrequency mode used determines the penetration depth. Unlike higher-frequency ultrasound, which may produce longer periods of downtime, radiofrequency use results in virtually no downtime, and transient side effects have been reported [10][11][12]. Cryolipolysis, a non-invasive modality, has recently received FDA approval in the use of submental fat treatment. This technique is based on the supposition that adipocytes, which are more prone to cooling than other skin cells, are cooled such that apoptosis is triggered. ...
Excess submental fat may make the patient appear overweight and/or older. As a result, these patients seek treatment to address their displeasing “double chin.” Many modalities are at the disposal of the surgeon to address the patient’s complaint, and at times, these techniques may be combined to achieve the optimal result for the patient. Through these methods described herein, the patient is able to obtain a stronger appearing chin that increases self-confidence. Two newer techniques, crypolipolysis, and the injectable fat-dissolving product, ATX-101, demonstrate promising results for these patients.
Background
Fractional radiofrequency (FRF) has been reported to be effective in improving wrinkles. A combination of microneedle and sublative fractional radiofrequency (SFRF) may have the potential synergy to improve photoaged skin.
Objectives
To evaluate the efficacy and safety of combined microneedle and SFRF in photoaging management.
Methods
This prospective study included 12 subjects with moderate photoaging (skin phototype III–IV). The subjects received three consecutive combined microneedle and sublative FRF at 1-month intervals. Punch biopsies were obtained before and after three months of treatment. Routine H&E, Masson-trichrome, Orcein staining, histometric measurements, as well as Collagen type I and Elastin immunohistochemical staining were performed.
Results
Significant improvement was noticed regarding skin tightening and texture ( p < 0.05), rhytides, and volunteers’ satisfaction ( p < 0.001). Collagen fibers appeared better organized, with a significant increase in collagen type I ( p = 0.001). Meanwhile, normal-appearing elastic fibers were restored, and a significant reduction in abnormal elastin was achieved ( p = 0.0005).
Conclusion
Combined microneedle and sublative FRF may provide a new therapeutic approach for photoaged skin.
Level of Evidence II
For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
BACKGROUND
Jowling is a common aesthetic complaint in aging individuals.
OBJECTIVE
Injectable filler placed at the lateral jawline will improve the appearance of jowls, as defined by the Merz Aesthetic Jawline Grading Scale (MAJGS). This improvement will be independent of concomitant injection of filler into the lateral cheek.
METHODS
Fifteen female subjects with grade 2 to 3 jowls on a scale of 0 to 4 were enrolled to receive either VYC-20L in the mandibular angle/ramus (Group 1) or the mandibular angle/ramus and lateral cheek (Group 2). The subjects were evaluated by a blinded cosmetic dermatologist and themselves at 4 weeks after the last injection.
RESULTS
A statistically significant improvement was noted in Group 1 by all blinded reviewers and subjects. Group 2 did not reach statistical significance as evaluated by the blinded dermatologist although did by the subject’s rating. The average amount of filler injected per subject was 3.36 mL for group 1 and 8.38 mL for group 2. A novel adverse event was tenderness when chewing lasting for 2 to 3 days.
CONCLUSION
Injection of VYC-20L showed statistical improvement in a validated jowl scale when injected at the angle of the mandible and the mandibular ramus, independent of concomitant lateral cheek injections.
Background: There is increasing demand for noninvasive body contouring but objective data is difficult to compare between modalities. Currently, the most accepted forms of noninvasive body contouring are cryolipolyisis (Cryo), focused ultrasound (FUS), radiofrequency (RF), and low level laser therapy (LLLT).Objective: To summarize the objective data on noninvasive body contouring.Methods: In October 2016, a pubmed search was performed with terms “noninvasive body contouring” or “non-invasive body contouring.” The search was limited to human studies in English on the four major modalities. Results: 55 articles yielded data from 3649 patients. The most well studied modality was Cryo and the least was RF. Decreased abdominal/flank localized adiposity was most the most common endpoint reported. Both the minimum and maximum reported decreases in abdominal girth were from studies using RF (1.4cm and 7.4cm, respectively). Side effects were most common and significant with Cryo and absent with LLLT.Conclusions: Noninvasive body contouring has a significant amount of objective data available in the literature to date. Reductions of localized adiposity are clinically and statistically significant but modest. To date, the best reported positive results have been obtained with RF and the lowest risk of side effects is with LLLT.
Localized fat and excess body fat: this is one of the main causes of dissatisfaction with body contour and decreased self-esteem. The objective of this report is to present the results of treatment using Capenergy C 200 in a group of young volunteers who received treatment only in the right half of the body. We will review the science and literature of the effect of TECAR and its role in body contouring. The average decrease in the arm is 2.9 cm p = .026. The nipple rise was 2.1 cm, p = .002. The decrease in abdominal diameter was 3.3 cm, p = .027 at the end of the treatment. For the thigh, the difference in diameter was 3.9 p = .026, this difference being statistically significant. TECAR radiofrequency treatment therapies, for body contouring in the breast, arms, abdomen and thighs, are effective and can show positive results after 6 treatment sessions, resulting in body satisfaction at the end of the treatment.
BACKGROUND: In the literature, there are no scientifically based studies on the use of combination therapy using radio wave lifting and autologous platelet-rich plasma for the correction of involutional changes in the skin of the lower third of the face. AIMS: To determine the effect of complex therapy of involutional changes in the skin of the lower third of the face with minimally invasive radio wave lifting using a cannula electrode and platelet-rich autoplasma using non-invasive diagnostic methods. MATERIALS AND METHODS: Examination and treatment of 55 healthy women of Slavic appearance with involutional changes in the skin of the lower third of the face were carried out. Group № 1 patients received radio wave lifting therapy (n=28) and group № 2 patients received combined therapy with radio wave lifting and autologous platelet-rich plasma (n=27). The study was conducted from January 2020 to December 2020. To assess the condition of the skin, laser Doppler flowmetry, ultrasound sonography, and elastometry were used before and after the study. Clinical manifestations were assessed by an anthropometric method. RESULTS: The most pronounced changes were observed in the group where the combined method of radio wave lifting therapy with autologous platelet-rich plasma was used. The change in microcirculation was of a multidirectional nature, however, the average values were in the range of 8.8668.89 pf units, which is the normalization of trophic processes in tissues (p 0.05). When analyzing the conduct of ultrasound sonography, statistically significant thickening of the epidermis and dermis was noted, however, in patients of the second group, the thickening was more pronounced (p 0.0005). The change in the echogenicity of the dermis was of a multidirectional nature; by the end of treatment, the mean values were in the range of 10.511.3 units, which, apparently, indicates a more homogeneous structure of the dermis (p 0.05). Anthropometric indices (measurement of ptosis of the lower cheeks) decreased in both groups, which is related to skin lifting as a result of treatment (p 0.0005). The amplitude of tissue upward mobility decreased in both groups (p 0.0005). The amplitude of downward movement of tissues after therapy was of a multidirectional nature in both groups, which is possibly associated with the density of the dermis and indicates the normalization of collagen and elastin fibers (p 0.05). Elastometry indices (F0, R4, R6, R8) decreased, R2 increased in both groups, however, the dynamics was more pronounced in the second group (p 0.0005). CONCLUSIONS: Minimally invasive radio wave lifting in combination using a channel electrode with autologous platelet-rich plasma is an effective and safe method of treating age-related changes in the skin of the lower third of the face.
Rhytides and striae are prominent clinical signs of skin aging. Photoaging, characterized by a thinning epidermis and a decrease in collagens, is the main form of skin aging. Delaying the aging process is a concerning issue for dermatologists. Radiofrequency (RF) is a non-ablative technology used for skin rejuvenation, body contouring, and weight reduction. The selective electro-thermolysis stimulates collagen contraction and neocollagenesis. Compared to traditional cosmetic treatment, it has the advantages of fewer side effects and short patient downtime. This review aims to summarize the efficacy and safety of different RF devices and the limitations during RF treatments. Combinations of RF and other cosmetic technologies are demonstrated. Results have been approving for the various uses of RF, including skin laxity and wrinkles smoothening. However, many studies use subjective ways of evaluation. Further studies are needed to determine the optimization of RF treatments for facial rejuvenation.
Delete Review of body contouringin aesthetics, Edited by R D Murgia et alAbstract
The recent demand for noninvasive fat reduction and muscle toning has generated the need for a variety of noninvasive body contouring devices, including cryolipolysis, radiofrequency, focused ultrasound, laser energy, and high intensity focused electromagnetic energy. Many of the recent technologies are still relatively new, and clinical trials are limited. There is also a lack of comparison between modalities, which makes it difficult for practitioners to select the best treatment option for patients. We review the currently available treatment modalities and offer relevant insights.
The demand for the use of non-invasive methods for body circumference and fat reduction is growing year by year. Accordingly, different non-invasive body contouring modalities exist. We presented a therapeutic response in 20 patients to a device that reduce abdominal circumference and fats, without overheating the application sites of causing other discomfort to patients. The ease of use and versatility make it a valid non-invasive technique for body remodeling.
Background:
Radiofrequency (RF) and high-intensity focused electromagnetic (HIFEM) technologies are used for noninvasive body shaping as standalone modalities.
Objective:
To examine the effects of novel synchronized RF and HIFEM on subcutaneous adipose tissue in a porcine animal model.
Materials and methods:
Seven large white pigs aged 6 months received 3 abdominal treatments of simultaneous application of synchronized RF and HIFEM (30 minutes, once per week). Punch biopsies of treated and control subcutaneous tissue were collected at the baseline, 4 days, 2 weeks, 1 month, and 2 months. Specimens were examined by light and scanning electron microscopy. Adipocyte volume was analyzed. Fat tissue temperature was measured in situ (fiber optic probes) and superficially (thermal imager).
Results:
Fat layer was heated to temperatures of 42 to 45°C. Signs of fat apoptosis (shape alternations and pyknotic nuclei) appeared at day 4 and peaked between 2 weeks and 1 month. Adipocyte volume decreased significantly (p < .001) by 31.1% at 2 weeks, 1 month (-23.6%), and 2 months (-22.0%). Control samples showed healthy adipocytes. Scanning electron microscopy micrographs corroborated histology findings, showing flattened, volume-depleted and disrupted adipocytes.
Conclusion:
Synchronized RF with HIFEM procedure resulted in a significant and sustained fat reduction with no adverse events.
Background
Energy‐based devices are increasingly used for noninvasive body contouring. Our aim was to investigate the clinical efficacy of combined radiofrequency and ultrasound device for reduction in body circumference in various body parts.
Aims
The aim of our study was to investigate the clinical efficacy of combined focused radiofrequency and ultrasound device for reduction in body circumference in various body parts. We aimed to report objective measurements in terms of circumference reduction and patient satisfaction scores.
Methods
We retrospectively analyzed data of 64 patients who were treated with focused radiofrequency and ultrasound device during August 2017‐December 2019. All patients had received 4 sessions at one‐week interval. Body circumference measurements were done before treatment and one month after the last session. Patients were also asked to score their satisfaction with the result of treatment on a scale of 1 to 5.
Results
Abdomen was treated in 40 patients, thighs in 18 patients, and arms in 7 patients. One patient had received treatments to both abdomen and thighs. Circumference measurements in all body parts differed significantly between baseline and one month after the 4th session. Patients were satisfied with the result of treatment (score: 4.48 ± 0.66). No adverse events were noted.
Conclusions
Focused radiofrequency and ultrasound combination is a safe and effective treatment modality for body contouring. Patients should be informed about moderate degrees of improvement.
Radiofrequency (RF) devices have evolved over time to effectively and noninvasively tighten and contour the skin and body with minimal to no downtime. RF devices can be categorized as monopolar, unipolar, bipolar, and multipolar based on the number of electrodes used and how the energy is delivered to the tissues beneath the skin. The polarity of the RF determines the comfortability, effectiveness, and frequency of the treatments. Since the first of these deviceswere launched in the early 2000s, different companies have developed RF skin tightening and contouring platforms which utilize new and unique technologies to enhance the clinical results. There have been many clinical trials which study the safety and efficacy of these technologies in tightening and contouring the skin and body, although large randomized, controlled clinical trials are lacking. This article reviews the current literature on an assortment of the latest skin tightening devices and their technologies used.
Radiofrequency (RF) devices use electromagnetic radiation at frequencies similar to radio bands to deliver electric current and heat the skin. The biologic effects depend upon the tissue impedance and the RF characteristics. Generally, the thermal injury results in denaturated fibrils of collagen and initiates a wound healing response. Ultimately, neo-collagenesis, neo-elastogenesis and dermal remodelling is observed. RF has been used in medicine since the nineteenth century. Lately, this technology has generated great interest in the field of aesthetic medicine. Typically, a generator introduces RF current into the skin through one or more electrodes. There are monopolar, unipolar, bipolar devices and combinations of RF with light, vacuum or mechanical rollers. More recently, fractional radiofrequency was added to the devices’ armamentarium. Unlike lasers, this technology does not apply the concept of selective photothermolysis and is not chromophore targeted. Therefore, it is postulated to be safer compared to laser energy sources. The RF technology represents a dynamic field and the applications include face and body skin rejuvenation, acne, scars and cellulite. This chapter will consider the variety of RF techniques based on the current evidence. In order to maximize the efficacy and safety of the therapy, it is paramount for the operator to have appropriate knowledge of the nature of this technology and to understand potential adverse effects.
Dermatologic Surgery: March 2021 - Volume 47 - Issue 3 - p e101-e105
Background:
Fractional microneedle radiofrequency (FMR) and nonablative 1927-nm fractional thulium fiber laser (TFL) are widely used for skin rejuvenation treatment.
Objectives:
To investigate the efficacy and safety of combined treatment with both devices for wrinkles.
Patients and methods:
Twenty-five patients with wrinkles were enrolled. One side of the face was treated with FMR alone, while the other side was treated with a combination of FMR and TFL. Each treatment consisted of 3 sessions at four-week intervals and patients were followed up 12 weeks after the last treatment. Overall improvement was assessed by patient global assessment (PGA) and investigator global assessment (IGA). Depression scores for the evaluation of wrinkles were objectively assessed by Antera 3D system.
Results:
Both sides of the face led to clinical improvement in both mean PGA and IGA. Combination treatment demonstrated a greater improvement in both mean PGA and IGA compared with FMR alone. In addition, wrinkle grading scales and depression scores showed greater improvement in the combination group than in FMR alone.
Conclusion:
This study demonstrated that FMR and TFL comprise a good combination treatment for the treatment of wrinkles because both treatments have a synergistic effect on wrinkle improvement.
Being profitable procedures with little disposable costs, a number of noninvasive technologies have gained much popularity in recent years and are permeating the aesthetic marketplace. High-intensity focused ultrasound (HIFU) when focused at a targeted depth of 1.1 to 1.6 cm within subcutaneous tissue raises local tissue temperature at the focal point resulting in almost immediate cell death without damage to the surrounding tissues. Despite having gained popularity, little information is available regarding HIFU use for the treatment of localized fat and aesthetic body sculpturing. The current literature review is intended to investigate evidence-based efficacy of HIFU in aesthetic body contouring. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Background and Objectives
Demand for non‐invasive body sculpting procedures has been steadily increasing, spurring the development of new energy‐based technologies. This study assessed the safety and efficacy of a new monopolar 2 MHz radiofrequency (RF) device for fat reduction of the flanks and abdomen.
Study Design/Materials and Methods
Nineteen subjects from two clinical sites were enrolled in this study and received a single 15‐minute treatment with the 2 MHz RF device. Up to six applicators were placed on the abdomen and/or flanks during the treatment. Follow‐up assessments were scheduled 12 weeks after treatment. Efficacy evaluations included live ratings and Global Aesthetic Improvement Scale (GAIS) ratings by blinded investigators, ultrasound measurements of fat thickness, and patient‐reported outcomes before and after treatment.
Results
Investigator assessments showed more than one‐point change in the GAIS scale at the 12‐week follow‐up visit. Ultrasound measurements revealed a significant reduction in fat thickness in both the abdomen (average 24%) and the flanks (22%). The majority of the patients were satisfied with the treatment and mild self‐resolving side effects were observed. No serious adverse events were reported.
Conclusions
Treatment of local adiposities with a new monopolar 2 MHz radiofrequency device leads to improvement of body contour with no downtime or side effects. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
Background and Objectives
The finite element method was used, and experiments were performed to analyze the effect of different electrode spacings and power combinations on the electrical and thermal aspects of biological tissues during bipolar radiofrequency (RF) fat dissolution. Through these efforts, this study also attempted to develop a reasonable electrode spacing and power combination that can achieve fat dissolution effects, the RF energy of which will not thermally damage the tissue.
Study Design/Materials and Methods
COMSOL was adopted to conduct a finite element analysis for bio‐thermoelectric coupling, and a two‐dimensional time‐domain model of biological tissue was built. A self‐developed single‐channel bipolar RF device was employed to load RF energy on the ex vivo porcine abdominal tissue. The thermal characteristics of the tissue were characterized and analyzed with a thermal imager and thermocouple probes.
Results
Under a power of 5 W combined with the electrode spacings of 1, 2, and 3 cm, the temperature in the tissue could not reach that required for fat dissolution. Under a power of 15 W combined with the electrode spacings of 1, 2, and 3 cm, the RF energy would thermally damage part of the skin areas. Besides this, the combination of a power of 10 W and the electrode spacing of 1 cm would thermally damage the skin areas. The combination of a power of 10 W and the electrode spacing of 2 or 3 cm made part of the fat layer of the tissue satisfy the requirements of fat dissolution, and the fat dissolution area caused by the former was 118% larger than that of the latter; in the meantime, no heat damage to the skin layer was found.
Conclusion
Different electrode spacings and power combinations significantly affect the electrical and thermal properties of bipolar RF energy loaded on biological tissue, a reasonable electrode spacing and power combination is one of the critical factors leading to the success of bipolar RF fat dissolution. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
A novel class-E amplifier topology, based on the functioning principle of the stacked converters, is presented. In this amplifier the available output electric power is determined by the addition of the electric power generated by each of the associated devices. Herein, two MOSFETs connected in series are linked, on the one hand, to a DC voltage source and, on the other hand, to a resonant
LC
circuit and a resistance charge connected in parallel to the capacitor. Both MOSFETs are driven by a gate-to-source square signal allowing a synchronized commutation, promoting a quasi-resonant amplifier behavior similar to that of the classical class-E amplifier; with the characteristic of being able to manage the double of applied DC voltage amplitude and to supply twice electric power to the same load in comparison with the class-E amplifier. This device is able to distribute the same electric power between both MOSFETs, reducing at almost half the magnitude of applied drain-to-source voltage. As a result, voltage stress of each power switch is reduced in comparison with the typical class-E amplifier. Drain efficiency, power added efficiency and gain of the proposed device were obtained in function of the applied DC voltage.
Liposuction is a safe and effective method of subcutaneous fat removal involving aspiration of subcutaneous adipose tissue via cannulas introduced through small skin incisions. In tumescent liposuction, the surgeon utilizes subcutaneous infiltration of dilute lidocaine and epinephrine to provide local anesthesia and hemostasis prior to aspiration of the adipose tissue. In addition to its aesthetic indications, tumescent liposuction is also a safe and effective treatment modality for breast reduction, gynecomastia, lipomas, lipoedema, and hyperhidrosis. Despite the development of newer, noninvasive body-contouring modalities, liposuction remains the gold standard.
The popularity of cutaneous laser surgery has soared, however, the use of lasers in patients with darker skin types has been quite challenging. The main obstacle with cutaneous laser surgery in darker skinned patients is epidermal melanin absorption of laser energy. The absorption spectrum of melanin ranges from 320 to 1200 nm with the greatest absorption observed in the lower end of this spectrum. The main objective in treating patients with skin of color is to avoid epidermal melanin absorption of laser energy and resultant thermal injury. Laser surgery in darker skinned patients must be approached carefully to avoid this unwanted side effect of post inflammatory pigment alteration. In this chapter, we will review the advances in lasers for ethnic skin with special emphasis on the treatment of acne scars, photorejuvenation, skin tightening, hair removal, tattoos, and body contouring.
Introduction
Liposuction and mesotherapy are popular treatments for fat reduction of lower face, but because these treatments are invasive, a novel non‐invasive treatment with similar or better efficacy has been sought. There are various devices such as CoolSculpt, laser, RF, and HIFU that are used as non‐invasive treatments for fat reduction and body contouring, but these applications have not been applied to facial fat reduction. In this study, we selected Monopolar 1‐MHz RF for body contouring to be applied for fat reduction and tightening of the lower face.
Material and Methods
From March through August of 2016, we treated fourteen Asian women (average age: 44.6 years old) for fat reduction and tightening of the lower face using 1‐MHz Monopolar RF (truSculpt™, Cutera, Inc., Brisbane, CA). We performed the treatment primarily in the nasolabial fold and buccal area weekly for five consecutive weeks, and evaluated the effects for fat reduction and tightening before each treatment and for 2 months after the treatment using handy VECTRA 3D® (Canfield Scientific, Inc.) for imaging. Three‐dimensional (3D) volumetric assessments were performed at pre‐ and post‐two‐months after treatment. Patients rated their satisfaction for tightening using a 5‐points scale.
Results
During the study, more than ninety percent of patients showed volumetric change by fat reduction at the treated area, with an average of 2.7 ml. Sixty percent of patients were either “satisfied” or “very satisfied” with the tightening effects. The treatments were accompanied only by very mild heat pain. Efficacy was maintained for 2 months after the treatments, and three patients showed a higher fat reduction effect at 2 months after the final treatment compared with the final treatment. A mild redness was observed just for few hours after the treatment, but complications such as, swelling, induration, burn, sensory disturbance or facial paralysis, were not observed.
Conclusion
In this study, we found that Monopolar 1‐MHz RF applied with a stationary applicator was effective especially for lower face fat reduction and with a tightening effect in facial contouring. A highly efficacious treatment with satisfactory comfort and safety can be achieved with no downtime, and the device has the potential for becoming one of the standard non‐invasive treatments for fat reduction of facial contouring. Lasers Surg. Med.49:750–755, 2017. © 2017 Wiley Periodicals, Inc.
Background:
Previous studies have shown that radiofrequency (RF) energy is safe and effective for improving skin laxity. Unlike monopolar and bipolar devices, little has been studied with the unipolar hand piece.
Objectives:
We sought to evaluate the safety and efficacy of a novel fractional unipolar RF device on facial tightening.
Patients and methods:
This was a retrospective, single-center study of 14 subjects with age-related facial laxity who underwent five sessions of fractional unipolar RF at an interval of 2 weeks, and then followed-up for 3 months. Standardized photos were taken at baseline and at 3-months follow-up, and were assessed by two independent dermatologists using a 4-point scale (0=no improvement, 1=mild improvement, 2=moderate improvement, 3=significant improvement). Punch biopsies (2 mm) were performed and a questionnaire was used to evaluate the patient's satisfaction and the incidence of adverse reactions.
Results:
Fourteen subjects with mild to moderate age-related facial laxity were included in the study. The mean age of the subjects was 49.7 years (range 32-80). 35.7% of the subjects showed significant improvement, 50% moderate improvement, and 14.3% slight improvement of facial laxity in their follow-up photos. About 85.7% of the patients replied that they were either greatly satisfied or satisfied with the results at 3-months follow-up. Skin biopsies revealed an increase in collagen in the dermis. None of the subjects experienced any serious adverse events during or after the procedure.
Conclusion:
Our findings suggest that fractional Unipolar RF can be safely performed on the face and is effective in skin tightening. It has a great advantage over other forms of RF by being entirely painless.
Özet
Amaç: Bu çalışma hemşirelik öğrencilerinin öfke kontrolleri ile tolerans düzeyleri arasındaki ilişkiyi çeşitli sosyodemografik verilere göre belirlemek amacıyla tanımlayıcı olarak yapılmıştır.
Materyal-Metod: Araştırmanın örneklemini, 12.12.14 - 09.01.2015 tarihleri arasında, Balıkesir Üniversitesi Sağlık Yüksekokulu Hemşirelik Bölümünde öğrenim gören ve çalışmaya katılmayı kabul eden 424 öğrenci oluşturmuştur. Araştırma verileri, kişisel bilgi formu ve Tolerans Ölçeği ve Sürekli Öfke-Öfke Tarz Ölçeği (SÖ-ÖTÖ) kullanılarak toplanmıştır. Elde edilen veriler bilgisayar ortamında yüzdelik, ortalama, t testi, One Way Anova analizleri ile değerlendirilmiştir.
Bulgular: Öğrencilerin sürekli öfke düzey puan ortalaması 22.84±5.81, Öfke Tarz Ölçeği’nin kontrol altına alınmış öfke alt boyutunun puan ortalaması 21.38±4.38, dışa vurulmuş öfke alt boyutunun puan ortalaması 16.97±4.51 ve bastırılmış öfke puan ortalamasının 17.44±4.29, tolerans ölçeği puan ortalamasının 64.51± 16.61 görülmüştür.
Araştırmaya katılan öğrencilerin Tolerans puanları ve sürekli öfke-öfke tarz puan ortalamalarının yaş, cinsiyet, gelir düzeyi, baba mesleği, babanın-annenin eğitim düzeyi, evde yaşayan kişi sayısına göre anlamlı bir farklılık gösterip göstermediğini belirlemek amacıyla yapılan t-testi/One way ANOVA sonucunda istatiksel olarak anlamlı bir farklılık saptanamamıştır. Öğrencilerin Sü rekli Öfke ve Öfke İfade Tarzı Ölçeği puanları ile Tolerans Ölçeği puanları arasında istatistiksel olarak anlamlılık taşıyan ilişkiler bulunmuştur.
Sonuçlar: Hemşirelik öğrencileri öfke duygularını yaşayabilmektedir. Hemşirelik öğrencilerinin öfke enerjisini olumlu bir şekilde kullanmaları için rehberlik programlarının dü zenlenmesinin gerektiği ve böylece tolerans düzeylerinin de olumlu şekilde etkilenebileceği dü şü nü lmektedir.
Anahtar Kelimeler: Hemşirelik Öğrencisi, Öfke Kontrolü, Tolerans Düzeyi
Abstract
Objective: This study was conducted in order to determine the relationship between anger management and tolerance level of the nursing students according to various socio-demographic data as descriptive.
Material-Method: The Study Sample comprised of 424 students that study at Nursing Department of Balıkesir University Health High School between the dates 11/01/2014-02/26/2015 and accept to participate in the study. Research data was collected via personal information form, Tolerance Scale and Trait Anger and Anger Style Scales. The obtained data was assessed with percentage, average, t test and One Way Anova analysis.
Results: The mean value of the trait anger level of students was 22.84±5.81. It was also seen that the mean value of the anger control subscale was 21.38±4.38, the mean value of the anger-out subscale was 16.97±4.51, the mean value of the anger-in subscale was 17.44±4.29 and the mean value of the tolerance scale was 64.51±16.61.
Statistically, a significant difference was not detected as a result of t test and one way Anova conducted to determine whether tolerance average scores and Anger Subscale Average Scores of the students particiapting in the study change within the context of age, gender, income level, father’s occupation, parents’ education level and the number of people living in their house. Statistically significant relationships were found between students’ Trait Anger and Anger Expression Scales scores and the Tolerance Scale scores.
Conclusion: Nursing students may experience feelings of anger. It is thought that guidance programmes should be established in order to use nursing students’ anger energy positively, and that their tolerance levels also can be influenced in a positive way.
Keywords: Nursing Student, Anger Management, Tolerance Level
Background:
The popularity of aesthetic procedures in the face has led to greater disparity between treated areas and those that still show evidence of true age. Although many areas of the body often require multiple treatment procedures for optimal rejuvenation, combination therapy for specific areas is not yet well defined.
Objective:
To develop recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite (CaHA), and microfocused ultrasound with visualization in nonfacial areas across all skin phototypes.
Methods:
Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus.
Results:
Recommendations have been provided for the neck, décolletage, and hands and include the timing and sequence of specific procedures when used concurrently or over several treatment sessions. Position statements are offered in lieu of consensus for the upper arms, abdomen, buttocks, and knees.
Conclusion:
Nonfacial rejuvenation often requires multiple procedures for optimal results in individuals with significant age-related changes. Further clinical studies are recommended to raise awareness of non-facial indications and provide clinicians with the best evidence for best treatment practices.
Multiple therapies involving ablative and nonablative techniques have been developed for rejuvenation of photodamaged skin. Monopolar radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth.
We evaluated the clinical effects and objectively quantified the histologic changes of the nonablative RF device in the treatment of photoaging.
Six individuals of Fitzpatrick skin type III to IV and Glogau class I to II wrinkles were subjected to 3 months of treatment (6 sessions at 2-week intervals). Standard photographs and skin biopsy specimens were obtained at baseline, and at 3 and 6 months after the start of treatment. We performed quantitative evaluation of total elastin, collagen types I and III, and newly synthesized collagen using computerized histometric and immunohistochemical techniques. Blinded photographs were independently scored for wrinkle improvement.
RF produced noticeable clinical results, with high satisfaction and corresponding facial skin improvement. Compared with the baseline, there was a statistically significant increase in the mean of collagen types I and III, and newly synthesized collagen, while the mean of total elastin was significantly decreased, at the end of treatment and 3 months posttreatment.
A limitation of this study is the small number of patients, yet the results show a significant improvement.
Although the results may not be as impressive as those obtained by ablative treatments, RF is a promising treatment option for photoaging with fewer side effects and downtime.
Radio frequency (RF) is electromagnetic radiation in the frequency range of 3-300GHz. The primary effects of RF energy on living tissue are considered to be thermal. The goal of the new devices based on these frequency ranges is to heat specific layers of the skin. The directed use of RF can induce dermal heating and cause collagen degeneration. Wound healing mechanisms promote the remodeling of collagen and wound contraction, which ultimately clinically enhances the appearance of mild to moderate skin laxity. Preliminary studies have reported efficacy in the treatment of laxity that involves the periorbital area and jowls. Because RF energy is not dependent on specific chromophore interaction, epidermal melanin is not at risk of destruction and treatment of all skin types is possible. As such, radiofrequency-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision and treatment of unwanted hair, vascular lesions and inflammatory acne. The use of RF is becoming more popular, although a misunderstanding exists regarding the mechanisms and limitations of its actions. This concise review serves as an introduction and guide to many aspects of RF in the non ablative rejuvenation of skin.
Previous studies suggest that radiofrequency (RF) energy may be effective as a treatment for cellulite.
This bilateral paired blinded comparative study assesses the efficacy and safety of a unipolar RF device for improving the appearance of cellulite using a new quantitative cellulite grading system.
In this randomized, blinded, split-design study, 10 individuals (aged 32-57 years) with a clinically observable excess of subcutaneous fat and cellulite (minimum grade 2 out of 4) on the thighs received up to six unilateral treatments (number of treatments at the investigator's discretion) at 2-week intervals with unipolar RF. The untreated side of the thigh served as an internal control. Treated thighs were randomly assigned by alternate allocation. Results were evaluated using study participant questionnaires and by two blinded evaluators (JSD, KAA) using photographs and the author's (MAA) cellulite grading scale at each treatment visit and at 1-month and 3-month follow-up visits after the final treatment. A novel quantitative four-point cellulite grading system is presented and applied, which separately grades dimple density, dimple distribution, dimple depth, diameter and contour.
All participants responded to treatment (mean of 4.22 and range of three to six treatments). The blinded evaluations of photographs using the cellulite grading scale demonstrated the following mean grading scores for the treated leg versus the control leg: dimple density of 2.73 vs 3.18 (11.25% mean improvement), dimple distribution 2.89 vs 3.32 (10.75% mean improvement), dimple depth 1.47 vs 1.54 (2.5% mean improvement), and mean score of 2.36 (SEM 0.45) vs 2.68 (SEM 0.57) (8.00+/-2.84% mean improvement). The treatment was painless and side effects included minimal to moderate erythema which resolved within 1 to 3 hours. No crusting, scarring or dyspigmentation was observed.
This randomized, blinded, split-design, controlled study employing a quantitative four-point grading scale demonstrated that this unipolar RF device is safe for the treatment of cellulite. Clinically visible and quantified improvement which did not achieve statistical significance but showed a trend toward improvement was observed in all patients following a mean of four treatments at 2-week intervals.
Many light- and laser-based systems are used to reduce cutaneous wrinkles, and some have been shown to stimulate dermal collagen production. Using the ThermaCool TC radiofrequency device to treat bovine tendon and human abdominal skin, we documented the cutaneous effects of a radiofrequency-based system for nonablative treatment.
Electron microscopy of bovine tendon treated at varied heat and cooling settings revealed collagen fibrils with increased diameter and loss of distinct borders as deep as 6 mm. Human skin treated at varied heat and cooling settings and examined by means of routine light microscopy demonstrated no significant changes in the epidermis or dermal ground substance immediately after treatment; there was scattered mild perivascular and periadnexal inflammation. Three and 8 weeks after treatment, no observable changes were noted. Ultrastructural analysis, however, disclosed isolated, scattered areas of collagen fibrils with increased diameter and loss of distinct borders. In addition, Northern blot analysis demonstrated an increase in collagen type I messenger RNA steady-state expression.
Our findings suggest that collagen fibril contraction occurs immediately after treatment and gives rise to tissue contraction and thermally mediated wounding, which induces new collagen production.
Background:
Fine lines and rhytides are clinically evident signs of photodamage. Traditionally, ablative and nonablative lasers have been used for nonsurgical facial rejuvenation, but their side effects and downtime have limited their use.
Objective:
Radiofrequency (RF) is novel nonablative technology originally used to target photodamage. It differs from lasers in that it uses an electric current rather than a light source. It is frequently used in dermatology to treat skin laxity, rhytides, acne vulgaris and scarring, and cellulite. The goal of this review is to summarize the various types of RF devices and their uses and to determine the evidence-based efficacy of these devices.
Materials and methods:
This article reviews the current literature on RF, its uses and clinical effectiveness, and a practical guide for application of the assorted RF devices.
Results and conclusion:
Results have been favorable for the different clinical uses of RF, but many studies are nonrandomized, noncomparative trials that use subjective means of evaluation. Overall, nonablative RF is a safe, tolerable, and effective tool for skin rejuvenation and cellulite treatment that produces modest results. RF should serve as an alternative but not as an equivalent substitute to surgery.
Background and Objectives
This 6-month study evaluated the efficacy and safety of treatment with a nonablative radiofrequency (RF) device.Study Design/Materials and Methods
Eighty-six subjects received a single treatment with the ThermaCool TC™ System (Thermage, Inc., Hayward, CA) and were evaluated for 6 months after treatment.ResultsIndependent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months.ConclusionsA single treatment with this RF tissue tightening (RFTT) device produces objective and subjective reductions in periorbital wrinkles, measurable changes in brow position, and acceptable epidermal safety. These changes were indicative of a thermally induced early tissue-tightening effect followed by additional tightening over a time course consistent with a thermal wound healing response. Lasers Surg. Med. 33:232–242, 2003. © 2003 Wiley-Liss, Inc.
The main objective of the present study is to demonstrate the feasibility of utilizing a novel non-invasive radiofrequency (RF) device to induce lethal thermal damage to subcutaneous adipose tissue only by establishing a controlled electric field that heats up fat preferentially.
Adipocyte cells in six-well plates were subjected to hyperthermic conditions: 45, 50, 55, 60, and 65 degrees C during 1, 2, and 3 minutes. Cell viability was assessed 72 hours after exposure. Two groups of abdominoplasty patients were treated with the RF device during and days before their surgical procedure. Temperatures of cutaneous and subcutaneous tissues were measured during treatment (3 minutes) of the first group. The immediate tissue response to heating was assessed by acute histology. The delayed tissue response was assessed by histology analysis of the second group, 4, 9, 10, 17, and 24 days after treatment (22 minutes). A mathematical model was used to estimate treatment temperatures of the second group. The model uses patient-based diagnostic measurements as input and was validated with in vivo clinical temperature measurements.
Cell viability dropped from 89% to 20% when temperature increased from 45 to 50 degrees C during 1 minute exposures. Three minutes at 45 degrees C resulted in 40% viability. In vivo, the temperature of adipose tissue at 7-12 mm depth from the surface increased to 50 degrees C while the temperature of cutaneous tissues was <30 degrees C during RF exposure. Acute and longitudinal histology evaluations show normal epidermal and dermal layers. Subcutaneous tissues were also normal acutely. Subcutaneous vascular alterations, starting at day 4, and fat necrosis, starting at day 9, were consistently observed within 4.5-19 mm depth from the skin surface. Subcutaneous tissue temperatures were estimated to be 43-45 degrees C for 15 minutes.
A controlled internal electric field perpendicular to the skin-fat interface is selective in heating up fat and, consequently, has the ability to induce lethal thermal damage to subcutaneous adipose tissues while sparing overlying and underlying tissues. In vitro adipocyte cells are heat sensitive to thermal exposures of 50 and 45 degrees C on the order of minutes, 1 and 3 minutes, respectively. In vivo, 15 minutes thermal exposures to 43-45 degrees C result in a delayed adipocyte cellular death response-in this study, 9 days. The novel RF device presented herein effectively delivers therapeutic thermal exposures to subcutaneous adipose tissues while protecting epidermal and dermal layers.
Treatments for localized adiposities range from topical creams to liposuction. Most treatments lack a substantial proof of efficacy. The unpredictable treatment outcome can be related to the fact that cellulite adipose tissue is physiologically and biochemically different from subcutaneous tissue found elsewhere in the body. Part II of this two-part series on cellulite reviews the various treatment options that are currently available for human adipose tissue including, but not limited to, cellulite. It also focuses on newer techniques that can be potentially useful in the future for the treatment of cellulite.
Skin laxity, wrinkles and cellulite are common aesthetic problems associated with the aging process. These symptoms are due to the weakening and thinning of dermal connective tissue and the enlargement of hypodermal fat cells. The aim of this study was to evaluate the safety and efficacy of the TriPollar RF technology in reducing fat and collagen regeneration.
Twelve healthy patients underwent weekly treatments on different body sites using the TriPollar technology. Treatment areas were photographed and measured and patient satisfaction was monitored. One abdominal patient consented to a series of TriPollar treatments prior to her scheduled abdominoplasty. A controlled histopathology analysis was performed on skin samples taken during the abdominoplasty procedure.
Histopathological examination revealed marked differences between treated and non-treated abdominal skin areas. An increase of 49% in dermal thickness, focal thickening of collagen fibers and focal shrinkage of fat cells was shown following TriPollar treatments. Average patient satisfaction indicated clear satisfaction with the clinical results achieved.
The TriPollar is a safe and effective non-invasive technology leading to skin tightening and body shaping. Histology results indicate changes at the dermal and fat layers following TriPollar treatments resulting in increased collagen regeneration and stimulated fat metabolism.
We recently introduced Renesis, a novel minimally invasive radiofrequency (RF) device, for the treatment of human skin. The wound healing response post-fractional RF (FRF) treatment was examined in human subjects.
The FRF system delivered RF energy directly within the dermis via 5 micro-needle electrode pairs. Tissue temperature was held at 72 degrees C for 4 seconds using an intelligent feedback system. The wound healing response was evaluated histologically and by RT-PCR up to 10 weeks post-RF treatment. Neoelastogenesis and the role of heat shock proteins (HSPs) were assessed by immunohistochemistry.
FRF treatment generated a RF thermal zone (RFTZ) pattern in the reticular dermis that consisted of zones of denatured collagen separated by zones of spared dermis. RFTZs were observed through day 28 post-treatment but were replaced by new dermal tissue by 10 weeks. HSP72 expression rapidly diminished after day 2 while HSP47 expression increased progressively through 10 weeks. Reticular dermal volume, cellularity, hyaluronic acid, and elastin content increased. RT-PCR studies revealed an immediate increase in IL-1beta, TNF-alpha, and MMP-13 while MMP-1, HSP72, HSP47, and TGF-beta levels increased by 2 days. We also observed a marked induction of tropoelastin, fibrillin, as well as procollagens 1 and 3 by 28 days post-treatment.
Our study revealed a vigorous wound healing response is initiated post-treatment, with progressive increase in inflammatory cell infiltration from day 2 through 10 weeks. An active dermal remodeling process driven by the collagen chaperone HSP47 led to complete replacement of RFTZs with new collagen by 10 weeks post-treatment. Furthermore, using both immunohistochemical and PCR studies, we successfully demonstrated for the first time evidence of profound neoelastogenesis following RF treatment of human skin. The combination of neoelastogenesis and neocollagenesis induced by treatment with the FRF system may provide a reliable treatment option for skin laxity and/or rhytids.
Previous studies have shown that radiofrequency (RF) energy is a safe and effective treatment for rhytide-reduction.
This randomized, blinded, split-face study assesses the safety and efficacy of the unipolar versus bipolar handpieces on an RF device with a mobile delivery method for the treatment of rhytides and laxity using quantitative grading.
In this randomized, blinded, split-face design study, 10 subjects (aged 18-75 years) with a clinically observable excess of rhytides and laxity (minimum grade 2 out of 4) on the face received four treatments at 1-week intervals with random assignment of unipolar RF to one side and bipolar RF to the contralateral side. Each side received approximately four passes per treatment delivered in a mobile continuous manner. Results were evaluated by two blinded investigators of photographs employing a comprehensive 4-point grading scale at baseline, and 1- and 3-month follow-up visits after the final treatment.
All subjects completed and responded to treatment. The blinded evaluations demonstrated the following mean percent improvements in grading scores of rhytides and laxity: for the unipolar side 6.0+/-4.6% and 4.6+/-4.8% versus the bipolar side 4.4+/-2.5 and 7.3+/-3.5%. The degree of improvement approached but did not achieve statistical significance for either handpiece, but demonstrated a trend toward improvement (P = 0.5599 unipolar vs. 0.1108 bipolar). The treatment was painless (rated 0 out of 10 by all subjects) and side effects included minimal erythema which resolved within 1-3 hours. No crusting, dyspigmentation or scarring was observed.
This randomized, split-face study with blinded evaluations employing a quantitative grading scale demonstrated that minimal pass, mobile energy delivery serial treatments with either the unipolar or bipolar handpieces of a novel RF device appears to safe and painless. Each handpiece demonstrated minimal clinical efficacy which was not statistically significant, but with a trend toward improvement in rhytides and laxity of facial skin.
Acne vulgaris is an exceedingly common condition in adolescence and may extend into adult life in some individuals. Even though this condition is at times minimized, it has been found to have a profound impact in the quality of life of many affected individuals. Acne scarring can be even more of a source of psychological and social problems than active acne is, and when inadequately treated, the latter can lead to the former. Moderate and severe acne vulgaris usually require a regimen of systemic and/or topical medications, which are given for several months or even years and frequently require multiple visits to the physician office, the laboratory, etc. This results in loss of time at school and considerable expense. Side effects from medications and the frequent need to use alternative drugs when there is no response to medical treatment are possible.
To evaluate the role of a novel medical device that uses radiofrequency as a source of energy to produce volumetric tissue heating, while sparing the epidermis, allowing for a procedure with no down time and no postoperative care required.
Twenty-two patients, 10 women and 12 men, ranging in age from 16 to 28, with moderate to severe, scarring, cystic, active, acne vulgaris participated. Only nine of these patients were on concomitant medical treatment such as oral antibiotics or topical agents. All 22 patients were treated with a new nonablative radiofrequency unit, which delivers a concomitant spray of cryogen for epidermal sparing. One session was done in 20 patients and two sessions in 2 patients. The average fluence per energy delivery was 72 J/cm2. Follow-up ranged from 1 to 8 months. Patient questionnaires and active acne lesion counts were used to evaluate the response to treatment.
Excellent response was seen in 82% (n=18). Modest response was seen in 9% (n=2), and no response was seen in 9% (n=2); t-test on active lesion counts before treatment and after treatment was less than 0.009004. No side effects were identified on any of these patients. No down time from the procedure was seen. Only topical anesthesia, ELA-Max 5% (Ferndale Labs, Ferndale, MI) was used; 59% of patients were on no acne medication before, during, or after the procedure.
Nonablative radiofrequency appears to be a new safe and effective treatment alternative for moderate to severe acne vulgaris. Further research is in progress to evaluate this treatment modality in a larger number of patients.
Laxity of cheek and neck skin is a common cosmetic complaint of patients as they age. Improvement of skin laxity can be difficult to achieve without invasive surgical lifting procedures. The object of this study was to evaluate the safety and efficacy of a novel nonablative radiofrequency device in the treatment of cheek and neck laxity.
Fifty patients (skin phototypes I to IV) with mild-to-moderate cheek laxity (n=30) or neck laxity (n=20) received one treatment with a radiofrequency device (ThermaCool; Thermage Corp., Hayward, CA). Topical anesthetic cream was applied under occlusion for 60 minutes before treatment of the skin extending laterally and inferiorly from the nasolabial folds to the preauricular regions and mandibular ridge for treatment of the cheeks and from the mandible to mid neck for treatment of the neck. Clinical improvement of treatment areas was independently determined by three masked assessors' evaluations of comparative photographs at baseline, immediately after treatment, at 1 week, and at 1, 3, and 6 months after treatment using a quartile grading scale (0=less than 25%, 1=25% to 50%, 2=51% to 75%, 3=more than 75% improvement). Patient satisfaction surveys were also obtained at each follow-up visit.
Significant improvement in cheek and neck skin laxity was observed in the majority of patients. Patient satisfaction scores paralleled the clinical improvements observed. Side effects were mild and limited to transient erythema, edema, and rare dysesthesia. No scarring or pigmentary alteration was seen.
Noninvasive radiofrequency bulk dermal heating of skin can achieve safe and effective tissue tightening of the cheeks and neck. Although tightening continued to be evident 6 months after a single treatment, the longevity of clinical results has yet to be determined.
To evaluate the use of the ThermaCool TC nonablative radiofrequency device for rejuvenation of the upper one-third of the face, as determined by brow elevation. Study design and setting Twenty-four patients in a facial plastic surgery office were treated with the nonablative radiofrequency device. The patients had pretreatment photos, in-office procedure, and follow-up photos. Brow elevation measurements were used to gauge efficacy of the procedure. These results were compared to an untreated, control group of 12 patients.
Compared to the control group, the post-treatment measurements were improved (P < 0.05). The post-treatment measurements were also improved from pretreatment baseline (P < 0.05). Subjective results obtained from patient satisfaction questionnaires did not correlate to the objective data. The data also showed that improvement in brow elevation was not uniform in each patient.
The ThermaCool TC nonablative radiofrequency device for in-office rejuvenation of the upper one-third of the face procedure does provide brow elevation in a majority of patients; however, the majority of the study patients did not perceive benefit from the procedure. Patient satisfaction in facial plastic surgery must be an important part of the decision of whether or not to introduce a new device into a practice setting.
Radiofrequency application through a proprietary device has recently been used for facial tissue tightening. Uniform volumetric heating of the dermis is created by passage of electrical current, while protection of the epidermis is maintained by concurrent cryogen cooling.
To objectively quantify the effectiveness of volumetric radiofrequency application on the face, we treated 10 patients on the left side of the face with radiofrequency and evaluated the changes in brow position, superior palpebral crease, angle of the eyebrow, and jowl surface area.
Uniform treatments were applied at 134 J/cm(2) to the left side of the forehead and 1 cm past midline, at 115 J/cm(2) to the left side of temple and cheeks, and at 97 J/cm(2) to the left side of the jaw line and inferior postauricular surface. Patients were evaluated at monthly intervals up to 3 months with digital photography. Morphologic changes were evaluated with the "measuring tool" and "angle tool" of the Mirror Suite imaging system for aligned frontal-view photographs (for eyebrow position, superior palpebral crease elevation, and eyebrow angle changes) and the "outline tool" for aligned oblique-view photographs (for jowl surface area changes).
At the end of 3 months on the side that was treated, patients exhibited on average 4.3 mm of brow elevation and 1.9 mm of superior palpebral crease elevation along the midpupillary line and an average of 2.4 mm of brow elevation along the lateral canthal line. There was no significant improvement of brow elevation along the lateral canthal line on the contralateral side. The peak angle of the ipsilateral eyebrow became slightly more acute by an average of 4.5 degrees after treatments. Moreover, the jowls on the lower part of the face, displayed a mean decrease of 22.6% in surface area after treatments. The nontreated side displayed a lack of eyebrow angle and jowl surface area changes.
The application of radiofrequency to the face provides quantifiable changes. The brow along the midpupillary line is elevated to a greater degree than the lateral brow. This is consistent with acute angle changes seen in the eyebrow. Improvements in the lower part of the face with radiofrequency application can be quantified by demonstrating a decrease jowl surface. Moreover, these measurement techniques can be useful tools for evaluating other treatment parameters with radiofrequency application.
Background and objective:
The radio-frequency (RF) device is a system capable of volumetric heating of the mid to deep dermis and selective heating of the fibrous septa strands and fascia layer. Clinically, these effects promote dermal collagen production, and tightening of these deep subcutaneous structures. A new technique of using multiple low energy passes has been described which results in lower patient discomfort and fewer side effects. This technique has also been anecdotally described as giving more reproducible and reliable clinical results of tissue tightening and contouring. This study will compare ultrastructural changes in collagen between a single pass high energy versus up to five passes of a multiple pass lower energy treatment.
Study design/materials and methods:
Three subjects were consented and treated in the preauricular region with the RF device using single or multiple passes (three or five) in the same 1.5 cm(2) treatment area with a slight delay between passes to allow tissue cooling. Biopsies from each treatment region and a control biopsy were taken immediately, 24 hours or 6 months post treatment for electron microscopic examination of the 0-1 mm and 1-2 mm levels. Sections of tissue 1 mm x 1 mm x 80 nm were examined with an RCA EMU-4 Transmission Electron Microscope. Twenty sections from 6 blocks from each 1 mm depth were examined by 2 blinded observers. The morphology and degree of collagen change in relation to area examined was compared to the control tissue, and estimated using a quantitative scale.
Results:
Ultrastructural examination of tissue showed that an increased amount of collagen fibril changes with increasing passes at energies of 97 J (three passes) and 122 J (five passes), respectively. The changes seen after five multiple passes were similar to those detected after much more painful single pass high-energy treatments.
Conclusions:
This ultrastructural study shows changes in collagen fibril morphology with an increased effect demonstrated at greater depths of the skin with multiple low-fluence passes and at lesser depths with single pass higher fluence settings. Findings suggest that similar collagen fibril alteration can occur with multiple pass low-energy treatments and single pulse high-energy treatments. The lower fluence multiple pass approach is associated with less patient discomfort, less side effects, and more consistent clinical results.
Reduction of wrinkles is increasingly becoming one of the most sought after aesthetic procedures. A variety of treatment modalities are available for this application, including radiofrequency energy in various modes of action.
The goal of the reported study was to evaluate the safety and efficacy of a new device, which implements an innovative combination of bipolar radiofrequency and vacuum.
Forty-six healthy adults at two clinics underwent eight facial treatments every 1 to 2 weeks. For 6 months after treatment, patients were assessed directly by two evaluators at each clinic (the treating physician and an additional reviewer) using standard evaluation tools-the Fitzpatrick-Goldman Classification of Wrinkling and Degree of Elastosis and a visual analog scale.
Significant improvement in the skin's appearance and texture was observed during the treatment course and continued to increase during the follow-up period. The mean elastosis score on the wrinkling and elastosis scale before treatment was 4.5 and was reduced to less than 2.5 by 6 months after treatment, representing a drop of an entire wrinkle class (from II to I) on this scale. The reported pain levels were low, and the subjects expressed their satisfaction with the treatment and its outcome. The adverse responses consisted mainly of transient erythema and burn/blistering; there were also a few occurrences of edema, purpura, and crusting and one transient hyperpigmentation. No permanent complications had occurred.
Our results demonstrate the safety and efficacy associated with use of this radiofrequency and vacuum device, employing Functional Aspiration Controlled Electrothermal Stimulation (FACES) technology, for reduction of facial wrinkles and elastosis.
In recent years, several new radiofrequency devices have been introduced for treatment of a variety of skin conditions, particularly, skin wrinkling and laxity. These nonsurgical systems induce tissue tightening and contour changes through dermal collagen remodeling without disruption of the overlying epidermis, obviating a significant recovery period or risk of serious adverse sequelae. As such, radiofrequency-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision, and treatment of unwanted hair, vascular lesions, and inflammatory acne.