Radiofrequency Tightening

INTRODUCTION

Radiofrequency (RF) energy treatment is technology for non-surgical tightening of the early signs of loose or sagging skin. It is primarily used to treat skin laxity by facial tightening, and is best suited to patients with mild to moderate sagging of facial tissues, usually those in their mid 30s to 50s, with any skin colour.

 RADIOFREQUENCY BACKGROUND

The use of electric currents in medicine has been documented almost since electricity itself was discovered.

Radiofrequency (RF) surgery has a lengthy history of use in oral, ophthalmic, plastic, and gynecological surgery of over 70 years. Gradually, its use in the practice of dermatology, cosmetology, cardiology, neurosurgery, hepatic surgery, and ENT procedures gained momentum and popularity. Low frequency alternating currents are also used in physiotherapy for their ability to cause contractions in muscles. RF surgery traditionally utilizes a wave of electrons to cause frictional heating of tissues to incise, excise, ablate or coagulate the targeted tissue.

However with recent developments in cryogenics (the use of extremely cold substances) and information technology, non-ablative RF energy is the newest addition to the treatment options available for the aging face. With the introduction of cryogenics it is possible to deliver RF energy to the deep dermis and sub-dermal layers of the skin, whilst protecting the epidermis. Heating in this area, without damaging the outer layers of skin, causes microscopic changes to the tissues and collagen contraction, with subsequent collagen remodelling over the months that pass.

Statistics from the American Society for Aesthetic Plastic Surgery (ASAPS) indicate that non-surgical skin tightening was the seventh most common non-surgical cosmetic treatment in the U.S.A. in 2016 with nearly 526,700 treatments performed in that year. 

If you are considering an RF treatment, the following information will give you a basic understanding of the procedure. It can’t answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask a practitioner about anything you don’t understand.

WHAT IS RADIOFREQUENCY WAVES

Technically speaking, radiofrequency is the number of waves per second of the electric and magnetic fields within the radio waves portion of the electromagnetic spectrum.

It is lowest of the electromagnetic radiation frequencies within the spectrum, which itself spans from radio waves, microwaves, infrared, optical (visible light), ultraviolet, x-rays, to gamma rays.

Radiofrequencies, or radio waves, have wavelengths ranging from less than a centimetre to as long as 100 kilometres.

By applying RF energy to the human body, which can conduct current and therefore act as part of the electrical circuit, any resistance encountered by the energy flow will cause heat to be produced at the site of maximum resistance, which can also be used to cut or coagulate tissue.

RF energy when used for skin tightening is able to penetrate deep into the skin and affect the deeper dermis and subcutaneous layers, causing tightening and improvements to the underlying tissue structure, but with little change in skin texture or fine lines and wrinkling

TYPES OF RADIOFREQUENCY

 Monopolar (also called Unipolar)

Monopolar or unipolar refers to a device having one pole or electrode.

With monopolar delivery, the current from the generating machine flows through the body from a single electrode (handpiece) and meets maximum resistance in the area around the tip of the handpiece, where tissue heating in the subdermal layers then occurs.

A grounding, or “return pad” may also be used, attached to the patient’s lower back or abdomen, to provide a low resistance path for the current to flow back to the generating machine, to complete the electrical circuit.

Biopolar

Biopolar refers to a device having two poles or electrodes.

With bipolar delivery, the current from the generating machine flows only through the tissue which is between the two electrodes on the handpiece. These electrodes start and complete the electrical circuit. Hence, with bipolar delivery, no current flows through the rest of the body, so no grounding or return pad is needed.

In all cases of radiofrequency delivery types, it is the resistance to the current flow in the tissue, not the electrode that generates the heating effect.

 

INDICATIONS

Pure RF energy alone is primarily used to treat skin laxity by facial tightening, and is best suited to patients with mild to moderate sagging of facial tissues, usually those in their mid thirties to fifties, with any skin colour.

It is commonly used to treat the forehead (lift brows and tightens forehead skin), under the eyes (thickens skin and tightens and lifts the upper cheek skin), cheeks (lifts slightly and diminishes enlarged pores), mid-face, jaw line (diminishes jowling and sagging along the jaw line), and the neck (tightens skin and diminishes wrinkling of the neck).

However, if there is a significant amount of redundant or sagging skin, often seen in older patients over sixty, this procedure may not show a significant enough improvement and a traditional mid-face, face or brow lift operation may be recommended in order to remove the excess skin, therefore achieving a better result.

In combination with other modalities, as we have discussed above, RF can be used to enhance a variety of treatments including hair removal, photo-rejuvenation, pigmented and vascular problems, acne treatment and cellulite treatment.

 CONTRAINDICATIONS

As long as you are generally healthy and don’t have any skin diseases or infections in the area treated, there are few medical reasons why patients should not undergo this treatment.

People with sensory disturbance to the skin may not be considered good candidates as this could make the reporting of discomfort during the procedure unreliable, leading to potential harm.

Although there is no evidence that this treatment is harmful for pregnant women, you would generally be advised to wait until after you have given birth before embarking upon a course of treatment.

More importantly, people with electrical devices e.g., pacemakers, or metal implants e.g., artificial metal hip joints, heart valves or dental plates, cannot be treated because RF current flowing through the body may interfere with these devices or heat up metal implants, which could be dangerous.

 PREPARATION FOR THE TREATMENT

You should try to avoid doing anything that will irritate your skin immediately before treatment. This includes sunbathing (natural or artificial). Practitioners are unlikely to treat someone who has sun burn for example, as they would be more likely to suffer pain from the addition of heat to the already damaged skin. However an established tan would be fine.

Some women find that their skin is more sensitive right before and during their menstrual cycle so if you are a woman, you might want to take this effect on pain threshold into consideration when scheduling your treatment appointments.

Careful discussions regarding your reasons for wanting treatment are very important before you begin the treatment. You must also make sure that this treatment can deliver what you want and how you would like to look afterwards. Your practitioner should be able to answer all these questions.

A medical history should also be taken to make sure that there are no reasons why you shouldn’t undertake treatment. You may be asked to sign a consent form which means that you have understood the potential benefits and risks associated with the procedure.

Photographs may also be taken by the practitioner for a “before and after” comparison at a later date.

 PROCEDURE

You may be required to wash your face with soap and warm water prior to your treatment, in order to remove any makeup and skin oils which could interfere with the application of the RF treatment.

A topical anesthetic cream may then be applied to your skin a short time prior to treatment, to help numb the skin slightly; this will normally be removed using alcohol cleansers immediately before your clinician commences the procedure.

Depending on the device being used and your practitioner, a “treatment grid” ink transfer may then be applied over your face to assist the practitioner in navigating your face whilst delivering the RF energy; helping to assure an even application of the RF and to prevent inadvertent overlapping of treatment.

Again, dependent of the device being used you may be fitted with a single-use, self-adhesive return pad attached to your stomach or back to ground you; normally with monopolar devices.

A coupling gel may then also be applied over your face which acts as an additional barrier between the surface layers of your skin and the handpiece of the device.

Your clinician will then commence the RF treatment working across your face. Once completed a soothing gel or lotion may be applied to your skin.

 

AFTER THE PROCEDURE

Immediately following the treatment, your skin will feel tighter, with more tightening improvements appearing gradually over the months after treatment.

No special care is needed after treatment although your practitioner may suggest some of the following:

• Light application of soothing/moisturising lotions, creams or gels to the treatment area;
• cool, moisturising mists applied as you feel necessary;
• cool water rinses or ice packs applied to the treatment area.

 

RESULTS

Results are said to last up to a couple of years, and a single initial treatment can be enough to produce results in some people, depending on skin thickness; however your practitioner will be able to determine a course of treatments specific to you and your needs.

 RECOVERY

Some people experience mild redness immediately following treatment (similar to a sunburnt look), but this usually disappears quickly. Most people find that they can return to work and normal activities immediately after treatment.

Depending on your practitioner you may be advised to use certain soothing lotions, creams or gels to lightly apply to the treatment area, or possibly cool, moisturising mists to apply as you feel necessary.

RISKS AND COMPLICATIONS

As the treatment is carried out you will experience brief, deep heating sensations every time the RF energy is delivered to your skin and underlying tissue. Devices may have an inbuilt cryogenic capability whereby the handpiece is either chilled or emits a cooling spray before, during and after the RF burst, to protect your skin from the heating, and make the treatment more comfortable.

As each person’s pain tolerance and threshold varies, it is difficult to quantify how painful or uncomfortable the treatment is. It also depends on the device used and the power settings for the treatment. Your clinician may offer you anaesthetic options, such as a topical anaesthetic cream applied to your skin prior to treatment, or relaxants and pain management drugs, that can minimize your discomfort.

The most frequently reported side effects of treatment with RF energy are swelling, redness, bumps and blisters on or around the treated area, which typically disappear in a few days or weeks.

One of the most serious potential complications from RF energy treatment is a “depression”; this is attributed to the overheating of underlying tissue causing fat atrophy or excessive tightening, giving you a sunken appearance in the affected area. Generally, although further studies and more available data is needed, it is considered that there is a correlation between the occurrence of these depressions and the treatment being given at frequency levels above the manufacturer’s guidelines. It is therefore imperative that you make sure that your practitioner is adequately trained and certified to perform the RF treatment.