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QUAD™ RF SKIN TIGHTENING 2009

QUAD™ RADIOFREQUENCY REJUVENATION DEVICE REPLACES AND SUPERSEDES FIRST GENERATION RF TECHNOLOGY FOR FACIAL SKIN TIGHTENING, CONTOURING AND LIFTING

The recently launched Quad™ RF in 2008 has opened a new chapter in facial rejuvenation of bipolar radiofrequency,       regarding skin tightening and wrinkle amelioration in the skin beauty salon. The Quad RF is the latest competitor to other available RF devices such as Thermage™, Titan™,  Syneron™, and  Alma Accent™.  Apart from surgical face-lift, RF is still considered the first-line, gold standard device for non-invasive rejuvenation of the sagging and wrinkling face, compared to IPL, LED, lasers etc.

APPLICATION OF RADIOFREQUENCY (RF) IN THE BEAUTY SALON FOR FACIAL REJUVENATION AND OTHER INDICATIONS:

  • SKIN TIGHTENING: face laxity, facial folds and creases, neck, arms and abdomen: lifting experience
  • WRINKLE TREATMENT: Forehead, crow-feet, cheeks, upper-lip and mandibular jaw-line
  • CELLULITE: body shaping and contouring

  Fig 1: Radiofrequency medical face lift workshop


WHAT SKIN TYPES WILL RESPOND TO RF AND TISSUE-TIGHTENING RATHER THAN PREMATURE SURGICAL FACE LIFT?

  • Fine wrinkles and early sagging; laxity of cheek and neck, and for contouring
  • Fine to moderate depth wrinkles, moderate number of lines
  • Fine to moderate elastosis of the skin ( Medical Technology™, Italy)
  • Modest sagging of the lower jaw skin and neck ( mild skin laxity of face): discuss other choices
  • Skin re-wrinkling after face-lift
  • Skin types II-VI Fitzpatrick, and clients of colour

ADVANTAGES OF RADIOFREQUENCY (RF) INCLUDE:

  • Quite an effective non-surgical skin lifting procedure that can show fine line and wrinkle amelioration the same day, but recurs the next day.  A 30% early response rate is visible and reported by some workers including pleasant contouring provided the wrinkles are not too deep. Thereafter  the improvement is gradual over 4 months, and the benefits are lost if maintenance treatment is not kept up. Long term results are limited , but the procedure can be repeated. More effective than skin peeling for facial tissue tightening. Some argue that LED is more effective than RF, but this remains to be tested in trials. Both modalities have their place, however. RF is a valuable acquisition in your beauty salon.
  • Improvement of nasolabial and mesolabial lines can be achieved although the results are modest and subtle.
  • Well tolerated procedure, comfortable , especially with the Quad™ RF device
  • RF addresses submandibular and upper-neck skin laxity. Clients do detect micro-lifting
  • Usually, RF does not induce pigmentary alteration, blistering or scarring
  • Quite safe and effective in tightening of the lower face: modest tightening of loose or sagging skin. Maintenance therapy is emphasized, and no result can be expected after one treatment session. Can be used in conjunction with BOTOX, but at separate sessions, because the skin is slightly inflamed after  RF
  • A modest clinical improvement of peri-orbital skin laxity and brow elevation can be expected, but older skins are less amenable to heat-induced tissue tightening ( Alster et al)
  • Basically, no down time and the client can work the next day. Some clients feel  hot and sweaty for a short interval after RF
  • In some cases the result is variable, but in most cases a mild change can be observed
  • Most skin types can be treated by RF
  • RF works by deep thermal heating and collagen contraction and collagen remodelling; infra-red devices

Fig 2: Quad radiofrequency device used for medical face lift.

RADIOFREQUENCY PROTOCOL: PHYSICIAN PLANNING WITH THE CLIENT AT FIRST VISIT IN THE ROOMS OR BEAUTY SALON

  • Take a detailed cosmetic history; establish suitability of facial or cellulite for radiofrequency treatment (RF). Identify possible contraindications to RF (heart arrhythmias or pace-makers), and establish sensitivity index of the face. Note down propensity to rashes, contact dermatitis, and allergies. Red, sensitive faces are a no-go for RF
  • Discuss skin tightening and wrinkle reduction with the client: advantages, disadvantages and down-time. Discuss best and worst case scenarios and what is possible
  • Determine expectation levels of client and manage. What does the patient want? What can you offer from your beauty salon?
  • Determine skin type or Fitzpatrick grade
  • Discuss potential procedural discomfort, which is usually minimal, and operator dependent. With modern devices, topical anaesthesia is seldom needed. Some clients experience redness and swelling shortly after the intervention. Clients can expect this and is transient in nature. At worse, this is gentle stinging of the face and that can be avoided by lowering the power of the output.
  • Noticeable results can only be expected after 4-5 treatments, performed at two-week intervals. Some clients may be lucky and respond after 1 week, but this is the exception rather than the rule. It is best to do repeat follow-up therapy at two weekly intervals and allow the skin to settle down between treatment sessions.
  • RF can achieve the following outcomes if the settings are properly done and 4-5 treatments are administered:
  • Improvement of vertical forehead lines ( not to the same degree as BOTOX™ or fillers)
  • Improvement of crow feet wrinkles: so modest wrinkle improvement ( not as effective as BOTOX™)
  • Skin tightening of the cheek , jowls and neck ( not as effective as a face-lift)
  • Slight improvement of upper lip wrinkles ( not as effective as a filler such as Juvederm™)
  • Slight improvement of jowl creases ( not as effective as a face-lift)

Fig 3: Quad radiofrequency device in action to produce a facial lifting experience.

POTENTIAL SIDE-EFFECTS AND DRAW-BACKS OF FACIAL RF TREATMENT

  • Discomfort ( mild), at the point of treatment on the skin, or skin area treated
  • Erythema and oedema (usually local and transient). Some clients feel hot and sweat on the forehead for a few hours post-procedural, but are mild and transient in nature. This is normally experienced after each treatment session.
  • Bruising: very seldom seen and is a rare finding
  • Itching after treatment: rarely seen
  • Contact dermatitis: rarely seen but may occur in clients with sensitive skins and may be related to the skin heating process or allergy to the coupling medium
  • Blistering or burn: very seldom seen and is related to excessive heating of the skin
  • Skin pigmentary changes: can occur with any form of facial rejuvenation and may manifest as focal hypo- or hyper-pigmentation.
  • Infection: very rarely seen and topical antibiotic ointments may be of value.
  • Skin atrophy: rare cases of focal skin depressions have been reported after the application of RF, and the use of excessive energy levels

Fig 4:Quad radiofrequency device in use . Close up view.

POST-INTERVENTIONAL SKIN CARE

  • Cool packs applied locally may be of value, but usually no treatment is needed
  • Blistering or crusting: contact the doctor. Topical antibiotics may be needed.
  • Avoid hot water on the face treated with RF
  • Hydrate with skin moisturiser
  • As with any light-therapy, avoid hot direct sun light, and sun-block is essential

SAFETY DRILL IN PLACE IN THE SALON: RESPONSIBILITIES AND ACCOUNTABILITY

  • Limit traffic in room
  • Therapists need training/competency and credentials
  • Fire-drill in place
  • Know hazards to pace-makes and active implants
  • Know where emergency shut-off button is
  • Avoid excessive power and passes that can cause a burn
  • Be careful of sensitive skins

DISADVANTAGES OF RF TREATMENT FOR TIGHTENING AND WRINKLES

  • Don’t expect dramatic reversal of the aging process, because this will not occur. The changes are subtle, modest and non-permanent.
  • Early results can be seen the same day by skin tightening, but the aging reverts back to square one very quickly. You need at least 4 treatments and maintenance care.
  • RF cannot take away brown blotches and sun lentigenes on the face
  • Only a 30% response is seen after a single treatment ( 30% response)
  • Older skins are less amenable to RF skin tightening: results may only be seen after several months
  • Results in the literature: gradual softening of naso-labial lines( poorer than Botox or fillers), slight improvement of cheek contour ( but much less than face lift), mandibular line improvement ( but less than face lift), slight improvement of peri-oral marionette lines
  • Clinical results have been variable and non-responders are well documented

Posted 20/2/2009
DISCLAIMER:
A balanced view has been provided and the content has been reviewed by an International BIOMED EXPERT. The website accepts no responsibility for the contents of this section and potential aesthetic clients are requested to see a medical doctor, specialist, plastic surgeon or dermatologist and to sign informed consent.
REFERENCES ON RADIOFREQUENCY, SKIN TIGHTENING AND WRINKLE TREATMENT:

  • Alster TS et al. Improvement of neck and cheek laxity with a non-ablative radiofrequency device: a lifting experience. Dermatol Surg.4: 503-507, 2004.
  • Goldberg DJ et al. Clinical, Laboratory, and MRI  Analysis of cellulite treatment with a unipolar radiofrequency device. Dermatologic Surgery 34:204-209,2008
  • Ruiz-Ezparanza J and Gomez JB. The medical face lift: a non-invasive, non surgical approach to tissue tightening in facial skin using non-ablative radiofrequency. Dermatol Surgery 29:325-332, 2003.
  • Saddick N. Tissue tightening technologies: fact or fiction. Aesthetic Surgery Journal: 28: 180-188.
  • Rusciani A et al. Non-surgical tightening of skin laxity: a new radiofrequency approach. Journal of Drugs in Dermatology 6:381-385, 2007
  • Weiss RA et al. Monopolar radiofrequency facial tightening: a retrospective analysis of efficacy and safety in over 600 treatments. Journal of Drugs in Dermatology 5: 707-712,2006
  • Narins DJ et al. Non-surgical radiofrequency facelift. Journal of Drugs in Dermatology.2:495-500, 2003.
  • Gold MH. Tissue tightening: a hot topic utilizing deep dermal heating. Journal of Drugs in Dermatology.6:1238-1242.

MANUFACTURER AND DISTRIBUTOR IN SOUTH AFRICA:  QUAD ™ (Medical Technology) is manufactured in Italy, and distributed by Bester Medical Aesthetics in Cape Town, South Africa (021-5597263).

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Boland Cell - Cell Technology - Aesthetic Biotechnology