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THERMAGE

SELECTING OPTIONS FOR SKIN-TIGHTENING TREATMENT BY MONOPOLAR RADIOFREQUENCY

Bogle 2007, has reported that lower facial laxity can be effectively ameliorated by non-ablative monopolar radiofrequency technology, that delivers heat to the deep dermis and subdermal layers of the skin. The Thermacool (Thermage, Haywood , CA ) has been shown to accomplish non-invasive skin tightening of the face, abdomen, and extremities. Outcomes that can be expected include:

  • Skin tightening of mid- and lower sagging jowls and loose skin.
  • Skin tightening and redefinition of the mandibular jaw line.
  • Improvement of facial texture and tone (see Barrett-Hill, 2004).
  • Avoidance of surgery with no downtime.
  • Smoothing, tightening and contouring of skin (upper arms, abdomen and thighs).
  • Improvement of individuals with early-stage, mild-to-moderate degenerative dermal changes (Goldberg et al 2007). Patients undergoing RF treatment and decline blepharoplasty surgery, can expect " shrinkage" of the eyelid with wrinkles in the range of mild to moderate (Carruthers et al 2007).

A 15% failure rate can be expected and no positive changes can be observed by some clients. This is the case with all forms of facial rejuvenation attempts: no response or variable results . Apart from a formal surgical face lift (that renders the best results in expert hands), the following approaches can be considered to achieve facial skin lifting and tightening (to address ptosis, lines, folds and volume loss).

  • ELOS technology for skin tightening ( Syneron , Israel ).
  • Fractional photothermolysis (Fraxel, Titan, Mosaic, F1).
  • Autologous platelet-rich plasma facial rejuvenation (ACR/PRP: for further information click on "ACR" button. This approach provides for improvement of tone (hypodermal volumetric regeneration as a filling effect) or improved skin texture (autologous epidermal rejuvenation). A new term is " Facial ACR-mesotherapy" , and was coined by Prof DF du Toit of Cape Town during 2007. This form of cosmetic/facial mesotherapy by the biological route, using the patient's own PRP ( platelet-rich plasma ) is popular in South Africa , Europe , England and Japan .
  • Use of vitamin-A , based cosmetic creams (but know restrictions and down-sides).
  • Use of cosmetic creams impregnated with growth factors and peptides engineered by nano-capsulation (to enhance skin penetration). For anti-aging the following growth factors are available in cosmoceuticals (EGF, IGF, bFGF, KGF, TGF-beta 3, thymosin-beta 4, SCF (stem cell factor), and VEGF (Dermaheal: Caregen Co Ltd: Korea ).
  • Athermal light : Light-emitting diode (LED) phototherapy for facial rejuvenation ( Omnilux Plus, Photo Therapeutics Ltd, Fazeley , UK and Omnilux Revive: 830 and 633nm for the infrared and red light: the radiant fluences, or doses, during a single treatment for twenty minutes, is 66 J/cm 2 and 126 J/cm 2 : See overview by Lee et al 2007 of Seoul , Republic of Korea ). This is a highly effective approach for facial skin rejuvenation with virtually no adverse effects. For further details, refer to the reviews by Goldberg (of the United States ) and Calderhead (of Japan ).

FACTS TO CONSIDER WHEN APPLYING FACIAL REJUVENATION

"Facial aging is primarily an atrophy of the hard and soft tissues of the face leading to a loss of three-dimensional structure and antigravity support of the overlying skin."

" Soft tissue augmentation has been seen as a renaissance of interest as an increasing number of patients seek aesthetic improvement without major down time." There is a re-interest in the concept of the three-dimensional face . Klein et al (2000) has emphasized that the youthful face has a much fuller look, not a pulled, flat, two-dimensional look. According to his group this has become one of the central tenets of the field of soft tissue augmentation . The two-dimensional look is often achieved by traditional surgical, face-lift approaches (Klein et al 2006). Kornstein et al 2005 has emphasized that patients can enjoy the synergy of the lifting, tightening and recontouring, by non-invasive technology.

THE PROCESS OF SKIN TIGHTENING

The proposed mechanism is by controlled skin heating through radiofrequency. The technology heats the dermis and deeper layers and leads to inflammation and collagen contraction. An inflammatory process follows the heating and results in:

  1. Early tightening by collagen contraction and skin oedema (thermally induced).
  2. Persistent tightening over 4-6 months due to deposition of collagen as part of the thermal damage, inflammatory process. One of the advantages of Thermage treatment is that the technology works on all skin types and colours. Often only one treatment is needed apposed to three or five treatments observed with some laser therapies. More details are available at www.thermage.com . The ThermaCool device has been cleared by the FDA for the non-invasive treatment of wrinkles and rhytids. Recent work shows that using lower energy and a multiple-pass approach allows end-points to be achieved, that are tolerable and reliable (see Dover et al 2007).

REVIEW OF RADIOFREQUENCY (RF) RESULTS AND "NON-SURGICAL FACELIFTS"

  • Mild to moderate shrinkage of the eyelids is possible by application of new monopolar radiofrequency device tips (Carruthers et al 2007).
  • Bipolar radiofrequency can be combined with broadband infrared light (Yu et al 2007) for nonablative tissue tightening by volumetric heating of the deep dermis.
  • Noninvasive rejuvenating procedures remain popular for non-surgical tightening of skin laxity (Rusciani et al 2007).
  • RF works by skin heating (tissue tightening , or collagen contraction , and contour changes through dermal collagen remodeling (Alster et al 2007).
  • New bipolar RF devices are effective, non-invasive and easy to use. Duration of results remain to be determined (Montesi et al 2007). However, controversy persists over the effectiveness of RF (Dierick x 2006), because most patients experience gradual tightening (Narins et al 2003). Some patients only experience modest improvement of laxity (Fritz et al 2004).There are many reasons for this observation.
  • Thermage has also proved useful in the treatment of stria distanae (Suh et al 2007).No doubt there will be a big market for abdominal stria or stretch marks .

FRACTIONAL PHOTOTHERMOLYSIS: AN ALTERNATIVE TO RADIOFREQUENCY

Fractional phototherapy (ie Fraxel) is non-ablative laser treatment that induces microscopic dermal heating in tiny columns referred to as microscopic treatment zones (MTZ). Thermal heating occurs in a controlled fashion with islands of uninjured tissue in-between. In the healing phase, keratinocytes have a shorter migration path and healing is supposedly quicker. In the thermally heated area, both the epidermis and collagen are denatured in the dermis. Both layers of the skin are therefore minimally coagulated by the light therapy. The treatment is painful in some patients and anaesthetic gel has to be applied atleast 1 hour before the procedure. FDA have approved treatment for pigmented lesions, periorbital rhytids, skin resurfacing, melasma and soft tissue coagulation (Smit 2007). Photo-aging of the neck and moderate wrinkling of the dorsal aspect of the hands respond well to fractional resurfacing, but the apparatus and costs of treatment is expensive. Both RF and fractional resurfacing are popular treatments for skin laxity and tightening .

TABLE SHOWING EFFICACY OF THERMAGE, NON-ABLATIVE TREATMENT OF SKIN LAXITY (FACE AND NECK)

Safe and effective

Achieve early skin tightening

Effect on laxity

Modest

Works via dermal heating

Failure rate about 15%

Success rate 85%

Post procedural tenderness

Occasional

Suitable for facial and neck skin laxity

Single or multiple treatments

Minimal down time

Skin tightening of upper arms

Older individuals responsive

Human eyelid, with fine wrinkles improved

Thermacool protects epidermis

Reversible erythema and oedema visible

Patient satisfaction: high

Sometimes painful

Improvement of cheek laxity

Skin wrinkling and laxity responsive

Application in Asian facial rejuvenation


ACADEMIC REFERENCES: RELEVANT TO MONOPOLAR RADIOFREQUENCY

  1. Fritz M et al. Radiofrequency treatment for middle and lower face laxity. Arch Facial Plast Surg 2004; 6: 370-3.
  2. Jacobson LG et al. Treatment of nasolabial folds and jowls with a noninvasive radiofrequency device. Arch Dermatol 2003; 139: 1371-2.
  3. Bogle MA et al. Evaluation of the multiple pass flow fluency algorithm for radiofrequency tightening of the lower face. Lasers Surg Med 2007; 39: 210-7.
  4. Abraham MT et al. Current concepts in nonablative radiofrequency rejuvenation of the lower face and neck. Facial Plast Surg 2005; 21: 65-73.
  5. Weiss RA et al. Monopolar radiofrequency facial tightening: a retrospective analysis of efficacy and safety in over 600 treatments. J Drugs Dermatol 2006; 5: 707-712.
  6. Dover JS et al. Results of a survey of 5,700 patient monopolar radiofrequency facial skin tightening treatments. Am Soc of Dermatol Surg 2007; 33: 900-907.
  7. Fitzpatrick R et al. Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med 2003; 33: 232-42.
  8. Chua SH et al. Nonablative infrared skin tightening in Type IV and V Asian skin: a prospective clinical study. Dermatol Surg 2007; 33: 146-151.
  9. Mayoral FA. Skin tightening with a combined unipolar and bipolar radiofrequency device. J Drugs Dermatol 2007; 6: 212-5.
  10. Biesman BS et al. Monopolar radiofrequency treatment of the eyelids: a safety evaluation. Dermatol Surg 2007; 33: 794-801.
  11. Curruthers J et al. Shrinking upper and lower eyelid skin with a novel radiofrequency tip. Dermatol Surg 2007; 33: 802-9.
  12. Lee SY et al. Clinical study on LED phototherapy for skin rejuvenation. J Photochem Photobiol 2007; 88: 51-67.
  13. Smit E. Fractional resurfacing in Dermatology. SAAR 2007; 1: 26-29. Go to top of page

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Boland Cell - Cell Technology - Aesthetic Biotechnology