Commentary on Prospective Clinical Trial of the Latest Generation of Noninvasive Monopolar Radiofrequency for the Treatment of Facial and Upper Neck Skin Laxity

Abstract

M onopolar capacitive-coupled radiofrequency (MRF) was first approved for the treatment of rhytids in 2002, and since then, it has been an important tool for noninvasive, nonablative facial rejuvenation. Monopolar capacitive-coupled radiofrequency devices deliver a current that is converted to heat energy via the impedance of tissue. This results in denaturation of existing collagen and promotes neocollagenesis, leading to decreased skin laxity. 1 The article, "Prospective Clinical Trial of the Latest Generation of Noninvasive Monopolar Radiofrequency for the Treatment of Facial and Upper Neck Skin Laxity" by Angra and colleagues presents an objective evaluation of a new MRF device (Thermage FLX). This device provides increased precision, patient comfort, and efficiency via an optimized energy delivery algorithm, vibrating hand piece, and larger treatment tip, respectively. A major strength of this article is that it is not sponsored by the manufacturer of the device. Objective and unbiased studies such as this one are important for our understanding of the efficacy and limitations of skin tightening devices.To place the outcomes reported by Angra and colleagues into context, the authors do compare their physician Global Aesthetic Improvement Scores (GAIS) for the new device with the physician GAIS for an older generation device (Thermage CPT) tested at the same center. With the new device, they report improvement in physician GAIS of 80% and 73% at 3 and 6 months, respectively. On the other hand, using similar parameters, the improvement in physician GAIS using the older generation device was 44.4% and 66.7% at 3 and 6 months, respectively. 2 This suggests that although the new device seems to provide a favorable early improvement in skin tightness, the effect may not be as durable as that seen with the earlier generation device.The authors also include data on patient-reported satisfaction, which is 82% in this study. This is in contrast to the average patient satisfaction in the literature of 50%, as described in the article. It is important to note that the treatments in the study were complimentary, and we query how this may influence reported patient satisfaction. As described by Reich in 1975, patient dissatisfaction after aesthetic procedures is often first reported upon receipt of the bill, which suggests that complimentary procedures may have higher associated satisfaction scores. Reich 3 alsoThe authors have indicated no significant interest with commercial supporters.