Deep Layer Radiofrequency Thermo-coagulative Technology for Cervicofacial Contouring: Sonographic and Clinical Results

Abstract

Background: Radiofrequency energy thermally induces collagen contraction and remodeling. The resultant dermal tightening is well established. However, facial aging encompasses also deeper layers of collagen-containing tissues. We present a deep layer radiofrequency-based thermo-coagulative technique for cervicofacial contouring and evaluate its efficacy. Methods: This prospective single center study was conducted from June 2017 to June 2018 and included 10 women. Echogenicity and thickness of layers 1–5 of the lower face, lateral neck, and submental regions were sonographically measured at baseline and at 6 weeks postoperatively. Echogenicity analysis was based on the number of high echogenic pixels counted and processed using Matlab-based image application (The Mathworks, Natick, Mass.). Clinical outcome at 12 months postoperatively was evaluated by 2 independent evaluators using a validated 5-point lower face improvement scale and the Merz jawline scale (0–4). Patient satisfaction and adverse effects were recorded. Results: Mean age was 60.2 years (range, 52–76). A statistically significant increase in echogenicity (P ≤ 0.02) and a decrease in thickness (P = 0.01) was noted. Echogenicity increased at 149%, 78%, and 60%, for the lateral neck, lower face, and submental region, respectively. The corresponding decrease in thickness per site was 16%, 6%, and 19%. The average physicians’ improvement in lower face contour was 3.8, and the Merz jawline scale was improved from 2.85 at baseline to 1.05 at 12 months postoperatively. Patient satisfaction was high. Side effects were minimal. Conclusions: Deep layer radiofrequency-based technology thermally induces profound soft tissue tightening and neocollagenesis. It is a safe and effective technique for cervicofacial contouring in selected patients.

A Systematic Review of Subsurface Radiofrequency Treatments in Plastic Surgery

“…All tissues are coagulated, including vessels, lymphatics, nerves, and connective tissue, causing the tissue to condense. 15,35 There is no evidence for a more delicate controlled action like strings on the dermis. 40 The liquefied tissue resembles a milkshake as it is aspirated.…”

“…2). Another study published almost simultaneously reported a prospective study of patients treated 26 Cohen et al 35 (2020) with the Thermi product. Major improvements in the jawline and neck were demonstrated in photographs.…”

“…Radiofrequency, unlike ultrasound, which was a previous energy-based treatment, does not specifically target fat. All tissues are coagulated, including vessels, lymphatics, nerves, and connective tissue, causing the tissue to condense 15,35 . There is no evidence for a more delicate controlled action like strings on the dermis 40 .…”

“…41 Ahn et al 14 caution operators not to pass the internal probe too deeply in the face to avoid fat necrosis and a resulting contour depression, or injury to the facial nerve. Unlike most operators, who prefer to stay superficial in the face, Cohen et al 35 insert the probe deep to the superficial musculoaponeurotic system.…”

Contractile Effects of Radiofrequency Energized Helium Plasma on the Fibrous Septal Network

“…Recalling that the total ability to re-drape the skin is related to the contractile nature of the dermis, as reflected by dermal thickness, the amount of FSN and fat to be aspirated, the delivery of RF energy to multiple tissue planes has proven advantageous. Treating the immediate subdermal layer leads to neo-collagenesis and subdermal remodeling, while treating above and below Scarpa's fascia maximally augments fat liquification, coagulates blood vessels, and creates an active fibroblastic reaction that replaces liquified fat [15,16], neo-angiogenesis, and a compact, reorganized layer of collagen and elastin over 4-6 months [17]. The delivery of immediate heating between 60 and 80°C causes collagen fibrils to contract to one third their length and alters the microenvironment of the extracellular matrix toward favorable remodeling and healing.…”