Effects of Bipolar Radiofrequency on Collagen Synthesis from Patients with Brachial Ptosis

Abstract

Background: Radiofrequency is frequently used for skin rejuvenation, localized fat elimination and cellulite treatment. It prompts the expression of thermal shock proteins that lead to dermal thickening as a result of collagen synthesis. The authors report a histological and clinical analysis of the arm subdermal changes before and after bipolar radiofrequency treatment plus liposuction to determine their benefits for arm contouring. Methods: Inclusion criteria included patients with stage 1, 2a, and 2b brachial ptosis (Duncan classification) and upper limb fat deposits who were considered candidates for third-generation ultrasound-assisted liposculpture plus radiofrequency-assisted lipolysis/skin tightening. Arm subdermal tissue samples (5 mm³) were analyzed before and after the intervention. We used 10% formaldehyde for tissue fixation and stained each sample with hematoxylin/eosin, Masson trichrome, and antibody markers against the cell cycle Ki-67 protein. Results: We analyzed a total of 12 biopsies from six patients who meet the inclusion/exclusion criteria. Histological findings with hematoxylin/eosin revealed hyperplastic and metaplastic changes with focal distribution within the papillary and reticular dermis. Masson trichrome staining showed an increase of the characteristic basophilia of thin type-I and type-III collagen fibers. In contrast, molecular analysis reported an increase in fibroblast activity mediated by the activation of the heat shock protein HSP47. Conclusion: Radiofrequency may be a great alternative to improve skin retraction in patients with mild to moderate brachial dermatochalasis through the activation of HSP47 heat shock protein and the production of type-I and type-III collagen.

Variable Energy and Ultrasound–based Liposculpture of the Arms: Multicenter and Multidevice Study

“…1,6,26,31,32 In fact, we recently published the effects of RF on collagen synthesis and fibroblast activity in a biopsy and molecularbased article. 8 The operative techniques that we are reporting align with the current concepts and premises of high-definition arm contouring described by Hoyos and Perez. 2,4 However, we incorporate new technologies for skin tightening to embrace more conservative approaches, as suggested by Hoyos et al 33 in their recent work on excisional body contouring surgery.…”

“… 1 , 6 , 26 , 31 , 32 In fact, we recently published the effects of RF on collagen synthesis and fibroblast activity in a biopsy and molecular-based article. 8 …”

“…subdermal collagen fibers and reducing the loose skin in the posterior arm, without the need for additional surgical incisions. [5][6][7][8] PAL relies on either cannula enhanced closed-suction device (Power X, VASER Lipo System 2021 Solta Medical; Bausch Health Companies Inc., Bothell, Wash.) or cannula oscillating and vibrating movement to accelerate fat removal (MicroAire Liposuction System 2020; MicroAire Surgical Instruments, LLC). 4 US-assisted liposuction (VASER Lipo System 2021 Solta Medical; Bausch Health Companies Inc.) uses US wave energy to break up supportive tissue from fat cells, emulsify some fat cells while protecting other structures such as vessels, lymphatics and nerves.…”

“…Most of these devices are designed to improve skin quality by actively contracting subdermal collagen fibers and reducing the loose skin in the posterior arm, without the need for additional surgical incisions. 5–8…”

“…This aids liposuction procedures by improving skin tone and elasticity. 5 , 8 , 9 Lasers selectively cause photothermolysis, breaking down adipocytes without affecting surrounding structures. They effectively emulsify fat to ease extraction; however, they disrupt the fat cells to a level that might not be suitable for autologous lipoinjection.…”