Nonablative Radiofrequency for Skin Rejuvenation

Abstract

The authors have indicated no significant interest with commercial supporters.T here is growing interest in a wide range of nonablative interventions that, predictably, are claimed to rejuvenate skin and subcutaneous tissue ''safely and effectively.'' Although for many years surgery in its many forms has been the criterion standard treatment in aesthetic aspect of aging, nonsurgical methods have always been an attractive choice because of their low invasiveness and shorter recovery time. Nevertheless, most nonsurgical modalities have centered around those that destroy the epidermis and cause a dermal wound, with resultant dermal collagen remodeling and secondary skin tightening and rhytid improvement. Radiofrequency (RF) tissue tightening was developed to create thermal effects in the dermis without external cutaneous wounding. The current review aims at summarizing the nonablative RF currently in use for skin rejuvenation. HistoryRedundant facial, neck, or body laxity is a major feature of aging and, until recently, surgery was the sole option for its correction. As newer methods developed, RF was introduced at the beginning of the 21st century as a nonlaser technology for cosmetic dermatology, although it has been in use for much longer as a therapeutic option in medicine and surgery. Tissue tightening was one of the first dermatologic uses of RF, where it was used as an alternative or complement to nonablative laser technologies. RF-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision, treatment of hypertrophic scars and keloids, 1 treatment of unwanted hair, rosacea, 2 vascular lesions, and inflammatory acne. 3,4 RF Technology How it Works: Biophysics of Thermal Collagen RemodelingThermal collagen contraction can be applied to the skin for use in aesthetic rejuvenation, restoring skin laxity and aging symptoms. Collagen fibers consist of triple helix strands of protein containing strong hydrogen bonds that deteriorate over the course of several years. The application of thermal energy over a period of time contracts, compresses, and thickens the collagen fibers. An ideal heat of 571C to 611C is adjusted for collagen shrinkage, with a time depending on type and area of skin applied. The dermal collagen fibers are detected at a depth of 1 to 2 mm for treatment of skin laxity. Nonablative Skin RemodelingPhotomodulation, a nonablative laser treatment, allows matrix metalloproteinase reduction to produce an increase in the cellular response of dermal collagen. There are two hypotheses to explain this treatment method: (1) water and collagen absorb the light energy, producing a thermal effect on the dermis, and (2) cellular mediators and growth factors

Will nonablative rejuvenation replace ablative lasers? Facts and controversies

“…Both produce collagen contraction, but the advantage of bipolar systems is in the controlled distribution of RF inside the tissue. 35,37 The best results have been achieved with combinations of bipolar RF and optical optical energy, including combinations with IR laser at 900 nm and with IPL (515-1200 nm). 35,38,39 Both combinations demonstrated improvement of rhytides, laxity, and other signs of photodamage.…”

“…30,31 Radiofrequency Radiofrequency (RF) devices produce electrical energy that heats the dermis without plume at comparatively low temperatures, which leads to collagen denaturation and skin tightening. 35 The first monopolar RF system demonstrated the improvement in skin laxity of the face and neck with minimal down time; however, the results were inconsistent; improvement was minimal in the most of patients, whereas dramatic improvement was noted in a minority. Additionally, the treatment was associated with significant discomfort.…”

A Histological Study on the Treatment of Acne Scars with Fractional Radiofrequency: Preliminary Findings

“…The device employed in the present study is described as a sicalled bipolar RF system, whereby the delivery and return electrodes are incorporated in the hand piece [7,12]. RF-based technologies depend for their effect of the resistance or impedance of target tissue to the RF energy, resulting in the creation of heat through Joule's law, and delivery of electrothermal damage, with subsequent greater heat diffusion to deeper tissues as compared to laser-based technologies.…”

“…However, the ablative laser approach is associated with the problem of a high incidence of hyperpigmentation, especially in Japanese skin types III and IV, and the nonablative approach suffers in terms of the efficacy in reaching the deeper layers of the dermis, absolutely required in the treatment of acne scars. The fractional CO 2 laser and radiofrequency systems (RF) have been reported as creating the desired controlled dermal damage down to the deeper layers of the dermis and have been successfully used in the treatment of atrophictype acne scars, in addition to their use in the treatment of acne (an established indication of these approaches), with numerous clinical reports published in the literature [6,7]. The present study presents the histological and ultrastructural findings of changes in the dermal architecture at one month following fractional RF treatment for acne scars.…”

Efficacy of Fractional Microneedle Radiofrequency Device in the Treatment of Primary Axillary Hyperhidrosis: A Pilot Study

“…Fractional microneedle radiofrequency (FMR) is a recently developed, minimally invasive method for delivering thermal energy to the target tissue without destroying the epidermis, by using rapid penetration with microneedles. FMR treatment has demonstrated excellent efficacy for skin rejuvenation, face lifting, large pores and acne scars [13,14,15,16]. Therefore, we postulated that FMR could be considered as an alternative treatment for PAH on a similar principle of microwave devices, and to test this hypothesis, we prospectively evaluated the efficacy of the FMR device as a therapeutic option for PAH.…”