1
|
Dullnig AW, Perenack JD, Chapple AG, Kirby CL, Christensen BJ. Is Bipolar Radiofrequency-Assisted Liposuction Equivalent to Open Anterior Platysmaplasty in Facelift Surgery? J Oral Maxillofac Surg 2024; 82:169-180. [PMID: 37992758 DOI: 10.1016/j.joms.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND During facelift surgery, anterior platysmaplasty (AP) has been used for decades, but it limits lateral advancement and can induce contour irregularities. Radiofrequency (RF)-assisted-liposuction in the anterior neck can avoid these disadvantages by tightening skin without open surgery. PURPOSE The purpose of the study was to compare the esthetic outcomes of facelift surgery with those of AP and RF. STUDY DESIGN, SETTING, SAMPLE A 5-year retrospective cohort study was performed on facelift patients treated by a single surgeon. Exclusions were single-side surgery, previous facelift, chin/lip augmentation/reduction, and inadequate data. PREDICTOR VARIABLE The predictor variable was neck management technique (AP vs RF). MAIN OUTCOME VARIABLES The primary outcome variable was the change in cervicomental angle (CMA) following surgery as measured on facial photographs. Secondary outcomes included distance changes from the central CMA point in vertical and horizontal planes to repeatable reference planes. COVARIATES Covariates were age, body mass index, American Society of Anesthesiologists classification, smoking, and simultaneous procedures. ANALYSES The statistical analysis was performed using Wilcoxon rank-sum, Fisher's exact, Kruskal-Wallis tests, Pearson's correlation, and linear regressions. The level of statistical significance was P < .05. RESULTS There were 132 patients included in the study; 67 received AP and 65 received RF. AP trended toward better performance in CMA change in the unadjusted analysis (-18.7° ± 13.8° vs -22.3° ± 13.7°, respectively, P = .08). AP and RF performed similarly in the adjusted analysis (P = .29). Techniques were similar in horizontal distance change to the CMA (P = .31). RF was associated with less change in the vertical distance to the CMA in the unadjusted analysis (-11.9 mm ± 11.0 mm vs -6.7 mm ± 8.7 mm, respectively, P = .01) and adjusted analysis (β = 4.3 mm, 95% confidence interval .8 to 7.9 mm, P = .02). CONCLUSION AND RELEVANCE Utilization of the RF technique for management of the anterior neck in facelift surgery is associated with similar outcomes to the AP technique in horizontal distance to the CMA, but AP performed better in CMA change and vertical distance to the CMA.
Collapse
Affiliation(s)
- Andrew W Dullnig
- Assistant Professor, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Jon D Perenack
- Fellowship Director and Associate Clinical Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA; Medical and Surgical Director, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA
| | - Andrew G Chapple
- Assistant Professor, Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA
| | - Christopher L Kirby
- Dental Student, Louisiana State University School of Dentistry, New Orleans, LA
| | - Brian J Christensen
- Associate Professor, Department of Oral Medicine and Maxillofacial Surgery, Geisinger Health System, Danville, PA
| |
Collapse
|
2
|
Mineroff J, Nguyen JK, Jagdeo J. Potential treatment modalities for suprapubic adiposity and pubic contouring. Arch Dermatol Res 2023; 315:1615-1619. [PMID: 36757442 DOI: 10.1007/s00403-023-02555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/22/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
Excess suprapubic adiposity can have negative consequences for patients, including concerns related to physical comfort, sexual function, hygiene, and esthetics. Historically, treatment options for pubic contouring have been limited to surgical methods. The purpose of this article is to review the literature investigating the use of minimally invasive fat reduction treatments for suprapubic adiposity including cryolipolysis, injection lipolysis, radiofrequency, and ultrasound. A thorough search of the PubMed database was conducted to search for studies evaluating the use of cryolipolysis, injection lipolysis, radiofrequency, and ultrasound for suprapubic adiposity. The literature search did not yield any publications that evaluated the use of cryolipolysis, injection lipolysis, radiofrequency, or ultrasound for treatment of suprapubic adiposity. Minimally invasive treatments for fat reduction, including cryolipolysis, injection lipolysis, radiofrequency, and ultrasound, have clinically demonstrated safety and efficacy in various anatomic locations. However, clinical studies evaluating these procedures for suprapubic adiposity are noticeably absent. These options may confer benefits such as decreased recovery time, risk, and cost to patients. Future clinical studies evaluating these potential treatment modalities for suprapubic fat reduction are warranted.
Collapse
Affiliation(s)
- Jessica Mineroff
- Department of Dermatology, SUNY Downstate Medical Center, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA
| | - Julie K Nguyen
- Department of Dermatology, SUNY Downstate Medical Center, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
| | - Jared Jagdeo
- Department of Dermatology, SUNY Downstate Medical Center, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8th Floor, Brooklyn, NY, 11203, USA.
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA.
| |
Collapse
|
3
|
Wu S, Wang C, Yao M, Han D, Li Q. Photothermal lipolysis accelerates ECM production via macrophage-derived ALOX15-mediated p38 MAPK activation in fibroblasts. JOURNAL OF BIOPHOTONICS 2023; 16:e202200321. [PMID: 36529997 DOI: 10.1002/jbio.202200321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Skin and subcutaneous tissue tightening is usually treated by noninvasive photothermal treatment for medical esthetics purpose, while the underlying mechanism remains to be elucidated. Here, we hypothesized that adipocyte injury, as a stimulator, may regulate extracellular matrix (ECM) production by increasing ALOX15 in macrophages, which could lead to fibroblast activation. In this study, we show that lipolysis was induced by laser heating (45°C for 15 min) in patients and rats, and adipocyte thermal injury stimulates the ECM production in fibroblasts by ALOX15 that was increased in cocultured macrophages. These phenomena were evidenced by the ALOX15 knockdown. In addition, ALOX15 metabolite 12(S)-HETE activated p38 MAPK signaling pathway that mediated the production of ECM in fibroblast. In summary, the results of this study demonstrate that the mechanisms of adipose photothermal injury-induced skin and/or subcutaneous tissue tightening may have clinical relevance for noninvasive or minimally invasive photothermal therapeutics.
Collapse
Affiliation(s)
- Shan Wu
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caixia Wang
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Yao
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Han
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Noninvasive Hands-free Bipolar Radiofrequency Facial Remodeling Device for the Improvement of Skin Appearance. Dermatol Surg 2023; 49:54-59. [PMID: 36533797 PMCID: PMC9760459 DOI: 10.1097/dss.0000000000003666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Aging is a multifactorial response to genetic preprogramming nuances, sun exposure, and ultraviolet radiation. Recently, there has been a paradigm shift toward minimally invasive rejuvenation. OBJECTIVE This prospective multicenter study aims to evaluate the efficacy and safety of a novel hands-free bipolar bulk radiofrequency (RF) device in terms of improvement in skin appearance. PATIENTS AND METHODS This multicenter prospective study enrolled subjects aged 35 to 75 years with visible signs of aging. The primary objective was to evaluate skin appearance pretreatment and at 1, 3, and 6 months after the final treatment. Each patient received 3 total treatments to the chin and cheeks using the hands-free RF device spaced 2 weeks apart. RESULTS In total, data from 87 patients were assessed from 6 treatment sites. The average age was 54 years (range 35-75 years). Most patients were female (97%), and Fitzpatrick skin types I to V were represented. Overall, patients found the procedures to be relatively pain-free, and both patients and investigators felt they noted some improvement in their skin appearance. Histological sections demonstrated an increase in collagen or elastic fibers within the papillary dermis. CONCLUSION This study supports the use of this novel noninvasive hands-free bipolar facial remodeling device for the improvement of skin appearance.
Collapse
|
5
|
Cotofana S, Kaminer MS. Anatomic Update on the
3‐Dimensionality
of the Subdermal Septum and its Relevance for the Pathophysiology of Cellulite. J Cosmet Dermatol 2022; 21:3232-3239. [DOI: 10.1111/jocd.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester MN USA
| | | |
Collapse
|
6
|
A Prospective Trial: Handsfree Thermoregulated Bipolar Radiofrequency for Face and Neck Contouring. Plast Reconstr Surg Glob Open 2022; 10:e4194. [PMID: 35492231 PMCID: PMC9038493 DOI: 10.1097/gox.0000000000004194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
Background: The use of radiofrequency in aesthetic surgery has evolved significantly since it was first introduced in the early 2000s. Nonexcisional correction of the lower one-third of the face and neck has long been a challenging problem. The purpose of this prospective study was to assess the safety and efficacy of the first handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. Methods: This prospective multicenter (New York, Nevada) IRB-approved study evaluated healthy candidates who desired noninvasive correction of their lower face and neck laxity. The primary objective of this study was to evaluate safety and soft tissue remodeling pretreatment and at 1-, 3-, and 6-months post last treatment. Assessment was made using blinded evaluators, 3D photographic analysis (Quantificare, France), and volumetric measurements. Investigator and subject assessments were obtained using a 0-4 point Likert scale. Results: A total of 34 patients completed both the cheek and chin applicator treatment series. Average age of patients was 38 (STD 3.4), BMI 27 (STD 2.2), average Baker Face & Neck classification 2.6 (STD 1.1), and average Fitzpatrick type 2.4 (STD 1.2). Mean treatment time was 41 min (STD 3.5) with a temperature of 42°C–43°C. Patient discomfort data were statistically very low based on t-test analysis. Satisfaction metrics measured at 1- and 3-month follow-up demonstrated a significant change in subject skin appearance, subject overall satisfaction, and investigator improvement perception. More patients were satisfied at the 3-month follow-up compared with the 1-month follow-up for all three measures. Volumetric data demonstrated an average change of −3.2 cm3 (STD ±1.2 cm3) per side for the cheek applicator and −4.1 (STD ±2.3) for the submental applicator. Of note there were cases where volume increases were noted that were believed to be related to soft tissue contraction. Conclusions: This is the first prospective study to evaluate a handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. This device demonstrates a significant advance in the control and delivery of radiofrequency for aesthetic purposes. With a favorable safety and comfort profile, this device is able to concentrate thermal energy consistently at a depth that allows for fibroseptal network tightening to improve lower third of face and submental soft tissue contraction.
Collapse
|
7
|
Chawvavanich P, Singthong S, Intarachaieua K. The effectiveness and side effects of bipolar radiofrequency to treat submental laxity. J Cosmet Dermatol 2022; 21:4392-4397. [PMID: 35255190 DOI: 10.1111/jocd.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Submental skin laxity becomes a common cosmetic problem with age. Bipolar radiofrequency is a new, non-invasive procedure. Unlike the LASER, the radiofrequency (RF) device has no specific chromophore absorption. Thus, the device can be used on any skin type. OBJECTIVE To evaluate the effectiveness and adverse effects of the bipolar RF for treatment of submental laxity and skin tightening. MATERIAL AND METHODS Twenty-two patients with submental laxity were treated with FormaTM on both sides of the submental area. The patients underwent four sessions every two weeks for one and half months. Two blinded dermatologists evaluated the pre-treatment and post-treatment photographs every visit. The three-dimensional photographs were recorded by Vectra® camera and determined the association. RESULTS All 22 patients completed all the treatment sessions. The degree of improvement was statically significant after the third session based on the physical assessment scale and after the second session in terms of the submental laxity score. The fat volume reduction was statically significant from one week to six months from baseline. Almost all subjects developed transient erythema immediately after the treatment. No serious side effects were noted. CONCLUSIONS The bipolar RF device is another potential choice for skin tightening due to its efficacy and safety profile. It can be used with any skin type and has few side effects.
Collapse
|
8
|
Kavali CM, Nguyen TQ, Zahr AS, Jiang LI, Kononov T. A Randomized, Double-Blind, Split-Body, Placebo-Controlled Clinical Study to Evaluate the Efficacy and Tolerability of a Topical Body Firming Moisturizer for Upper Arm Rejuvenation. Aesthet Surg J 2021; 41:NP472-NP483. [PMID: 32462206 DOI: 10.1093/asj/sjaa134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Aging of upper arm skin, induced by intrinsic and extrinsic factors, often results in a loss of contour, elasticity, and firmness, and an increase in laxity, crepiness, roughness, and photodamage. A topical body firming moisturizer (TBFM) was developed to target all aspects of skin aging. OBJECTIVES The aim of this study was to evaluate the efficacy and tolerability of the TBFM for upper arm firming and rejuvenation. METHODS Forty female subjects, 40 to 60 years old, Fitzpatrick skin type II to V, with mild to moderate laxity, crepiness, and photodamage on the upper arms, were recruited into the study, 10 of whom were selected for biopsy analysis. Subjects were randomly allocated to apply the TBFM and placebo moisturizer on the assigned arms twice daily for 12 weeks. At each visit, efficacy and tolerability evaluation, self-assessment, and standardized clinical photography were performed. Ultrasound measurements were performed at baseline, week 8 and week 12. RESULTS Efficacy evaluation by a clinical grader and bioinstrumentation analysis showed the TBFM improved all skin parameters of the aged upper arm while outperforming the placebo moisturizer after 12 weeks. Clinical photography showed the test product toned and firmed the skin. The TBFM was well tolerated and well perceived by the subjects. Ultrasound images indicated an improvement in skin density and skin structure at week 12. CONCLUSIONS This clinical trial indicates that the TBFM was well tolerated and was effective in improving crepey, lax, and photodamaged skin of the upper arms after 12 weeks of treatment twice daily. LEVEL OF EVIDENCE: 2
Collapse
Affiliation(s)
| | | | | | - Lily I Jiang
- Thomas J. Stephens and Associates, Inc., Richardson, TX
| | | |
Collapse
|
9
|
Dayan E, Rovatti P, Aston S, Chia CT, Rohrich R, Theodorou S. Multimodal Radiofrequency Application for Lower Face and Neck Laxity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2862. [PMID: 32983756 PMCID: PMC7489644 DOI: 10.1097/gox.0000000000002862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Nonexcisional facial skin tightening has long been an elusive goal in aesthetic surgery. The "treatment gap" includes cases who are not "severe" enough for excisions surgery but not "mild" enough for most traditional noninvasive aesthetic modalities. In this retrospective review, we present the largest evaluation to date of radiofrequency (RF) skin tightening technology combination including bipolar RF (FaceTite; InMode) and fractional bipolar RF (Fractora modified to Morpheus8; InMode). METHODS A multicenter retrospective study was conducted between January 2013 and December 2018 using a combination of bipolar RF and fractional bipolar RF for the treatment of facial aging. Data collection included demographic information, Baker Face/Neck Classification, amount of energy used, adverse events, and patient satisfaction. Four cadaver dissections were also conducted to correlate the underlying neuromuscular anatomy with RF treatment of the lower face and neck. RESULTS Two hundred forty-seven patients (234 women and 13 men) were included in the study. Average age was 55.1 years (SD, ±8), body mass index was 24.3 (±2.4), and 9% (23/247) of patients were active smokers at the time of treatment. Patients had an average Baker Face/Neck Classification score of 3.1 (SD, ±1.4). The procedure was performed under local anesthesia in 240/247 cases (97.2%). Patients objectively improved their Baker Face/Neck Classification score by 1.4 points (SD, ±1.1). Ninety-three percent of patients indicated that they were pleased with their results and would undergo the procedure again. Complications recorded for our cohort included prolonged swelling >6 weeks (4.8%, 12/247), hardened area >12 weeks (3.2%, 8/247), and marginal mandibular neuropraxia (1.2%, 3/247), which all resolved without further intervention. When considering possible control variables, age seems to be a significant factor. That is, older patients were more likely to benefit from a larger magnitude of the treatment effect (as demonstrated by a decrease in the Baker rating from pre- to posttreatment) when compared with younger patients. However, both groups did demonstrate significant improvements across time. CONCLUSION While this combination RF treatment (FaceTite bipolar RF and fractional bipolar RF) does not aim to replace a facelift/necklift in appropriate candidates, it does broaden the plastic surgeons' armamentarium to potentially fill a treatment gap.
Collapse
Affiliation(s)
- Erez Dayan
- From Plastic and Reconstructive Surgery, Avance Plastic Surgery Institute, Reno/Tahoe, Nev
| | | | - Sherell Aston
- Plastic and Reconstructive Surgery, Manhattan Eye, Ear & Throat Hospital, New York, N.Y
| | | | - Rod Rohrich
- Plastic and Reconstructive Surgery, Dallas Plastic Surgery Institute, Dallas, Tex
| | - Spero Theodorou
- Plastic and Reconstructive Surgery, BodySculpt, New York, N.Y
| |
Collapse
|
10
|
Mazzoni D, Lin MJ, Dubin DP, Khorasani H. Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition. Australas J Dermatol 2019; 60:278-283. [PMID: 31168833 DOI: 10.1111/ajd.13090] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
Abstract
Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening. This article reviews the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound. These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery. When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.
Collapse
Affiliation(s)
- Daniel Mazzoni
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Matthew J Lin
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Danielle P Dubin
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Hooman Khorasani
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
11
|
Alam M, Pongprutthipan M, Nanda S, Kim NA, Swary JH, Roongpisuthipong W, Kauvar AN, Weil A, Iyengar S, Chen BR, Vasic J, Maisel A, West DP, Nodzenksi M, Veledar E, Poon E. Quantitative evaluation of skin shrinkage associated with non-invasive skin tightening: a simple method for reproducible linear measurement using microtattoos. Lasers Med Sci 2018; 34:703-709. [PMID: 30280300 DOI: 10.1007/s10103-018-2646-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
Non-invasive skin-tightening devices can induce thermal denaturation and skin shrinkage via externally applied radiofrequency emissions or high-frequency ultrasound. Therefore, the purpose of this study is to develop and test a method for measurement of skin reduction associated with application of such energy devices. Twenty-five healthy participants with mild to moderate skin laxity of the arms were enrolled. Pinpoint microtattoos were placed at each of the treatment sites to delineate two 6 × 12 cm rectangles per subject. A non-stretchable filament, tape and marking pen apparatus was used to measure the size of each rectangle before treatment and at follow-up visit by two blinded investigators. After randomization, one side received a single pass with a radiofrequency device (6.78 MHz), while the contralateral side received multiple passes. Participants underwent two treatment sessions to each side 2 weeks apart, and returned for follow-up 4 weeks after the second treatment. Length and area measurement were analyzed to assess precision and accuracy of measurements and to compare efficacy of treatment between pre- and post-treatment. Concordance correlation coefficients (CCC) demonstrated substantial inter-investigator reliability and precision in length measurements (CCC, 0.94 to 0.98 in pre-treatment; 0.95 to 0.98 in post-treatment). Measurements at the 6-week post-treatment follow-up demonstrated a statistically significant skin reduction in all six of the measured parameters. A simple skin measurement method requiring minimal instrumentation can quantitatively evaluate skin shrinkage associated with non-invasive skin-tightening devices.
Collapse
Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA. .,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Marisa Pongprutthipan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA.,Division of Dermatology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Shivani Nanda
- Department of Dermatology, Henry Ford Health System, West Bloomfield Township, MI, USA
| | - Natalie A Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Jillian H Swary
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Wanjarus Roongpisuthipong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA.,Division of Dermatology, Department of Medicine, Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand
| | - Arielle N Kauvar
- Division of Pulmonary, Allergy and Critical Care Medicine, New York Laser and Skin Care, New York, NY, USA
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Brian R Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Jelena Vasic
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Amanda Maisel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Michael Nodzenksi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Emir Veledar
- Emory University School of Medicine, Atlanta, GA, USA.,Baptist Health South Florida, Miami, FL, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| |
Collapse
|
12
|
Krychman M, Rowan CG, Allan BB, Durbin S, Yacoubian A, Wilkerson D. Effect of Single-Session, Cryogen-Cooled Monopolar Radiofrequency Therapy on Sexual Function in Women with Vaginal Laxity: The VIVEVE I Trial. J Womens Health (Larchmt) 2017; 27:297-304. [PMID: 29182498 PMCID: PMC5865245 DOI: 10.1089/jwh.2017.6335] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: This subanalysis of the VIVEVE I trial aimed to evaluate the impact of cryogen-cooled monopolar radiofrequency (CMRF) therapy, for the treatment of vaginal laxity, on the domains of sexual function included in the Female Sexual Function Index (FSFI). Materials and Methods: The VIVEVE I clinical trial was prospective, randomized, single-blind, and Sham-controlled. Nine clinical study centers in Canada, Italy, Spain, and Japan were included. This subanalysis included premenopausal women with self-reported vaginal laxity who had ≥1 term vaginal delivery and a baseline FSFI total score ≤26.5, indicating sexual dysfunction. Enrolled subjects were randomized (2:1) to receive CMRF therapy [Active (90 J/cm2) vs. Sham (≤1 J/cm2)] delivered to the vaginal tissue. Independent analyses were conducted for each FSFI domain to evaluate both the mean change, as well as the clinically important change for Active- versus Sham-treated subjects at 6 months post-intervention. Results: Subjects randomized to Active treatment (n = 73) had greater improvement than Sham subjects (n = 35) on all FSFI domains of sexual function at 6 months postintervention. The analysis of covariance change from baseline analyses showed statistically significant improvements, in favor of Active treatment, for sexual arousal (p = 0.004), lubrication (p = 0.04), and orgasm (p = 0.007). In addition, Active treatment was associated with clinically important and statistically significant improvements in sexual desire [Odds ratio (OR) = 3.01 (1.11–8.17)], arousal [OR = 2.73 (1.06–7.04)], and orgasm [OR = 2.58 (1.08–6.18)]. Conclusions: This subanalysis showed CMRF therapy is associated with statistically significant and clinically important improvements in sexual function in women with vaginal laxity. These findings provide the first randomized, placebo-controlled energy-based device evidence for functional improvements associated with a nonsurgical modality for a highly prevalent and undertreated condition.
Collapse
Affiliation(s)
- Michael Krychman
- 1 Southern California Center for Sexual Health and Survivorship Medicine , Newport Beach, California
| | - Christopher G Rowan
- 2 Collaborative Healthcare Research and Data Analytics (COHRDATA) , Santa Monica, California
| | | | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND Aging, childbearing, and hormonal changes can lead to vulvovaginal laxity and mucosal atrophy that negatively affect a woman's quality of life. As more minimally and noninvasive options for genital rejuvenation become available in the outpatient setting, it becomes increasingly important for the dermatologic surgeon to be familiar with these popular procedures. OBJECTIVE To familiarize dermatologists with the nonsurgical options available for female genital rejuvenation, patient motivations for pursuing these procedures, relevant anatomy, and potential adverse events. MATERIALS AND METHODS A MEDLINE search was performed on nonsurgical female genital rejuvenation from 1989 to 2015, and results are summarized. RESULTS Reports of nonsurgical female genital rejuvenation procedures using fractional carbon dioxide lasers, nonablative lasers, monopolar radiofrequency devices, hyaluronic acid fillers, and fat transfer are concisely summarized for the practicing dermatologist. CONCLUSION Review of the literature revealed expanding options for nonsurgical female genital rejuvenation.
Collapse
|
14
|
Rejuvenation of the Aging Arm: Multimodal Combination Therapy for Optimal Results. Dermatol Surg 2017; 42 Suppl 2:S119-23. [PMID: 27128237 DOI: 10.1097/dss.0000000000000732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aging arm is characterized by increased dyspigmentation, a proliferation of ectactic blood vessels, excessive adiposity, excessive skin laxity, and actinic keratosis. A variety of laser, energy, and surgical techniques can be used to improve these features. OBJECTIVE The objective of this article is to describe the treatment modalities that have proven efficacious in rejuvenating the aging arm and combination therapies that have the potential to optimize patient outcomes while maintaining safety and tolerability. METHODS A Medline search was performed on nonsurgical aesthetic combination treatments because it relates to arm rejuvenation, and results are summarized. Practical applications for these combination treatments are also discussed. RESULTS Although there is significant evidence supporting the effective use of nonsurgical treatments for arm rejuvenation, little in the literature was found on the safety and efficacy of combining such procedures and devices. However, in the authors' clinical experience, combining arm rejuvenation techniques can be done safely and often result in optimal outcomes. CONCLUSION Arm rejuvenation can be safely and effectively achieved with combination nonsurgical aesthetic treatments.
Collapse
|
15
|
Krychman M, Rowan CG, Allan BB, DeRogatis L, Durbin S, Yacoubian A, Wilkerson D. Effect of Single-Treatment, Surface-Cooled Radiofrequency Therapy on Vaginal Laxity and Female Sexual Function: The VIVEVE I Randomized Controlled Trial. J Sex Med 2017; 14:215-225. [DOI: 10.1016/j.jsxm.2016.11.322] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
|
16
|
Kim EJ, Kwon HI, Yeo UC, Ko JY. Lower face lifting and contouring with a novel internal real-time thermosensing monopolar radiofrequency. Lasers Med Sci 2016; 31:1379-89. [PMID: 27389364 DOI: 10.1007/s10103-016-1989-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
As demand for a youthful appearance has increased, various techniques for face lifting and contouring have been used to reduce excess fat deposition and improve skin laxity. Recently, radiofrequency (RF)-assisted lipolysis and liposuction (RFAL) has been introduced for body and face contouring. This study aimed to evaluate the clinical improvement and safety of a new RFAL device for face lifting and contouring. A prospective study was conducted in 20 Korean patients who underwent an internal real-time thermosensing monopolar RFAL procedure. Prior to treatment and 12 and 24 weeks after treatment, digital photographs were taken, and the degree of improvement as measured by investigators and patients was recorded. Skin elasticity was measured using a Cutometer (CT575, Courage and Khazaka®, Cologne, Germany). Safety profiles were also evaluated at each visit. Results showed favorable improvement in skin laxity and fat deposition. Both investigators' evaluations and patients' evaluation showed significant improvement between 12 and 24 weeks. Although the changes in skin elasticity measured by the Cutometer were not statistically significant, all three treated regions showed a trend toward improvement. No major side effects such as infection or burn were observed. The internal, real-time thermosensing monopolar RFAL device showed clinical efficacy and safety. After further studies with more patients and longer follow-up periods, internal real-time thermosensing monopolar RF devices might become one of the popular treatment options for face lifting and contouring.
Collapse
Affiliation(s)
- Eun Jin Kim
- Department of Dermatology, Hanyang University College of Medicine, 221-1 Wangsimri-ro, Seoul, Korea
| | - Hyoung Il Kwon
- Department of Dermatology, Hanyang University College of Medicine, 221-1 Wangsimri-ro, Seoul, Korea
| | - Un Cheol Yeo
- Department of Dermatology, S&U Clinic, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, 221-1 Wangsimri-ro, Seoul, Korea.
| |
Collapse
|
17
|
Levy AS, Grant RT, Rothaus KO. Radiofrequency Physics for Minimally Invasive Aesthetic Surgery. Clin Plast Surg 2016; 43:551-6. [PMID: 27363769 DOI: 10.1016/j.cps.2016.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Radiofrequency energy has a wide range of medical applications, including noninvasive treatment of wrinkles and body contouring. This technology works by differential heating of skin and soft tissue layers causing dermal remodeling or adipolysis, ultimately leading to observable effects. This article reviews the physics of radiofrequency as applied clinically.
Collapse
Affiliation(s)
- Adam S Levy
- Division of Plastic Surgery, Department of Surgery, New York Presbyterian - Weill Cornell Medical Center, New York, NY 10065, USA.
| | - Robert T Grant
- Division of Plastic Surgery, Department of Surgery, New York Presbyterian - Weill Cornell Medical Center, New York, NY 10065, USA
| | - Kenneth O Rothaus
- Division of Plastic Surgery, Department of Surgery, New York Presbyterian - Weill Cornell Medical Center, New York, NY 10065, USA
| |
Collapse
|
18
|
|
19
|
Man J, Goldberg DJ. Safety and efficacy of fractional bipolar radiofrequency treatment in Fitzpatrick skin types V-VI. J COSMET LASER THER 2012; 14:179-83. [PMID: 22658062 DOI: 10.3109/14764172.2012.699682] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of a bipolar fractionated radiofrequency device for the improvement skin texture, fine lines and wrinkles in the treatment of skin types V through VI. DESIGN Fifteen subjects, skin types V and VI, between the ages of 40 and 64 were enrolled. Each received three treatments to the full face with fractionated bipolar RF device (Syneron Inc., Irvine, USA) spaced 30 days apart. Patients were evaluated by the study investigator and a blinded investigator at each treatment and 90 days after the last treatment for the treatment safety and efficacy. SUMMARY A statistically significant improvement in wrinkles, texture and fine lines was noticed in most subjects. Any adverse events in particular post inflammatory hyperpigmentation or hypopigmentation were not seen in any of the patients. CONCLUSION Our study suggests that the use of this fractionated radiofrequency device is a safe and effective method of skin rejuvenation for skin types V through VI.
Collapse
Affiliation(s)
- Jeremy Man
- Skin Laser & Surgery Specialists, Westwood, NJ 07675, United States
| | | |
Collapse
|
20
|
Dobke MK, Hitchcock T, Misell L, Sasaki GH. Tissue Restructuring by Energy-Based Surgical Tools. Clin Plast Surg 2012; 39:399-408. [DOI: 10.1016/j.cps.2012.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Mlosek RK, Woźniak W, Malinowska S, Lewandowski M, Nowicki A. The effectiveness of anticellulite treatment using tripolar radiofrequency monitored by classic and high-frequency ultrasound. J Eur Acad Dermatol Venereol 2011; 26:696-703. [PMID: 21692869 DOI: 10.1111/j.1468-3083.2011.04148.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cellulite affects nearly 85% of the female population. Given the size of the phenomenon, we are continuously looking for effective ways to reduce cellulite. Reliable monitoring of anticellulite treatment remains a problem. OBJECTIVE The main aim of the study was to evaluate the effectiveness of anticellulite treatment carried out using radiofrequency (RF), which was monitored by classical and high-frequency ultrasound. METHODS Twenty-eight women underwent anticellulite treatment using RF, 17 women were in the placebo group. The therapy was monitored by classical and high-frequency ultrasound. The examinations evaluated the thickness of the epidermal echo, dermis thickness, dermis echogenicity, the length of the subcutaneous tissue bands growing into the dermis, the presence or absence of oedema, the thickness of subcutaneous tissue as well as thigh circumference and the stage of cellulite (according to the Nürnberger-Müller scale). RESULTS Cellulite was reduced in 89.286% of the women who underwent RF treatment. After the therapy, the following observations were made: a decrease in the thickness of the dermis and subcutaneous tissue, an increase in echogenicity reflecting on the increase in the number of collagen fibres, decreased subcutaneous tissue growing into bands in the dermis, and the reduction of oedema. In the placebo group, no statistically significant changes of the above parameters were observed. CONCLUSION Radiofrequency enables cellulite reduction. A crucial aspect is proper monitoring of the progress of such therapy, which ultrasound allows.
Collapse
Affiliation(s)
- R K Mlosek
- Department of Diagnostic Imaging of the II Medical Faculty, Medical University of Warsaw, Warsaw, Poland.
| | | | | | | | | |
Collapse
|
22
|
Suh DH, Chang KY, Ryou JH, Lee SJ, Kim HS. Monopolar radio-frequency treatment in Asian skin: A questionnaire-based study. J COSMET LASER THER 2011; 13:126-9. [DOI: 10.3109/14764172.2011.581288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
23
|
Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med 2011; 7:3088-95. [PMID: 20584127 DOI: 10.1111/j.1743-6109.2010.01910.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION All women who have given birth vaginally experience stretching of their vaginal tissue. Long-term physical and psychological consequences may occur, including loss of sensation and sexual dissatisfaction. One significant issue is the laxity of the vaginal introitus. AIM To evaluate safety and tolerability of nonsurgical radiofrequency (RF) thermal therapy for treatment of laxity of the vaginal introitus after vaginal delivery. We also explored the utility of self-report questionnaires in assessing subjective effectiveness of this device. METHODS Pilot study to treat 24 women (25-44 years) once using reverse gradient RF energy (75-90 joules/cm(2) ), delivered through the vaginal mucosa. Post-treatment assessments were at 10 days, 1, 3, and 6 months. MAIN OUTCOME MEASURES Pelvic examinations and adverse event reports to assess safety. The author modified Female Sexual Function Index (mv-FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), Vaginal Laxity and Sexual Satisfaction Questionnaires (designed for this study) to evaluate both safety and effectiveness, and the Global Response Assessment to assess treatment responses. RESULTS No adverse events were reported; no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months (P<0.001). Mean sexual function scores improved: mv-FSFI total score before treatment was 27.6 ± 3.6, increasing to 32.0 ± 3.0 at 6 months (P < 0.001); FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 post-treatment (P < 0.001). Twelve of 24 women who expressed diminished sexual satisfaction following their delivery; all reported sustained improvements on SSQ at 6 months after treatment (P = 0.002). CONCLUSION The RF treatment was well tolerated and showed an excellent 6-month safety profile in this pilot study. Responses to the questionnaires suggest subjective improvement in self-reported vaginal tightness, sexual function and decreased sexual distress. These findings warrant further study.
Collapse
Affiliation(s)
- Leah S Millheiser
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | | | | | | |
Collapse
|
24
|
Ramesh M, Gopal M, Kumar S, Talwar A. Novel Technology in the Treatment of Acne Scars: The Matrix-tunable Radiofrequency Technology. J Cutan Aesthet Surg 2010; 3:97-101. [PMID: 21031069 PMCID: PMC2956966 DOI: 10.4103/0974-2077.69021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Despite the many advances, scarring, particularly acne or pimple scarring, does not have a satisfactory treatment. A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology, which utilizes radiofrequency emission in the treatment of acne scars. Aims: To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes. Settings and Design: A prospective study of 30 randomly selected patients with acne scars was carried out. Material and Methods: Thirty healthy patients with different types of acne scars – ice pick, box and rolling type – were randomly selected. The scars were either shallow or deep, varied in size from 2 to 20 mm and ranged in number from 10 to 50. These patients were first treated with broad-spectrum antibiotics and local exfoliating agents (topical tretinoin 0.025%) and then subjected to matrix-tunable radiofrequency technology. Each scar was treated at intervals of 1 month. A maximum of four such sittings were carried out. Patients were followed-up every 15 days. Results were noted at the end of 2 months and 6 months. Improvement was assessed by using the visual analog scale (VAS) at 2 months and 6 months, and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives. The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit. Results: The VAS improvement in scars ranged from 10 to 50% at the end of 2 months to 20 to 70% at the end of 6 months. Of the 30 patients of acne scars, the cosmetic result was excellent (>60% improvement) in four, good (35–60% improvement) in 18 and moderate to poor (<35% improvement) in eight. A few patients reported burning sensation and a mild sunburn-like sensation for about 1 h after treatment. The patients reported a pinkish tone for 2–3 days. Importantly, with the help of some slight make up, all the 30 patients could return to work the following day. Conclusion: Matrix-tunable radiofrequency technology is a safe and economically viable option for the dermatologists for the treatment of acne scars, because of the effective results coupled with a low downtime.
Collapse
Affiliation(s)
- M Ramesh
- Department of Dermatology, Kempegowda Institute of Medical Sciences Hospital, Bangalore, India
| | | | | | | |
Collapse
|