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Martínez-Pascual MA, Sacristán S, Toledano-Macías E, Naranjo P, Hernández-Bule ML. Effects of RF Electric Currents on Hair Follicle Growth and Differentiation: A Possible Treatment for Alopecia. Int J Mol Sci 2024; 25:7865. [PMID: 39063106 PMCID: PMC11277185 DOI: 10.3390/ijms25147865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Androgenic alopecia (AGA) is the most common type of alopecia and its treatments involve drugs that have various adverse effects and are not completely effective. Radiofrequency-based therapies (RF) are an alternative for AGA treatment. Although there is increasing clinical evidence of the effectiveness of RF for alopecia, its effects at the tissue and cellular level have not been studied in detail. The objective of this study was to analyze ex vivo the potential effect of RF currents used in capacitive resistive electrical transfer (CRET) therapy on AGA. Hair follicles (HFs) were donated by patients with AGA and treated with CRET. AGA-HFs were exposed in vitro to intermittent 448 kHz electric current in subthermal conditions. Cell proliferation (Ki67), apoptosis (TUNEL assay), differentiation (β-catenin), integrity (collagen and MMP9), thickness of the epidermis surrounding HF, proportion of bulge cells and melanoblasts in AGA-HF were analyzed by immunohistochemistry. CRET increased proliferation and decreased death of different populations of AGA-HF cells. In addition, the melanoblasts increased in bulge and the epidermis surrounding the hair follicle thickened. These results support the effectiveness of RF-based therapies for the treatment of alopecia. However, clinical trials are necessary to know the true effectiveness of CRET therapy and other RF therapies for AGA treatment.
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Affiliation(s)
- María Antonia Martínez-Pascual
- Photobiology and Bioelectromagnetic Laboratory, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (M.A.M.-P.); (E.T.-M.)
| | - Silvia Sacristán
- Aptamer Group, Histology Laboratory, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain;
| | - Elena Toledano-Macías
- Photobiology and Bioelectromagnetic Laboratory, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (M.A.M.-P.); (E.T.-M.)
| | - Pablo Naranjo
- Elite Laser Clinic, C/de Orense, 56, 28020 Madrid, Spain;
| | - María Luisa Hernández-Bule
- Photobiology and Bioelectromagnetic Laboratory, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (M.A.M.-P.); (E.T.-M.)
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Menon A, Shauly O, Marxen T, Losken A, Faulkner HR. A Clinical Guide to the Treatment of Cellulite and Comprehensive Review of the Etiology, Pathophysiology, and Utility of Intervention. Aesthetic Plast Surg 2024; 48:1985-1992. [PMID: 38057600 DOI: 10.1007/s00266-023-03762-9] [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: 08/05/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Cellulite is a common esthetic concern affecting most women. Despite its prevalence, there is no consensus on the optimal treatment approach for cellulite, partly due to the complex and multifactorial nature of its pathophysiology. Understanding the underlying biological processes along with available treatment options is important to be able to effectively counsel patients on effective management of this condition. This review aims to focus on high-quality evidence behind pathophysiology of cellulite, severity and grading, and its available treatment options. METHODS A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to pathophysiology, grading scales, and applications of treatment options were utilized. RESULTS Using the existing CSS classification, an evidence-based algorithm is proposed for treatment of cellulite. Mild cellulite is best served with lifestyle modifications such as healthy diet, hydration, and exercise. Use of topicals in mild cellulite patients as adjuncts to lifestyle modifications have the highest efficacy, although there are inconsistent data on topical treatments. Moderate cellulite is best targeted with noninvasive treatment options including laser therapy, radiofrequency, and ultrasound. Radiofrequency demonstrates the strongest efficacy in the current peer-reviewed literature. Severe cellulite is recommended to be treated with minimally invasive approaches such as subcision and injectables. CONCLUSION Cellulite is a challenging cosmetic problem to treat, and thus multimodal treatment options should be considered in an attempt to achieve optimal outcomes and patient satisfaction. As the pathophysiology of cellulite is further elucidated, more targeted treatments may be developed in the future. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ambika Menon
- Emory University School of Medicine, Atlanta, Georgia
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Troy Marxen
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Heather R Faulkner
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia
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Rothaus K, Brown C. Evaluation of a Combination Approach to Improving Muscle Tone and Decreasing Subcutaneous Tissue Thickness Using a Sequential, Dual-Modality, Energy-Based Device. Aesthet Surg J Open Forum 2024; 6:ojae024. [PMID: 38938929 PMCID: PMC11210056 DOI: 10.1093/asjof/ojae024] [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: 06/29/2024] Open
Abstract
Background The body shaping market has long been at the forefront of the aesthetic industry. With technological advances, patient demand for body sculpting in terms of reduction in subcutaneous tissue and enhancement of muscle has seen continual growth. Several devices have emerged in the space; however, few achieve both subcutaneous tissue reduction (SQR) and voluntary muscle increase (VMI) as measured by thickness, during the same treatment session. Objectives This article presents the results of a pilot study on a unique approach to subcutaneous tissue reduction and increasing muscle thickness using a dual-modality, energy-based device. Methods Twelve compliant patients (8 females and 4 males with an average age of 40 years) were enrolled in this single center, prospective study. All patients were treated with the dual-modality device (850 nm superluminescent diode matrix and electrical muscle stimulation), with external applicators being placed over the lower abdomen. The patients received 5 weekly treatments. Ultrasound measurements, photographs, weight, and waist measurements were taken at baseline, prior to the start of the fifth treatment, and at the 2-week and 2-month follow-up visits. Results At the 2-month follow-up visit, the average SQR was 34.03% and the VMI measured 22.97% in all patients who completed the study. All patient and physician evaluations rated the results as satisfactory or better. There were no complications. Conclusions Preliminary data show this dual-modality, electrical muscle stimulation/superluminescent diode matrix system provides both a safe and effective treatment for the reduction of subcutaneous tissue thickness and an increase in muscle definition and thickness. Objective and subjective evaluations demonstrated high levels of efficacy and satisfaction in all patients. Level of Evidence 2
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Affiliation(s)
- Kenneth Rothaus
- Corresponding Author: Dr Kenneth Rothaus, 325 East 72nd Street, New York, NY 10021, USA. E-mail: ; Instagram: @rothaus_md
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Toledano-Macías E, Martínez-Pascual MA, Hernández-Bule ML. Electric currents of 448 kHz upregulate anti-senescence pathways in human dermal fibroblasts. J Cosmet Dermatol 2024; 23:687-700. [PMID: 37945550 DOI: 10.1111/jocd.16019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Currently, finding new therapeutic strategies that reduce skin aging is a challenge for dermatologists and aesthetic doctors. In recent years, physical therapies have been included in the options for antiaging treatments; however, the biological bases of such treatments have scarcely been studied. One of these physical therapies is capacitive-resistive electric transfer (CRET) therapy. Previous studies have shown that subthermal treatment with CRET promotes the proliferation and migration of various cell types involved in skin regeneration, such as human ADSC (stem cells), fibroblasts, or keratinocytes. OBJECTIVE This study investigates the effects of in vitro treatment with CRET-Std (standard, non-modulated signal) or CRET-Mod (modulated signal) on cell proliferation and migration, markers of aging, and extracellular matrix production. METHODS Three types of human dermal fibroblasts were used: neonatal fibroblasts (HFn), replicative senescent fibroblasts (HFs), and adult fibroblasts (HFa). The effects of electric stimulation on cell proliferation and migration were studied through XTT and wound closure assays, respectively. The expression of the aging marker β-galactosidase was assessed using a colorimetric assay, whereas immunoblot, immunofluorescence, and ELISAs were carried out to analyze the expression levels of migration, aging, and extracellular matrix proteins. RESULTS The treatment with CRET-Std increased HFn and HFa proliferation, as well as migration in the three types of fibroblasts studied compared to those of the controls. Conversely, CRET-Mod did not modify either of these two processes with respect to the controls. Additionally, CRET-Std also reduced the cellular senescence markers β-gal, vimentin, p53, and p21 in all three types of human skin fibroblasts. In addition, the application of CRET-Std also induced fibronectin production in HFn and was able to stimulate ECM neocollagenesis. CONCLUSION CRET treatment improves a number of functions related to migration and proliferation, and it reduces age-related cellular changes in human dermal fibroblasts. Therefore, the use of this CRET therapy to reduce the signs of dermal aging and to promote tissue regeneration could be of interest.
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Affiliation(s)
- Elena Toledano-Macías
- Bioelectromagnetic Laboratory, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - María Luisa Hernández-Bule
- Bioelectromagnetic Laboratory, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Dhillon RK, Dayan SH, Hexsel D, Shridharani S, Chilukuri S, LaTowsky B, Fabi SG. Update: Cellulite Therapies and Optimizing Treatment Combinations. Aesthet Surg J 2023; 43:1508-1520. [PMID: 37184131 DOI: 10.1093/asj/sjad143] [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: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. LEVEL OF EVIDENCE: 5
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Shauly O, Marxen T, Menon A, Gould DJ, Miller LB, Losken A. Radiofrequency Microneedling: Technology, Devices, and Indications in the Modern Plastic Surgery Practice. Aesthet Surg J Open Forum 2023; 5:ojad100. [PMID: 38887534 PMCID: PMC11181949 DOI: 10.1093/asjof/ojad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Background Since the initial invention of microneedling, advancements have been made to improve the desired effects. The addition of radiofrequency to microneedling devices was developed within the past decade as a way to induce thermal injury and increase dermal heating to enhance the dermal wound healing cascade. Objectives With an overabundance of literature and mainstream media focused on microneedling and radiofrequency microneedling, this review aims to focus on the available high-quality evidence. Methods A comprehensive review of the literature was performed across PubMed (National Institutes of Health, Bethesda, MD) and Embase (Elsevier, Amsterdam, the Netherlands) databases. Attention was focused on manuscripts that provided objective data with respect to clinical application, innovation, anatomy, and physiology. Results Optimal outcomes are achieved when needle depth is targeted to the reticular dermis. Needle depth should reflect the relative differences in epidermal and dermal thickness throughout the face. A depth of at least 1.5 mm should be used for the forehead and temporal skin, 1.0 mm for the malar region, 2.0 mm (maximum depth for radiofrequency microneedling) for the nasal side walls, 0.5 mm for the perioral skin, and 1.5 mm for the neck. Deeper settings can be used with care to provide some fat reduction in the submentum. Conclusions The authors find herein that radiofrequency microneedling is a safe adjunctive tool to surgical aesthetic procedures. The addition of radiofrequency poses an advance over traditional microneedling devices for skin tightening, with improvements in both safety and efficacy over time. Level of Evidence 5
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Affiliation(s)
- Orr Shauly
- Corresponding Author: Dr Orr Shauly, Division of Plastic Surgery, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA. E-mail: ; Instagram: @orrshaulymd
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Ma Y, Huang Q, Ji X, Bai J. A Three-dimensional Simulation Based on Radiofrequency Electrothermal Coupling fields for Skin Rejuvenation . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083140 DOI: 10.1109/embc40787.2023.10340026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Radiofrequency (RF) current is used as an effective non-ablative method for skin rejuvenation. However, mixed results have been reported using different home-use RF devices. In order to evaluate the safety and effectiveness of home-use RF devices, this study has provided a three-dimensional (3D) simulation procedure based on the electrothermal coupling model for home-use RF devices. Firstly, the tissue geometric model with the setting electrode shapes was established and then imported into the simulation software. Secondly, electrical and thermal boundary conditions with excitation voltages were loaded to the corresponding components. In addition, the items of 3D temperatures at all locations and key temperatures of the tissue were assessed. The results have shown the temperature distributions of four commercial RF products, respectively. This 3D RF electrothermal coupling simulation can be conducted quickly and effectively to obtain the temperature and electric distribution of the home-use RF devices at different using periods, which is also useful for the design of home-use RF devices.Clinical Relevance- This study provides a simple and effective simulation procedure for device developers to evaluate the home-use RF devices when designing products. This simulation is also helpful for customer decision-making and performance evaluation considering different devices.
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Hypertrophic Scars of the Hand: The Role of Electrophotobiomodulation Theory as a Recent Line of Treatment. Plast Reconstr Surg 2023; 151:375-383. [PMID: 36696322 DOI: 10.1097/prs.0000000000009962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND A more enduring strategy for the treatment of hypertrophic scars of the hand is still a challenge facing restorative dermatologists and plastic surgeons. Nonetheless, with the use of nonablative devices, intense pulsed light and different types of lasers have started to yield promising outcomes and are close to becoming an effective and dependable technique. The advances in radiofrequency energy have brought new life to optical-based frameworks. Radiofrequency current delivers an unadulterated heat effect according to the electrical response characteristics of each tissue. The purpose of this study was to assess the patient satisfaction, safety, and clinical efficacy of the use of electrophotobiomodulation (combined intense pulsed light and radiofrequency energy) in the treatment of postburn hypertrophic scars of the hand. METHODS This was a prospective clinical study that was performed on 56 patients who presented with postburn hypertrophic scars on the hands between March of 2013 and January of 2020. RESULTS The clinical appraisal showed excellent results in 33 patients (58.9%), good results in 18 patients (32.2%), fair results in five patients (8.9%), and no poor results. CONCLUSION The use of radiofrequency energy combined with intense pulsed light was effective for the treatment of hand scars on people with various skin tones. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Kolczewski P, Kozłowski M, Cymbaluk-Płoska A. Micro-Focused Ultrasound Therapy in Patients with Urogenital Atrophy and Vaginal Laxity. J Clin Med 2022; 11:jcm11236980. [PMID: 36498554 PMCID: PMC9739894 DOI: 10.3390/jcm11236980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Vaginal laxity (VL) and genitourinary syndromes of menopause (GSM) create physical, psychological, and functional problem for women and their partners. We aimed to evaluate the efficacy and safety of micro-focused ultrasound (MFU) therapy performed twice in the vaginal canal in a patients with VL and GSM. A total of 20 women with GSM and VL were treated with MFU Ultravera by Hironic. The treatment course consisted of two vaginal applications of MFU at an interval of 6 weeks. The clinical effects of the protocol were evaluated using the Vaginal Laxity Questionnaire (VLQ), the Vaginal Health Index (VHI), and the Female Sexual Function Index (FSFI). The overall values of the vaginal laxity evaluation for the total subject population showed a statistically significant improvement between the baseline and the findings at 3 and 6 months after treatment. The effect of therapy was consistent across all domains of FSFI. It peaked at the 6 week follow-up visit (from 26.5 to 32) and plateaued at 12 weeks and 6 months. There was a significant VHI improvement over time, with the greatest and most significant change between the study entry and 21 days after treatment; the VHI score leveled off up to 3 months after the procedures. MFU therapy, performed twice in the vaginal canal, showed promising efficacy and safety profiles, meriting further investigation.
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Manuskiatti W, Nanchaipruek Y, Gervasio MK, Lektrakul N, Apinuntham C. Combination of monopolar 2 MHz radiofrequency and electrical multidirectional stimulation for reducing abdominal circumference and enhancing the muscle definition in subjects with overweight range body mass index. Lasers Surg Med 2022; 54:1198-1206. [PMID: 36183371 PMCID: PMC9828667 DOI: 10.1002/lsm.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/17/2022] [Accepted: 09/22/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The popularity of noninvasive body contouring procedures has been steadily increasing in recent years, however, studies evaluating its effectiveness in individuals with overweight range body mass index (BMI) are limited. OBJECTIVE To evaluate the efficacy and safety of combined 2 MHz radiofrequency (RF) and electrical multidirectional stimulation (EMDS) for the improvement of the abdominal contour in subjects with overweight range BMI. METHODS Twelve participants with overweight range BMI (23.6-24.9 kg/m2 ) underwent a single RF treatment, followed by a series of six EMDS treatments. Follow-up assessments (abdominal circumference [AC] and skinfold thickness measurements) were scheduled 1, 2, and 3 months after the final session. RESULTS At 1 month after the final treatment, a 3.1% (2.6 ± 0.47 cm, mean ± SD) significant reduction in mean AC was observed (p ˂ 0.001) and a maximal skinfold thickness reduction of 14% (4.6 ± 1.1 mm) was also noted (p = 0.032). Transient dysesthesia lasting 2-3 hours after EMDS treatment was the most common adverse effect reported by 5 of 12 subjects (41.7%), with no other serious side effects. CONCLUSIONS Combined RF and EMDS treatments are safe and effective, yielding significant reductions in both AC and skinfold thickness in patients with overweight range BMI, causing only minimal and transient adverse effects.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Mia Katrina Gervasio
- Department of Dermatology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Nittaya Lektrakul
- Department of Radiology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Chalermkwan Apinuntham
- Department of Dermatology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
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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.
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Not all Radiofrequency Devices Are Created Equal: A Thermal Assessment. Plast Reconstr Surg Glob Open 2022; 10:e4077. [PMID: 35141101 PMCID: PMC8820913 DOI: 10.1097/gox.0000000000004077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022]
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Friedman O, Artzi O, Haran O. Preauricular Aging: A Three-Point Grading System to Guide Treatment in Facial Rejuvenation. Aesthetic Plast Surg 2021; 45:2180-2187. [PMID: 33851254 DOI: 10.1007/s00266-021-02255-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aging affects the face in all its dimensions. However, more has been published about the improvement of the periocular, midface, and perioral aging changes. We believe the profile view, particularly the preauricular area, is of great value when assessing the need for facial contouring procedures, as well as their effectiveness. OBJECTIVE To develop and evaluate a classification based on the aging changes around the preauricular area, which aims to provide an objective direction to the appropriate treatment method. METHODS AND MATERIALS All patients who attended the clinic for different aesthetic procedures between June 2019 and January 2020 were photographed. Two non-treating dermatologists and two non-treating plastic surgeons were asked to evaluate the perceived aging of the preauricular area using a three-point grading system. The assessment of each photograph was made once by each evaluator, and the inter-rater correlation was calculated. RESULTS A total of 158 profile pictures of the preauricular area of 158 patients were evaluated by two non-treating dermatologists and two non-treating plastic surgeons. The inter-rater correlation was excellent at 0.942. The mean grading system of the patient samples was 1.42, with a standard deviation of 0.9 and a variance of 0.001. CONCLUSIONS The preauricular area is often overlooked and undertreated. Our results demonstrate an excellent inter-rater correlation between plastic surgeons and dermatologists at assessing the degree of aging in the area. This relatively hidden lateral area can serve as a test point, evaluating response to selected treatment before proceeding to full-face intervention. We suggest using a simple three-point scale to help guide treatment of the preauricular area and as part of our holistic approach to facial rejuvenation. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Oliveira Paggiaro A, Pinheiro R, Soares K, Fernandes Carvalho V, Gemperli R. Evaluation of the evidence level for the use of radiofrequency in aesthetic treatments: A systematic review and meta-analysis. J Cosmet Dermatol 2021; 20:2691-2702. [PMID: 34333828 DOI: 10.1111/jocd.14353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radiofrequency (RF) is a non-invasive or minimally invasive procedure with a low risk of complications. It has been employed for several aesthetic purposes. AIM This study aimed to conduct a systematic literature review on the use of RF for aesthetic applications and assess the level of accumulated evidence for each condition. METHODS Using the MEDLINE/PubMed and EMBASE databases, we searched for articles published from 2009 to 2019 describing the use of RF treatment for aesthetic purposes. RESULTS Our search approach identified 25 randomized clinical trials investigating the efficacy of RF in the following clinical situations: body contour improvement, facial rejuvenation, acne scar treatment, alopecia, and rosacea. There were problems with the quality of the studies, especially regarding selection, performance, and detection bias. CONCLUSION Our study revealed that RF treatment is potentially promising in all of the evaluated clinical situations; however, we were not able to identify a level of evidence that justifies its use over other therapeutic options currently available on the market.
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Affiliation(s)
- André Oliveira Paggiaro
- Plastic Surgery Department, São Paulo University, São Paulo, Brazil.,Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Rafael Pinheiro
- Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Kaolanna Soares
- Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Rolf Gemperli
- Plastic Surgery Department, São Paulo University, São Paulo, Brazil
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Kam J, Frost A, Bloom JD. Radiofrequency Rejuvenation of the "Tweener" Patient: Under, Over, or Through the Skin. Facial Plast Surg 2021; 37:240-248. [PMID: 33511577 DOI: 10.1055/s-0041-1722890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The demand for noninvasive facial rejuvenation continues to increase as younger, well-informed patients enter the aesthetic market. We refer to a subset of these patients as "tweeners," those who present with early signs of neck and facial aging, but who have not yet developed changes significant enough to warrant a traditional excisional surgery approach. Many of these patients are in search of a minimally invasive intervention, a bridge in between observation and surgery. The authors describe their experience with radiofrequency (RF) technology as an in-office tool to address the aging face in a select patient population. This review also attempts to comprehensively search the existing body of literature to describe the RF technologies and devices available for facial rejuvenation. The efficacy and safety profiles of the devices are discussed, and the devices are categorized by their method of RF delivery-over (contact), through (microneedle), and under (percutaneous) the skin.
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Affiliation(s)
- Joanna Kam
- Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariel Frost
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason D Bloom
- Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.,Bloom Facial Plastic Surgery, Bryn Mawr, Pennsylvania
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Aesthetic Applications of Radiofrequency: Lymphatic and Perfusion Assessment. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3193. [PMID: 33173697 PMCID: PMC7647541 DOI: 10.1097/gox.0000000000003193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/18/2020] [Indexed: 12/03/2022]
Abstract
Background: The use of radiofrequency in aesthetics has increased in popularity since the early 2000s. To date, there have been limited studies investigating the effect of thermal energy secondary to radiofrequency treatment. The purpose of this study was to evaluate perfusion and lymphatic assessment tools pre and post bipolar and fractional radiofrequency treatment. Methods: A retrospective IRB-approved study was conducted between January 2019 and April 2019. Patients who were independently deemed appropriate candidates for radiofrequency soft tissue remodeling were evaluated. Diagnostic perfusion and lymphatic imaging obtained were reviewed using indocyanine green (SPY, Stryker) and optical coherence tomography (Vivosight OCT). Results: A total of 63 patients were treated during the study period, of which 37 had diagnostic perfusion and lymphatic imaging. Average patient age was 47 (STD 12), 95% (35/37) of patients were women, and no patients were active smokers. In total, 27% (10/37) of patients were post-surgical patients with recurrent laxity, 32% (12/37) did not have enough skin laxity to justify traditional excisions procedures, and 41% (15/37) may have been candidates for excisional procedures but were willing to accept more moderate results to avoid excisions surgery. Indocyanine green perfusion and lymphatic assessment for bipolar and fractional radiofrequency, as well as optical coherence tomography pre and post radiofrequency, did not show compromise from thermal injury. Conclusions: This study supports safety of radiofrequency in terms of preservation of tissue perfusion and lymphatic drainage. This correlated to our low clinical incidence of burns, prolonged swelling, or tissue ischemia.
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A retrospective study of neck rejuvenation using a noninsulated microneedle radiofrequency in Chinese subjects. Lasers Med Sci 2020; 36:1261-1266. [PMID: 33113076 DOI: 10.1007/s10103-020-03175-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022]
Abstract
Large-scale long-term retrospective study of noninsulated microneedle radiofrequency treatment on neck rejuvenation is lacking. We conducted a 3-year retrospective observation of subjects treated with noninsulated microneedle radiofrequency (NIMNRF) for neck rejuvenation in Chinese subjects. Of all subjects, 28 subjects (28.6%) received only 1 session of treatment. About 50% subjects achieved ≥ 50% improvement, and average improvements were 37.0% at 3 months follow-up (M3) and 41.6% at 6 months follow-up (M6). Seventy subjects (71.4%) accepted 3 sessions of treatments. The neck aging scores were 3.57 ± 1.28 at baseline, and significantly decreased to 1.10 ± 0.84 at M3 (p < 0.05), 1.04 ± 0.86 (p < 0.05) at M6, separately. The average improvements were 73.3% at M3 and 75.1% at M6. It showed a trend of better efficacy with the increasing number of sessions (p < 0.05). Among of 6 subjects who was followed up for 1 year, 5 subjects who received 3 sessions of treatment achieved about 70% improvement after final session, and another 1 subject who received 1 session remained the improvement up to 40%. The results demonstrate NIMNRF treatment has significant and long-lasting effect on neck laxity and wrinkle reduction with minimal discomfort and downtime.
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Somenek MT, Ronan SJ, Pittman TA. A Multi-Site, Single-Blinded, Prospective Pilot Clinical Trial for Non-Invasive Fat Reduction of the Abdomen and Flanks Using a Monopolar 2 MHz Radiofrequency Device. Lasers Surg Med 2020; 53:337-343. [PMID: 32621362 DOI: 10.1002/lsm.23295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Demand for non-invasive body sculpting procedures has been steadily increasing, spurring the development of new energy-based technologies. This study assessed the safety and efficacy of a new monopolar 2 MHz radiofrequency (RF) device for fat reduction of the flanks and abdomen. STUDY DESIGN/MATERIALS AND METHODS Nineteen subjects from two clinical sites were enrolled in this study and received a single 15-minute treatment with the 2 MHz RF device. Up to six applicators were placed on the abdomen and/or flanks during the treatment. Follow-up assessments were scheduled 12 weeks after treatment. Efficacy evaluations included live ratings and Global Aesthetic Improvement Scale (GAIS) ratings by blinded investigators, ultrasound measurements of fat thickness, and patient-reported outcomes before and after treatment. RESULTS Investigator assessments showed more than one-point change in the GAIS scale at the 12-week follow-up visit. Ultrasound measurements revealed a significant reduction in fat thickness in both the abdomen (average 24%) and the flanks (22%). The majority of the patients were satisfied with the treatment and mild self-resolving side effects were observed. No serious adverse events were reported. CONCLUSIONS Treatment of local adiposities with a new monopolar 2 MHz radiofrequency device leads to improvement of body contour with no downtime or side effects. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
| | | | - Troy A Pittman
- Advanced Plastic Surgery, Washington, District of Columbia
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Radiofrequency Treatment of Labia Minora and Majora: A Minimally Invasive Approach to Vulva Restoration. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2418. [PMID: 32440388 PMCID: PMC7209841 DOI: 10.1097/gox.0000000000002418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/29/2019] [Indexed: 11/26/2022]
Abstract
Labiaplasty has rapidly increased in popularity over the past 5 years.Traditional labiaplasty is associated with potential complications, such as dehiscence, hematoma, flap necrosis, narrowed introitus, pain, and asymmetry. Minimally invasive techniques such as radiofrequency (RF) have emerged as viable alternatives to traditional labiaplasty through a temperature-controlled bipolar mechanism to heat tissues to target temperatures of 40°C–45°C. This controlled energy delivery leads to an inflammatory cascade initiating neocollagenesis, angiogenesis, and elastogenesis over the coming 3–4 months. A single surgeon series of labia minora and majora treatment by RF (InMode, Lake Forrest, Calif.) was reviewed between April 2018–October 2018. Demographic data were collected as well grade of hypertrophy (pre/posttreatment), number of vaginal deliveries, and reason for treatment. Procedural parameters were recorded, including internal/external temperatures, total energy used, and time of treatment. All adverse events were recorded. Objective and subjective data points were obtained in the form of patient surveys and photographic evaluation by lay persons as well as plastic surgeons objective to the treatment. Ten consecutive patients were treated with bipolar RF (InMode, Lake Forrest, Calif.) between April 2018–October 2018. Mean age was 44 (29–54). Average number of pregnancies was 2 (STD 1.1). Three patients were treated for aesthetic concerns, 3 for functional complaints, and 4 desired improvement in both. Overall graded improvement in labia size/contour was +50% (STD ±15.3). Patient satisfaction scale data demonstrated 9.5/10 (±1.7). All patients (10/10) stated that they would undergo treatment again. In all cases, the surgeon observed tightening of the clitoral hood, introitus, forchett, as well as improved distribution of dark pigmentation of the labia minora. There were no significant complications and no need for additional procedures. Average recovery time was 14 days (STD 2.2). Treatment of labia hyperplasia and laxity with bipolar RF may potentially fill a treatment gap of women seeking aesthetic and functional improvements without surgical labiaplasty. A powered prospective randomized double-blinded study is needed to further elucidate the role of this technology.
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Abstract
Cosmetic devices using non-ionizing radiation (NIR) are increasingly available for people who wish to modify their appearance for aesthetic purposes. There are a wide range of NIR modalities used for cosmetic procedures, including devices that use optical radiation (laser, intense pulsed light, and light-emitting diode), electromagnetic fields, and ultrasound. Common procedures involving the application of NIR include epilation, skin rejuvenation, body sculpting and contouring, treatment of vascular and skin lesions, tattoo removal, and scar reduction. The majority of research on the use of NIR cosmetic devices has focused on the efficacy of the treatment rather than adverse effects or complications. Studies that assessed safety consisted mostly of case reports and small case series. Common adverse effects on the skin reported include mild and transient pain, erythema, swelling, and changes in pigmentation. Less common, more severe side effects include burns, blisters, scarring, persisting erythema, altered pigmentation, and eye damage. Some of the latter may have resulted from treatment errors. Particular groups of people that may be at greater risk from optical radiation include people with dark skin, with high sun exposure, and taking photosensitizing medications or supplements. There is lack of evidence for the safety profile of cosmetic NIR procedures during pregnancy. Reports of injuries to workers administering treatments with cosmetic NIR devices are rare, but inadvertent damage to the eye from optical devices may occur. Randomized controlled trials are required to fully assess potential adverse effects from the use of NIR cosmetic devices. Regulation varies worldwide and some regions apply the same safety classification and guidance as for medical devices. In order to reduce harm associated with the use of cosmetic devices, ICNIRP considers it important that regulations that cover all types and frequencies of cosmetic NIR devices are adopted worldwide and that there is greater oversight regarding their use.
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Cellulite: Patient Selection and Combination Treatments for Optimal Results—A Review and Our Experience. Dermatol Surg 2019; 45:1171-1184. [DOI: 10.1097/dss.0000000000001776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Sadick N. Treatment for cellulite. Int J Womens Dermatol 2018; 5:68-72. [PMID: 30809581 PMCID: PMC6374708 DOI: 10.1016/j.ijwd.2018.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
Cellulite is a multifactorial condition that is present in 80% to 90% of postpubertal women and is one of the most intolerable esthetic imperfections. There are several theories on the pathophysiology of cellulite, and a number of different therapeutic regimens have been developed, from topical treatments to mechanical or energy-based devices. In this brief review, we summarize the scientific landscape to determine the clinical evidence with regard to the safety and efficacy of cellulite treatment options. Clinical protocols and the author’s experience using a combination of internal and external procedures are also discussed. Studies using laser and light modalities along with radiofrequency have shown improvements in cellulite and a good safety profile, but acoustic wave therapy, subcision, and the 1440-nm Nd:YAG minimally invasive laser have demonstrated the most beneficial results in cellulite reduction. Although there is paucity of scientific evidence for treatments that improve cellulite, future emerging options and their combination may pave the way to eradicate this primarily cosmetic esthetic concern.
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Affiliation(s)
- Neil Sadick
- Department of Dermatology, Weill Cornell Medical College, New York, New York.,Sadick Dermatology, New York, New York
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24
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Abstract
Men seek cosmetic procedures for vastly different reasons than women. Men often seek discrete cosmetic services with little downtime. Male skin structure generally differs from female skin structure. Dermatologists should consider subtle differences in the psyche of the male cosmetic patient.
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Bohnert K, Dorizas A, Sadick N. Prospective, pilot evaluation of the performance of nanofractional radiofrequency for improvement of skin texture via skin resurfacing. J Cosmet Dermatol 2017; 17:61-65. [PMID: 29090501 DOI: 10.1111/jocd.12398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The latest generation of radiofrequency, nanofractional radiofrequency, allows the heat energy to be delivered through the use of pins or needles as electrodes, facilitating increased efficacy and reduced pain, downtime, and side effects. OBJECTIVE The objective of this prospective pilot clinical study was to evaluate the efficacy of nanofractional radiofrequency in skin resurfacing. METHODS AND MATERIALS Seventeen subjects were enrolled in the study, and each received three nanofractional radiofrequency (160-pin tip) treatments in the facial area at 3-week intervals. Follow-up visits were scheduled at 1 and 2 months after the final treatment. Clinical photography, patient, and investigator assessments were conducted during the treatment visits and follow-up. RESULTS All subjects completed the study. At the 1- and 2-month follow-up, there was a moderate to significant improvement (2.6 and 3.5, respectively, P = .01) according to the investigator global esthetic improvement scale rating. Most subjects reported that they were satisfied or very satisfied with the outcome and level of comfort. CONCLUSION Nanofractional radiofrequency is a safe and effective strategy for improving texture, tone, and skin laxity with high patient satisfaction and tolerable safety profile.
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Affiliation(s)
| | | | - Neil Sadick
- Sadick Dermatology, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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Effects of Multipolar Radiofrequency and Pulsed Electromagnetic Field Treatment for Face and Neck Rejuvenation. Dermatol Res Pract 2017; 2017:4146391. [PMID: 28373880 PMCID: PMC5360959 DOI: 10.1155/2017/4146391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/28/2017] [Indexed: 11/23/2022] Open
Abstract
Skin aging is a gradual process that leads to wrinkle formation, laxity, and overall changes in skin appearance. In recent years, the demands to noninvasive treatments for facial rejuvenation increased, along with a variety of technologies and devices, such as radiofrequency. The present study aimed to evaluate the clinical effects of a multipolar radiofrequency and pulsed electromagnetic field treatment for face and neck rejuvenation. Eleven patients with mild to moderate grades of photoaging underwent eight radiofrequency and pulsed electromagnetic field treatment sessions, once a week. Clinical photographs were taken before and a week after the end of the treatment, and improvement of facial skin parameters was evaluated by two different investigators. Significant improvement in skin laxity was observed in all eleven patients (100%). Improvement in facial contour was noted in 73% and 100% of patients when analyzed by investigators A and B, respectively. The score for overall improvement in skin condition was 3 ± 0.78 for investigator A and 3.6 ± 0.67 for investigator B. All patients were satisfied with the procedure and noted significant improvement in the skin. The combined multipolar radiofrequency and pulsed electromagnetic field device is effective and safe for treatment of aged skin in Brazilian patients.
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Nicoletti G, Perugini P, Bellino S, Capra P, Malovini A, Jaber O, Tresoldi M, Faga A. Scar Remodeling with the Association of Monopolar Capacitive Radiofrequency, Electric Stimulation, and Negative Pressure. Photomed Laser Surg 2017; 35:246-258. [PMID: 28128685 PMCID: PMC5439422 DOI: 10.1089/pho.2016.4180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: A study was established to objectively assess the effects of low-intensity electromagnetic and electric stimulation plus negative pressure on mature scars. Background: Radiofrequency plus negative pressure therapy demonstrated a favorable reorganization and regeneration of the collagen and elastic fibers and was proposed for the treatment of cellulitis and skin stretch marks. Methods: Twenty-six mature scars in 20 Caucasian patients (15 females and 5 males) were enrolled in the study. The treatments were carried out with a Class I, BF-type electromedical device equipped with a radiofrequency generator, an electric pulse generator, and a vacuum pump twice a week for 3 months. Corneometry, transepidermal water loss, elastometry, colorimetry, and three-dimensional skin surface pattern were objectively assessed with Multi Probe Adapter System MPA and PRIMOS pico. A subjective assessment was carried out with the VAS and PSAS scales. Each scar was compared before and after the treatment and with the skin in the corresponding healthy contralateral anatomical area at the same times. Results: Reduction of the scar surface wrinkling and overall scar flattening were demonstrated after the treatment. The scar slightly tended to approach the color and elasticity of healthy skin too. Conclusions: The combined local treatment of mature scars with low-intensity electromagnetic and electric stimulation in association with negative pressure might suggest a favorable synergic effect on the scar collagen and elastic fiber remodeling.
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Affiliation(s)
- Giovanni Nicoletti
- 1 Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy .,2 Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia , Pavia, Italy .,3 Plastic and Reconstructive Surgery Unit, Istituti Clinici Scientifici Maugeri , Pavia, Italy
| | - Paola Perugini
- 4 Department of Drug Sciences, University of Pavia , Pavia, Italy
| | - Sara Bellino
- 1 Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy
| | - Priscilla Capra
- 4 Department of Drug Sciences, University of Pavia , Pavia, Italy
| | - Alberto Malovini
- 5 Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri , Pavia, Italy
| | - Omar Jaber
- 6 Freelance Plastic Surgeon, San Martino Siccomario , Pavia, Italy
| | - Marco Tresoldi
- 1 Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy .,3 Plastic and Reconstructive Surgery Unit, Istituti Clinici Scientifici Maugeri , Pavia, Italy
| | - Angela Faga
- 1 Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy .,2 Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia , Pavia, Italy .,3 Plastic and Reconstructive Surgery Unit, Istituti Clinici Scientifici Maugeri , Pavia, Italy
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