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Jalalabadi F, Rohrich RJ. The 10-7 Facial Analysis Method for Face Lifting and Facial Rejuvenation. Plast Reconstr Surg 2024; 154:275e-282e. [PMID: 37220216 DOI: 10.1097/prs.0000000000010739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
SUMMARY Proper facial analysis is the first step toward delivering an excellent result in any face lifting or facial rejuvenating operation or procedure. Every case should be approached in a systematic and comprehensive manner, ensuring proper assessment of specific anatomic regions contributing to facial aging as well as the global facial aesthetic. Failure to do so may result in an unnatural or partially rejuvenated face. The senior author's (R.J.R.) approach entails 10 key anatomic regions on the frontal view and 7 on the lateral view. The 10-7 facial analysis method allows the surgeon to reliably assess every patient in a detailed, top-down, structural approach when considering face lifting or facial rejuvenation.
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Affiliation(s)
- Faryan Jalalabadi
- From the Division of Plastic and Reconstructive Surgery, University of Southern California
| | - Rod J Rohrich
- Division of Plastic Surgery, Baylor College of Medicine
- Dallas Plastic Surgery Institute
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2
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Flegontova E, Kreindel M, Vranis NM, Mulholland RS. Correction of age-related changes in the skin at the dermal and subdermal level using radiofrequency macroneedling therapy. J Cosmet Dermatol 2024; 23:2401-2410. [PMID: 38778550 DOI: 10.1111/jocd.16361] [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: 09/26/2023] [Revised: 02/08/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The negative effects of skin aging are primarily related to the destruction of dermal architectural structure. More specifically, this includes changes in the spatial arrangement of collagen, elastin fibers, mucopolysaccharides, proteoglycans, and ground substances. AIMS The purpose of this study is to investigate the histologic effects of dermal and subdermal tissue after a controlled single treatment with radiofrequency (RF) macroneedling. This therapy provides a controlled, localized, thermal effect on the dermis whereby triggering the body's own healing processes of extracellular matrix remodeling. Clinically benefits include skin tightening. METHODS Biopsies were obtained for histologic evaluation from four patients (n = 4), 4 weeks after completing a single RF macroneedling facial treatment. RESULTS Age-related changes of the dermal and subdermal architecture were observed at baseline. After treatment, all biopsies demonstrated an increase in epidermal cells, collagen, elastin, fibroblasts, vasculature, and a decrease in inflammatory cells. CONCLUSIONS The results of this histologic study confirm a significant "subsurfacing" thermal effect from the noncoagulative ascendant thermal injury. The obtained results characterize RF macroneedling therapy as an effective method for correcting age-related changes in facial skin.
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Affiliation(s)
- Elena Flegontova
- Moscow Clinical Hospital by Speransky, Moscow, Russia
- Laboratory Angiopharm Private Clinic, Moscow, Russia
| | | | - Neil M Vranis
- Division of Plastic Surgery, Department of Surgery, Cedars Sinai Hospital, Los Angeles, California, USA
- Private Practice, Ghavami Plastic Surgery, Beverly Hills, California, USA
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3
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Huang X, Zheng S, Chen P, Zhu M, Guo J, Li Q, Zeng K, He S. Effective treatment of corticosteroid-induced facial erythema using fractional radiofrequency microneedling. Lasers Surg Med 2024; 56:466-473. [PMID: 38693708 DOI: 10.1002/lsm.23787] [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: 01/23/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To investigate the efficacy of Fractional Radiofrequency Microneedling (FRM) in treating corticosteroid-induced facial erythema. METHODS A retrospective study was conducted involving eight patients diagnosed as corticosteroid-induced facial erythema. Each patient underwent a single session of FRM. Evaluative measures included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), assessment of telangiectasia severity, procedure-associated pain (10-point scale), patient satisfaction (3-point scale) and secondary outcomes. RESULTS The study found a 75% success rate and 100% effectiveness rate in alleviating erythema symptoms. CEA and PSA scores decreased by 67.7% and 78.1%, respectively. No cases of erythema rebound were recorded during the 3-month follow-up period. CONCLUSIONS FRM demonstrated effectiveness and safety in treating facial erythema, offering promising advancement in dermatologic therapeutics.
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Affiliation(s)
- Xiaowen Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siqi Zheng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Menghua Zhu
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Guo
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sijin He
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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4
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Vranis NM, Ghavami A, Rohrich RJ, Theodorou S. Radiofrequency and Electrical Muscle Stimulation: A Synergistic Treatment That Achieves Lipolysis and Circumferential Waist Reduction in Noninvasive Body Contouring. Aesthet Surg J Open Forum 2024; 6:ojae042. [PMID: 39165914 PMCID: PMC11333964 DOI: 10.1093/asjof/ojae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
Background Surgeons and providers in aesthetic medicine seek noninvasive devices that can be utilized for safe, efficient, and effective body contouring. Patient demand has propelled the development of novel devices that can simultaneously improve skin laxity, adipolysis along with stimulation of muscle hypertrophy. Objectives To determine the efficacy of body contouring after 3 treatments using the noninvasive Transform (InMode, Lake Forest, CA) device. Methods A prospective, multicenter study was performed. Outcomes evaluated include: standardized caliper and ultrasound measurements of abdominal skin/soft-tissue thickness, waist circumference, histologic evaluation, patient comfort, and satisfaction assessments. Results Forty-four patients were successfully enrolled in the study and completed the series of 3 treatments which involved combined electrical muscle stimulation (EMS) and noninvasive bipolar radiofrequency (RF). Abdominal ultrasound measurements reveal a decrease in soft-tissue thickness (average 3.1 mm; P = .001), there was a significant decrease in caliper measurements of periumbilical skin thickness (P < .003), and the average reduction of abdominal circumference was 1.9 cm (P < .0001) 3 months after the treatment series. Histology confirmed subcutaneous adipolysis without damaging the dermal layer. Patients reported a high degree of satisfaction with the overall result (P = .003) and that each of the 3 treatments were progressively more comfortable (P < .005). Conclusions This study demonstrates that a series of simultaneous noninvasive RF with EMS treatments to the abdomen decreases subcutaneous soft-tissue thickness of the treated area. These comfortable treatments ultimately result in a high degree of patient satisfaction at 3 months. Level of Evidence 4
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Affiliation(s)
- Neil M Vranis
- Corresponding Author: Dr Neil M. Vranis, 433 N Camden Dr # 780, Beverly Hills, CA 90210, USA. E-mail:
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Cala Uribe LC, Perez Pachon ME, Babaitis R, Zannin Ferrero A, Aljure Diaz MF. Variable Energy and Ultrasound-based Liposculpture of the Arms: Multicenter and Multidevice Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5649. [PMID: 38948160 PMCID: PMC11213598 DOI: 10.1097/gox.0000000000005649] [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: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 07/02/2024]
Abstract
Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.
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Affiliation(s)
| | | | | | | | - Manuel F. Aljure Diaz
- Department of Plastic and Reconstructive Surgery, Universidad El Bosque, Bogota, Colombia
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6
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Ruff PG, Sterodimas A. Enhanced Fat Graft Viability and Remodeling Using a Helium-based Radiofrequency Device to Prepare the Recipient Site. Aesthetic Plast Surg 2024; 48:612-620. [PMID: 38097690 PMCID: PMC10954941 DOI: 10.1007/s00266-023-03749-6] [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: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Improvements to autologous fat grafting for soft tissue augmentation are needed to overcome the unpredictable volume retention. Approaches such as fat harvesting and processing, injection technique, preparation of the recipient site, and supplemental biologics are topics of ongoing research. Here, an energy-based device was investigated as a stimulatory tool for recipient site preparation for improving fat graft retention. OBJECTIVE The objective was to measure the stimulatory responses in fat grafts after 4 weeks when using a helium-based radiofrequency device to pretreat the recipient tissue. METHODS Using an autologous fat grafting mouse model, the inguinal fat pad was grafted in a small cranial pocket after either a saline injection alone (control) or a saline injection followed by pretreatment (treated). The fat pad was resected after 4 weeks, sectioned and stained with immunofluorescence markers to investigate tissue remodeling. RESULTS Pretreatment resulted in higher viability of adipocytes, a higher concentration of viable ASCs in areas of adipose tissue regeneration, and localized macrophages in the areas of regeneration when compared to the control. There was no observable difference in vascularity or angiogenesis. The staining for ASCs was higher in the pretreated group in comparison with the control group (5.0% vs. 3.3%, p=0.36) when using a pixel classifier in QuPath in the viable adipose tissue regions. CONCLUSIONS The use of a helium-based radiofrequency device as a pretreatment tool appears to increase the viability of the adipose tissue likely due to higher concentration of ASCs. The apparent increase in viable ASCs may be due to enhanced proliferation or paracrine recruitment of these cells in response to the helium-based radiofrequency treatment. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 . Bullet List of Important Points: Pretreatment of the fat graft recipient site increases the viability of the adipose tissue after 4 weeks in comparison with the control grafts. The increased viability is likely due to the observed increase in adipose-derived stem cells in the pretreated group. Pretreatment enhanced the adipose tissue remodeling as colocalization of adipose-derived stem cells and macrophages showed an active remodeling, whereas the control group exhibited more necrotic and fibrotic tissue.
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Affiliation(s)
- Paul G Ruff
- West End Plastic Surgery, MedStar Georgetown University, Washington, DC, USA
| | - Aris Sterodimas
- Department of Plastic and Reconstructive Surgery, Metropolitan General Hospital, Athens, Greece.
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Hamadani F, Theodorou SJV. Invited Discussion "From the SAFE to the SAFEST Liposuction: Combining PAL and RFAL Technology in Body Contouring Procedures". Aesthetic Plast Surg 2024:10.1007/s00266-023-03792-3. [PMID: 38216790 DOI: 10.1007/s00266-023-03792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/30/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Fadi Hamadani
- Division of Plastic & Reconstructive Surgery, H Clinic Hospital, Ramallah, 9730000, Palestine
| | - Spero J V Theodorou
- Clinical Assistant Professor of Surgery, Aesthetic Plastic Surgery, Zucker School of Medicine Hofstra University, 128 Central Park South, New York, NY, 10019, USA.
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8
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Olivas-Menayo J, Chang-Azancot L. From the SAFE to the SAFEST Liposuction: Combining PAL and RFAL Technology in Body Contouring Procedures. Aesthetic Plast Surg 2023; 47:2486-2494. [PMID: 36849664 DOI: 10.1007/s00266-023-03291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The SAFE liposuction technique is a worldwide extended method used to achieve great and reproducible results after the surgical aspiration of fat. We propose an evolution of the technique to address one of the major limitations of liposuction, loose skin. The SAFEST liposuction technique combines PAL and RFAL to achieve skin tightening and fat reduction with minimal added morbidity. METHODS Patients treated with the SAFEST liposuction technique between December 2019 and February 2022 were included in the study. Demographic and surgical data were collected retrospectively. Photographs and satisfaction interviews were conducted preoperatively and 12 months postoperatively in every case. RESULTS Sixty-five patients (58 female and 7 male) were included in the cohort, and a total of 169 anatomical areas were treated with the SAFEST liposuction technique (abdomen, arms, back, flanks and thighs). Globally, satisfaction at 12 months follow-up was of 94.1% and complications only presented in 4.7% of the treated areas. 6 of the 38 treated abdomens (18.4%) presented a complication (4 seromas and 2 access point infections) and 2 of the 38 treated flanks (5.3%) presented one (2 seromas). The rest of the treated anatomical areas (arms, back and thighs) showed no complications and high satisfaction rates. CONCLUSIONS The SAFEST liposuction technique achieves outstanding and satisfying results with minimal complications by safely combining the advantages of two different technologies, PAL and RFAL. The main advantages of the presented technique are the skin tightening, the body ligament contraction, the coagulation and the reduction of the operative time. 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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Affiliation(s)
- Jesus Olivas-Menayo
- MS Medical Institutes by Exclusive Doctors, Lisbon, Portugal.
- FEMM Cirugía y Medicina Estética, Madrid, Spain.
| | - Luis Chang-Azancot
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
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Kneiber D, Amin M, Nguyen TA, Gharavi NM. Review of radiofrequency microneedling: history, devices and uses. J COSMET LASER THER 2023; 25:59-64. [PMID: 37844087 DOI: 10.1080/14764172.2023.2268308] [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: 03/05/2022] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
Radiofrequency microneedling (RFM) has recently become a popular choice for the treatment of various dermatologic conditions and rejuvenation. Many studies have sought to evaluate the efficacy of RFM. However, its role in the management of these conditions remains unclear. A comprehensive literature search including randomized controlled trials, cohort studies, and case series evaluating the efficacy of RFM in various skin conditions was performed. In this review, we discuss the history and mechanism of RFM, describe various device features, and discuss the use of RFM in various skin conditions and rejuvenation.
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Affiliation(s)
- Diana Kneiber
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Mina Amin
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Tuyet A Nguyen
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Nima M Gharavi
- Department of Dermatologic Surgery & Mohs Micrographic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA, USA
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10
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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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Alexiades M. Radiofrequency Microneedling. Facial Plast Surg Clin North Am 2023; 31:495-502. [PMID: 37806682 DOI: 10.1016/j.fsc.2023.06.010] [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] [Indexed: 10/10/2023]
Abstract
Radiofrequency microneedling is a technique that allows energy to be delivered to specified target depths in the skin via needle electrodes and measures temperature and impedance within the tissue. This method of delivery and real-time feedback has increased safety and efficacy, providing clinically significant improvements in skin laxity, rhytids, and cellulite.
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Affiliation(s)
- Macrene Alexiades
- Yale University School of Medicine, New Haven, CT, USA; Dermatology & Laser Surgery Center of New York, NY, USA.
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12
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Stepien DM, Ghavami A. Art and Safety of Gluteal Augmentation: Future Directions. Clin Plast Surg 2023; 50:629-633. [PMID: 37704329 DOI: 10.1016/j.cps.2023.06.009] [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] [Indexed: 09/15/2023]
Abstract
Gluteal augmentation is a quickly evolving field that continues to grow in the realms of patient safety, surgical education, and technological advancement. This article discusses innovation in gluteal augmentation and suggests potential new pathways for developing the practice of gluteal augmentation.
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Affiliation(s)
- David M Stepien
- Duke Plastic Surgery, 2301 Erwin Road, Durham, NC 27710, USA
| | - Ashkan Ghavami
- Division of Plastic Surgery, David Geffen UCLA School of Medicine, UCLA Plastic Surgery, 200 Medcal Plaza Driveway, Suite 460, Los Angeles, CA 90095, USA; Private Practice, Ghavami Plastic Surgery, Inc., 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
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13
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Kurtzman JS, Pinkasovic E, Preminger BA. Treatment Options for the Clinical Management of Axillary Breast Tissue. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5189. [PMID: 37744672 PMCID: PMC10516387 DOI: 10.1097/gox.0000000000005189] [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: 11/16/2022] [Accepted: 06/29/2023] [Indexed: 09/26/2023]
Abstract
Background Axillary breast tissue includes any combination of fat, nipple, areolae, and glandular tissue alongside breasts and affects 2%-6% of women and 1%-3% of men. Patients may experience functional and/or cosmetic concerns due to axillary breast tissue. There are nonsurgical options for its removal, such as CoolSculpting and Kybella, and surgical options such as liposuction, BodyTite liposuction, and excision. Determining which technique to use in each case is critical in achieving an excellent outcome. Currently, there are no established treatment algorithms for the removal of axillary breast tissue. Methods A retrospective review between January 1, 2013, and June 20, 2022, was performed. Data that were extracted included age, BMI, date of procedure, procedure, fat suctioned, tissue excised, and follow-up period. The authors analyzed outcomes and formulated a treatment algorithm based on tissue type (fat versus glandular), amount of tissue excess, skin laxity, and accessory nipple presence. Results A total of 43 patients (83 axillae) met our inclusion criteria and were included in our analysis. All patients were female with a mean age of 35.5 ± 10.9 years, a mean BMI of 23.0 ± 3.1, and a mean follow-up period of 8.8 ± 11.1 months. For inclusion, patients had to have undergone CoolSculpting, liposuction, BodyTite liposuction, liposuction with excision, or excision alone. All patients tolerated the procedures well and reported no serious complications. Conclusions Nonsurgical and surgical removal of axillary breast tissue is safe and effective. The algorithm presented can be utilized by plastic and reconstructive surgeons to ensure optimal results for axillary breast tissue removal.
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Affiliation(s)
- Joey S. Kurtzman
- From Preminger Plastic Surgery, New York, N.Y
- Wake Forest School of Medicine, Winston Salem, N.C
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14
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Feng J, Zhang L, Qi J, Huang L. Histological damage characteristics and quantitive analysis of porcine skin with non-insulated microneedle radiofrequency. Skin Res Technol 2023; 29:e13396. [PMID: 37357651 PMCID: PMC10264746 DOI: 10.1111/srt.13396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE In recent years, the microneedle radiofrequency (MRF) has been widely used for skin rejuvenation, but histological studies on the immediate trauma caused by different parameters of non-insulated RF microneedles METHODS: The skin of three pigs was treated with different needle depths, pulse widths and energy levels of non-insulated microneedle RF. Samples were collected before, immediately, and 2 weeks after treatment. The immediate histological response of each group was assessed and quantified by hematoxylin and eosin staining, Masson staining and Victoria Blue staining. RESULTS In the treatment of non-insulated microneedle RF, different energy levels affected mainly the range of thermal damage (p = 0.044), and different needle depths affected mainly the depth of the cavity (p = 0.022). But the width of the coagulation zone width was determined by different factors. There was no significant difference in the histology of immediate damage caused by different pulse widths. Reepithelialization of the epidermis and basic wound repair can be completed within 2 weeks. CONCLUSION Non-insulated RF microneedle therapy is an effective and safe treatment that can stimulate dermal wound healing with less thermal coagulation and a wide range of reversible thermal damage. However, it should be noted that the set needle depth may not correspond to the actual penetration depth, nor to the actual depth of histologic trauma.
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Affiliation(s)
- Jiayi Feng
- Laser Aesthetic CenterPlastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Ling Zhang
- Laser Aesthetic CenterPlastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Jun Qi
- Laser Aesthetic CenterPlastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Lvping Huang
- Laser Aesthetic CenterPlastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
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15
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Huang X, Chang Q, Gao JH, Lu F. Sustained Release Microneedles: Materials and Applications in Facial Rejuvenation. TISSUE ENGINEERING. PART B, REVIEWS 2023. [PMID: 36200631 DOI: 10.1089/ten.teb.2022.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Wrinkled and loose skin resulting from collagen degradation along with fibers decreasing reflects the youth diminishing. Microneedles (MNs) have opened up new avenues for the development of painless and noninvasive transdermal drug delivery systems for facial rejuvenation. Encapsulated drugs or molecules are transmitted to targeted tissues via percutaneous microchannels, which eliminate potential gastric stimulation or first-pass metabolic effects, as well as boost patient compliance. Although MNs are considered effective and feasible therapeutic alternatives to metals, silicon, and polymers, traditional procedures with reduction processes continue to encounter methodological limitations. In recent years, promising additive manufacturing processes such as three-dimensional printing and two-photon polymerization manufacturing have been developed with the aim of overcoming the limitations by traditional processes to facilitate an efficient and economic production mode. This review summarizes the design, material selection, and manufacturing method for recently advanced MN systems. Furthermore, we also highlight specific polymeric or natural microneedle products, like hyaluronan, plant derivates, and vitamins, for esthetic applications in this review. Impact Statement In this review, the materials and manufactural routes of microneedles (MNs) are detailed. Moreover, similar to the diagnostic or therapeutic MNs, the feature of dispensation with training and ready-to-use is perfect for beautification and anti-aging, which necessitate repeated and long-term usage. Furthermore, the specific polymeric or natural products for esthetic applications of MNs are highlighted in this review.
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Affiliation(s)
- Xiaoqi Huang
- Department of Plastic and Reconstruction Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Chang
- Department of Plastic and Reconstruction Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian-Hua Gao
- Department of Plastic and Reconstruction Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Feng Lu
- Department of Plastic and Reconstruction Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Yin B, Zhang X, Li F, Han X. Microliposuction and radiofrequency combined with the thread technique as a new method used in lower face lifting. J Cosmet Dermatol 2022; 21:6902-6908. [PMID: 36039841 DOI: 10.1111/jocd.15343] [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: 03/28/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Minimally invasive facial rejuvenation is a popular and well-established treatment for patients seeking facial lifting. OBJECTIVE The authors combined facial microliposuction, radiofrequency, and thread lifting technology as a comprehensive treatment (LRT) for facial rejuvenation in a case series of 57 patients. METHODS A total of 76 patients underwent surgery and 75% completed 6 months of follow-up (57 patients); the patients were aged 26 to 51 (33.6 ± 4.5) years. All patients were followed up for hematoma within 1 week after the operation and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. Patient satisfaction with the postoperative aesthetic effects was analyzed by Face-Q™ at 6 months after the operation. RESULTS The score for hematoma within 1 week was 1.21 ± 0.33, scores for postoperative skin numbness within 1 week and 3 months were 2.06 ± 0.51 and 1.17 ± 0.32, respectively, and scores for postoperative muscle paralysis within 1 week and 3 months were 1.31 ± 0.55 and 1.00 ± 0, respectively. Fifty-seven patients completed Face-Q™ (score: 22.1 ± 1.8, standard score: 82.2 ± 14.8). CONCLUSION LRT is a minimally invasive method that can achieve a synergistic and satisfactory result for patients with mild to moderate facial skin sagging.
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Affiliation(s)
- Bo Yin
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Zhang
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Facheng Li
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuefeng Han
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Magro I, Kochhar A, Arnaoutakis D, Karimi K. Transcutaneous Radiofrequency Microneedling in the Facial Plastic Surgeon's Practice: A Review. Facial Plast Surg Aesthet Med 2022; 24:S3-S10. [DOI: 10.1089/fpsam.2022.0226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Isabelle Magro
- Department of Otolaryngology, Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Amit Kochhar
- Pacific Neuroscience Institute, Providence St. Johns Medical Center, Santa Monica, California, USA
| | - Demetri Arnaoutakis
- Department of Otolaryngology, Division of Facial Plastic Surgery, University of South Florida, Tampa, Florida, USA
| | - Kian Karimi
- Rejuva Medical Aesthetics, Los Angeles, California, USA
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18
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Tawfic SO, Hassan AS, El-Zahraa Sh Aly F, Elbendary A, Shaker OG, AlOrbani AM. Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars. Lasers Surg Med 2022; 54:1089-1098. [PMID: 35900305 DOI: 10.1002/lsm.23589] [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: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE New and improved treatment modalities, including lasers and energy-based devices, are promising treatment options for hypertrophic scars. This study aimed to assess the efficacy and safety of fractional microneedle radiofrequency (FMR) compared with fractional carbon dioxide (CO2 ) laser in the treatment of postburn hypertrophic scars. PATIENTS AND METHODS Twenty patients with hypertrophic scars were enrolled in the study. Two areas in each patient were randomly assigned to fractional CO2 laser or FMR. Four sessions, 6-8 weeks apart were performed. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation, H & E and orcein-stained samples were examined for histopathological assessment, and tissue transforming growth factor beta 1 (TGFβ1 ) levels were measured for biochemical evaluation. RESULTS Both fractional CO2 and FMR-treated areas showed significant improvement in all parameters 1 month after treatment. Fractional CO2-treated areas showed a higher degree of improvement compared with FMR in OSAS (p = 0.025), elastin grading (p = 0.004), and TGFβ1 levels (p = 0.000). Patients reported less downtime and showed less postinflammatory hyperpigmentation with FMR compared with fractional CO2, but this did not reach statistical significance (p = 0.327, p = 0.231; respectively). CONCLUSION Our results demonstrate the value of FMR as an effective alternative to fractional CO2 in the treatment of hypertrophic scars, with a potentially favorable safety profile.
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Affiliation(s)
- Shereen O Tawfic
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Akmal S Hassan
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Amira Elbendary
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Olfat G Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aya M AlOrbani
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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19
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Wang Y, Yin B, Li F. Facial Rejuvenation and Contouring with Radiofrequency-Assisted Procedures in Asians. Clin Plast Surg 2022; 50:43-49. [DOI: 10.1016/j.cps.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Hendricks AJ, Farhang SZ. Dermatologic facial applications of Morpheus8 fractional radiofrequency microneedling. J Cosmet Dermatol 2022; 21 Suppl 1:S11-S19. [PMID: 35916259 DOI: 10.1111/jocd.15231] [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: 04/08/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
Dermatologic patients are expressing increasing interest in minimally invasive procedures to address a wide range of common concerns from skin laxity to acne and scarring. Fractional radiofrequency (RF) microneedling offers an effective method for addressing a variety of dermatologic conditions with reduced downtime compared with historically more invasive procedural approaches. This article aims to describe the technology utilized in fractional RF microneedling (Morpheus8, InMode Aesthetics) and its studied applications in dermatology for treatment of the face.
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Affiliation(s)
- Aleksi J Hendricks
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona, USA
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21
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Alenichev AY, Kruglova LS, Fedorov SM, Sharypova IV, Ast NA. Evaluation of clinical results of combined correction of age-related skin changes using fractional microneedle therapy and platelet-rich plasma activated by autologous thrombin. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background. Involutive processes in the human body are often accompanied by the only visible manifestation - a change in appearance. Against this background, the search for new treatment methods that will focus on timely and rational correction of age-related skin changes and combine the possibility of complex effects on the mechanisms of skin aging is relevant. Hardware physiotherapy technologies and innovative autologous cellular preparations have a powerful regenerative potential, trigger and support physiological tissue regeneration. Despite the substantial amount of data on combined aesthetic correction protocols, there were only isolated data in the domestic and foreign literature on the combined use of fractional needle radiofrequency therapy and platelet-rich plasma activated by autologous thrombin. This was the basis for this study.
Aims. To evaluate the results of a combined method for correcting age-related skin changes based on a combination of hardware fractional needle radiofrequency exposure and injection therapy with platelet-rich plasma activated by autologous thrombin, comparing to monotherapy the same methods.
Materials and methods. Fractional microneedle radiofrequency therapy was carried out three times with an interval between procedures of 3 weeks with the use of a high-frequency electrosurgical device Scarlet RF. Therapy with autologous plasma rich in platelets activated by autologous thrombin (PRP therapy) was performed three times with an interval between procedures of 3 weeks without the use of preliminary topical anesthesia. Combination therapy combined the use of the above methods. Regression of clinical signs of skin aging was evaluated according to digital dermatoscopy and regression of the total value of the dermatological index of the quality of life of patients, as well as improvement of qualitative and functional parameters of the skin. A statistical analysis was carried out.
Results. A comparative analysis of the influence of various methods of correction of involutive changes in the skin of the face showed that the use of combination therapy provides the development of the most significant clinical effect in relation to all the assessed signs of skin aging. Combination therapy was accompanied by a significant increase in the integral index of microcirculation, regardless of age. The reconstructive effect on the morphological structures of the skin according to ultrasonography also turned out to be significantly higher for the combined method of treatment in comparison with radiofrequency therapy.
Conclusions. The combined use of fractional microneedle radiofrequency therapy and PRP therapy provides a more effective and prolonged correction of age-related skin changes compared to the monotherapy.
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22
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Technique for Minimally Invasive Face and Neck Contouring with Bipolar Radiofrequency Devices. Plast Reconstr Surg 2022; 150:337e-340e. [PMID: 35666170 DOI: 10.1097/prs.0000000000009358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiofrequency devices have grown in popularity as minimally invasive options for the treatment of skin laxity in the face and neck. These treatments are often combined with liposuction procedures to provide enhanced tissue contraction alongside the reduction in adiposity. Proper patient selection and intra-operative technique are crucial to achieving the desired outcomes in a safe manner. In this article, we discuss our indications and technique for the treatment of the face and neck with bipolar radiofrequency devices.
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23
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Two-stage Radiofrequency-assisted Lipoabdominoplasty. Plast Reconstr Surg Glob Open 2022; 10:e4212. [PMID: 35494885 PMCID: PMC9038494 DOI: 10.1097/gox.0000000000004212] [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: 10/09/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022]
Abstract
Decades of lipoabdominoplasty safety, reliability, and efficacy have permitted more aggressive contouring of the abdominoplasty flap without increased risk for wound healing complications. However, the recent introduction of unrestricted liposuction of all vascular zones and high-definition liposculpting continue to challenge the vascularity of the abdominoplasty flap, particularly in high-risk patients. The present study reviews the authors' approach to abdominal lipodystrophy, and introduces a technique which maximizes fat extraction and skin excision while reducing risk of complication (two-stage radiofrequency-assisted liposuction and abdominoplasty).
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24
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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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25
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Combined Treatment of Monopolar and Bipolar Radiofrequency Increases Skin Elasticity by Decreasing the Accumulation of Advanced Glycated End Products in Aged Animal Skin. Int J Mol Sci 2022; 23:ijms23062993. [PMID: 35328415 PMCID: PMC8950306 DOI: 10.3390/ijms23062993] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023] Open
Abstract
It is well known that skin aging is related to the destruction of collagen and elastin fibers by metalloproteinases (MMPs). Aged fibroblasts have a decreased ability to synthesize collagen and elastin. Nuclear factor erythroid 2-related factor 2 (NRF2) involves glyoxalase (GLO) activation, which inhibits the production of advanced glycated end products (AGE) and the expression of its receptor (RAGE). RAGE increases nuclear transcription factor-kappa B (NF-κB), which upregulates MMPs and decreases skin elasticity. NRF2 also decreases M1 macrophages, which secrete tumor necrosis factor-alpha (TNF-α), thereby decreasing AGE production. It is well known that radiofrequency (RF) decreases skin elasticity by increasing collagen synthesis. We evaluated whether RF increases skin elasticity via NRF2/GLO and whether they decrease AGE and RAGE expression in aged animal skin. We also compared the effects of RF based on the modes (monopolar or bipolar) or the combination used. In aged skin, NRF2, GLO-1, and M2 macrophage expression was decreased, and their expression increased when RF was applied. M1 and TNF-α demonstrated increased expression in the aged skin and decreased expression after RF application. AGE accumulation and RAGE, NF-κB, and MMP2/3/9 expression were increased in the aged skin, and they were decreased by RF. The papillary and reticular fibroblast markers showed decreased expression in young skin and increased expression in aged skin. The densities of collagen and elastin fiber in the aged skin were low, and they were increased by RF. In conclusion, RF leads to increased collagen and elastin fibers by increasing NRF2/GLO-1 and modulating M1/M2 polarization, which leads to decreased AGE and RAGE and, consequently, decreased NF-κB, which eventually slows collagen and elastin destruction. RF also leads to increased collagen and elastin fiber synthesis by increasing papillary and reticular fibroblast expression.
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26
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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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27
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Austin GK, Struble SL, Quatela VC. Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: A systematic review. Lasers Surg Med 2021; 54:27-45. [PMID: 34923652 DOI: 10.1002/lsm.23506] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Radiofrequency technology has emerged as a treatment for aesthetic rejuvenation. OBJECTIVE To examine radiofrequency for facial and neck rejuvenation, clinical studies were assessed on effectiveness and safety of radiofrequency for acne, acne scars, and facial aging by subjective and objective measures. METHODS A systematic literature review was performed. Eligibility criteria included articles in English, primary literature, clinical or ex vivo studies, use of radiofrequency, and face or neck treatment. Ablative techniques, home-use devices, combined modalities, and studies unrelated to rejuvenation were excluded. All studies were appraised for quality and biases. RESULTS We identified 121 articles. Radiofrequency effectively treated acne by reducing sebum levels and lesion count and improving acne scars. Radiofrequency demonstrated a volumetric reduction in facial fat, and improved skin laxity, elasticity, and global skin aesthetic. Patient satisfaction was higher for those desiring modest rejuvenation. There were histological changes consistent with repair response, neocollagenesis, and neoelastinogenesis. Radiofrequency was safe apart from one patient who developed a neck fistula. CONCLUSION Most studies demonstrated radiofrequency treatment of acne, scars, or facial rhytids had positive subjective improvement ratings. Objective studies demonstrated reduction of acne, decreased scarring, lifting effect, improvement in elasticity and collagen, volumetric fat changes, and wrinkle reduction.
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Affiliation(s)
- Grace K Austin
- Quatela Center for Plastic Surgery, Rochester, New York, USA.,Grace Kim Austin, MD, Inc, Glendale, California, USA.,Department of Surgery, Facey Medical Group, Valencia, California, USA
| | - Sarah L Struble
- School of Medicine, California University of Science and Medicine, Colton, California, USA
| | - Vito C Quatela
- Quatela Center for Plastic Surgery, Rochester, New York, USA
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28
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Kislevitz M, Lu KB, Wamsley CE, Parsa S, Hoopman JE, Kenkel JM, Akgul Y. Bipolar Fractional Radiofrequency Treatment of Suprapatellar Skin Assessment Using Noninvasive Devices and Microbiopsy. Aesthet Surg J 2021; 41:NP1997-NP2008. [PMID: 33942050 DOI: 10.1093/asj/sjab210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Noninvasive treatments for skin tightening are gaining popularity. However, no studies have assessed bipolar fractional radiofrequency treatment on suprapatellar skin. OBJECTIVES The purpose of this study was to evaluate the efficacy of bipolar fractional radiofrequency treatment on suprapatellar skin. METHODS Twenty patients received 1 bilateral suprapatellar bipolar fractional radiofrequency treatment. They returned 7 days, 3 weeks, 3 months, and 6 months posttreatment. Noninvasive measurements were obtained at each visit, including high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and skin elasticity. Microbiopsies were collected in the treatment area for histologic and gene expression analyses. Three clinicians completed photographic evaluations comparing texture and laxity at baseline vs 6 months posttreatment. RESULTS Fifteen subjects completed all 6 visits. Both transepidermal water loss and dermal-epidermal junction roughness were increased at 3 weeks and 3 months posttreatment. Both attenuation coefficient and stiffness were increased significantly at 3 and 6 months posttreatment. Blood flow 0.5 mm below the surface and expression of epidermal hyaluronic acid and inflammatory genes IL-1b and IL-6 were significantly higher at 7 days posttreatment compared with pretreatment and 3 months posttreatment. There were no statistically significant changes in collagen- or elastin-related genes and proteins at 7 days or 3 months posttreatment. An improvement in texture and laxity was observed at 6 months posttreatment in 17.7% and 24.4% of photographs, respectively. CONCLUSIONS Radiofrequency treatment by microneedling of suprapatellar skin shows limited effects in decreasing skin laxity and improving skin appearance. At a molecular level, the treatment resulted in lower elastin and hyaluronic acid levels and increased dermal-epidermal junction roughness based on histology and optical coherence tomography imaging. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mikaela Kislevitz
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karen B Lu
- Department of Plastic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Christine E Wamsley
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shyon Parsa
- UT Southwestern Medical School, Dallas, TX, USA
| | - John E Hoopman
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M Kenkel
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yucel Akgul
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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29
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Dayan E. Commentary on: Temperature-Controlled Monopolar Radiofrequency in the Treatment of Submental Skin Laxity: A Prospective Study. Aesthet Surg J 2021; 41:NP1657-NP1658. [PMID: 33728438 DOI: 10.1093/asj/sjab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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New Technologies in Skin Tightening. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Alexiades M, Munavalli GS. Single Treatment Protocol With Microneedle Fractional Radiofrequency for Treatment of Body Skin Laxity and Fat Deposits. Lasers Surg Med 2021; 53:1026-1031. [PMID: 33764552 PMCID: PMC8518615 DOI: 10.1002/lsm.23397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/10/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022]
Abstract
Background and Objectives Treatment modalities have been developed to address patient concerns with skin laxity and focal adipose excess. A previously published multicenter clinical trial reported improvement in cellulite severity after a single dermal and subcutaneous treatment on the upper thigh with a microneedle radiofrequency device. In the current study, this device was used to improve the esthetic appearance of body skin laxity and localized fat deposits above the knee, upper arms, and upper‐mid back/axillary region (“bra‐line”). Study Design/Materials and Methods Subjects with cellulite, skin laxity, and/or subcutaneous adipose excess in the suprapatellar region of the anterior thigh, upper arms, and bra‐line underwent a single dermal and/or subcutaneous treatment. Investigators and subjects assessed outcome at 1‐, 3‐, and 6‐month follow‐up, using 5‐point Likert scales for global esthetic improvement, skin laxity improvement, and satisfaction. Results In total, 31 females (mean age 51 ± 9 years) with Fitzpatrick skin types I–IV received a single treatment on 62 treatment areas: 22 upper arms, 34 suprapatellar, and 6 bra‐lines. Investigator assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms and bra‐line demonstrated improvements in 100% of subjects at all timepoints; for the suprapatellar region, these values were 69%, 92%, 65%, and 85%, 92%, 65%, respectively. Investigator satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 90% for upper arms; 80%, 80%, 80% for bra‐line; and 50%, 81%, 65% for suprapatellar region. Subject self‐assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms demonstrated improvements in 100% of subjects at all timepoints; for the bra‐line, these values were 40%, 60%, 80%, and 60%, 60%, 80%, respectively; for the suprapatellar region, these values were 81%, 92%, 88%, and 69%, 85%, 88%, respectively. Subject satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 100% for upper arms; 40%, 40%, 80% for bra‐line; and 50%, 77%, 65% for suprapatellar. Treatments were well tolerated with subjects reporting transient erythema and edema associated with 69% and 46% of treatments, respectively. Mild bruising, resolving within 5 days, was reported after 32% of the treatments. Conclusion Microneedle fractional radiofrequency provides a single treatment protocol to improve the esthetic appearance of body skin laxity and localized adipose excess to the upper arms, bra‐line, and suprapatellar regions. Further study is warranted to evaluate the degree of improvement and long‐term effect beyond 6 months post‐treatment. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC
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Affiliation(s)
- Macrene Alexiades
- School of Medicine, Yale University, New Haven, Connecticut, 06510.,Dermatology and Laser, Surgery Center, New York, New York, 10028
| | - Gilly S Munavalli
- Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, North Carolina, 28207
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32
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Boisen J, Alkul S, Malone CH, Munavalli G. Perioral volumization using a temperature controlled fractionated radiofrequency device. J Cosmet Dermatol 2021; 21:237-241. [PMID: 33742543 DOI: 10.1111/jocd.14083] [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: 02/14/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Cosmetic rejuvenation of the perioral area can be challenging due to a mix of skin laxity and volumetric loss. Current techniques including fillers, neurotoxins, and non-ablative and ablative resurfacing have several drawbacks and can create a stiff, box-shaped, unnatural appearance. Aside from filler, these techniques do not address deeper volume deficiency. Temperature controlled fractionated radiofrequency (FRF) provides consistent formation of new collagen, elastin, and hyaluronic acid. This has been reported to provide long-lasting results for the treatment of skin laxity and volume loss of the face and neck with a single treatment, but it has not been previously reported for perioral rejuvenation. PATIENTS/METHODS We present a series of seven patients who were treated with perioral FRF, and we assessed their results objectively using a published, validated scale for lower face laxity. RESULTS All of the patients in this case series showed improvement on the Facial Laxity Rating (FLR) scale after FRF treatment. CONCLUSIONS This case series represents the first reported use of temperature controlled FRF for perioral rejuvenation. FRF is a promising option for low-risk, natural perioral rejuvenation with long-lasting results and few risks.
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Affiliation(s)
| | | | | | - Gilly Munavalli
- Department of Dermatology, Wake Forest University, Winston-Salem, NC, USA
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33
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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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The Use of Radiofrequency in Aesthetic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2861. [PMID: 32983755 PMCID: PMC7489578 DOI: 10.1097/gox.0000000000002861] [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: 05/13/2019] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
The use of radiofrequency for soft tissue tightening has increased over the past 10 years. Both minimally invasive and noninvasive devices are frequently in use. This article describes the different types of radiofrequency technology and the current evidence behind their safety and efficacy.
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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.
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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
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Araco A. A case report of deep skin burns following radiofrequency-assisted liposculpting technology of BodyTite. Dermatol Ther 2020; 33:e13683. [PMID: 32449183 DOI: 10.1111/dth.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Antonino Araco
- Aesthetic Medicine Department, University Tor Vergata of Roma, Viale Oxfor 180, Rome, Italy
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Swanson E. Concerns Regarding Photographic Representation of the Results of Radiofrequency Treatment. Aesthet Surg J 2019; 39:354-356. [PMID: 31242299 DOI: 10.1093/asj/sjz147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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