Radiofrequency therapy in esthetic dermatology: A review of clinical evidences

Energy-Based Skin Rejuvenation: A Review of Mechanisms and Thermal Effects

BACKGROUND

Energy-based photoelectric and ultrasonic devices are essential for skin rejuvenation and resurfacing in the field of plastic surgery and dermatology. Both functionality and appearance are impacted by factors that cause skin to age, and various energy types have variable skin penetration depths and modes of transmission.

AIM

The objective is to advise safe and efficient antiaging treatment while precisely and sensitively controlling and assessing the extent of thermal damage to tissues caused by different kinds of energy-based devices.

METHODS

A literature search was conducted on PubMed to review the mechanisms of action and thermal effects of photoelectric and ultrasonic devices in skin remodeling applications.

RESULTS

This paper reviews the thermal effects of energy-based devices in skin resurfacing applications, including the tissue level and molecular biochemical level. It seeks to summarize the distribution form, depth of action, and influencing factors of thermal effects in combination with the mechanisms of action of various types of devices.

CONCLUSION

Accurate control of thermal damage is crucial for safe and effective skin remodeling treatments. Thorough investigation of molecular biochemical indicators and signaling pathways is needed for real-time monitoring and prevention of severe thermal injury. Ongoing research and technological advancements will improve the accuracy and control of thermal damage during treatments.

Radiofrequency energy in the treatment of erectile dysfunction-a novel cohort pilot study on safety, applicability, and short-term efficacy

The erectile mechanism depends, in part on the intactness of the collagen components in the penis. As such, impaired collagen may have a deleterious effect on erectile function. Radiofrequency energy has been shown to renew and restore spatial structural arrangement of collagen fibers; therefore, treatment of erectile dysfunction with radiofrequency could lead to anatomical and physiological changes at the penile tissue level and could lead to improvement in the erectile mechanism. We conducted this study to assess the effect of radiofrequency treatment on erection quality. We evaluated the safety, applicability, and efficacy of a self-applied, handheld, low-intensity radiofrequency device (Vertica®) in men with moderate and mild-to-moderate organic erectile dysfunction. The treatment protocol consisted of 12 treatments (twice a week during the 1st month, and once a week during the 2nd month), and each participant treated himself individually. Treatment outcomes were evaluated using the International Index of Erectile Function, Erection Hardness Scale, Erectile Dysfunction Index of Treatment Satisfaction, Benefit, Satisfaction & Willingness to continue, Quality of Erection Questionnaire, Sexual Quality of Life questionnaires and specific questions addressing side effects and ease of use. Twenty-eight out of 32 men (mean age 59.5 ± 9.8, range: 41-78 years) completed a one-month follow-up after treatment. Mean International Index of Erectile Function (43.7. ± 7.8 vs. 60.9 ± 10.8, p < 0.01), International Index of Erectile Function -Erection Function domain (16.8 ± 3.1 vs. 24.4 ± 4.4, p < 0.001), and Erection Hardness Scores (2.2 ± 0.8 vs. 3.2 ± 0.5, p = 0.01) were all significantly improved. Fifty percent of patients achieved normal erectile function parameters according to the International Index of Erectile Function -Erection Function domain score >25. High mean scores were achieved in the Erectile Dysfunction Index of Treatment Satisfaction (76.8 ± 20.3), Benefit, Satisfaction & Willingness to continue (4.83 ± 1.1), Quality of Erection Questionnaire (73.4 ± 23.8), and Sexual Quality of Life (67 ± 29.4) questionnaires. No side effects were reported and participants rated the device as very comfortable, simple, and easy to operate.

Radiofrequency Currents Modulate Inflammatory Processes in Keratinocytes

Keratinocytes play an essential role in the inflammatory phase of wound regeneration. In addition to migrating and proliferating for tissue regeneration, they produce a large amount of cytokines that modulate the inflammatory process. Previous studies have shown that subthermal treatment with radiofrequency (RF) currents used in capacitive resistive electric transfer (CRET) therapy promotes the proliferation of HaCat keratinocytes and modulates their cytokine production. Although physical therapies have been shown to have anti-inflammatory effects in a variety of experimental models and in patients, knowledge of the biological basis of these effects is still limited. The aim of this study was to investigate the effect of CRET on keratinocyte proliferation, cytokine production (IL-8, MCP-1, RANTES, IL-6, IL-11), TNF-α secretion, and the expression of MMP9, MMP1, NF-κB, ERK1/2, and EGFR. Human keratinocytes (HaCat) were treated with an intermittent 448 kHz electric current (CRET signal) in subthermal conditions and for different periods of time. Cell proliferation was analyzed by XTT assay, cytokine and TNF-α production by ELISA, NF-κB expression and activation by immunofluorescence, and MMP9, MMP1, ERK1/2, and EGF receptor expression and activation by immunoblot. Compared to a control, CRET increases keratinocyte proliferation, increases the transient release of MCP-1, TNF-α, and IL-6 while decreasing IL-8. In addition, it modifies the expression of MMPs and activates EGFR, NF-κB, and ERK1/2 proteins. Our results indicate that CRET reasonably modifies cytokine production through the EGF receptor and the ERK1/2/NF-κB pathway, ultimately modulating the inflammatory response of human keratinocytes.

Rotational radiofrequency-based technology leads to adipose tissue reduction and contouring effect in the thighs, abdomen, and flanks

BACKGROUND

Excess body adiposity and skin irregularities represent a major problem in today's society. Currently, radiofrequency-based devices constitute an increasingly popular medical-aesthetic application and a powerful non-invasive method to combat this problem.

OBJECTIVE

This study aims to determine the efficacy and safety of the high-frequency device Zionic™ (Termosalud, Inc., Gijón, Spain) in reducing body contouring and improving skin appearance in the abdomen/flanks or thighs.

MATERIALS AND METHODS

Thirty nine individuals were treated with the Zionic™ device in the abdomen/flanks or thighs. A total of 8 sessions of 40-50 min each, 72/96 h apart were performed. At baseline, body measurements were taken including photographs, body contours, and ultrasound scans to assess dermal thickness, dermal echogenicity, and subcutaneous fat thickness. The measurements were repeated after the eight sessions for comparison and analysis. Quantitative data was complemented with a customized survey to evaluate participants satisfaction level.

RESULTS

At the follow-up visit, a significant average reduction of 3% in abdomen/flanks circumferences and 2% in thighs contours was noticed. Abdomen/flanks and thighs subcutaneous fat layer thickness was significantly reduced by 8% and 6%, respectively. Dermal echogenicity changes, related to skin collagen content and organization, showed non-significant increasing tendencies of 7% for abdomen/flanks and 8% for thighs. Thighs dermal thickness was significantly increased by 6%. Results were associated to a high satisfaction level (80%) and no severe adverse events.

CONCLUSION

Zionic™ treatment is a safe, effective, and well-tolerated noninvasive procedure for body contouring and improvement of skin properties in abdomen, flanks, and thighs.

Radiofrequency Improves Facial Fine Lines by Thermal Effect: Damage or Just Stimulation?

BACKGROUND

Radiofrequency (RF) has been widely used for rejuvenation treatments, but without knowledge of the effective temperature of the target tissues or guidance on treatment parameters, it often leads to adverse reactions and pain. The aim of this study was to demonstrate that thermal stimulation can produce facial rejuvenation effects and to determine the optimal bipolar RF treatment parameters for treating facial fine lines.

METHODS

A bipolar RF device combined with CORE Technology was used in this study. Ex vivo studies were conducted on both miniature swine and human skin, utilizing thermographic thermometry and histological analysis. In vivo swine studies were conducted using histological analysis and electron microscopy. A clinical trial was conducted, and the results were evaluated using the Alexiades Comprehensive Grading Scale (ACGS) and Global Aesthetic Improvement Scale (GAIS) scales.

RESULTS

The bipolar RF technology can produce a significant effect by thermally stimulating collagen within just 2 weeks without causing thermal damage. A clinical trial involving 46 patients showed a noticeable rejuvenating effect of the bipolar RF device, especially on fine wrinkles.

CONCLUSION

This study confirmed that thermal stimulation, rather than thermal damage, is sufficient to achieve rejuvenation effects. The study also found a range of bipolar RF treatment parameters that are both safe and effective for facial fine lines.

The Impact of the Number and Duration of Treatments With a 1064 nm Diode Laser on Adipocyte Apoptosis: Implications for Noninvasive Fat Reduction Strategies

Background

Noninvasive treatment with a 1064 nm diode laser, generating hypodermal temperatures between 42 and 47 °C, induces adipocyte cell death, offering a solution to reduce fat in problematic areas.

Objectives

The objective of the authors of this study is to determine whether a 15 min treatment provides similar efficacy as the standard 25 min treatment.

Methods

Pigs underwent a 15 or 25 min 1064 nm laser treatment on 6 × 6 cm areas of abdominal skin. Single treatments were administered 14 or 28 days before biopsy, whereas dual treatments were performed at both 14 and 28 days prebiopsy. Hematoxylin and TUNEL staining were used to detect histological changes and apoptosis in harvested skin tissue.

Results

Pig skin subjected to a 25 min diode laser treatment exhibited nearly twice the apoptotic counts in the hypodermis compared with the 15 min treatment (10.5 vs 5.7) at 28 days following treatment. The degree of apoptosis increased with time following the treatment, with nearly twice the apoptosis counts at 28 days than at 14 days following a single 25 min treatment (10.5 vs 5.8). When testing 1 vs 2 treatments, 2 treatments (28 and 14 days before harvesting the tissue) did not result in significantly higher apoptosis than 1 treatment 28 days before harvesting. Apoptosis was primarily localized to adipocytes in the hypodermis and the dermis/hypodermis junction. There were no adverse side effects in the animals.

Conclusions

The degree of apoptosis following a 1064 nm laser treatment was proportional to the treatment duration. The 25 min treatment produced significantly more apoptosis than the 15 min treatment. The process of apoptosis continued over several weeks.

Level of Evidence 4 Therapeutic

Beyond cancer treatment: dermo-aesthetic and other wellness recommendations for breast cancer patients

Breast cancer, a prevalent malignancy among women, has various physical and psychological impacts. This comprehensive review offers an in-depth look at multidisciplinary dermo-aesthetic intervention approaches, emphasizing the balance between oncological therapies and the management of these effects. The information presented spans specialties such as aesthetic medicine, plastic surgery, dermatology, physiotherapy, nutrition, odontology, and gynecology. This review, which serves as a clinical guide, aims to establish a safe protocol for non-medical interventions involving oncologists, physicians, and specialists from various areas in patients with breast cancer focused on improving their quality of life. This work offers personalized and integrative care strategies for the eradication of cancer. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment.

Effects of RF Electric Currents on Hair Follicle Growth and Differentiation: A Possible Treatment for Alopecia

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.

A highly biocompatible and bioactive transdermal nano collagen for enhanced healing of UV-damaged skin

Skin damage caused by excessive UV radiation has gradually become one of the most prevalent skin diseases. Collagen has gradually found applications in the treatment of UV-damaged skin; however, their high molecular weight greatly limits their capacity to permeate the skin barrier and repair the damaged skin. Nano collagen has garnered growing attentions in the mimicking of collagen; while the investigation of its skin permeability and wound-healing capability remains vacancies. Herein, we have for the first time created a highly biocompatible and bioactive transdermal nano collagen demonstrating remarkable transdermal capacity and repair efficacy for UV-damaged skin. The transdermal nano collagen exhibited a stable triple-helix structure, effectively promoting the adhesion and proliferation of fibroblasts. Notably, the transdermal nano collagen displayed exceptional penetration capabilities, permeating fibroblast and healthy skin. Combo evaluations revealed that the transdermal nano collagen contributed to recovering the intensity and TEWL values of UV-damaged skin to normal level. Histological analysis further indicated that transdermal nano collagen significantly accelerated the repair of damaged skin by promoting the collagen regeneration and fibroblasts activation. This highly biocompatible and bioactive transdermal nano collagen provides a novel substituted strategy for the transdermal absorption of collagen, indicating great potential applications in cosmetics and dermatology.

Recent advances in the treatment of acne using radiofrequency techniques

Acne is a long-lasting inflammatory skin condition that impacts the sebaceous units of the hair follicles, affecting around 85-90% of the population. Due to the potential for permanent facial scarring and negative social consequences, as well as the limitations of conventional medications like drug resistance and difficulties following treatment plans, it's crucial to investigate non-pharmacological options for treating acne, among which radiofrequency(RF) shows distinct superiority. To assess the impact of RF in the management of acne vulgaris, we conducted a thorough examination of scientific literature (including clinical trials and scientific reviews) through electronic databases like MEDLINE and PubMed. Our analysis indicates that RF could be a viable substitute for acne treatment due to its notable effectiveness and minimal adverse effects.

First Evidence of Cutaneous Remodelling Induced by Synchronized Radiofrequency Aided by High-Intensity Facial Muscle Stimulation: Porcine Animal Model

BACKGROUND

The quality of one's facial appearance diminishes with aging as skin and underlying soft tissues deteriorate. Connective tissue and musculofascial degeneration leads to skin laxity and wrinkles developing.

OBJECTIVE

To evaluate the effects of synchronized radiofrequency with high intensity facial stimulation technology on dermal collagen and elastin fibers in a porcine model.

MATERIALS AND METHODS

Eight sows were divided into Active (N = 6) and Control (N = 2) groups. Synchronized radiofrequency and high intensity facial stimulation were delivered to the ventrolateral abdomen. The Active group received four 20-minute treatments, once a week. Control group was untreated. Skin biopsy sample were histologically analyzed for connective tissue changes pre- and post-treatment. Data were analyzed statistically (α = 0.05).

RESULTS

In the Active group: the collagen-occupied area at baseline was 1.12 ± 0.09 × 106 μm 2 and increased by +19.6% ( p < .001) at 1-month and by +26.3% ( p < .001) 2 months post-treatment; elastin-occupied area at baseline was 0.11 ± 0.03 × 106 μm 2 and increased by +75.9% ( p < .001) at 1-month and +110.8% ( p < .001) at 2-months follow-up. No significant changes ( p > .05) found in the Control samples.

CONCLUSION

Collagen and elastin fiber content increased significantly after treatments. Connective tissue in the treatment area was denser up to 2-months post-treatment.

Electric currents of 448 kHz upregulate anti-senescence pathways in human dermal fibroblasts

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.

Subjective evaluation of monopolar radiofrequency treatment by patients in aesthetic rejuvenation

OBJECTIVE

To assess the subjective experiences of patients following monopolar radiofrequency (RF) treatment for facial rejuvenation and anti-aging purposes.

METHODS

A study involving 50 female patients (aged 30-70 years, Fitzpatrick skin type III and IV) who received a single session of RF treatment. Exclusion criteria comprised active infections, skin diseases, pregnancy, or history of recent anti-aging treatments. Thirty-four patients completed a 10-question questionnaire after 3 months of treatment.

RESULTS

Among the respondents, 82% expressed satisfaction with the RF treatment, reporting significant improvements primarily in the mid and lower face, and eyelids. Mainly, patients noted improvements in skin laxity (52.9%), skin texture (17.6%), and skin tone (11.7%). Notably, 73.5% noticed changes within 1-2 months post-treatment, with the peak effect observed at 1-2 months. Mild complications (swelling and erythema) were reported, usually resolving within a week. The mean pain score was 1.94 (±0.66), indicating mild to moderate discomfort.

DISCUSSION

Monopolar RF devices, apply high-frequency electric currents generating heat, stimulating collagen production for skin tightening. This study's unique focus on detailed subjective patient experiences provides insights valuable in clinical settings, aiding clinicians in managing patient expectations and achieving optimal results. The satisfaction rates align with previous findings, emphasizing RF treatment's efficacy in addressing facial laxity, especially in the mid and lower face. Positive feedback extended beyond skin tightening, encompassing skin texture and tone improvements. While the study's observation period was 3 months post-treatment, longer-term studies are warranted for comprehensive assessments.

CONCLUSION

The study underscores the efficacy of monopolar RF device, as a non-invasive and effective anti-aging treatment. The findings contribute to diversifying the RF market, potentially aiding clinicians in optimizing patient care. Considering the growing complexity of patient demands and treatment responses, this study serves as a valuable reference for clinicians engaging in RF treatments.

Radiofrequency and pulsed electromagnetic field application following liposuction-Clinical evaluation of performance and safety

OBJECTIVE

With more than 1.5 million performed procedures, liposuction was the second most performed esthetic surgical procedure all over the world in males and in females in the year 2020. The objective of this open-label, evaluator-blinded study was to assess the efficacy and safety of an energy-based device that combines multipolar radiofrequency with pulsed electromagnetic field (PEMF) in patients that underwent liposuction.

MATERIALS AND METHODS

A total of 30 subjects, of whom 24 were females (80%), with a mean age of 48.4 ± 11.0 years (range: 27-69 years) and a mean weight of 69.5 ± 11.7 kg underwent unilateral treatment with radiofrequency and application of PEMF after bilateral liposuction. One month after the last of a total of six weekly treatments, skin elasticity, visco-elasticity and net elasticity, as well as subject reported satisfaction on a 5-point scale ranging from -1 (worse) to 3 (very much improved) and esthetic improvement ranging from 0 (very unsatisfied) to 4 (very satisfied) rated by three independent reviewers were assessed.

RESULTS

Three independent and blinded reviewers rated the improvement of the treated side on average as 1.17 + 0.07 compared with baseline. Subjects were very satisfied with their treatment, with a mean score of 3.24 (0.03) out of 4 at the 1-month follow-up visit. Cutometer measurements showed no significant changes.

CONCLUSION

This study revealed that the subjective satisfaction with the results of the application of RF and PEMF after liposuction is high, while at the same time the esthetic appearance as rated by independent raters improved on the treated side.

Synergistic effect of microneedle-delivered extracellular matrix compound and radiofrequency on rejuvenation of periorbital wrinkles

Background

A combination of minimally invasive modalities can induce collagen regeneration more quickly and promote the penetration of topical agents, thus promoting skin rejuvenation. In this study, we aimed to investigate the synergistic efficacy of extracellular matrix compound (ECM-C) via microneedle (MN) and radiofrequency (RF) on periorbital wrinkles.

Method

A total of 25 participants with periorbital wrinkles were selected for this study. The left and right side of the periorbital area was randomly given ECM-C via MN or ECM-C via MN combined with RF. MN combined with ECM-C treatment was given 5 times at 2 weeks intervals, whereas RF treatment was given 3 times at 4-week intervals. The following items were assessed: wrinkles by VISIA^® system; biophysical parameters such as skin hydration, transepidermal water loss (TEWL), erythema index, and melanin index by CK multiple probe adapter; and skin elasticity and skin thickness by DermaLab Combo^® photographs were taken at the baseline and 2 weeks after the last treatment. Subjective assessments, such as Crow's Feet Grading Scale (CFGS) and Global Aesthetic International Scale (GAIS), were also recorded.

Result

A total of 25 participants with an average age of 43 years participated in this trial. Periorbital wrinkles on both sides decreased after the treatment, and the side treated with ECM via MN and RF showed better improvement than the other side with ECM-C via MN alone. Skin hydration increased after the treatment on both sides. TEWL, skin erythema, and skin melanin indexes were not changed. Skin elasticity and skin thickness increased more on the side of ECM-C via MN and RF than on the other side of ECM-C via MN alone. The evaluation scores for CFGS improved on either side; however, no difference was found for CFGS and GAIS between intergroup comparisons after the treatment.

Conclusion

The objective assessment of wrinkles, elasticity, and thickness of periorbital skin improved more on the side with ECM-C treatment via MN combined with RF than on the other side of ECM-C treatment via MN only. However, no statistically significant difference was found between the subjective CFGS and GAIS evaluation of the two sides.

Radiofrequency and skin rejuvenation: a systematic review

Increasingly, there is an attempt to minimize expression lines through esthetic procedures, and radiofrequency (RF) is one of the therapeutic modalities. This article aims to systematically review the literature on the different types of RF treatment in clinical trials and in variables related to the aging process. This systematic review included 21 articles that treated 354 people with different physical characteristics. The most used RF was the fractional followed by the non-ablative RF. There was a large discrepancy in relation to the types and parameters. A parameter that did not show so much divergence was the temperature, which was between 38°C and 44°C. The main temporary adverse reactions reported by the authors were as follows: discomfort, pain, erythema, hyperpigmentation, crusting, swelling, edema, and purple and acneic appearance of the skin. Finally, our study concluded that non-ablative and ablative RF was reported to rejuvenate and improve the features of skin in all skin types.

The effect of a restricted diet on the results of fractional microneedle radiofrequency therapy: A comparison of vegan and omnivorous participants in terms of the antiaging effect of radiofrequency therapy

OBJECTIVES

The aim of the present study was to compare the results of fractional microneedle radiofrequency (FMR) therapy in vegan and omnivorous participants.

METHODS

A total of 30 vegan and 30 omnivorous women who were treated with FMR therapy for combating aging were included in the study. The clinical results were examined in Months 3 and 6 based on the Fitzpatrick Wrinkle Scale (FWS). Individual satisfaction was investigated in Month 6 using the Patient's Global Impression of Change (PGIC).

RESULTS

At the onset of the treatment, there was no significant difference with regard to the FWS scores in both groups. The decrease in the FWS score was significantly lower in vegans after 3 months (p = 0.01). Vegans had worsened clinical outcomes by Month 6 (p = 0.01). The PGIC scores were significantly lower in vegans (p = 0.01).

CONCLUSION

A vegan diet adversely affects the outcome of FMR therapy.

Focused radiofrequency and ultrasound for face and neck rejuvenation: A retrospective evaluation of 158 patients

BACKGROUND

Radiofrequency is a commonly used method to non-invasively tighten the skin that can be safely applied to any skin type.

AIMS

The aim of our study was to evaluate the safety and efficacy of the focused radiofrequency and ultrasound hybrid device for face and neck rejuvenation, in terms of improvement of facial wrinkles and jaw sagging.

METHODS

A total of 158 patients had undergone four weekly sessions of focused radiofrequency and ultrasound to face and neck area. Photodocumentation was obtained before first visit and two weeks after last visit. An independent, blinded dermatologist evaluated the severity of wrinkles and sagging of seven different anatomical regions on a validated scale of 0-4 (0: no lines/sagging, 1: mild, 2: moderate, 3: severe, 4: very severe) before and after the procedure. Patients rated their satisfaction with the result of the treatment on a scale of 1-5 (1: dissatisfied, 2: poorly satisfied 3: satisfied, 4: very satisfied, 5: perfectly satisfied).

RESULTS

For seven anatomical regions, statistically significant reduction was observed in mean wrinkle/sagging scores (p = < 0.001). Patients were satisfied with the effects of the procedure, with a mean satisfaction score of 4.61 ± 0.55.

CONCLUSIONS

Our findings demonstrate that combined focused radiofrequency and ultrasound is an effective and safe method for the rejuvenation of different sub-areas of the face and neck with high patient satisfaction scores.

Evaluation of the evidence level for the use of radiofrequency in aesthetic treatments: A systematic review and meta-analysis

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.

Effect of capacitive radiofrequency on the dermis of the abdominal region

The purpose of this study is to evaluate the effects of radiofrequency (RF) on sagging skin. This is a case series study with five volunteers who received a single application of capacitive RF (BTL-6000 TR-Therapy Pro®) in the right infraumbilical abdominal region, with epidermal temperature above 40°C, for 10 min (2 min per applicator area), and the skin of the contralateral region was used as control. After 30 days, on average, the skin of the abdominal region was collected for histological analysis and stained with hematoxylin and eosin, Picro-sirus, and Verhoff. The percentage of collagen and elastic fibers found was marked by the Image J®. The statistical analysis was performed in the SPSS program (version 20), with a significance level of 95%. This was registered with the ethics and research comitee of UFTM n 3.461.688 on Jul 12, 2019 and clinical trial registration n. NCT04182542, retrospectively registered. Morphometric analysis demonstrated a remodeling of collagen and elastic fibers on the side treated with RF; however, the morphometry for collagen showed no significant difference, with an average percentage of 60.94 ± 0.32 for the control side and 61.97 ± 2.80 for the treated with p=0.32. Similarly, elastic fibers also showed no significant difference between groups, with a mean percentage of 5.67 ± 2.70 for control and 6.21 ± 2.01 for treated with p=0.19. The RF with the parameters used in this study was able to cause morphological changes in collagen and elastic fibers of the abdominal region skin; however, it showed no change in the percentage of these fibers.