Capacitive Radiofrequency Skin Rejuvenation
Noninvasive methods have become increasingly popular, and there is significant demand for effective, proven methods of nonablative skin rejuvenation. Nonablative capacitive radiofrequency has been a successful and well-received approach for nonsurgical sk
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Manoj T. Abraham and Joseph J. Rousso
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Introduction
Skin rejuvenation procedures, particularly those that deal with rhytids and skin tightening, are a necessary skill set in the arsenal of the aesthetic clinician. In general, plastic surgical techniques provide the most dramatic improvement. Resurfacing lasers (traditional or fractionated), dermabrasion, deep chemical peels, and coblation are considered standard ablative nonsurgical tools for skin-rejuvenating procedures. However, longer duration of recovery, scarring, pigmentary changes, and other complications are more common with surgical and ablative procedures due to the very nature of these treatments. As a result, noninvasive methods have become increasingly popular, and there is significant demand for effective, proven methods of nonablative skin rejuvenation. The senior author has found nonablative capacitive radiofrequency to be a successful and well-received approach for nonsurgical skin tightening in his private practice.
M.T. Abraham (*) Facial Plastic, Reconstructive & Laser Surgery, PLLC, Poughkeepsie, NY, USA Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head & Neck Surgery, New York Medical College, Valhalla, NY, USA e-mail: [email protected] J.J. Rousso Department of Otolaryngology – Head & Neck Surgery, The New York Eye & Ear Infirmary, New York, NY, USA e-mail: [email protected]
Radiofrequency (RF) energy is electromagnetic radiation in the range of 3–300 GHz. Solta Medical, Inc. (formerly Thermage, Inc.), based in Hayward, California, has pioneered the aesthetic application of nonablative RF skin tightening. Thermage, Inc., was initially granted FDA regulatory clearance for treatment of periorbital wrinkles and rhytids in November 2002. This was followed by clearance for full-face treatment in June 2004. In January of 2006, the FDA expanded its clearance to treatment of all skin surface wrinkles and rhytids. Although there are a growing number of other devices and technologies available for nonablative skin tightening, none of these have the accumulation of published studies reporting efficacy compared to Thermage [1–38]. In addition, Thermage treatment protocols have had time to evolve through several generations, ensuring safety and more consistent and effective results [32, 34, 37]. Thermage systems utilize the company’s proprietary technology, incorporating large monopolar capacitive electrodes to deliver RF energy into the skin while concurrently protecting the skin surface with a cryogen cooling spray. Current flows from the device via the treatment tip, through the skin and out through a grounding pad applied to the patient. This creates a reverse thermal gradient in the skin, with cooling of the epidermis while simultaneously achieving precise volumetric heating of the deeper dermis. As a result, there is partial denaturation of the collagen within the dermis without injury to the skin surface [1, 19]. Initial contraction of the skin collagen network in the dermis occurs immediately as the col
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