RF technology altering skin rejuvenation, fat reduction

LAS VEGAS – Current radiofrequency technologies, which yield measurable results in little or no down time, have altered the way clinicians and patients alike think about cervicofacial skin tightening and reduction of body fat, according to Dr. Paul J. Carniol.

"These devices do not replace surgery," he said at the annual meeting of the American Academy of Cosmetic Surgery. "They do not replace a facelift or liposuction, but they have a role for patients who tell you they don’t want to undergo a surgical procedure."

As radiofrequency (RF) technology evolves, its application in cosmetic dermatology "is just going to get better," predicted Dr. Carniol, a cosmetic, laser, and reconstructive plastic surgeon in Summit, N.J. "It’s something to keep your eye on because these devices have changed in the past few years, and they continue evolving."

He discussed his experience using the Pellevè Wrinkle Reduction System (Ellman International, Oceanside, N.Y.) for skin tightening and wrinkle reduction. This 4.0-MHz high-frequency RF device produces lateral thermal spread on the dermal layer of skin, reducing the risk of injury to surrounding tissue and structures. Therapeutic levels of heat delivered at intradermal temperatures that range from 39 to 53  C induce collagen contraction, neocollagenesis, and elastin uniformity, resulting in firmer, denser rejuvenated skin with restored elasticity. The initial wound healing response takes 3-4 weeks.

"It’s great for the patient who comes in and wants no down time, a little bit of tightening, and they want some global facial rejuvenation," Dr. Carniol said of the Pellevè system, which was cleared by the Food and Drug Administration in 2009 for the nonablative treatment of mild to moderate facial wrinkles and rhytids for Fitzpatrick skin types I-IV. The technology is contraindicated for patients with pacemakers, implantable cardioverter defibrillators, and any other implanted devices.

In one study, 93 patients were followed for 6 months after a single treatment with the Pellevè system. The response rate was determined by three independent, blinded assessors, including two facial plastic surgeons and one dermatologist (J. Drugs Dermatol. 2007;6:381-6). The response rates at 30, 90, and 180 days were 90.3%, 88.2%, and 87.1%, respectively.

In Dr. Carniol’s clinical experience, the ideal patients for the Pellevè system include those aged 35-60 years who present with modest to moderate laxity, but relatively elastic skin, moderate submental sagging, lax jaw lines and early jowls, moderate nasolabial folds, perioral and periorbital wrinkles, and/or relatively thin connective tissue layers. "You also want patients who aren’t that heavy," he said. "If someone is very overweight, the device is not going to work because the effect of all the excess tissue is too much."

Other poor candidates for the procedure include those with severely photodamaged skin, severe laxity or sagging, very deep wrinkles or muscle motion–induced rhytids, thick connective tissues, and/or unrealistic expectations. Post treatment, he said, "there is essentially no down time, which is one of the reasons that it’s such a great procedure, because your patients can take a break from work, come in, and return right to work."

His posttreatment instructions include washing the skin with tepid water and a gentle cleanser, use of nonirritating moisturizers, and use of sun block with UVA and UVB protection with an SPF of 30 or greater. The Pellevè treatment may be combined with fractionated resurfacing, but RF treatment "should be done at least 4 weeks prior to the laser treatment," he advised. "Pellevè may also be given with other treatments such as neurotoxins and fillers. Most physicians recommend this either at least 2 weeks prior to radiofrequency or at 1-2 weeks after injection after tissue reactions have subsided."

He also advised suspending the use of topical agents, which may cause erythema or irritation, for a week before and a week after Pellevè treatment; these agents include retinol/Retin-A (tretinoin)/isotretinoin, glycolic acid, and salicylic acid.

Dr. Carniol also discussed his experience with truSculpt (Cutera, Brisbane, Calif.), a monopolar RF device cleared for deep tissue heating and the temporary reduction in the appearance of cellulite. It features a large applicator that delivers energy 1.3-3 cm into the skin to targeted subcutaneous tissue before dispersing in underlying highly conductive fluids and tissues. The goal is for patients to be treated at the highest temperature that they can comfortably tolerate, typically between 42 and 46  C. Pulse durations of 4 minutes are recommended for each imprint. "Treatment should be uncomfortable, but not unbearable," he said. "Moderate hyperemia is expected and will persist for several hours."

The subcutaneous heating creates apoptosis, "a process whereby the cells resorb over a period of 3-12 weeks," explained Dr. Carniol. "It’s a very slow and gradual loss of fat cells compared with necrosis, which gives you instantaneous cell death and an acute inflammatory response and indurations."

The truSculpt device includes a proprietary contoured design to ensure uniform delivery and current. The electrode is available in four sizes: 15 cm², 25 cm², 30 cm², and 40 cm². This design "optimizes treatment uniformity over large exposure areas, which results in enhanced patient comfort and no hot spots or edge effects to cause pain," Dr. Carniol said.

Studies using before and after ultrasound images have demonstrated that the technology reduces treated areas of subcutaneous fat by up to 25%. "In general, I don’t think you see as much improvement with just one treatment," he noted. "I think it takes two to three treatments for best results."

In his clinical experience, the ideal patients for the procedure include those in generally good health with a body mass index between 22 and 28 kg/m² who have focal areas that they want reduced. The device is indicated for use on all Fitzpatrick skin types and tanned skin.

Dr. Carniol disclosed that he has given presentations for Ellman and Cutera, but said that he has no relevant financial interests in either company.

[email protected]

LAS VEGAS – Current radiofrequency technologies, which yield measurable results in little or no down time, have altered the way clinicians and patients alike think about cervicofacial skin tightening and reduction of body fat, according to Dr. Paul J. Carniol.

"These devices do not replace surgery," he said at the annual meeting of the American Academy of Cosmetic Surgery. "They do not replace a facelift or liposuction, but they have a role for patients who tell you they don’t want to undergo a surgical procedure."

As radiofrequency (RF) technology evolves, its application in cosmetic dermatology "is just going to get better," predicted Dr. Carniol, a cosmetic, laser, and reconstructive plastic surgeon in Summit, N.J. "It’s something to keep your eye on because these devices have changed in the past few years, and they continue evolving."

He discussed his experience using the Pellevè Wrinkle Reduction System (Ellman International, Oceanside, N.Y.) for skin tightening and wrinkle reduction. This 4.0-MHz high-frequency RF device produces lateral thermal spread on the dermal layer of skin, reducing the risk of injury to surrounding tissue and structures. Therapeutic levels of heat delivered at intradermal temperatures that range from 39 to 53  C induce collagen contraction, neocollagenesis, and elastin uniformity, resulting in firmer, denser rejuvenated skin with restored elasticity. The initial wound healing response takes 3-4 weeks.

"It’s great for the patient who comes in and wants no down time, a little bit of tightening, and they want some global facial rejuvenation," Dr. Carniol said of the Pellevè system, which was cleared by the Food and Drug Administration in 2009 for the nonablative treatment of mild to moderate facial wrinkles and rhytids for Fitzpatrick skin types I-IV. The technology is contraindicated for patients with pacemakers, implantable cardioverter defibrillators, and any other implanted devices.

In one study, 93 patients were followed for 6 months after a single treatment with the Pellevè system. The response rate was determined by three independent, blinded assessors, including two facial plastic surgeons and one dermatologist (J. Drugs Dermatol. 2007;6:381-6). The response rates at 30, 90, and 180 days were 90.3%, 88.2%, and 87.1%, respectively.

In Dr. Carniol’s clinical experience, the ideal patients for the Pellevè system include those aged 35-60 years who present with modest to moderate laxity, but relatively elastic skin, moderate submental sagging, lax jaw lines and early jowls, moderate nasolabial folds, perioral and periorbital wrinkles, and/or relatively thin connective tissue layers. "You also want patients who aren’t that heavy," he said. "If someone is very overweight, the device is not going to work because the effect of all the excess tissue is too much."

Other poor candidates for the procedure include those with severely photodamaged skin, severe laxity or sagging, very deep wrinkles or muscle motion–induced rhytids, thick connective tissues, and/or unrealistic expectations. Post treatment, he said, "there is essentially no down time, which is one of the reasons that it’s such a great procedure, because your patients can take a break from work, come in, and return right to work."

His posttreatment instructions include washing the skin with tepid water and a gentle cleanser, use of nonirritating moisturizers, and use of sun block with UVA and UVB protection with an SPF of 30 or greater. The Pellevè treatment may be combined with fractionated resurfacing, but RF treatment "should be done at least 4 weeks prior to the laser treatment," he advised. "Pellevè may also be given with other treatments such as neurotoxins and fillers. Most physicians recommend this either at least 2 weeks prior to radiofrequency or at 1-2 weeks after injection after tissue reactions have subsided."

He also advised suspending the use of topical agents, which may cause erythema or irritation, for a week before and a week after Pellevè treatment; these agents include retinol/Retin-A (tretinoin)/isotretinoin, glycolic acid, and salicylic acid.

Dr. Carniol also discussed his experience with truSculpt (Cutera, Brisbane, Calif.), a monopolar RF device cleared for deep tissue heating and the temporary reduction in the appearance of cellulite. It features a large applicator that delivers energy 1.3-3 cm into the skin to targeted subcutaneous tissue before dispersing in underlying highly conductive fluids and tissues. The goal is for patients to be treated at the highest temperature that they can comfortably tolerate, typically between 42 and 46  C. Pulse durations of 4 minutes are recommended for each imprint. "Treatment should be uncomfortable, but not unbearable," he said. "Moderate hyperemia is expected and will persist for several hours."

The subcutaneous heating creates apoptosis, "a process whereby the cells resorb over a period of 3-12 weeks," explained Dr. Carniol. "It’s a very slow and gradual loss of fat cells compared with necrosis, which gives you instantaneous cell death and an acute inflammatory response and indurations."

The truSculpt device includes a proprietary contoured design to ensure uniform delivery and current. The electrode is available in four sizes: 15 cm², 25 cm², 30 cm², and 40 cm². This design "optimizes treatment uniformity over large exposure areas, which results in enhanced patient comfort and no hot spots or edge effects to cause pain," Dr. Carniol said.

Studies using before and after ultrasound images have demonstrated that the technology reduces treated areas of subcutaneous fat by up to 25%. "In general, I don’t think you see as much improvement with just one treatment," he noted. "I think it takes two to three treatments for best results."

In his clinical experience, the ideal patients for the procedure include those in generally good health with a body mass index between 22 and 28 kg/m² who have focal areas that they want reduced. The device is indicated for use on all Fitzpatrick skin types and tanned skin.

Dr. Carniol disclosed that he has given presentations for Ellman and Cutera, but said that he has no relevant financial interests in either company.

[email protected]

LAS VEGAS – Current radiofrequency technologies, which yield measurable results in little or no down time, have altered the way clinicians and patients alike think about cervicofacial skin tightening and reduction of body fat, according to Dr. Paul J. Carniol.

"These devices do not replace surgery," he said at the annual meeting of the American Academy of Cosmetic Surgery. "They do not replace a facelift or liposuction, but they have a role for patients who tell you they don’t want to undergo a surgical procedure."

As radiofrequency (RF) technology evolves, its application in cosmetic dermatology "is just going to get better," predicted Dr. Carniol, a cosmetic, laser, and reconstructive plastic surgeon in Summit, N.J. "It’s something to keep your eye on because these devices have changed in the past few years, and they continue evolving."

He discussed his experience using the Pellevè Wrinkle Reduction System (Ellman International, Oceanside, N.Y.) for skin tightening and wrinkle reduction. This 4.0-MHz high-frequency RF device produces lateral thermal spread on the dermal layer of skin, reducing the risk of injury to surrounding tissue and structures. Therapeutic levels of heat delivered at intradermal temperatures that range from 39 to 53  C induce collagen contraction, neocollagenesis, and elastin uniformity, resulting in firmer, denser rejuvenated skin with restored elasticity. The initial wound healing response takes 3-4 weeks.

"It’s great for the patient who comes in and wants no down time, a little bit of tightening, and they want some global facial rejuvenation," Dr. Carniol said of the Pellevè system, which was cleared by the Food and Drug Administration in 2009 for the nonablative treatment of mild to moderate facial wrinkles and rhytids for Fitzpatrick skin types I-IV. The technology is contraindicated for patients with pacemakers, implantable cardioverter defibrillators, and any other implanted devices.

In one study, 93 patients were followed for 6 months after a single treatment with the Pellevè system. The response rate was determined by three independent, blinded assessors, including two facial plastic surgeons and one dermatologist (J. Drugs Dermatol. 2007;6:381-6). The response rates at 30, 90, and 180 days were 90.3%, 88.2%, and 87.1%, respectively.

In Dr. Carniol’s clinical experience, the ideal patients for the Pellevè system include those aged 35-60 years who present with modest to moderate laxity, but relatively elastic skin, moderate submental sagging, lax jaw lines and early jowls, moderate nasolabial folds, perioral and periorbital wrinkles, and/or relatively thin connective tissue layers. "You also want patients who aren’t that heavy," he said. "If someone is very overweight, the device is not going to work because the effect of all the excess tissue is too much."

Other poor candidates for the procedure include those with severely photodamaged skin, severe laxity or sagging, very deep wrinkles or muscle motion–induced rhytids, thick connective tissues, and/or unrealistic expectations. Post treatment, he said, "there is essentially no down time, which is one of the reasons that it’s such a great procedure, because your patients can take a break from work, come in, and return right to work."

His posttreatment instructions include washing the skin with tepid water and a gentle cleanser, use of nonirritating moisturizers, and use of sun block with UVA and UVB protection with an SPF of 30 or greater. The Pellevè treatment may be combined with fractionated resurfacing, but RF treatment "should be done at least 4 weeks prior to the laser treatment," he advised. "Pellevè may also be given with other treatments such as neurotoxins and fillers. Most physicians recommend this either at least 2 weeks prior to radiofrequency or at 1-2 weeks after injection after tissue reactions have subsided."

He also advised suspending the use of topical agents, which may cause erythema or irritation, for a week before and a week after Pellevè treatment; these agents include retinol/Retin-A (tretinoin)/isotretinoin, glycolic acid, and salicylic acid.

Dr. Carniol also discussed his experience with truSculpt (Cutera, Brisbane, Calif.), a monopolar RF device cleared for deep tissue heating and the temporary reduction in the appearance of cellulite. It features a large applicator that delivers energy 1.3-3 cm into the skin to targeted subcutaneous tissue before dispersing in underlying highly conductive fluids and tissues. The goal is for patients to be treated at the highest temperature that they can comfortably tolerate, typically between 42 and 46  C. Pulse durations of 4 minutes are recommended for each imprint. "Treatment should be uncomfortable, but not unbearable," he said. "Moderate hyperemia is expected and will persist for several hours."

The subcutaneous heating creates apoptosis, "a process whereby the cells resorb over a period of 3-12 weeks," explained Dr. Carniol. "It’s a very slow and gradual loss of fat cells compared with necrosis, which gives you instantaneous cell death and an acute inflammatory response and indurations."

The truSculpt device includes a proprietary contoured design to ensure uniform delivery and current. The electrode is available in four sizes: 15 cm², 25 cm², 30 cm², and 40 cm². This design "optimizes treatment uniformity over large exposure areas, which results in enhanced patient comfort and no hot spots or edge effects to cause pain," Dr. Carniol said.

Studies using before and after ultrasound images have demonstrated that the technology reduces treated areas of subcutaneous fat by up to 25%. "In general, I don’t think you see as much improvement with just one treatment," he noted. "I think it takes two to three treatments for best results."

In his clinical experience, the ideal patients for the procedure include those in generally good health with a body mass index between 22 and 28 kg/m² who have focal areas that they want reduced. The device is indicated for use on all Fitzpatrick skin types and tanned skin.

Dr. Carniol disclosed that he has given presentations for Ellman and Cutera, but said that he has no relevant financial interests in either company.

[email protected]