http://www.icosmed.de medical aesthetics body language - The UK Journal of Medical Aesthetics and Anti-Ageing Consumers are increasingly seeking less-invasive aesthetic treatments with minimal downtime and consistent results. Dr Michael Kreindel and Dr Stephen Mulholland assess the benefits of using radio-frequency energy for non-invasive procedures

1. medical aesthetics
Radio-frequency
energy
Consumers are increasingly seeking less-invasive aesthetic treatments with minimal downtime
and consistent results. Dr Michael Kreindel and Dr Stephen Mulholland assess the benefits of
using radio-frequency energy for non-invasive procedures
R
adio-frequency energy has been used reliably in most frequently for cutting where RF energy is focused near
medical and cosmetic applications for almost 100 a needle-type electrode, creating tissue ablation and a second
years. Its use through various procedures and large-area return electrode is used to close the current loop.
devices has demonstrated its consistency, efficacy and Bi-polar devices are mainly used for coagulation of blood ves-
safety. RF energy used in medical applications is applied sels and tissue, and heat is generated between two electrodes
to the tissue by alternating high frequency electrical cur- positioned within the treatment area.
rent. This creates a thermal effect in the tissue in the area Many versatile RF energy devices are available, and it has
of the RF electrode. At frequencies higher than 100kHz, become common practice to use RF electrosurgical devices
the electrical current creates a pure thermal effect with- in plastic and dermatological surgery for skin and tissue cut-
out affecting local nerve and muscle tissue, thereby ena- ting and blood coagulation. Simultaneous tissue cutting and
bling the RF energy to become an effective instrument blood coagulation make it an effective tool for face-lifting,
for safe tissue treatment. By controlling RF current den- blepharoplasty, abdominoplasty and other excisional and in-
sity through optimising output power and electrode size, cisional surgeries. In the last decade, RF energy has become
physicians can heat, coagulate and ablate tissue. incorporated in non-invasive cosmetic treatments alone or
The simplicity, versatil- in combination with laser
ity and efficiency of the RF or intense pulsed light. The
devices, such as the electro- leading companies in this
surgical device, developed by RF aesthetic market are
Harvard University professor Solta Medical Inc (formerly
Dr Bovie and first used by Dr Thermage Inc) and Syneron
Harvey Cushing in surgery, Medical Ltd. The biggest
have made RF energy the advantage of RF versus la-
most popular thermal treat- ser energy is its unlimited
ment modality in a variety penetration depth. Laser ra-
of medical applications. The diation can penetrate to the
big advantage of RF energy depth of only a few millime-
over laser, cryotherapy and tres, requires a specific target
other treatment modalities chromophore for absorption
is the ability to monitor tis- and must often respect skin
sue electrical parameters sim- type.
ply and reliably through the However, RF energy ef-
direct measurements of its fectively penetrates into
impedance. Practitioners can and through the subdermal
adjust output power accord- layer into the subcutaneous
ing to local properties of the tissue. RF energy is indif-
treated tissue. ferent to chromophore and
There are many hand- is skin-type independent.
SKINCENTRAL
piece designs that allow the These unique features makes
optimal delivery of RF en- RF energy efficient for skin
ergy according to applica- The main advantages of non-invasive treatments are their simplicity, tightening, body contouring
tion. Mono-polar RF is used safety and quick recovery. Shown is Thermage monopolar RF energy and subcutaneous fat treat-
body language The UK Journal of Medical Aesthetics and Anti-Ageing 23

2. medical aesthetics
ment, which are the fastest-growing segments in the aesthetic heating of the superficial dermal layer. Developed by Invasix
industry, even during the recent economic downturn. Inc, the BodyTite RFAL system is gaining awareness among
As with electrosurgery, both monopolar and bipolar con- cosmetic physicians by creating a new approach in aesthetic
figurations of applicators and handpieces are used for non-in- medicine. The first use of RFAL is focused on improvement
vasive procedures. Non-ablative cosmetic treatments are usu- of body contour and cellulite, but there is also a big poten-
ally based on remodelling of collagen and ground substances, tial of this minimally invasive RF technology for face-lifting,
whereas heating adipocytes to sub-necrotic levels contours blepharoplasty and tightening of loose skin in areas such as
fat. Large electrode surface areas allow the delivery of energy the knees and arms.
in a uniform manner to a large treatment area. RF energy continues to be the most popular aesthetic en-
The main advantages of non-invasive treatments are their ergy used in invasive aesthetic medicine and now we see a RF
simplicity, safety and minimal recovery time—often making renaissance for a new minimally invasive treatment to address
them lunch-time procedures. However, non-invasive RF or the consumer desire for dramatic and consistent results with
laser therapy requires multiple treatments, demonstrating di- less downtime and risk.
minished efficacy and consistency in comparison to invasive The use of RF energy in minimally invasive aesthetic
treatments. treatments allows the physician to develop procedures for
While some patients have good results following a series of heavier patients, older patients and those with decreased skin
non-invasive procedures, the majority will often report minor elasticity. Therefore, the unique properties of RF energy,
improvement. The inherent limitation of a non-invasive ap- which include unlimited penetration depth, good control of
proach is based on the concept in which RF energy is deliv- parameters and versatility of electrode configurations, make
ered through the skin to affect the subdermal layer without it one of the most important instruments in the hands of aes-
epidermal damage. thetic medical professionals.
The most recent application of aesthetic RF energy is radio
frequency assisted liposuction (RFAL), which deploys both Dr Stephen Mulholland is a consultant plastic surgeon and direc-
the advantages of electro-surgical and non-invasive technolo- tor of SpaMedica Infinite Vitality Clinic in Toronto, Canada.
gies, combining aggressive coagulation of internal adipose, W: www.spamedica.com; Dr Michael Kreindel is chief technical
vascular and fibrous tissue and gentle, uniform and safe officer of Invasix Ltd . W: www.invasix.com
RF electrosurgical device used during abdominoplasty. Simultaneous tissue cutting and blood coagulation makes it an effective tool for face-
lifting, blepharoplasty, abdominoplasty and other excisional and incisional surgeries
24 body language The UK Journal of Medical Aesthetics and Anti-Ageing