Radiofrequency (RF) has been around for decades, mainly used to cauterize tissue during surgical procedures. Over the past several years, RF has made big waves in aesthetic medicine, according to Andrew Campbell, M.D., a facial plastic surgeon, with Quintessa Aesthetic Centers in Mequon, Delafield and Sheboygan, Wis.
Dr. Campbell shares how RF came to be in aesthetic medicine; indications for use; how to manage patient expectations; how to choose an RF device; warnings; and more, for The Aesthetic Channel’s Energy Device 101 series.
Early cosmetic RF devices delivered the energy topically.
“The energy would penetrate the skin and heat the collagen, causing new collagen deposition that helps the skin look better,” Dr. Campbell says. “There were monopolar RF devices, where the energy went from the handpiece to a grounding plate. And there were bipolar and then multipolar devices, where the energy went from one part of the handpiece to another part of the same handpiece.”
Many RF devices used topical cooling to protect the epidermis, in an attempt to safely get the heat to the desired target: the dermis.
Another device type uses RF as a field generator, with no handpiece — the machine doesn’t touch the skin. That particular machine isn’t indicated in facial plastic surgery; rather, it’s used by aesthetic medicine physicians who treat the body to help reduce subcutaneous fat, according to Dr. Campbell.
More recently, injectable RF devices have entered the market. Some of these use multiple tiny needles that pierce the skin and deposit energy directly to the dermis. Those devices can be used to improve the skin and require only topical anesthetic for comfort, according to Dr. Campbell.
“Other devices use longer, larger needles or cannulas to treat the deeper tissue in an attempt at improving laxity. These devices require the use of local anesthetic for comfort,” he says.
Most RF devices have the ability to monitor the treatment area’s temperature, for safe and effective RF treatment, he says.
“One device even monitors the temperature of the overlying skin with a temperature sensing camera. The goal is to prevent a burn injury to the epidermis,” Dr. Campbell says.
Typical RF device indications in cosmetic practice include treating photodamaged skin, skin texture issues and mild wrinkling, according to Dr. Campbell.
“The more aggressive devices are indicated for mild laxity of the face,” he says. “Overall, RF improves and increases the collagen in the treatment area. This healing response is what improves the appearance of the skin and can improve the laxity.”
Overall, RF can provide mild improvements associated directly with the amount of energy delivered, according to Dr. Campbell.
Devices that cause very little, if any, downtime can provide mild improvements in the skin, while more aggressive devices, which cause a lot of swelling and bruising, create more significant improvement — at the cost of more downtime.
“Overall, RF devices are supposed to minimize downtime, while giving patients visible improvements. Patient expectation management is paramount, since the result is seldom going to be spectacular compared to other ablative devices, such as the erbium laser or CO2 laser,” Dr. Campbell says.
Dr. Campbell says his policy with RF and other technologies is to under-promise and over-deliver, especially when a technology is new.
“Once we have a lot of experience with it, then we can make promises to our patients because we know we can deliver on them,” he says.
When it comes to choosing the right energy devices for a practice, Dr. Campbell says, “I think it’s important that we have the best technology for what we are trying to treat — whether that is browns and reds in the skin, texture, wrinkles or laxity. We need to be honest with our patients, so they have realistic expectations and ultimately a high satisfaction with whatever treatment or device we give them.”
Without the benefit of strong head-to-head RF device comparisons, Dr. Campbell says it’s tough to claim one device is superior to another.
“There are advantages and disadvantages to each of them,” he says. “Some are going to give patients no downtime at all, but they may not be very effective. Others may be effective, but at the cost of significant downtime, or a more involved procedure. Each provider will need to weigh those issues prior to a purchase.”
RF is generally a safe technology to use in cosmetic practice, according to Dr. Campbell.
The one warning, he says, is that providers shouldn’t be too aggressive when using RF devices.
“Too much heat can create a burn in the skin that may take a long time to heal and leave a scar,” he says. “You can also cause a nerve injury, which should recover eventually, but those are devastating to the patient.”
As for the future of RF, the technology has a strong foothold in cosmetic medicine and the future looks bright, according to Dr. Campbell.
“It is a relatively inexpensive technology that is very reliable and that will continue to improve as we improve the energy-tissue interaction,” he says.
