Unification of RF/fractional technologies to combat signs of aging gains momentum for patients in 40s, 50s

As the demand grows for procedures that enable patients to stave off major cosmetic surgery, the combination of fractional laser resurfacing and radiofrequency (RF) is making waves.

"This combination is perfect for patients in their 40s and 50s who don't need a lot," says Ron Moy, M.D., professor at the David Geffen School of Medicine at University of California, Los Angeles. "Fractional resurfacing takes away the surface sun damage and the surface wrinkles and even some deeper wrinkles, and it does some tightening, and radiofrequency provides modest tightening.

"People who have significant sagging are not going to be helped by radiofrequency or the combination of RF and fractional resurfacing," he explains.

Before (left) and after tightening of the jawline and around the eyes from the Thermage (radiofrequency, Solta) procedure. Additionally, the patient's pigment is cleared and skin texture improved following the Fraxel re:store (fractional laser, Solta) procedure.

Radiofrequency offers the benefit of no downtime, whereas fractional resurfacing could entail up to a week of healing. "But," he says, "there's no cutting, and the results always look natural."

RF DETAILS Currently, Thermage, Pollogen and Pelleve are some of the leading contenders in the RF aesthetics market. Thermage's offering is based on monopolar heat delivery, enabling RF energy to penetrate deep into the dermis and subcutaneous tissue, where it tightens existing collagen and stimulates new growth. The Thermage system is also known for its capacitive coupling technology, which distributes RF energy uniformly across the surface of the applicator tip.

Pollogen's TriPollar RF technology delivers focused RF energy to the skin surface and to subcutaneous fat layers via three electrodes focused specifically on the treatment area. Integrated preset parameters allow practitioners to choose between body and/or facial treatments. Targeted facial treatment regenerates collagen fibers in the dermis layer. Targeted body treatments shrink fat cells in the hypodermis layer and accelerate collagen regeneration.

Pelleve (Ellman International) works using one surface electrode that causes tightening by delivering superficial energy to any body area.

Depending on the patient, Dr. Moy explains, RF treatments usually last from 45 minutes to an hour, and are usually spaced about a month apart, and patients usually require one, two or three treatments. "We have never had a patient who did not notice a difference after treating one side, and almost all of my patients see the improvement after they look at their 'before' and 'after' pictures, which shows that it's not dramatic, but it is effective," Dr. Moy explains.

FRACTIONAL RESURFACING According to Dr. Moy, results can be taken up a notch when laser resurfacing is added to the mix. "Fractional resurfacing offers another method to tighten the skin, and at the same time it resurfaces the outer skin, ridding patients of brown spots, unevenness, fine lines and even some deep wrinkles," Dr. Moy says. "It's an extremely safe method, can be used effectively on the neck, arms and chest, and enables us to avoid problems associated with some other lasers, such as lighter pigmentation and scarring."

Fractional resurfacing can be performed with a carbon dioxide laser or with a nonablative laser, Dr. Moy says, and while CO₂ lasers entail up to a week of healing, the results tend to be so much better with this type of laser, that most of his patients now choose this option.

Using the example of a female patient with deep wrinkles around her mouth, Dr. Moy says, "I tell them that 50 percent of the wrinkles will go away with one treatment of the CO₂ laser, but that it will take a week to heal, or that they can have six to eight treatments with the nonablative laser and have almost no down time, but that they will only get about a 25 percent improvement of their wrinkles. More people opt for the one-week healing."

ADDING VOLUME The effects of skin tightening and removal of sun damage can be dramatic, but adding volume makes the difference between a non-lined face and a youthful face. "If you use a filler to put volume back into the face of a patient who is about 50 — even if the skin has already been tightened maximally and resurfaced thoroughly — the patient looks young again," says Dr. Moy. "It's like a liquid facelift."

Disclosures: Dr. Moy reports no relevant financial interests in any of the products or companies mentioned in the article.