Clinical papers

Abstract:

42 patients with broad age and ethnic demographics where treated with a novel, non-excisional, minimally invasive device to coagulate a very thin layer of sub-dermal septo-fascial fat, denature the deep reticular dermis and tighten the skin and sub-dermal matrix of connective tissue. The detailed treatment protocol and results are presented. Patients were observed for up to 6 month following the procedure. No major side effects were observed. The aesthetic outcome of this non-excisional procedure includes improvement of the position and shape of the cheek, lower lid-cheek junction, jawline and neck. The overall aesthetic results deliver a noticeable and impressive tightening of the soft-tissue and may be compared with a conservative, small excisional procedure. The authors propose this versatile device and treatment as a non-excisional, moderate facial rejuvenation procedure on its own, or as an adjunct to open procedures performed simultaneously, or as a simplified treatment for secondary skin laxity in combination with a lift procedure.

Introduction:

The increased prevalence of obesity worldwide has grown the body contouring market, as patients demand more solutions. One of the most popular body contouring methods is liposuction. Pioneered in Europe in the early 1980’s as a simple fat aspirating technique, liposuction has quickly expanded its breadth to incorporate a variety of energy sources and modus operandi.

Many types of energies have been combined with standard liposuction techniques in an attempt to improve and optimize treatment outcomes. The current chapter is dedicated to the authors’ experience with the most recent addition to the liposuction family, Radio-Frequency Assisted Liposuction (RFAL). RFAL delivers RF energy for a thermal effect to the adipose tissue, skin and sub-dermal matrix in a minimally invasive manner. Enhancing the standard lipoplasty experience with a safe and consistent thermal influence provides the following key benefits:

• Blood vessel coagulation to reduce patient downtime through less bleeding and bruising.
• Tissue tightening to expand the range of patients to now include individuals who are obese and/or have compromised skin conditions (lax skin).
• Increased patient comfort and safety will increase consumer acceptance.
• Reduced procedure time and ease of treatment will increase physician acceptance.

Excerpt:
“Linear contraction observed at 3 months follow-up were much more significant than reported with any other technology and varied from 12.7% up to 47% depending on patient and treatment variables.”

Abstract: The use of radiofrequency energy to produce collagen matrix contraction is presented. Controlling the depth of energy delivery, the power applied, the target skin temperature, and the duration of application of energy at various soft tissue levels produces soft tissue contraction, which is measurable. This technology allows precise soft tissue modelling at multiple levels to enhance the result achieved over traditional suction-assisted lipectomy as well as other forms of energy such as ultrasonic and laser-generated lipolysis.

Conclusion: We believe the study results confirm the hypothesis of Kenkel [17], i.e., skin tightening and elasticity changes following thermal lipoplasty are mostly a result of subdermal tissue contraction but not dermal, which experiences lower heating during the treatment. It is clear that 40–42°C on the skin surface cannot result in an immediate contraction effect. Deep dermal remodeling may account for some horizontal contraction over time. It is possible that the dermal-fat junction experiences higher temperatures, but this process requires future investigation. We believe that the mechanism of subcutaneous collagen contraction during RF-assisted liposuction is similar to that witnessed in other types of collagen in that the contraction process has thermal contraction thresholds in the range of 60–70°C.
It is likely more accurate to talk about tissue contraction rather than skin tightening because significant area contraction is a result of the strong contribution of deeper adipose fascial layers. Further studies with accurate 3D area measurements will tell us more about the RF-mediated area contraction in this RFAL technology. This RFAL thermal process and contraction can be effectively applied during a liposuction treatment in selected cases, improving patient satisfaction and extending liposuction procedures to higher-weight patients and patients with compromised skin conditions.