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Radiofrequency (RF) energy treatment is a new and promising technology for non-surgical body contouring, fat and cellulite reduction. Pure RF energy alone (such as the Accent™, Thermage™ and Tripollar™ devices) or RF in combination with other modalities (such as the Velasmooth™/Velashape™ device which combines RF with infrared, tissue mobilisation and suction) can be used in treatments to effectively contour the body and reduce the appearance of cellulite and fat. With deep, controlled heating of the fatty layers under the skin, the effects of tissue tightening and increased blood circulation mean that fatty deposits are drained through the lymphatic system, reducing the appearance of cellulite. Based on current RF technologies, most people should see at least a mild improvement in their skin tone, with a temporary reduction in the appearance of cellulite and possible inch loss, with minimal risks and downtime. Prices for radiofrequency depend on the area(s) treated and the device used.
The 3D-lipo system combines hand pieces for cryolipolysis, radiofrequency, cavitation, dermology and shockwave therapy to achieve skin tightening, cellulite reduction and body contouring.
The Accent system boasts dual handpieces – a bipolar one for volumetric dermal heating, aimed at skin tightening treatments; and a Unipolar one for for fat reduction and cellulite treatment.
The BTL Vanquish is the only contactless radiofrequency technology for non-invasive fat removal. The latest generation of the device is the BTL Vanquish ME, standing for Maximum Energy.
EndyMed’s 3DEEP RF applicators use radiofrequency technology to firm, tighten and lift sagging skin on the face and body by heating the collagen in the dermis.
Exilis® Elite uses a combination of monopolar radio frequency (RF) energy, ultrasound to stimulate fat lipolysis (the breakdown of fat cells) and collagen remodelling (for skin tightening), alongside skin cooking, helping to contour the body and face.
The ProMax Lipo is a combined radiofrequency, ultrasonic cavitation and vacuum massage device for facial skin tightening and body contouring.
The Thermage™ system is a mono-polar (one electrode) radiofrequency device that delivers radiofrequency energy deep into dermal tissues for facial skin tightening, body contouring and improvement in the appearance of cellulite.
TriPollar™ radio frequency (RF) technology is available via two devices, Apollo® and Regen®. The devices are marketed for cellulite reduction, body remodelling and skin tightening.
The Velasmooth™ combined Infrared and RF energy technology (plus tissue mobilization and suction) has proven to be an effective body contour and fat reduction tool, as well as cellulite reduction tool
The use of electric currents in medicine has been documented almost since electricity itself was discovered.
Radiofrequency (RF) surgery has a lengthy history of use in oral, ophthalmic, plastic, and gynaecological surgery of over 70 years. Gradually, its use in the practice of dermatology, cosmetology, cardiology, neurosurgery, hepatology, and ENT procedures gained momentum and popularity. Low frequency alternating currents are also used in physiotherapy for their ability to cause contractions in muscles. RF surgery traditionally utilizes a wave of electrons to cause frictional heating of tissues to incise, excise, ablate or coagulate the targeted tissue.
However with recent developments in cryogenics (the use of extremely cold substances) and information technology, non-ablative RF energy is the newest addition to the treatment options available for cellulite and fat reduction. With the introduction of cryogenics it is possible to deliver RF energy to the deep dermis and sub-dermal layers of the skin, whilst protecting the epidermis. Heating in this area, without damaging the outer layers of skin, causes microscopic changes to the tissues and collagen contraction, with subsequent collagen remodelling over the months that pass.
If you are considering an RF treatment, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask a practitioner about anything you don't understand.
What Is It?
Technically speaking, radiofrequency is the number of oscillations (or waves) per second of the electric and magnetic fields within the radio waves portion of the electromagnetic spectrum.
It is lowest of the electromagnetic radiation frequencies within the spectrum, which itself spans from radio waves, microwaves, infrared, optical (visible light), ultraviolet, x-rays, to gamma rays.
By feeding an alternating current (AC) or voltage through an antenna or electrode, electromagnetic waves can be generated that radiate through space at the speed of light; called radio waves. Radiofrequencies, or radio waves, have wavelengths ranging from less than a centimetre to as long as 100 kilometres.
UK domestic electricity which itself is an alternating current could in theory be used for “electrosurgery”, however as most people know, contact with this kind of electric current can cause very undesirable effects such as electrocution and uncontrolled neuromuscular (nerve and muscle) stimulation. However, if the frequency of the alternating current is raised above the response time of neuromuscular structures, we find the radiofrequency range which can safely be used for medical/surgical applications.
By applying RF energy to the human body, which can conduct current and therefore act as part of the electrical circuit, any resistance encountered by the energy flow will cause heat to be produced at the site of maximum resistance, which can be used to cut or coagulate tissue.
When comparing non-ablative (procedures that do not involve the destruction of the outer layer of the skin) techniques, RF energy differs from laser (light) energy in that light energy tends to scatter or absorb into the upper layers of the skin, making it difficult to deliver sufficient heat into the deeper layers without damaging the skin's surface.
Lasers therefore affect collagen in the upper dermis, improving fine lines, wrinkles and skin texture, while RF energy is able to penetrate deeper into the skin and affect the deeper dermis and subcutaneous layers, causing tightening and improvements to the underlying tissue structure, but with little change in skin texture.
Types of Radiofrequency
Monopolar (also called Unipolar)
Monopolar or unipolar refers to a device having one pole or electrode.
With monopolar delivery, the current from the generating machine flows through the body from a single electrode (handpiece) and meets maximum resistance in the area around the tip of the handpiece, where tissue heating in the subdermal layers then occurs. A grounding, or “return pad” may also be used, attached to the patient’s lower back or abdomen, to provide a low resistance path for the current to flow back to the generating machine, to complete the electrical circuit.
Bipolar refers to a device having two poles or electrodes.
With bipolar delivery, the current from the generating machine flows only through the tissue which is between the two electrodes on the handpiece; these electrodes start and complete the electrical circuit. Hence, with bipolar delivery, no current flows through the rest of the body, so no grounding or return pad is needed.
In all cases of radiofrequency delivery types, it is the resistance to the current flow in the tissue, not the electrode that generates the heating effect.
There are currently only a small number of RF only devices within the UK market place, these include:
The Thermage™ system is a monopolar RF device that uses patented technology within its ThermaTip™ to deliver RF energy deep into dermal tissues. This heating action causes deep collagen structures in the skin to immediately tighten. Over time, new collagen is produced by the body to further tighten the skin. This device was originally used mainly for facial rejuvenation but has now been expanded for use on other areas of the body and for the temporary reduction in the appearance of cellulite.
It was cleared by the U.S. Food and Drug Administration (FDA) in November 2002 for non-invasive treatment around the eyes, and then in June 2004 for the treatment of facial wrinkles, followed by off-face for the non-invasive treatment of wrinkles in January 2006. Thermage is the first and only system to receive FDA clearance for non-invasive eyelid treatments which was received in June 2007. It is also FDA cleared for the temporary improvement in the appearance of cellulite (when combined with vibration).
The Accent™ system boasts dual handpieces – a biopolar handpiece for volumetric dermal heating, aimed primarily at skin tightening treatments; and a monopolar one for a deep controlled penetration depth of the RF energy for fat reduction and cellulite treatment.
It was awarded a CE Mark in June 2005 for cellulite reduction, and FDA approval for the treatment of wrinkles in April 2007, with further approval for more applications currently pending.
TriPollar™ radio frequency uses mono-polar and bipolar devices which utilise one or two poles to conduct the RF energy, TriPollar™ RF is claimed to be the only radio frequency technology in the world that simultaneously combines the effects of mono and bi-polar radio frequency in a single treatment, which the manufacturers claim produces better results with less pain.
RF and Other Modalities
Increasingly innovation is producing devices that utilise RF energy in combination with other modalities, which are themselves enhanced by the addition of RF, producing machines able to treat more successfully a wider variety of aesthetic requirements from skin tightening to hair removal and cellulite.
RF in combination with light based technologies has the effect of removing the focal point that the light would normally seek out. For example, ablative carbon dioxide (CO2) lasers used in skin resurfacing seek water within the surface layers of the skin, which it heats up, causing both the water and the outermost layers of the skin to vapourise. Non ablative lasers and IPL however seek colour, such as the skin’s pigment (in the case of tattoo or port wine stain removal), or the colour of a hair follicle for hair removal treatments.
Some examples of devices combining RF with other modalities currently available or being developed for a wide variety of applications include:
There are several different machines manufactured by Syneron Ltd, which are powered by their patented elos™ (electro-optical synergy) technology — the combined energy technology that uses bipolar radiofrequency and light energies.
IPL and RF (The Aurora™)
The combined efficacy of Intense Pulsed Light (IPL) energy and bipolar radiofrequency energy in the same machine has greatly increased the predictability, safety and outcomes of basic photorejuvenation treatment.
Red and brown skin discolouration can be removed as, or more effectively than optical (IPL) only technology with fewer risks and downtime. The addition of modest levels of RF has also improved the resolution of fine lines and wrinkles.
The IPL and RF combined therapy also provides effective hair removal and permanent reduction outcomes on light and dark skinned patients, as well as red, blonde and grey haired patients.
Diode Laser and RF (The Polaris™ and The Comet™)
The combined 900nm diode laser and very high RF energy (The Polaris™) has added a new and powerful component to skin rejuvenation.
Multiple treatments of this deep, skin penetrating technology has provided pleasing skin tightening results on the face and body, as well as noticeable wrinkle reduction in more moderate and severe wrinkles.
The diode laser and RF combined technology is also effective on larger thread veins on the legs and face.
An 810nm diode laser and high energy RF (The Comet™) provides very effective, high speed 810nm optical hair removal results, with the added RF benefit of efficacious outcomes in dark skinned, or tanned patients, as well as red, blonde or grey hair.
Infrared and RF (VelaSmooth™ & VelaShape™)
The Velasmooth™ & VelaShape™ combined Infrared and RF energy technology (plus tissue mobilisation and suction) has proven to be an effective body contour and fat reduction tool, as well as cellulite reduction tool.
In June 2005, it received FDA approval for temporary reduction in the appearance of cellulite.
What Can It Treat?
Pure RF energy alone (such as the Accent™ device) or RF in combination with other modalities (such as the Velasmooth™ device which combines RF with infrared, tissue mobilisation and suction) can be used in treatments to effectively contour the body and reduce the appearance of cellulite and fat.
With deep, controlled heating of the fatty layers under the skin, the effects of tissue tightening and increased blood circulation mean that fatty deposits are drained through the lymphatic system, reducing the appearance of cellulite.
You should try to avoid doing anything that will irritate your skin immediately before treatment. This includes sunbathing (natural or artificial). Practitioners are unlikely to treat someone who has sun burn for example, as they would be more likely to suffer pain from the addition of heat to the already damaged skin; however an established tan would be fine.
Some women find that their skin is more sensitive right before and during their menstrual cycle so if you are a woman, you might want to take this effect on pain threshold into consideration when scheduling your treatment appointment(s).
Careful discussions regarding your reasons for wanting treatment are very important before you begin the treatment. You must also make sure that this treatment can deliver what you want and how you would like to look afterwards. Your practitioner should be able to answer all these questions.
A medical history should also be taken to make sure that there are no reasons why you shouldn’t undertake treatment. You may be asked to sign a consent form which means that you have understood the potential benefits and risks associated with the procedure.
Photographs may also be taken by the practitioner for a "before and after" comparison at a later date.
Depending on your pain tolerance, a topical anaesthetic cream may then be applied to your skin a short time prior to treatment, to help numb the skin slightly; this will normally be removed using alcohol cleansers immediately before your clinician commences the procedure.
Depending on the device being used and your practitioner, a “treatment grid” may then be drawn over the treatment area to assist the practitioner in navigating whilst delivering the RF energy; helping to assure an even application of the RF.
A lubricating oil, gel or cream will then also be applied over the area to be treated which acts as an additional barrier between the surface layers of your skin and the handpiece of the device, mainly to avoid skin chafing.
Your clinician will then commence the RF treatment working across the treatment area. Once completed a soothing gel/lotion or cold pack may be applied to your skin.
Depending on the device being used it may be recommended to have a session twice weekly with an average of 8 - 10 sessions in a treatment programme, or a session once every 1 - 2 weeks with an average of 8 sessions in a programme, however with all devices ongoing monthly maintenance will be required; your practitioner will be able to determine a course of treatments specific to you and your needs.
Some people experience mild redness immediately following treatment (similar to a sunburnt look), but this usually disappears quickly. Most people find that they can return to work and normal activities immediately after treatment.
Depending on your practitioner you may be advised to use certain soothing lotions, creams or gels to lightly apply to the treatment area, or possibly cool, moisturising mists to apply as you feel necessary.
Side Effects and Risks
As the treatment is carried out you will experience heating sensations every time the RF energy is delivered to your skin and underlying tissue.
Some devices have inbuilt cooling mechanisms, to protect your skin from the heating, and make the treatment more comfortable.
As each person's pain tolerance and threshold varies, it is difficult to quantify how painful or uncomfortable the treatment is. It also depends on the device used and the power settings for the treatment. Your clinician may offer you anaesthetic options, such as a topical anaesthetic cream applied to your skin prior to treatment, or relaxants and pain management drugs, that can minimize your discomfort.
The most frequently reported side effects of treatment with RF energy are swelling, redness or bruising on or around the treated area, which typically disappear in a few days or weeks. There are also reports of a feeling of dry skin in the treated area for a couple of days, lubrication with aloe-vera can be helpful for this.
Some people may notice a slight increase in urine output following treatment, especially with the Velasmooth™. This is because any excessive fluid build up in between cells in the area treated is drained through the lymphatic system via the treatment process – this then gets excreted in the urine.
In very rare circumstances and if the correct instructions are not followed by the practitioner, it is possible to suffer from a skin burn.
No special care is needed after treatment although your practitioner may suggest some of the following:
As long as you are generally healthy and don’t have any skin diseases or infections in the area treated, there are few medical reasons why patients should not undergo this treatment.
People with sensory disturbance to the skin may not be considered good candidates as this could make the reporting of discomfort during the procedure unreliable, leading to potential harm.
Although there is no evidence that this treatment is harmful for pregnant women, you would generally be advised to wait until after you have given birth before embarking upon a course of treatment.
More importantly, people with electrical devices e.g., pacemakers, or metal implants e.g., artificial metal hip joints, heart valves or dental plates, cannot be treated because RF current flowing through the body may interfere with these devices or heat up metal implants, which could be dangerous.
Who Can Do It
Depending on the device used, this procedure is generally available only in the offices of qualified physicians who specialise in cosmetic procedures.
You will not be able to access this treatment via the National Health Service.
Private prices for radiofrequency treatments depend on the area(s) being treated and the device being used.
Private costs for Velasmooth™ can range from £80 - £100 per 60 minute session, often with a discount for a course of 8 - 12 treatments.
Private costs for Accent™ body contouring and cellulite treatments can start from approximately £100 - £300 per body area per session. Discounts often apply for a course of sessions.
Private costs for TriPollar™ treatments depend on the area(s) being treated and can range between £80 - £200 per area per session. Discounts often apply for a course of sessions.
RF energy treatment is a new and promising technology for non-surgical body contouring, fat and cellulite reduction.
Based on current RF technologies available, most people should see at least a mild improvement in their skin tone and smoothness, with a temporary reduction in the appearance of cellulite and possible inch loss, with minimal risks and downtime compared to surgery.
It is difficult to assess the differences in results between the differing RF technologies that are currently available, and as this market place expands, we anticipate seeing many more devices introduced, with newer improved treatment methods and protocols to further enhance patient comfort and results.
Before and After Pictures
1 month after 8 treatments.
Excellent results 6 months after 10 treatments.
1 month after 8 treatments.
Images provided courtesy of Syneron Medical Ltd.
After 2 Accent™ cellulite treatments
Images provided courtesy of Advanced Beauty Cosmetics Ltd.
All before and after photographs are real patients, your results may differ.