Radiofrequency For Facial Rejuvenation In Pentre-llyn-cymmer

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 also be used to cut or coagulate tissue.

RF energy when used for skin tightening is able to penetrate deep 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 or fine lines and wrinkling

There are currently only a small number of RF only devices within the UK market place, targeted mainly at the process of facial rejuvenation via skin tightening; these include:

Thermage

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.

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 wass the first 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).   

Accent™ 

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™

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.

Pure RF energy alone is primarily used to treat skin laxity by facial tightening, and is best suited to patients with mild to moderate sagging of facial tissues, usually those in their mid thirties to fifties, with any skin colour.

It is commonly used to treat the forehead (lift brows and tightens forehead skin), under the eyes (thickens skin and tightens and lifts the upper cheek skin), cheeks (lifts slightly and diminishes enlarged pores), mid-face, jaw line (diminishes jowling and sagging along the jaw line), and the neck (tightens skin and diminishes wrinkling of the neck).

However, if there is a significant amount of redundant or sagging skin, often seen in older patients over sixty, this procedure may not show a significant enough improvement and a traditional mid-face, face or brow lift operation may be recommended in order to remove the excess skin, therefore achieving a better result.

In combination with other modalities, as we have discussed above, RF can be used to enhance a variety of treatments including hair removal, photorejuvenation, pigmented and vascular problems, acne treatment and cellulite treatment.

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.

Procedure

You may be required to wash your face with soap and warm water prior to your treatment, in order to remove any makeup and skin oils which could interfere with the application of the RF treatment.

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” ink transfer may then be applied over your face to assist the practitioner in navigating your face whilst delivering the RF energy; helping to assure an even application of the RF and to prevent inadvertent overlapping of treatment.

Again, dependent of the device being used you may be fitted with a single-use, self-adhesive return pad attached to your stomach or back to ground you; normally with monopolar devices.

A coupling gel may then also be applied over your face which acts as an additional barrier between the surface layers of your skin and the handpiece of the device.

Your clinician will then commence the RF treatment working across your face. Once completed a soothing gel or lotion may be applied to your skin.

Repeat Procedures

Immediately following the treatment, your skin will feel tighter, with more tightening improvements appearing gradually over the months after treatment.

Results are said to last up to a couple of years, and a single initial treatment can be enough to produce results in some people (using the Thermage device), depending on skin thickness; however your practitioner will be able to determine a course of treatments specific to you and your needs.

As the treatment is carried out you will experience brief, deep heating sensations every time the RF energy is delivered to your skin and underlying tissue. Devices may have an inbuilt cryogenic capability whereby the handpiece is either chilled or emits a cooling spray before, during and after the RF burst, 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, bumps and blisters on or around the treated area, which typically disappear in a few days or weeks.

One of the most serious potential complications from RF energy treatment is a “depression”; this is attributed to the overheating of underlying tissue causing fat atrophy or excessive tightening, giving you a sunken appearance in the affected area. The occurrence of this also depends on the device used and appears to be only currently reported with the Thermacool™ system. Generally, although further studies and more available data is needed, it is considered that there is a correlation between the occurrence of these depressions and the treatment being given at frequency levels above the manufacturer’s guidelines. It is therefore imperative that you make sure that your practitioner is adequately trained and certified to perform the RF treatment.

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.

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 can range from approximately £1,500 - £2,000 for the forehead and eye areas, £2,500 for the jaw and neck areas to £3,000 - £3,500 for the whole face with Thermage.

Costs are often less for other devices using combined treatments (with laser + RF for example) or the Accent™ bipolar RF machine – however, these usually require multiple treatments and may not be as effective. For example, an Accent™ RF Facial session costs from £350 - £600 depending on the treatment area and the condition of skin. It is recommended to have a course of 4 sessions (once every 3 - 4 weeks).

Thermage®

Images provided courtesy of Sigmacon Ltd.

Chin and jawline before and 7 weeks post radiofrequency treatment with Thermage® .

Images provided courtesy of Dr John Tanqueray at Mulberry House Clinic.

Accent™

3 weeks after a single Accent™ facial lift treatment.

2 weeks after 4th treatment with Accent™ on crow's feet around the eyes.

Images provided courtesy of ABC Lasers Ltd.

All before and after photographs are real patients, your results may differ.