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Chap. 53 - THERMAGE FOR FACE AND BODY

from PART FOUR - COSMETIC APPLICATIONS OF LIGHT, RADIOFREQUENCY, AND ULTRASOUND ENERGY

Published online by Cambridge University Press:  06 July 2010

Sorin Eremia
Affiliation:
University of California, Los Angeles, School of Medicine
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Summary

Thermage uses monopolar radiofrequency to achieve nonablative skin tightening. This system employs a patented monopolar capacitive radiofrequency technology called ThermaCool. The ThermaCool device has been approved by the Food and Drug Administration for the noninvasive treatment of rhytids.

This system relies on radiofrequency-derived heat, which promotes skin tightening via two proposed separate mechanisms: first, heat causes immediate collagen denaturation and fibril contraction; second, long-term benefits include progressive dermal remodeling and subsequent tightening from a wound-healing response lasting several months. Thus treatment attempts to provide renewed facial contours without the need for invasive surgery. It has been clinically proven to tighten and gently smooth out wrinkles and requires no downtime from normal activities.

PATIENT SELECTION

Like many cosmetic procedures, patient selection is important. The ideal patient for Thermage has the earliest signs of aging, with mild skin rhytids and substantial laxity but minimal lipodystrophy, and does not desire invasive procedures for rejuvenation. Nonablative skin tightening via radiofrequency is not intended to replace the more dramatic effects of invasive surgical lifts. Results tend to be subtle and are not as reliably produced as those obtained from surgery. The skin contraction reportedly achieved is in the order of 1–3 mm (Sadick 2006). If patient selection is appropriate, these subtle changes are perceptible to patients, particularly eyebrow position or softening of the nasolabial fold. Educating patients on realistic expectations is paramount to patient satisfaction. In the authors' experience, patients report receiving comments such as, “You look refreshed; what have you been doing differently?

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Publisher: Cambridge University Press
Print publication year: 2010

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References

Alam, M, Levy, R, Pajvany, U, et al. Safety of radiofrequency treatment over human skin previously injected with medium-term injectable soft-tissue augmentation materials: a controlled pilot trial. Lasers Surg. Med. 2006;38:205–10.CrossRefGoogle ScholarPubMed
Bogle, MA, Ubelhoer, N, Weiss, RA, et al. Evaluation of the multiple pass, low fluence algorithm for radiofrequency tightening of the lower face. Lasers Surg. Med. 2007;39:210–17.CrossRefGoogle ScholarPubMed
Dover, JS, Zelickson, B. Results of a survey of 5,700 patient monopolar radiofrequency facial skin tightening treatments: assessment of a low-energy multiple-pass technique leading to a clinical end point algorithm. Dermatol. Surg. 2007;33:900–7.Google ScholarPubMed
Goldman, MP, Alster, TS, Weiss, R. A randomized trial to determine the influence of laser therapy, monopolar radiofrequency treatment, and intense pulsed light therapy administered immediately after hyaluronic acid gel implantation. Dermatol. Surg. 2007;33:535–42.Google Scholar
Kushikata, N, Negishi, K, Tezuka, Y, et al. Is topical anesthesia useful in noninvasive skin tightening using radiofrequency?Dermatol. Surg. 2005;31:526–33.CrossRefGoogle ScholarPubMed
Sadick, NS, l. Nonsurgical approaches to skin tightening. Cosmet. Dermatol. 2006;19:473–7.Google Scholar
Semchyshyn, NL, Kilmer, SL. Does laser inactivate botulinum toxin?Dermatol. Surg. 2005;31:399–404.CrossRefGoogle ScholarPubMed
Shumaker, PR, England, LJ, Dover, JS, et al. Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model: part 2. Lasers Surg. Med. 2006;38:211–17.CrossRefGoogle Scholar
Weiss, RA, Weiss, MAMunavalli, G, et al. Monopolar radiofrequency facial tightening: a retrospective analysis of efficacy and safety in over 600 treatments. J. Drugs Dermatol. 2006;5:707–12.Google ScholarPubMed

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