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Fractional Radiofrequency Holds Promise for Skin Tightening

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Destin, Fla. — Fractional radiofrequency “is new and has a lot of promise” for skin tightening to rejuvenate the jaw and facial skin, according to Dr. Marian Northington.

Similar to fractional photothermolysis, a bipolar microneedle system creates zones of thermal damage in the reticulated dermis. These zones are surrounded by untreated dermis that speeds healing. The heat delivered alters the molecular structure of the triple helix of collagen and causes collagen contraction. The heat also stimulates a “vigorous wound healing response,” Dr. Northington said at a meeting sponsored by the Alabama Dermatology Society.

Another advantage of radiofrequency is that it uses electrical current and not a light source, so there is no damage to epidural melanin. Therefore, radiofrequency treatments are safe for all skin types, she said.

“It takes time, but you get thicker, healthier dermis,” Dr. Northington said. “As this improves slowly with time, it is important to take before pictures. Patients will forget with something that gradually occurs.”

On the plus side, there is no downtime compared with more invasive approaches to facial rejuvenation. However, “patients need appropriate expectations. Fractional radiofrequency does not yield a surgical result,” Dr. Northington said. Results are modest and sometimes not reproducible.

Nevertheless, “this has a lot of promise as a nonsurgical option ... for those who don’t want a face lift, but want some improvement,” said Dr. Northington of the University of Alabama at Birmingham. 

She cited a recent study of 15 fractional radiofrequency patients, in which 5 blinded raters were asked to assess outcomes from photos (Arch. Dermatol. 2010;146:396-405). The investigators mixed in photos of surgical face-lift patients. There was an average 16% improvement with radiofrequency, compared with 44% for the face-lift patients. “Although improvement with face-lift was greater, it also showed improvement with radiofrequency,” Dr. Northington said.

Unlike with standard monopolar or bipolar radiofrequency, anesthesia is not necessary so patients can provide useful feedback that they feel the heat during the treatment, Dr. Northington said. “You know the energy is going where you want it.”

Energy is delivered at 72° C for 4 seconds while the epidermis is protected with cooling. The selective heating of fibrous septae in the subcutaneous area explains why we do not see fat atrophy with radiofrequency, Dr. Northington said.

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