Radiofrequency-assisted liposuction (RFAL) is a relatively new technology which is based on the delivery of direct radiofrequency energy into the subcutaneous fat achieving simultaneously coagulation, fat dissociation, and collagen contracture. RFAL can be performed under local anesthesia in a varieties of body areas. In this chapter, we describe the use of RFAL for treatment of the neck area which is one of the most difficult areas to treat. RFAL the last year acquired FDA approval.
16 Neck: Radiofrequency Liposuction
RFAL is a relatively new technique that applies radiofrequency energy to soft tissues in a bipolar manner.
RFAL can offer significant skin contraction to the neck and body area.
RFAL could be used effectively to achieve long-lasting non-excisional neck skin tightening and face contouring.
The most common side effects is temporary in duration and firmness of the soft tissue of the neck and superficial burns.
The cervical region and face contour are some of the most challenging anatomic areas and difficult to aesthetically correct.
Face and neck lift is the gold standard treatment for correction of skin laxity of the neck. However, these techniques leave the patient with scars and long recovery time.
The non-excisional improvement of the face and neck contour remains a challenging problem and the noninvasive or minimally invasive techniques gain much popularity day by day.
RFAL technology has been widely applied over the last years with promising results in several areas of the body. 1 , 2 , 3 , 4 , 5 , 6 Peer-reviewed articles show skin contracture of up to 34% over 12 months period with very satisfactory and long-lasting aesthetic results. 2
16.2 Patient Selection
Best candidates for the treatment are patients of type I and type II neck irregularities, according to the Baker classification are as follows: 7
Type I: Slight cervical skin laxity with submental fat and early jowls.
Type II: Moderate cervical skin laxity, moderate jowls, and submental fat.
Type III: Moderate cervical skin laxity, but with significant jowling and active platysmal banding.
Type IV: Loose redundant cervical skin and folds below the cricoid, significant jowls, and active platysmal bands.
16.3 Preoperative Planning and Preparation
The procedure can be performed under local anesthesia (LA), or LA and sedation whereas for patients that are combined with other procedures (blepharoplasty, facelift etc.), general anesthesia is recommended. Prophylactic intravenous antibiotic is administered half an hour before the operation. Prophylactic antithrombotic stockings and sequentially compression stockings are applied to all patients. Temperature of the operating room is maintained at 22°C.
Continuous pulse oximetry and intermittent blood pressure monitoring is recorded in all patients during surgery and recovery.
Patient is marked in a standing position. For patients above 40 years old we check EGG, full blood count, blood clotting test, liver function test, kidney test, and chest X-ray.
Patients are requested to give up any herbal or supplement which could increase the chances for hematoma two weeks before and two weeks after the treatment.
Patients who are excluded are as follows: Under 16 years of age and above 70 years old, history of medication taking that may increase bleeding, pregnancy, lactation, high expectations, history of liver or kidney failure, patients with pacemaker, previous scarring in the neck, history of blood clotting problems, heart disease, history of diabetes, loss of weight <40 kg.
16.4 Surgical Technique
16.4.1 Marking the Neck
The neck is divided into three zones (▶Fig. 16.1) one medially (I) and two laterally (II, III). The central zone I is the area between the right and left tracheal gutter. The lateral zones II and III extent from the medial border of the sternocleidomastoid muscle to the jawline and the lateral tracheal gutter. We apply the RFAL handpiece separately to each area.
Three stab incisions are used. These incisions are performed with 11 blades. One submental incision and two sub-lobular.
A 14-G infiltration cannula is used to deliver the infiltration solution that consists of 1.5 mg adrenaline 1:1000, 50 mgr lidocaine 2% and 10 cc bicarbonate. The solution is delivered to the subcutaneous tissue until sufficient turgor is achieved.
After 15–20 minutes of waiting for the vasoconstriction effect of the adrenaline, we begin the operation.
The RFAL is performed with the bodyTite device (Invasix, Yoki-nem, Israel). The bodyTite system uses an RF generator and a handpiece bipolar RF which delivers the RF frequency and heat internally to the adipose tissue. The RF generator provides continuous skin temperature measurements with a negative feedback loop control of power.
The necktite hand piece is 12 cm of length and with diameter of 24 mm. There is also a hole for fat aspiration in this cannula. The facetite handpiece is of 10 cm length, 17 mm diameter and is a solid non-aspiration bipolar RF device for sub-dermal coagulative heating and transdermal non-ablative RF skin tightening. There is no hole in this device.
The necktite cannula, delivers the bipolar radiofrequency energy, which is internally coagulative and externally non-ablative bulk heating. Coagulation, deep FSN contraction, and soft-tissue tightening and the external electrode glides along the skin surface in coordination with the internal electrode, receiving RF from the internal electrode and delivering non-ablative skin heating and tightening. The device has an external thermistor, high and low impedance and no contact sensors and will turn off the RF when the therapeutic target temperature has been reached, or if there are potentially dangerous high or low tissue impedance readings, or loss of epidermal contact. 8 , 9 , 10