19 Maximizing Safety with Radiofrequency-Based Devices
Radiofrequency (RF) energy delivered internally or externally has been successfully used to treat rhytids, jowling, skin laxity, telangiectasias, and other age-related skin changes. It has also been used to target subcutaneous tissues for subdermal adipose remodeling and contouring. RF devices create alternating currents to polarize tissue within an electrical path using negatively and positively charged electrodes to generate heat. Safe and consistent use of this technology depends on an understanding of (1) specific characteristics of the patient’s skin and soft-tissue anatomy, (2) characteristics of the radiofrequency device, and (3) energy/tissue interactions. In this chapter, we outline the utility of radiofrequency technology, including indications, contraindications, and anatomic danger zones.
RF is of particular interest as a safe and effective way to decrease skin laxity in facial rejuvenation; either as a primary treatment or to correct recurrent laxity after a facelift or neck lift (▶ Fig. 19.1 ). 1 , 2 , 3
Thermal devices such as those that are radiofrequency (RF)-based impact the soft tissues at a molecular level by collagen denaturation at 55 to 60°C, leading to subsequent neocollagenesis, ellastogenesis, angiogenesis, and subdermal adipose remodeling over the subsequent 4 to 8 weeks from treatment (Video 19.1). 2 , 4 , 5
RF energy can be delivered using monopolar, bipolar, or multipolar devices. Other variants of RF delivery include fractional, sublative, and combination technologies (laser, light, electromagnetic energy). 4 , 6 , 7 , 8 , 9
Frequently, RF is used in conjunction with liposuction. RF energy is applied first to tighten the fibroseptal network and induce skin tightening, while the subsequent liposuction decreases the underlying adipose tissue volume. 2 , 4 , 5 , 11