Radiofrequency surgery operative skills: Tips and tricks to master the technique

The hallmarks of radiofrequency surgery are

High radiofrequency
Low electrode temperature

Both these features make this surgical modality safe. The higher the radiofrequency, the better and finer the cut.1 The higher radiofrequency also is safer from the fact that it does not cause nerve and muscle stimulation, which occurs with lower radiofrequency waves. Low temperature means “cold electrode,” thus minimizing the chances of tissue destruction and making the technique safe.

The method of using radiofrequency surgery remains the same whether it is used in dermatologic surgery, dentistry, general surgery, ophthalmology, gynecology, proctology, neurosurgery, or spine surgery. Chapter 6 provided tips for switching over for different faculty surgeons as well as orthodox and newer dermatologists.

The learning curve for radiofrequency surgery involves a few tips and tricks that are connected with the full knowledge of the fundamental features covered in Chapter 7. In dermatologic surgery, the primary concern is the skin surface, which has aesthetic value whether it is over exposed area or covered area. Patients today are always concerned about postoperative scarring.

The tips and tricks given in the following are for the general use of radiofrequency dermatologic surgery. Yet, when put into practice any practitioner can be best assured of superior results. In addition, more gems for achieving aesthetically superior results are given in Chapter 15.

Tips and tricks to master radiofrequency surgery techniques are listed in Table 8.1 and briefly explained next:

Table 8.1Tips to master radiofrequency surgery

Pressureless incision
Fine and light strokes (feather touch or paintbrush like)
Appropriate electrode size
Appropriate waveform selection
Appropriate power setting
Antenna plate position
Hydration of skin lesion
Interval between two strokes

Pressureless incision—Figure 8.1 provides a very good idea about how such an incision will cut the skin and subcutaneous tissues, resulting in a very clean cut as though the tissues have just split off without charring or unevenness.
Fine and light strokes (feather touch or paintbrush like)—Figure 8.2 will give a very good idea about how to use feather-touch strokes to delicately excise the skin lesions for delivering the best aesthetic result. These strokes are made until the whole lesion is fully removed; judgment of the depth of skin lesions is well understood while making the fine strokes. Once the excision is over, the blending is also done with fine strokes. I would like to define this as “portrait-shading strokes” (Figure 8.3).
Appropriate electrode size and shape—Figure 8.4 gives an idea of different electrodes with their shapes and sizes. The thinner the electrode, the finer the cut. The appropriate shape to match the skin lesion is also important for best results.
Appropriate waveform selection—Chapter 7 discussed the available waveforms and their applications. Waveform selection is of paramount importance for flawless dermatologic surgery.
Appropriate power setting—There are no fixed power settings for particular skin lesions, though some settings can be fixed for indications of desiccation and fulguration. For various skin lesions tackled by excision, only a range of power settings can be given as guidelines. These settings will vary for different skin lesions as well as the equipment used. Optimum power always gives the best operability and thus best results. Optimum power settings for practitioners are individualized and come by experience.
Antenna plate position—The antenna plate is nonmetal and is not required to touch the patient’s skin. It should be kept close to the site of operation for best results.
Hydration of skin lesion—Radiofrequency surgery works on principle of vaporization and hence while cutting, the skin lesion should be well hydrated so that it is moist enough for the electrode tip to literally glide through without efforts or dragging of tissues. Dry lesions will resist cutting. Hydration is not required ideally for superficial lesions tackled using desiccation and fulguration.
Interval between two strokes—It is advisable to avoid hurried strokes while excising to avoid tissue charring. There is no rule about how much interval, but strokes given one after another should be at comfortable intervals that will not allow tissue charring.