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J Cosmet Med 2018; 2(2): 109-114

Published online December 31, 2018

https://doi.org/10.25056/JCM.2018.2.2.109

A retrospective study on treatment of moderate cervicomental laxity with subdermal monopolar radiofrequency with real-time monitoring

Kar Wai Phoebe Lam , MBChB, MRCS, PgDipSEM, DPD, MScDPD

Perfect Skin Solution, Kowloon, Hong Kong

Correspondence to :
Kar Wai Phoebe Lam, E-mail: drlamkarwai@gmail.com, ORCID: https://orcid.org/0000-0002-3237-3229

Received: August 30, 2018; Revised: November 30, 2018; Accepted: December 13, 2018

© Korean Society of Korean Cosmetic Surgery & Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Subdermal monopolar radiofrequency (RF) redefines jawline by delivering controlled thermal energy that induced soft tissue contraction. However, the type of candidates best suited for this treatment has not been determined. A retrospective analysis of the treatment results and satisfaction, at 6 weeks and 3 months, in 15 female patients, aged 34 to 77 years, with mild to moderate skin laxity (Submental Skin Laxity Grading [SMSLG], 1-3) and submental fat (SMF) (Clinician rating-SMF-Rating Scale [CR-SMF-RS], 1-3), and a Subject Self Rating Scale (SSRS) ≤2. They received ThermiRF to either jowl and neck or neck only, in a single clinic, between the period of October 2017 to July 2018. The probe treatment temperature was set and maintained between 52°C to 65°C whereas the epidermal temperature was targeted around 42°C to 43°C. All patients with SMSLG 2 to 3, reported at least 1 grade SMSLG response with a mean change of 1.23 of CR-SMF-RS and mean change of 3.08 of SSRS. None of the patients experienced a burn or erythema following treatment. Transient swelling, nodule and mild numbness following ThermiRF procedure has been reported but all resolved completely with time. All reported GAIS ≥3 and 46.7% reported a Global Aesthetic Improvement Scale (GAIS) score of 5, i.e. optimal results by 3 months. Therefore, according to treatment results those with good to at least moderate skin laxity (SMSLG, 2-3), mild to moderate SMF (CR-SMF, 1-3) and absent of platysmal pathology reported at least a one-grade improvement on SMSLG and CR-SMF-RS within 3 months of ThermiRF treatment. Level of Evidence: IV

Keywords: cervicomental, skin laxity, skin tightening, submental fat, thermiRF, thermogenesis

  1. Northington M. Patient selection for skin‐tightening procedures. J Cosmet Dermatol 2014;13:208-11.
    Pubmed CrossRef
  2. Blugerman G, Paul MD, Schavelzon D, Mulholland RS, Sandhoffer M, Lisborg P, et al. Radio-frequency assisted liposuction (RFAL). In: Serdev N, editor. Advanced techniques in liposuction and fat transfer. London: InTech; 2011.
    CrossRef
  3. Paul M, Blugerman G, Kreindel M, Mulholland RS. Threedimensional radiofrequency tissue tightening: a proposed mechanism and applications for body contouring. Aesthetic Plast Surg 2011;35:87-95.
    Pubmed KoreaMed CrossRef
  4. Key DJ. Integration of thermal imaging with subsurface radiofrequency thermistor heating for the purpose of skin tightening and contour improvement: a retrospective review of clinical efficacy. J Drugs Dermatol 2014;13:1485-9.
    Pubmed
  5. Badin AZ, Moraes LM, Gondek L, Chiaratti MG, Canta L. Laser lipolysis: flaccidity under control. Aesthetic Plast Surg 2002;26:335-9.
    Pubmed CrossRef
  6. Sadick N. Tissue tightening technologies: fact or fiction. Aesthet Surg J 2008;28:180-8.
    Pubmed CrossRef
  7. Fedok FG, Kellman RM. Controversies in facial plastic surgery. Facial Plast Surg Clin North Am 2018;26:xi-xii.
    Pubmed CrossRef
  8. Kinney BM, Andriessen A, DiBernardo BE, Bloom J, Branson DF, Gentile RD, et al. Use of a controlled subdermal radio frequency thermistor for treating the aging neck: consensus recommendations. J Cosmet Laser Ther 2017;19:444-50.
    Pubmed CrossRef
  9. Kythera Biopharmaceuticals. ATX-101 (deoxycholic acid) injection. FDA advisory advisory committee briefing materials:available for public release. Westlake Village, CA: Kythera Biopharmaceuticals, 2015.
  10. Lin SJ, Hsiao CY, Sun Y, Lo W, Lin WC, Jan GJ, et al. Monitoring the thermally induced structural transitions of collagen by use of second-harmonic generation microscopy. Opt Lett 2005;30:622-4.
    Pubmed CrossRef
  11. Ruiz-Esparza J, Gomez JB. The medical face lift: a noninvasive, nonsurgical approach to tissue tightening in facial skin using nonablative radiofrequency. Dermatol Surg 2003;29:325-32; discussion 332.
    CrossRef
  12. Ferguson J. Effects of subdermal monopolar RF energy on abdominoplasty flaps. J Drugs Dermatol 2016;15:55-8.
    Pubmed
  13. Hayashi K, Thabit G 3rd, Massa KL, Bogdanske JJ, Cooley AJ, Orwin JF, et al. The effect of thermal heating on the length and histologic properties of the glenohumeral joint capsule. Am J Sports Med 1997;25:107-12.
    Pubmed CrossRef
  14. Vangsness CT Jr, Mitchell W 3rd, Nimni M, Erlich M, Saadat V, Schmotzer H. Collagen shortening. An experimental approach with heat. Clin Orthop Relat Res 1997;(337):267-71.
    Pubmed CrossRef
  15. Key DJ. Comprehensive thermoregulation for the purpose of skin tightening using a novel radiofrequency treatment device:a preliminary report. J Drugs Dermatol 2014;13;185-9.
    Pubmed
  16. Jewell ML, Fodor PB, de Souza Pinto EB, Al Shammari MA. Clinical application of VASER--assisted lipoplasty: a pilot clinical study. Aesthet Surg J 2002;22:131-46.
    Pubmed CrossRef
  17. Coleman WP III, Brody HJ, Narins RS, Moy RL, Hanke CW, Lillis PL, et al. Update from the ultrasonic liposuction task force of the American Society for Dermatologic Surgery. Dermatol Surg 1997;23:211-4.
    CrossRef
  18. Ahn DH, Mulholland RS, Duncan D, Paul M. Non-excisional face and neck tightening using a novel subdermal radiofrequency thermo-coagulative device. J Cosmet Dermatol Sci Appl 2011;1:141-6.

Article

Case Report

J Cosmet Med 2018; 2(2): 109-114

Published online December 31, 2018 https://doi.org/10.25056/JCM.2018.2.2.109

Copyright © Korean Society of Korean Cosmetic Surgery & Medicine.

A retrospective study on treatment of moderate cervicomental laxity with subdermal monopolar radiofrequency with real-time monitoring

Kar Wai Phoebe Lam , MBChB, MRCS, PgDipSEM, DPD, MScDPD

Perfect Skin Solution, Kowloon, Hong Kong

Correspondence to:Kar Wai Phoebe Lam, E-mail: drlamkarwai@gmail.com, ORCID: https://orcid.org/0000-0002-3237-3229

Received: August 30, 2018; Revised: November 30, 2018; Accepted: December 13, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Subdermal monopolar radiofrequency (RF) redefines jawline by delivering controlled thermal energy that induced soft tissue contraction. However, the type of candidates best suited for this treatment has not been determined. A retrospective analysis of the treatment results and satisfaction, at 6 weeks and 3 months, in 15 female patients, aged 34 to 77 years, with mild to moderate skin laxity (Submental Skin Laxity Grading [SMSLG], 1-3) and submental fat (SMF) (Clinician rating-SMF-Rating Scale [CR-SMF-RS], 1-3), and a Subject Self Rating Scale (SSRS) ≤2. They received ThermiRF to either jowl and neck or neck only, in a single clinic, between the period of October 2017 to July 2018. The probe treatment temperature was set and maintained between 52°C to 65°C whereas the epidermal temperature was targeted around 42°C to 43°C. All patients with SMSLG 2 to 3, reported at least 1 grade SMSLG response with a mean change of 1.23 of CR-SMF-RS and mean change of 3.08 of SSRS. None of the patients experienced a burn or erythema following treatment. Transient swelling, nodule and mild numbness following ThermiRF procedure has been reported but all resolved completely with time. All reported GAIS ≥3 and 46.7% reported a Global Aesthetic Improvement Scale (GAIS) score of 5, i.e. optimal results by 3 months. Therefore, according to treatment results those with good to at least moderate skin laxity (SMSLG, 2-3), mild to moderate SMF (CR-SMF, 1-3) and absent of platysmal pathology reported at least a one-grade improvement on SMSLG and CR-SMF-RS within 3 months of ThermiRF treatment. Level of Evidence: IV

Keywords: cervicomental, skin laxity, skin tightening, submental fat, thermiRF, thermogenesis

References

  1. Northington M. Patient selection for skin‐tightening procedures. J Cosmet Dermatol 2014;13:208-11.
    Pubmed CrossRef
  2. Blugerman G, Paul MD, Schavelzon D, Mulholland RS, Sandhoffer M, Lisborg P, et al. Radio-frequency assisted liposuction (RFAL). In: Serdev N, editor. Advanced techniques in liposuction and fat transfer. London: InTech; 2011.
    CrossRef
  3. Paul M, Blugerman G, Kreindel M, Mulholland RS. Threedimensional radiofrequency tissue tightening: a proposed mechanism and applications for body contouring. Aesthetic Plast Surg 2011;35:87-95.
    Pubmed KoreaMed CrossRef
  4. Key DJ. Integration of thermal imaging with subsurface radiofrequency thermistor heating for the purpose of skin tightening and contour improvement: a retrospective review of clinical efficacy. J Drugs Dermatol 2014;13:1485-9.
    Pubmed
  5. Badin AZ, Moraes LM, Gondek L, Chiaratti MG, Canta L. Laser lipolysis: flaccidity under control. Aesthetic Plast Surg 2002;26:335-9.
    Pubmed CrossRef
  6. Sadick N. Tissue tightening technologies: fact or fiction. Aesthet Surg J 2008;28:180-8.
    Pubmed CrossRef
  7. Fedok FG, Kellman RM. Controversies in facial plastic surgery. Facial Plast Surg Clin North Am 2018;26:xi-xii.
    Pubmed CrossRef
  8. Kinney BM, Andriessen A, DiBernardo BE, Bloom J, Branson DF, Gentile RD, et al. Use of a controlled subdermal radio frequency thermistor for treating the aging neck: consensus recommendations. J Cosmet Laser Ther 2017;19:444-50.
    Pubmed CrossRef
  9. Kythera Biopharmaceuticals. ATX-101 (deoxycholic acid) injection. FDA advisory advisory committee briefing materials:available for public release. Westlake Village, CA: Kythera Biopharmaceuticals, 2015.
  10. Lin SJ, Hsiao CY, Sun Y, Lo W, Lin WC, Jan GJ, et al. Monitoring the thermally induced structural transitions of collagen by use of second-harmonic generation microscopy. Opt Lett 2005;30:622-4.
    Pubmed CrossRef
  11. Ruiz-Esparza J, Gomez JB. The medical face lift: a noninvasive, nonsurgical approach to tissue tightening in facial skin using nonablative radiofrequency. Dermatol Surg 2003;29:325-32; discussion 332.
    CrossRef
  12. Ferguson J. Effects of subdermal monopolar RF energy on abdominoplasty flaps. J Drugs Dermatol 2016;15:55-8.
    Pubmed
  13. Hayashi K, Thabit G 3rd, Massa KL, Bogdanske JJ, Cooley AJ, Orwin JF, et al. The effect of thermal heating on the length and histologic properties of the glenohumeral joint capsule. Am J Sports Med 1997;25:107-12.
    Pubmed CrossRef
  14. Vangsness CT Jr, Mitchell W 3rd, Nimni M, Erlich M, Saadat V, Schmotzer H. Collagen shortening. An experimental approach with heat. Clin Orthop Relat Res 1997;(337):267-71.
    Pubmed CrossRef
  15. Key DJ. Comprehensive thermoregulation for the purpose of skin tightening using a novel radiofrequency treatment device:a preliminary report. J Drugs Dermatol 2014;13;185-9.
    Pubmed
  16. Jewell ML, Fodor PB, de Souza Pinto EB, Al Shammari MA. Clinical application of VASER--assisted lipoplasty: a pilot clinical study. Aesthet Surg J 2002;22:131-46.
    Pubmed CrossRef
  17. Coleman WP III, Brody HJ, Narins RS, Moy RL, Hanke CW, Lillis PL, et al. Update from the ultrasonic liposuction task force of the American Society for Dermatologic Surgery. Dermatol Surg 1997;23:211-4.
    CrossRef
  18. Ahn DH, Mulholland RS, Duncan D, Paul M. Non-excisional face and neck tightening using a novel subdermal radiofrequency thermo-coagulative device. J Cosmet Dermatol Sci Appl 2011;1:141-6.

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