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INTRODUCTION

There have been a variety of noninvasive devices that purport to lift and tighten “loose” necks, jawlines, and eyes. These devices work by delivering monopolar, bipolar, or infrared energy to the deep dermis and subcutaneous tissue, resulting in tightening and lifting of skin and creation of new collagen. The chief obstacle for these devices has been inconsistent clinical results. Some patients have had dramatic results in comparison to traditional invasive surgery and others have seen little or no improvement. Patients who understand the risks before the procedure are happy with excellent results and not disappointed by lack of improvement.

MECHANISM OF ACTION

There are different radiofrequency (RF) technology and infrared devices that deliver volumetric heat to the deep dermis and subcutaneous tissue which tightens existing collagen and helps create new collagen.

CANDIDATE SELECTION

As with all procedures, candidate selection is vital to the success of the procedure. These devices will not treat epidermal changes of aging such as lentigo, telangiectasia, or rough skin. Candidates should have deep cutaneous signs of aging such as “sagging” skin in the neck, jaw, or around the eyes. Some physicians have reported good success in treating areas off the face including upper arms, abdomen, and breasts. All patients must be aware that the amount of clinical improvement is highly variable not predictable before the procedure. Patients that do not understand this should not undergo the procedure.

THE PROCEDURE

When first introduced the chief complaint with RF devices was intolerable pain. The procedure was done with a single pass at high energy settings. Over the years the trend has been toward more passes with lower fluencies. This has greatly reduced the pain associated with the procedure. Multiple passes, lower fluencies, and different spot sizes have resulted in greater immediate tissue tightening observed in patients and a higher percentage of patients with improvement after 6 months.

Figure 10.1 (A)

Prior to treatment skin laxity is observed in the jowl region.

Figure 10.1 (B)

Six months after treatment appearance of the jowl and neck is improved slightly. (Reproduced, with permission, from Hirsch R, Sadick N, Cohen JL. Aesthetic Rejuvenation: A Regional Approach. New York: McGraw-Hill, 2009:97.)

Preprocedure Checklist

  • Remove all makeup.

  • Remove all jewelry.

  • No pacemaker or defibrillator.

  • All patients with facial implants should have the material of the implant identified before the procedure. If it is unknown, do not treat directly over the implant.

  • Apply thick layer of topical anesthetic 30 minutes before procedure.

  • Determine appropriate spot size and fluence.

  • Keep the hand piece even with the skin throughout the procedure.

  • After the procedure patients can resume regular activities immediately.

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