Facial rejuvenation has become a widespread phenomenon in the cosmetic industry. The demand for noninvasive and minimal risk procedures has created an extensive search for the best treatments for photoaging. Lasers have traditionally been the most popular device used for noninvasive cosmetic procedures and have largely focused on the treatment of redness, pigment, and facial wrinkles. While ablative lasers are effective for facial rejuvenation, some patients may become hesitant due to the need for several treatments, the extended post-operative recovery period, and the potential for side effects.[1,2] This has led to the development of new age technology that is focused on facial tightening and one of these devices is radiofrequency treatment based approaches for rejuvenation.
Originally used in several medical practices including cardiology, urology, and sleep medicine, the use of radiofrequency has evolved to noninvasively treat photoaging, specifically by stimulating collagen growth in areas such as the face, stomach, and arms. As opposed to lasers that use light to specific targets within the skin, radiofrequency treatments use hand-held devices that deliver an electric current to the skin and tissue of the body to stimulate collagen growth.
How Radiofrequency Skin Tightening Works
More than 99% of the body's resistance to electric current flow is at the skin. When current passes through the skin, it is dissipated by the skin’s resistance which heats up the skin. This heat is what stimulates the skin to respond by producing collagen. A cooling spray is typically applied to protect the superficial layer of the skin known as the epidermis.
There are two types of radiofrequency devices: monopolar and bipolar. Monopolar handpieces achieve a deeper effect up to 20mm of volumetric heating, whereas the bipolar handpiece heats the skin more superficially between the depths of 2 to 6 mm.[6,7]
Why It Works – The Science of Radiofrequency Skin Tightening
Current is the flow of charge or the amount of electricity flowing per second.
Resistance is the property of an element or device that impedes, or resists, the flow of current. In this case, the skin acts as the resistance to the electricity that is flowing from the radiofrequency device.
The energy represents the energy provided by the device as the current is moved through the skin. This energy is a product of current, resistance, and time. The current is sent from the electrode, and the resistance is from the skin. When the energy is transferred, some of the energy is transferred to heat energy, causing the contraction of collagen.
This is safe because the body can take up to 500V, whereas the voltage used by radiofrequency skin tightening devices is very minimal.
How Well Do Radiofrequency Treatments Work?
A large majority of patients (upwards of 90%) have improvement in facial and neck laxity and that majority of patients demonstrated improvement. Radiofrequency treatments have also shown skin tightening and contraction on the buttocks and thighs, and have shown the positive signs for the reduction of cellulite appearance.[6,9] However, there is no consistent data available for long-term effects of the use of radiofrequency for skin tightening as most of the studies are performed over a 6 month period. Although there are studies demonstrating the success of radiofrequency treatments, there is a lack of agreed upon standards that are universally used to mark how well a treatment is helped with facial rejuvenation. These lack of consistent protocols and parameters for each experiment make it difficult to compare across studies or make definitive conclusions about radiofrequency skin tightening treatments. Still, radiofrequency skin tightening treatments are promising and more studies are needed to better understand the long-term success and to make studies consistent with one another.
Which People Are Best for Radiofrequency Treatments
Unlike lasers, intense pulsed light devices, and other light-based treatments, the electrical current delivered by the radiofrequency handpiece does not selectively target pigments within the skin. Thus, patients of all skin colors can be more safely treated with radiofrequency. However, although radiofrequency is more theoretically safe for all skin types, there is a risk of altered skin pigment if a thermal injury occurs due to overheating of the skin, especially in those with darker skin. Other risks include burns, skin breakdown, and scarring with the use of inappropriately high energies. This makes it even more important to find well-trained physicians that can perform the treatment.
Radiofrequency devices seem promising in the world of skin tightening and may be an option for people of all skin types and colors. However, more studies are needed to evaluate the long-term effects of this procedure and to see how long lasting the results are after treatment.
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Alster TS, Tanzi E. Improvement of neck and cheek laxity with a nonablative radiofrequency device: a lifting experience. Dermatol Surg.2004;30(4 Pt 1):503-507; discussion 507; PMID: 15056138 Link to research.
Ortiz AE, Goldman MP, Fitzpatrick RE. Ablative CO2 lasers for skin tightening: traditional versus fractional. Dermatol Surg.2014;40 Suppl 12:S147-151; PMID: 25417566 Link to research.
Greene RM, Green JB. Skin tightening technologies. Facial Plast Surg.2014;30(1):62-67; PMID: 24488639 Link to research.
Fish RM, Geddes LA. Conduction of electrical current to and through the human body: a review. Eplasty.2009;9:e44; PMID: 19907637 Link to research.
Gold MH, Goldman MP, Rao J, et al. Treatment of wrinkles and elastosis using vacuum-assisted bipolar radiofrequency heating of the dermis. Dermatol Surg.2007;33(3):300-309; PMID: 17338687 Link to research.
Emilia del Pino M, Rosado RH, Azuela A, et al. Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs. J Drugs Dermatol.2006;5(8):714-722; PMID: 16989185 Link to research.
Friedman DJ, Gilead LT. The use of hybrid radiofrequency device for the treatment of rhytides and lax skin. Dermatol Surg.2007;33(5):543-551; PMID: 17451576 Link to research.
Finzi E, Spangler A. Multipass vector (mpave) technique with nonablative radiofrequency to treat facial and neck laxity. Dermatol Surg.2005;31(8 Pt 1):916-922; PMID: 16042936 Link to research.
Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar radiofrequency treatment to improve the appearance of cellulite. J Cosmet Laser Ther.2008;10(3):148-153; PMID: 18788033 Link to research.
Araújo AR, Soares VP, Silva FS, et al. Radiofrequency for the treatment of skin laxity: mith or truth. An Bras Dermatol.2015;90(5):707-721; PMID: 26560216 Link to research.