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Several of my patients brought to my attention an article in the weekend edition of the Wall Street Journal: “A gentler turning back of the clock.” They found it amusing that these “new” energy treatments had just arrived in New York, while we have been offering the most advanced radio-frequency treatments to our patients for two years. This led me to review our experience with these useful therapies, so that I can provide an up-to-date summary of what they can and cannot do.

Radio-frequency hand piece device.

Radio-frequency hand piece device.

We have found radio-frequency treatments to be very useful in two specific applications: tightening of the skin and reduction of fine lines. These are issues that may become apparent in men and women in their 30’s and 40’s and are related to sun exposure, stress, and each individual’s genetic constitution.

Why use radio-frequency to tighten and smooth the skin?

There are many non-invasive skin tightening and wrinkle reduction treatments available to tighten and smooth the skin. These run the spectrum from gentle treatments with a modest result and minimal recovery to very powerful treatments that impose a significant recovery and run the risk of complications. Examples of milder treatments include medical grade skin care products and microdermabrasion. Examples of powerful treatments include ablative laser resurfacing, phenol peels and deep dermabrasion. Radio-frequency treatments have the advantage of occupying the middle ground in the spectrum of results and recovery. Our patients experience a significant improvement in skin tone and smoothness with a limited recovery and downside.

Will radio-frequency treatments replace the face lift?

A doctor interviewed in the Wall Street Journal article suggested that non-invasive radio-frequency treatments will replace the face lift. This is wishful thinking. Radio-frequency treatments can do a wonderful job for patients who have a mild degree of skin looseness but will disappoint those people who have skin that is loose enough to require a lift. As these treatments become more powerful and refined they may push back the average age for a face lift by year or two, but won’t make a a change in the overall need for lifting surgery. I have a sense of deja vu when I hear pronouncements from certain practitioners about radio-frequency being a face lift substitute. I remember when the same was said of Botox and fillers.

Not All Radio-Frequency Devices Are Created Equal

There is a wide range of radio-frequency devices, from low energy devices that you might find in a salon or spa to high performance devices that can only be used in medical practices. As you might expect, the results that can be obtained from low energy devices do not equal those that medical grade radio-frequency machines produce.

It’s Not Just The Device, It’s The Skill of The Team

There are three important factors that influence the results of radio-frequency skin treatments. The first is proper selection of patients who will truly benefit from these non-invasive procedures and who have a realistic understanding of what can and what cannot be accomplished. The second is the quality of the equipment. This affects both the precision of the treatment and the extent of improvement that can be obtained. The third is the quality of the individual who is using the equipment. At the Whole Beauty® Institute our team has a great deal of experience with radio-frequency treatments. We have been working with this technology for over two years

Radio-frequency Treatments Work Well in Combination with Botox&Reg; and Facial Fillers

The article in the Wall Street Journal set up an artificial competition between radio-frequency skin therapy and other treatments such as Botox® and fillers. The suggestion was made that Botox® and fillers produce and artificial “frozen face,” while radio-frequency treatments will not.

I will be the first to agree that there are far too many faces that have a frozen appearance. There are also many patients who have been over-filled in the lips and a growing number who are over-filled in the cheeks with the availability of more robust fillers. The misapplication of relaxants such as Botox® and fillers is not related to problems with these materials in themselves, but is related to the fact that many practitioners who use them lack technical skill and artistic sensibility.

In our practice we have found that radio-frequency treatments make excellent teammates for relaxants and fillers. Combination therapy produces the most natural rejuvenation.

Where Radio-frequency Treatments Fit in the Spectrum of Treatments for Facial Aging

One way to look at facial aging is to break it into five component parts: abnormal muscle dynamics, volume loss, deep creases, skin laxity, and fine lines. There is no one solution that will address all five components.

Abnormal muscle dynamics produce overactive frown lines between the brows, squint lines in the crow’s feet area, and a turning down of the corner of the mouth. These and other more subtle issues are best addressed with relaxants such as Botox®.

Volume loss produces predictable changes in the face as we age. Often the temples become hollow, the cheeks lose their fullness, a trough develops between the lower eyelid and the cheek, and the face generally appears gaunt. At the Whole Beauty® Institute we make use of a wide range of fillers, each suited to a particular application.

Deep creases between the upper lip and the cheek and beneath the corner of the mouth are related to both volume loss and structural descent of the cheek and jaw border. Severe creases may require surgical lifting. lesser creases can be softened by revolumizing the cheek, which has the effect of lifting the cheek and reducing the creases, or by injecting filler into the creases themselves.
So far I have not even mentioned radio-frequency and other non-ablative skin tightening technologies. This is because they are best suited to treat the last two components of facial aging, skin laxity and fine lines.

Skin laxity often begins to become noticeable in people in their 30’s and 40’s. This is often the “sweet spot” for non-ablative skin tightening technologies. If there is a great deal of loose skin or descent of the deeper facial structures, the best result will be obtained by a surgical lift. If there is a mild to moderate degree of skin laxity radio-frequency treatments can often produce very pleasing results.

For our patients with mild skin laxity we have achieved nice improvements with the use of radio-frequency in the neck, the jaw border, the cheek and the outer brow.

It is important to distinguish between skin laxity and deep structural laxity. Both are important components of the facial aging process.

Skin laxity occurs early in the facial aging process. The skin begins to lose its firmness and tone and the crisp contours of the youthful face begin to relax. Radio-frequency treatments can be very helpful for people with milder degrees of skin laxity.

As the facial aging process continues, the deeper structures of the face begin to relax. A surgical lift is necessary to bring these structures back to a proper position.

Some practitioners are trying to tighten the deeper structures with non-invasive devices that are based on ultrasound, but this is unwise for several reasons. First of all the repositioning of deeper structures requires a high degree of precision; if they are moved in the wrong direction, the result will be bizarre. Second, the results have been highly unpredictable. Third there is the possibility of damage to the motor nerves that coordinate facial expression. Fourth energy at the deeper levels may melt the natural fat of the face, which is the opposite of rejuvenation. Fifth, as was mentioned at the most recent Cutting Edge Symposium in New York (which is an assemblage of many of the world’s best minds in aesthetic plastic surgery), surgical rejuvenation is made much more difficult by the presence of scar at the deeper levels.

Fine lines, textural changes, and pore enlargement also respond well to radio-frequency treatment. There is a wide spectrum of treatments for these conditions hat have been available for years. Milder treatments include medical grade products, lighter chemical peels, microdermabrasion, and micro-channeling. Intense treatments include deep chemical peels, laser resurfacing, and traditional dermabrasion. The deeper, more powerful treatments can produce dramatic results, but do so at significant cost to the patient: prolonged recovery, significant complications, and permanent pigment changes. Radio-frequency treatments produce results that are not quite as pronounced as what can be obtained with the most powerful treatments, but with a much easier recovery and significantly less trouble for the patient.

Our choice of radio-frequency treatments is based upon a careful selection process

The Fractora radio-frequency hand-piece.

The Fractora radio-frequency hand-piece.

Every technology that is added to the treatment portfolio at the Whole Beauty® Institute is selected after a careful vetting process. We look for products and technologies that deliver meaningful and consistent results and that have advantages over competing options. We believe that the bipolar radio-frequency devices that we use are the current state of the art for non-invasive facial rejuvenation.

The Fractora® device delivers radio-frequency energy to a variety of levels of the skin in order to reduce fine lines, diminish pore size, and improve skin tone. Different levels of energy can be delivered depending on the patient’s time available for recovery. We are able to treat a wider range of skin types than can be treated with most competing technologies.

original_radio-frequency_diagram

Diagram of how radio-frequency works.

The Forma® device brings the deeper level of the skin to a temperature level that stimulates new collagen formation, which provides for skin tightening. There is a very narrow temperature range that is warm enough to produce tightening, but not so warm as to cause injury or excessive discomfort. The software behind the system allows our team to reach this sweet spot on a consistent basis.

We have found that Forma® produces very pleasing results in the jaw border and neck and other facial zones. The same technology can be applied to other body areas.

Our skilled teams at the Chicago and Winnetka offices of the Whole Beauty® Institute often combine a series of the Fractora® and Forma® treatments to provide a powerful non-invasive facial rejuvenation.

Our team members at the Whole Beauty® Institute are recognized leaders in surgical and non-surgical facial rejuvenation

We provide our patients with a complete portfolio of therapies and always adhere to naturalistic principles. We take seriously our mission to preserve the unique expressive identity of each face. With years of experience with the Fractora® and Forma® radio-frequency treatments we offer our patients extensive knowledge of these advanced therapies.