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New option for nonsurgical brow lifting

Article-New option for nonsurgical brow lifting

Cosmetic dermatologist Paul M. Graham, D.O., noticed a side effect after using the radiofrequency Pelleve device (Hologic) to treat periorbital lines. It appeared patients were emerging from the noninvasive treatment with higher eyebrows.

So, Dr. Graham and David H. McDaniel, M.D., investigated whether it made sense, clinically, to use Pelleve as a brow lifting option. The study of 30 male and female patients looking at safety and effectiveness of radiofrequency for brow lifting, was presented in April 2018 at the 38th Annual Conference of the American Society for Laser Medicine & Surgery (ASLMS) in Dallas.

“Radiofrequency has been used for a long time — usually for facial wrinkles and skin rejuvenation,” Dr. Graham says. “…but our study demonstrated an innovative new nonsurgical, no-downtime, radiofrequency procedure for nonsurgical brow lifts.”

Study subjects had brow laxity and were between ages 35 and 65, with Fitzpatrick skin types ranging from II to VI. They received five treatments with the 4 MHz monopolar radiofrequency device at four-week intervals, on the forehead and in the periorbital area.

Researchers used Pelleve’s existing attachments — FDA cleared for other indications — for off-label brow lifting. They used both the 10 & 15 mm hand piece to treat the forehead and eye area, targeting an epidermal temperature of 40 to 44 degrees centigrade. Average treatment time was 20 minutes, according to the abstract.

“We treated the forehead, which contains the orbital retaining ligament…. Then we treated the upper and lower eyelids,” he says. “What sets that device apart is the small hand piece and the articulating arm. The hand pieces move and are able to conform to the treatment area. It’s not just one rigid rod that we’re putting on the skin. It has an articulating end to it, where we’re able to put it in an area of concavity or convexity, and it’s able to conform.”

According to results, 81% of study participants responded to treatment, according to the average eyebrow height measurement.

“We also found that 82% of subjects were satisfied at 120 days of follow-up,” Dr. Graham says.

In some cases, the brow lift radiofrequency treatment resulted in a noticeable skin contraction right after the first treatment.

“The immediate changes were temporary. When we brought the patients back, though, after a cumulative amount of treatment, that’s when we were able to see that eyebrow lift,” Dr. Graham says.

Side effects included erythema and edema for up to 24 hours post treatment.

“Twenty-four hours is an overstatement. Most patients are not even red when they leave the office,” he says.

In the bigger picture, radiofrequency brow lifting is among the more conservative treatments that cosmetic physicians perform, according to Dr. Graham.

“It’s for patients looking for skin tightening and subtle brow lifting, but don’t want to undergo the downtime associated with more invasive lasers or procedures, such as surgery,” he says.

NEXT: The RF Brow Lift in Practice

Dr. Graham says using the radiofrequency device to lift brows is a viable alternative to ultrasound for the same indication. And while patients say that radiofrequency brow lifting feels like a hot stone massage, ultrasound treatment can be painful, he says.

Radiofrequency might also offer a different alternative than using neuromodulator injections to relax the forehead and lift the brows, according to Dr. Graham.

“… people looking more for a brow lift with [neuromodulators may get an unpredictable brow lift, meaning we don’t know how far that [neuromodulator] is going to diffuse. There’s no exact location to inject that’s going to give a defined amount of lift. It’s all based on how active the patient’s lateral frontalis muscles are and how much depressor movement or pull-down there is from the orbicularis oculi muscles,” he says.

This radiofrequency device tested in the study creates heat in the skin and has been shown to cause collagen to contract and stimulate wound healing and new collagen, thus it lifts the brows, according to the dermatologist.

Since conducting the study, Dr. Graham says the Virginia Beach, Va., practice at which he is completing his fellowship, has been promoting the use of Pelleve for brow lifting to the younger set.

“If we’re using this device on someone with a lot of photodamage and skin laxity, you’re not going to see that effect, because we have to harness that collagen percentage in the skin and that skin elasticity to get that lift,” he says. “This is a good treatment for patients in their 30s and 40s with minimal to early photodamage.”