Eye opener

In recent clinical testing, a new "shallow" tip designed for a popular radiofrequency (RF) treatment (ThermaCool, Thermage; Hayward, Calif.) has proven safe and effective for eyelid tightening and perhaps impacts lower eyelid fat pads, researchers tell Cosmetic Surgery Times . To evaluate the efficacy of a 0.25-cm2 monopolar RF treatment tip, investigators at four North American locations treated a total of 72 patients for eyelid skin laxity. After baseline ophthalmic examinations, researchers gave each patient a single treatment with the 0.25-cm2 treatment tip, moving from the eyelashes to the eyebrows superiorly, and from the eyelashes to the inferior orbital rim inferiorly, and including the crows' feet region laterally.

PROTECTIVE PROTOCOL To protect patients' eyes, physicians inserted specially designed plastic corneoscleral lenses (Oculo-Plastik; Montréal) before treatment, first applying two drops of topical ophthalmic anesthetic solution — the only anesthetic patients required, states Brian S. Biesman, M.D., assistant clinical professor of ophthalmology, dermatology and otolaryngology at Vanderbilt University Medical Center, Nashville, and the study's lead investigator.

Investigators typically began treatments at a setting of 32.5 (13 J), increasing or decreasing until patients reported discomfort of two to 2.5 on a four-point ascending scale. They also applied ThermaCool TC Coupling Fluid (Thermage) throughout treatment. Researchers — along with independent observers working from digital photos and patients themselves — then evaluated results at several intervals for six months post-treatment.

"We assessed patients for tightening of the upper and lower eyelids and reduction of hooding of the upper eyelids," relates Dr. Biesman. Researchers observed upper eyelid tightening in 88 percent of subjects, reduced hooding in 86 percent and lower eyelid tightening in 70 to 74 percent, he says.

"The correlation between the treating physicians' evaluations, patients' reports and those of independent observers was very high," and no significant complications occurred, Dr. Biesman adds.

Regarding longevity, Dr. Biesman says some study subjects showed ongoing improvement throughout the six-month follow-up period. In his practice, patients who elect to repeat tightening treatments usually do so every one to two years, he notes.

EYE SPY Furthermore, Dr. Biesman says that he left one very unexpected observation out of his report: in 40 to 50 percent of patients, "It appeared to the independent observers scoring the photographs as if some reduction in the fat prominence had occurred in the lower eyelids." He says that, while he's unsure whether this observation reflects true change in the orbital fat, he clearly has seen the same effect in at least one patient treated after the study.

"We seemed to see a toning of the skin, which appeared to pull the fat back in a bit. I don't believe there was a direct effect on the fat. It was more like a girdle" tightening the skin over the fat, explains Jean D. Carruthers, M.D., clinical professor of ophthalmology at the University of British Columbia, Vancouver, and a study co-author.

"There seemed to be a dose-response curve" among patients her office treated, she adds. While most patients received five passes, Dr. Carruthers notes, "The one patient we did eight passes on had a bigger lift."

SKIN SUBTLETIES Conversely, Dr. Biesman says, "The biggest drawback to this technique is the variability of response. More patients got a modest response than a dramatic one, which is true of skin tightening in general."