Dallas — Mild to moderate redundant laxity of the lower face and neck can be treated — and the results sustained — without surgery using a nonablative radiofrequency device. According to Laurie Jacobson, M.D., long-term facial rejuvenation results have been maintained for one year.
The ThermaCoolTM radiofrequency device (Thermage, Hayward, Calif.) tested by Dr. Jacobson and colleagues "offers a noninvasive treatment for a problem that has previously been addressed by surgery only. This treatment provides a low-risk treatment option," she says.
Dr. Jacobson, who presented at the annual meeting of the American Society for Laser Medicine and Surgery, says other major benefits of the radiofrequency approach include no recovery period, few side effects and relatively brief treatment duration.Treatment carries none of the high risks of infection, dyschromia, bleeding and scarring associated with laser resurfacing or surgical methods of rhytidectomy or blepharoplasty. Nor does the modality require the lengthy recovery period that typically follows treatments with carbon dioxide and erbium lasers.
Other nonablative modalities for facial rejuvenation — such as pulsed dye and Yag lasers, or intense pulsed light sources — can produce mild to moderate improvement, but often require multiple treatments, Dr. Jacobson explains.
ThermaCool appears to cause collagen tightening by producing controllable volumetric heating of the deep dermis. Appropriate temperature changes must be achieved during treatment. Overheating can cause cell death and scarring. If heat generation is not sufficient, laxity or rhytides will not improve.
Dr. Jacobson and colleagues from the Laser & Skin Surgery Center of New York conducted a study of the nonablative radiofrequency treatment in 10 patients who had laxity of marionette lines, nasolabial folds, neck and jawline.
Prior to treatment, each patient received topical anesthetic and oral pain relief of oxycodone/acetaminophen (Percocet)
"Discomfort is significant during the procedure," says Dr. Jacobson, because the device can achieve ultrastructural changes as deep as 5 mm. Intravenous sedation is rarely used.
Patients underwent 40-minute sessions in which the lower two-thirds of the face and neck were treated. Treatment on the face consisted of three passes of the device, while the neck received just a single pass. Energy delivered was 124 J on the face and 81 J on the neck. Patients received one or two treatments, with at least two months between treatments.
Side effects included temporary erythema and edema in a majority of patients. There were single cases of subcutaneous nodules on the neck, which resolved in three weeks, and dysesthesia on the jawline, which resolved in one week.
To evaluate results, two investigators compared pre-treatment and follow-up photos, which were taken in the same room with the same camera and identical lighting, headrest and photo angles. By visually inspecting treated areas, they found initial improvement in all 10 patients after one to three months. Of those 10, seven maintained that improvement for one year.
Nine patients maintained jawline improvement following initial treatment. Seven maintained marionette line improvement and neck improvement. All 10 maintained nasolabial fold improvement.
Dr. Jacobson says this radiofrequency treatment does not benefit obese patients or those with significant skin redundancy. It is safe for patients who have had other cosmetic procedures, such as rhytidectomy, laser surgery, fillers or botulinum toxin injections.
"This in no way can compare to the results following a rhytidectomy," she says. "The upside is that there are no surgical scars, it is used safely on all skin types, and down time is minimal."