Dr. Goldberg, who is clinical professor and director of laser research in the Department of Dermatology at Mount Sinai School of Medicine in New York, focused his discussion of RF rejuvenating techniques on ThermaLift, a procedure accomplished using the ThermaCool™ TC machine.
"First, the device provides primary skin tightening with a single treatment and with no epidermal loss," he says. "In addition, the ThermaCool™ device can be used either as a primary non-ablative device, or it can be used as skin-tightening technology in conjunction with other nonablative devices."A veteran dermatologist and director of the Skin Laser & Surgery Specialists of New York and New Jersey, Dr. Goldberg discussed RF rejuvenation in a seminar, "Tissue Tightening: Brow Lift and Upper Face," he presented at the Cosmetic Dermatology Seminar.
"What's important to know about this procedure is that it is not a laser treatment," Dr. Goldberg says, "and that previous nonablative techniques do not provide any tissue tightening at all. Nonablative radiofrequency with this device does provide skin tightening in the treated areas. That's the major point of difference."
Dr. Goldberg points out other differences between laser and RF non-ablative treatment.
"With laser nonablative treatment, photons of light are used, there is absorption by a specific chromophore and this absorption leads to heat formation," he says. "With RF nonablative treatment, there are no photons of light, the heating is nonspecific in terms of chromophores, and heat is based on tissue resistance of electron movement, or Ohm's law."
Dr. Goldberg says this difference yields a major benefit to the makeup of the prospective patient population: Because the heating is nonspecific with the ThermaCool™ device, the patient's skin pigmentation is irrelevant. Therefore, the procedure is appropriate — and effective — for a much wider variety of ethnicities than is seen with most lasers.
"Treatment with the ThermaCool™ RF device does have its unique points. It is, for instance, the only noninvasive device that tightens tissue," Dr. Goldberg says. "However, remember that it is not a substitute for browlift or facelift surgery. It does not work quite as well as those procedures, and the changes it produces are more subtle. But again, the ThermaCool™ procedure is noninvasive, so recovery time is virtually nil when compared with recovery time for surgical procedures."
Dr. Goldberg cites results of FDA trial studies done in 2002 by himself and several colleagues on nonablative RF technology used to lift the brow. The study focused on 86 patients who were treated for periorbital rhytid by "lifting" of the forehead skin with RF treatment. In each case, the patient underwent single treatment of the area above the rhytid or lax skin; in 90 percent of the cases, pain was managed with topical ELA-Max (now known as LMX4, Ferndale Laboratories), while only 10 percent required additional brow-nerve blocks.
"Of the total of 124 treated eyes, 74 percent of right-eye and 84 percent of left-eye areas showed improvement four months after treatment," Dr. Goldberg says. "After six months, 85 percent of right-eye and 80 percent of left-eye areas improved."
In determining optimum ranges of treatment settings for ThermaCool™ procedures, Dr. Goldberg says patients' pain sensation should be "of deep heat, not agony," and that the optimal setting range for facial treatment is 12 on the lower end and 16 on the upper.