Do they work?
Brian D. Zelickson, M.D., of Minneapolis outlined some of the challenges facing doctors who want to offer the treatments — most of which are still relatively new to public use.He is medical director of Abbott Northwestern Hospital Laser Center and assistant professor in the dermatology department at the University of Minnesota.
No surgery substitute
He says the standard for assessing non-invasive skin tightening is the ThermaCool™ device made by Thermage®.
"The ThermaCool™ device is a monopolar radiofrequency device with contact cooling which has been out the longest and has shown that it can perform the task. It does work."
Dr. Zelickson reminded those attending the American Academy of Dermatology's Academy '05 here that no device is a replacement for surgical options.
He says, "They make a nice alternative for those who don't want to go through an invasive procedure or who don't need that kind of tightening."
Other devices now being used are the Titan by Cutera, which uses light therapy, and the Syneron Polaris — a laser and bipolar radiofrequency device.
"Currently there are no studies comparing the results of these newer devices to Thermage®," Dr. Zelickson says. "Clinically, however, all of these performed well using the current protocols. The ThermaCool™ treatment consists of one treatment session taking about 1 to 1.5 hours, whereas the Titan and Polaris treatments require two to three 30-to 60-minute treatments."
Dr. Zelickson has all three devices in his practice. He says there are too few published studies evaluating the definitive tightening that results from these latter two devices, but he expects more to be done, and expects his practice to get involved, too.
Dr. Zelickson says histology shows changes do occur in the dermis with the newer devices. However, to date, the deeper changes detected in the fibrous septae of the fat have only been detected after the ThermaCool™ treatments.
"We published changes in collagen fibrils using electron microscopy," he says. "These changes are a partial to complete denaturation of some of the collagen fibrils within the dermis. That suggests you're getting some immediate tightening with the contraction of the collagen fibril."
Dr. Zelickson says additional changes can be seen — specifically with ThermaCool™.
"The way that monopolar radiofrequency works is that the heat and electrons pass through the least-resistant tissue," he explains. "So when that goes down to the fat, there is fibrous septae within the fat and the heat is funneled through those fibrous bands. They then contract so that there is more contouring — or tightening — in the vertical aspect, as opposed to the horizontal aspect of the tissue."
Dr. Zelickson thinks that may be why the ThermaCool™ treatment may prove to be somewhat more effective than the other two therapies.
"Light-based devices that perform bulk heating do not have that selectivity that we've been able to demonstrate with ThermaCool™," he says.
"And the bipolar radiofrequency used in the Polaris device, that radiofrequency just goes from one pole of the device to the other, both of which are placed on the surface of the skin, so the heating is fairly superficial," he adds.