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Sagging cheeks, necks get a lift with RF technology

Article-Sagging cheeks, necks get a lift with RF technology

Dallas — A single treatment with radiofrequency energy provides a safe, non-invasive method for treating mild-to-moderate laxity of the neck and cheeks, said Tina S. Alster, M.D., at the annual meeting of the American Society for Laser Medicine and Surgery.

Dr. Alster
Dr. Alster, director of the Washington Institute of Dermatologic Laser Surgery in Washington, DC and her co-director, Dr. Elizabeth Tanzi, reported results achieved in a series of 50 patients with skin phototypes 1-4 treated a single time with the radiofrequency device (ThermaCool TC™, Thermage, Inc. Hayward, Calif.) Thirty of the patients were treated for cheek laxity and 20 were treated for neck laxity.

Performed under topical anesthesia (LMX 5 cream for 60 minutes), the treatment was found to be moderately uncomfortable by most patients, and it resulted in mild, temporary local erythema and edema. However, during follow-up extending 12 months post-treatment there were no scarring complications or pigmentary alterations.

Just a single treatment Outcomes judged by comparisons of baseline and follow-up photographs made by three masked observers along with the results of patient satisfaction surveys showed the single treatment afforded significant improvement for the majority of patients that appears to be long-lasting.

Tissue tightening occurred immediately and continued to increase consistently over the post-treatment follow-up evaluations, reaching a peak at about three months to six months and gradually declining by 10 percent during the next six months. There was appreciable variability in the intra-individual responses, although in general, cheek laxity responded better than the neck, Dr. Alster reports.

"This procedure is not a substitute for a facelift, but with the advantage of having no post-treatment recovery, it is a reasonable option for people in their 40s or 50s with early jowling and/or neck laxity who could benefit from a modest tightening effect," she explains. "In addition, it might also be considered by anyone with contraindications to incisional surgery who is prepared and willing to accept a less than dramatic result."

For treatment of cheek laxity, the radiofrequency energy was delivered to the skin extending laterally and inferiorly from the nasolabial folds to the preauricular regions and mandibular ridge; the region from the mandible to mid-neck was treated to address neck laxity.

Mild erythema developed in all patients, as it was used as a treatment endpoint. However, it was transient, lasting an average of 2.3 hours and no longer than 12 hours. Other side events encountered included mild, acute edema, and rarely, transient dysesthesia.

Follow-up assessments were made immediately post-treatment and one week and one, three, six and 12 months post-treatment.

Responses were graded using a quartile rating scale, where 0 = < 25 percent improvement, 1 = 25 to 50 percent improvement, 2 = 51 to 75 percent improvement and 3 = > 75 percent improvement.

At the three- and six-month visits, the average improvement scores were 1.6 and 1.5, respectively, for the cheeks and 1.25 and 1.3, respectively, for the neck. All patients achieved at least 25 percent improvement, while there were a few who benefited with a >75 percent change.

"There is no way to predict who will be a great responder, and while everyone in this study experienced some clinical improvement, it is possible that a patient could show no visible response.

The worst case scenario, however, is that the patients who achieve minimal to no change will be out the cost of the procedure, but at least they are not risking significant complications or post-treatment morbidity," says Dr. Alster, who is also clinical professor of dermatology, Georgetown University, Washington, D.C.

Based on the continued improvement observed during the first 3 to 6 months after the procedure, Dr. Alster hypothesized that the mechanism of action whereby the radiofrequency procedure causes tissue tightening involves not only immediate collagen contraction, but also a secondary collagen synthesis and remodeling process.

"The tissue response is not unlike what occurs after ablative laser resurfacing, although it seems to be less prolonged since the peak benefit after the radiofrequency treatments occurs by 3 to 6 months," she says.

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