Aesthetic Applications of Radiofrequency: Lymphatic and Perfusion Assessment

Abstract

Background: The use of radiofrequency in aesthetics has increased in popularity since the early 2000s. To date, there have been limited studies investigating the effect of thermal energy secondary to radiofrequency treatment. The purpose of this study was to evaluate perfusion and lymphatic assessment tools pre and post bipolar and fractional radiofrequency treatment. Methods: A retrospective IRB-approved study was conducted between January 2019 and April 2019. Patients who were independently deemed appropriate candidates for radiofrequency soft tissue remodeling were evaluated. Diagnostic perfusion and lymphatic imaging obtained were reviewed using indocyanine green (SPY, Stryker) and optical coherence tomography (Vivosight OCT). Results: A total of 63 patients were treated during the study period, of which 37 had diagnostic perfusion and lymphatic imaging. Average patient age was 47 (STD 12), 95% (35/37) of patients were women, and no patients were active smokers. In total, 27% (10/37) of patients were post-surgical patients with recurrent laxity, 32% (12/37) did not have enough skin laxity to justify traditional excisions procedures, and 41% (15/37) may have been candidates for excisional procedures but were willing to accept more moderate results to avoid excisions surgery. Indocyanine green perfusion and lymphatic assessment for bipolar and fractional radiofrequency, as well as optical coherence tomography pre and post radiofrequency, did not show compromise from thermal injury. Conclusions: This study supports safety of radiofrequency in terms of preservation of tissue perfusion and lymphatic drainage. This correlated to our low clinical incidence of burns, prolonged swelling, or tissue ischemia.

Enhanced Lipocontouring of the Arms

“…Bodytite incorporates internal and external temperature monitors with safety shut-offs if the tissue heats beyond temperature boundaries set by the surgeon. Perfusion imaging assessment using indocyanine green imaging and optical coherence tomography demonstrated no compromise of subdermal perfusion following treatment with a bipolar RF device [12].…”

“…First, cleavage of hydrogen bonds in the collagen fibrils results in shrinkage and thickening of the FSN immediately after energy application. Second, the wound healing cascade is initiated, which results in neocollagenesis, angiogenesis, and elastin reorganization with effects on the skin quality observed over the three to four months following treatment [12]. Subdermal RF heating has been shown to result in FSN contraction and soft tissue contraction of up to 47% [13].…”

“…Fractional RF devices (Fractora or Morpheus8; InMode or Profound, Candela Medical, Mississauga, ON, Canada), utilize (micro)needles or electrodes to heat the dermal and subdermal levels in a nonablative fashion. Heating of the subdermal tissues results in a degree of fat emulsification and mild contouring [12]. Skin needle puncture has been shown to improve skin texture and mild rhytids.…”

“…Additionally, due to its less invasive nature, RF (micro)needling can be used to address difficult-to-treat areas such as fat pads just proximal to the elbow or at the axillary-arm junction. Untreated islands of skin expedite recovery with fractional RF treatments, similar to fractional laser resurfacing [12,15].…”

“…The use of subcutaneous RF techniques have been beneficial in further improving skin tightening and quality [6,9]. RF subdermal skin tightening is more powerful and is particularly advantageous as it avoids targeting dermal chromophores and epidermal injury, thus can be used in any Fitzpatrick skin type, unlike transdermal RF and laser treatments [12].…”