Histological and Ultrastructural Evaluation of the Effects of a Radiofrequency-Based Nonablative Dermal Remodeling Device

Zelickson, Brian D.; Kist, David A.; Bernstein, Eric F.; Brown, Diane Storer; Ksenzenko, Sergey M.; Burns, Jay A.; Kilmer, Suzanne L.; Mehregan, David A.; Pope, Karl

doi:10.1001/archderm.140.2.204

Cited by 334 publications

(277 citation statements)

References 22 publications

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“…As shown in this result, the focal zone of the ultrasound beam was measured to be 1. The thermal effects of a focused field propagating through skin/superficial tissue have been extensively modeled using well-established acoustic beam propagation schemes [13][14][15][16] as well as using the bio-heat equation [15][16][17][18]. A multi-layer approach has been applied for numerical simulations, whereby the significant differences in tissue attenuation between the epidermis (nominal thickness 0.2 mm), dermis, and subcutaneous tissue have been accounted for.…”

Section: Numerical Simulationsmentioning

confidence: 99%

“…For this reason, physicians and surgeons alike have tried to develop various methods (e.g., radiofrequency), termed ''Nonablative Skin Resurfacing,'' to induce collagen shrinkage and remodeling while preserving the epidermis in an effort to minimize these post-operative changes. These modalities have produced variable efficacy at best [7,8,13].…”

Section: Introductionmentioning

confidence: 99%

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Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound (IUS)

White

Makin²,

Slayton³

et al. 2008

Lasers Surg Med

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Objective: Various energy delivery systems have been utilized to treat superficial rhytids in the aging face. The Intense Ultrasound System (IUS) is a novel modality capable of transcutaneously delivering controlled thermal energy at various depths while sparing the overlying tissues. The purpose of this feasibility study was to evaluate the response of porcine tissues to various IUS energy source conditions. Further evaluation was performed of the built-in imaging capabilities of the device. Materials and Methods: Simulations were performed on ex vivo porcine tissues to estimate the thermal dose distribution in tissues after IUS exposures to determine the unique source settings that would produce thermal injury zones (TIZs) at given depths. Exposures were performed at escalating power settings and different exposure times (in the range of 1-7.6 J) using three IUS handpieces with unique frequencies and focal depths. Ultrasound imaging was performed before and after IUS exposures to detect changes in tissue consistency. Porcine tissues were examined using nitro-blue tetrazolium chloride (NBTC) staining sensitive for thermal lesions, both grossly and histologically. The dimensions and depth of the TIZs were measured from digital photographs and compared. Results: IUS can reliably achieve discrete, TIZ at various depths within tissue without surface disruption. Changes in the TIZ dimensions and shape were observed as source settings were varied. As the source energy was increased, the thermal lesions became larger by growing proximally towards the tissue surface. Maximum lesion depth closely approximated the pre-set focal depth of a given handpiece. Ultrasound imaging detected well-demarcated TIZ at depths within the porcine muscle tissue. Conclusion: This study demonstrates the response of porcine tissue to various energy dose levels of Intense Ultrasound. Further study, especially on human facial tissue, is necessary in order to understand the utility of this modality in treating the aging face and potentially, other cosmetic applications.

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Section: Numerical Simulationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound (IUS)

White

Makin²,

Slayton³

et al. 2008

Lasers Surg Med

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“…The first noninvasive device for skin tightening took advantage of the heat generated in tissue by radiofrequency (RF) energy [2][3][4]. Specifically, RF energy heats hydrodermal collagen while the skin is cooled, promoting both collagen remodeling [5] and skin tightening [6]. This ''tightening response'' was considered unique to RF until a split-face study [7] showed that facial skin tightening after a single treatment with RF was comparable to facial skin tightening after a single treatment with the long-pulse Nd:YAG 1064-nm laser (LP Nd:YAG).…”

Section: Introductionmentioning

confidence: 99%

Single‐treatment skin tightening by radiofrequency and long‐pulsed, 1064‐nm Nd: YAg laser compared

Key¹

2007

Lasers Surg Med

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Background and Objective: To compare single-treatment facial skin tightening achieved with the current radiofrequency (RF) protocol with single-treatment tightening achieved with the long-pulsed, 1064-nm Nd:YAG laser. Study Design/Materials and Methods: A total of 12 patients were treated with RF energy on one side of the face and laser energy on the other. Results were evaluated on a numerical scale (0-12 with 12 ¼ greatest enhancement) from pre-and posttreatment photographs by a blinded panel.Results: Upper face improvement (posttreatment score minus pretreatment score) was essentially the same on both sides (30.2 and 31.3% improvement for laser and RF, respectively, P ¼ 0.89). Lower face improvement was greater in the laser-treated side (35.7 and 23.8% improvement for laser and RF, respectively), but the difference was not significant (P ¼ 0.074). Overall face improvement was significantly greater on the laser-treated side (47.5 and 29.8% improvement for laser and RF, respectively, P ¼ 0.028). Conclusion: A single high-fluence treatment with the long-pulse 1064-nm Nd:YAG laser may improve skin laxity more than a single treatment with the RF device. Further controlled split-face or very large non-self controlled studies are needed to conclusively determine the relative efficacies of the two technologies. Lasers Surg.

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“…The change of procollagen I mRNA of 2.4-to 1.7-fold, correspondingly two and seven days after RF treatment of the skin [14], also cannot be responsible for any improvement in the skin's appearance, since the overexpression of the procollagen I protein in this case has to be even smaller than in the study of [13].…”

Section: Quasi-physiological and Pathological Conditionsmentioning

confidence: 75%

Neocollagenesis in Non-Invasive Aesthetic Treatments

Kruglikov¹

2013

JCDSA

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Dermal neocollagenesis is often assumed to be the main reason of visible skin improvement after different non-invasive and minimal invasive aesthetic treatments. However, the very slow dynamics of the mature collagen remodelling in the extra cellular matrix (ECM) of dermis, with a half-life time of 15 years, renders every observable upregulation of collagen production insufficient to replace a significant part of the matrix during the short time in which it is claimed skin improvement takes place.

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Histological and Ultrastructural Evaluation of the Effects of a Radiofrequency-Based Nonablative Dermal Remodeling Device

Cited by 334 publications

References 22 publications

Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound (IUS)

Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound (IUS)

Single‐treatment skin tightening by radiofrequency and long‐pulsed, 1064‐nm Nd: YAg laser compared

Neocollagenesis in Non-Invasive Aesthetic Treatments

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