7 minute read
Radio Frequency for Skin Rejuvenation By Nancy Abdou
Radio Frequency for Skin Rejuvenation:
An Oldie, But A Goodie! B y N a n c y A b d o u
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Skin ageing is inescapable, due to both intrinsic and extrinsic factors which lead to a reduction in collagen, degradation by metalloproteases (MMPs) activity and lowered function of epidermal keratinocytes, resulting in wrinkling and skin laxity. This leads us to an increase in demand for results driven skin rejuvenation – without surgery or extended periods of downtime!
Radio Frequency (RF) has not let us down, stepping up to the challenge that we are currently facing (excuse the pun!). Utilising controlled thermal trauma, RF is able to overcome this ageing dilemma by inducing neocollagenesis, and contracting lax skin – and quite well too, on all Fitzpatrick skin types, since RF is colour blind!
RF energy is a current that can be delivered through various tissue types (ie, skin, fat, and muscle) to generate thermal energy, that has been used in many medical fields including; cardiology, urology & oncology, just to name a few.
Initially used in the 1920s as an electrocautery tool, the use of RF to contract collagen isn’t a new concept. For example, orthopaedic surgeons have used RF to contract areas such as shoulder ligaments, responsible for instability, for over a decade. Over the last 15 years RF has seen an increase in its diversity, being used in aesthetic surgery.
In 2002, the FDA approved the first mono-polar RF device for facial wrinkle reduction and since then other RF devices have evolved such as bipolar, multipolar, and fractional, with even more safety features.
Unlike lasers, RF does not target specific chromophores by selective photo-thermolysis. Instead, RF generates heat as a result of different tissue resistance or impedance to the current. This means that heat is produced when the tissues’ inherent resistance, converts the electrical current to thermal energy.
energy is applied to the skin:
1. Splitting of hydrogen bonds in the collagen triple helix causes shortening and thickening of collagen fibrils. 2. Initiation of a wound healing response, triggering angiogenesis, collagenesis, and elastin reorganisation, along with fibroblast stimulation to produce collagen over the following 3-6 months and 3. An increase in angiogenesis, lymphatic flow, increased oxygen supply and greater toxin clearance.
Clinical studies show that skin surface temperatures ranging from 39°C to 42°C (subdermally temperatures from 65°C to 68°C) need to be reached for optimal contraction. However, if temperatures exceed a critical heat threshold, there is potential for collagen ablation and full-thickness injury, along with lipolysis (fat
destruction) – so it is vital to stay under 42°C. This is why it is imperative that practitioners utilise an Infrared Surface Thermometer. A common mistake made when performing RF treatments, is to use the clients pain tolerance, or visual and tactile cues (such as erythema and warmth to the touch) as a guide to reaching clinical endpoint. With such a small window of error, why wouldn’t you use such an affordable tool, to ensure you are creating skin tightening and not volume loss, or worse?
There are 2 major electrode configurations available in current RF devices: monopolar and bipolar.
Monopolar devices deliver a current using one electrode that transmits the current toward a grounding pad. Monopolar RF energy has been successfully used to accomplish non invasive skin tightening of the face, periorbital area, abdomen, and extremities. These devices typically have mild adverse effects, mainly being transient erythema and odema.
Bipolar devices differ because they pass electrical current between 2 positioned electrodes. The tissue to be heated and tightened is between these 2 electrodes, and the depth of penetration is approximately half the distance between the electrodes. Therefore, bipolar RF devices offer a shallower depth of penetration when compared with monopolar. However, this configuration does provide more controlled or localized distribution of energy and less discomfort. No grounding pad is necessary with these systems because current does not flow through the rest of the body. Non-ablative fractional RF is available, which typically uses needles to deliver thermal injury to the sub-dermis, while leaving islands of tissue intact in between treated ares. As with fractional laser resurfacing, the unaffected areas serve to expedite recovery time. The fractional energy is delivered in a bipolar fashion with the tips of the needles carrying a positive charge and the faceplate of the disposable handpeice carrying a negative charge. The mechanical puncture of the needles also has been shown to improve skin texture and fine lines. Improvements in skin laxity and elastosis have been shown clinically with different fractional RF devices.
RF energy has been shown to be a safe and effective method to obtain soft tissue tightening, in both clinical and histologic studies. We know that younger clients typically respond better to RF treatment. Contraindications are few, but may include elderly patients with thin skin, autoimmune or collagen vascular diseases, smokers, patients taking anti-inflammatory medications (which may impair collagen remodeling), and the presence of a pacemaker or other implantable devices.
This is why skin prepping is so important, to ensure efficacious/enhanced results and higher client satisfaction rates, with minimal risks and downtimes.
The Importance of Skin Preparation:
When performing any traumatic treatment, such as IPL, RF, Plasma Fibroblast, Needing, whether thermal or mechanical we always need to make sure the skin is adequately prepared.
in darker skin types where the melanocytic activity is higher than a Fitzpatrick 1-3. 2. Preparing the skin optimises cell functionality, so when we are wanting to stimulate collagen (as we are when performing RF) we need to make sure the cells are working at their optimal capacity. Whats the point in treating a skin that doesn’t have the capability of producing collagen? Ensuring the skin functions the way it is supposed to is vital. 3. Skin preparation and it’s consequent improvement of cell functionality & wound healing, significantly reduces down time and the likelihood of side effects.
We can prepare a skin in a number of ways. Firstly through homecare products. A minimum of 2-4 weeks of active ingredients is required, to ensure cells are working at their peak.
LED - LED increases ATP levels in the skin. By the age of 50, our ATP productions reduces by 50% which means the cells don’t have the ability to heal properly. Increasing ATP, ensures the skin functions the way a younger skin would. I recommend 2-3 treatments a week, for 2-4 weeks before traumatic treatments. LED can be performed directly before a treatment, but not after. We don’t want to reduce the inflammation after treatment, as the inflammatory response is going to trigger fibroblasts, help increase cytokines and growth factors and contract collagen, we don’t want to halt that process!
Perhaps as important as preparing the skin is post care - we don’t want to draw too much heat out of the skin, so stay away from soothing or calming products and cool compresses post RF, again because we want our inflammatory response to play out. We really just want to stick to a gentle moisturiser and SPF. You can lightly fan the client if they need it, however the heat from RF dissipates quickly and clients are generally quite comfortable 5-10 minutes after you reach your clinical endpoint.
Increasing efficacy + Hydration!
RF likes the path of least resistance, which means a hydrated skin will enhance depth of penetration of the current, and allow for deeper and more even volumetric heating = better results! T. The use of a hyaluronic acid, such as Skindividual’s HyaGlide (which contains both hyaluronic acid for optimal dermal hydration, as well collagen inducing peptides), as part of the clients home care routing and applied underneath your gliding medium prior to treatment, increases RF penetration and results. Clients should be drinking plenty of water leading up to any RF treatment.
When delivering RF, we do not want to ‘dump’ heat too superficially into the skin, this means we want to try to reach our target temperature slowly and evenly. We need to avoid reaching our end point so quickly, that all of the heat is in the superficial epidermal / dermal junction. Generally working for 1 -2 minutes per area, results in the heat being evenly delivered to the dermis. The gliding medium you choose will help to achieve this!
Not all gliding mediums are created equal or deliver the same results! Who would’ve thought? Conductive gel is exactly that, a conductor that conducts some of the RF energy superficially, which may result in superficial grazing and more epidermal heating.
On the other hand, glycerine based gliding mediums, such as the Skindividual’s RF Glyde, are insulators, which insulate and protect the epidermis, ensuring the RF current is delivered to the dermis, enhancing results whilst reducing the risk of grazing, especially when a transducer is accidentally lifted off the skin!
