Radiofrequency in Cosmetic Dermatology
Aesthetic Dermatology Vol. 2 Series Editor David J. Goldberg New York, N.Y.
Radiofrequency in Cosmetic Dermatology Volume Editors Moshe Lapidoth Petach Tikva Shlomit Halachmi Herzelia Pituach 46 figures, 36 in color, and 2 tables, 2015 Basel Freiburg Paris London New York Chennai New Delhi Bangkok Beijing Shanghai Tokyo Kuala Lumpur Singapore Sydney
Dr. Moshe Lapidoth Dermatologist, Head of Laser Unit Dermatology Department Rabin Medical Center 7 Keren Kayemet St. Petach Tikva Israel Dr. Shlomit Halachmi Herzelia Dermatology and Laser Center 9 Hamenofim St. Herzelia Pituach Israel Library of Congress Cataloging-in-Publication Data Radiofrequency in cosmetic dermatology / volume editors, Moshe Lapidoth, Shlomit Halachmi. p. ; cm. -- (Aesthetic dermatology, ISSN 2235-8609 ; vol. 2) Includes bibliographical references and indexes. ISBN 978-3-318-02316-9 (hard cover : alk. paper) -- ISBN 978-3-318-02317-6 (electronic version) I. Lapidoth, Moshe, editor. II. Halachmi, Shlomit, editor. III. Series: Aesthetic dermatology (Series) ; v. 2. 2235-8609 [DNLM: 1. Cosmetic Techniques. 2. Radio Waves--therapeutic use. 3. Skin Diseases--therapy. 4. Skin--pathology. WR 650] RL113 616.5 0642--dc23 2014042585 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2015 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) www.karger.com Printed in Germany on acid-free and non-aging paper (ISO 9706) by Kraft Druck, Ettlingen ISSN 2235 8609 e-issn 2235 8595 ISBN 978 3 318 02316 9 e-isbn 978 3 318 02317 6
Contents VI Preface Lapidoth, M. (Petach Tikva) 1 Basic Radiofrequency: Physics and Safety and Application to Aesthetic Medicine Duncan, D.I. (Fort Collins, Colo.); Kreindel, M. (Richmond Hill, Ont.) 23 Monopolar Radiofrequency Osley, K.; Ross, N.; Saedi, N. (Philadelphia, Pa.) 33 Unipolar Radiofrequency Halachmi, S. (Herzelia Pituach); Britva, A. (Caesarea); Lapidoth, M. (Petach Tikva) 43 Bipolar Radiofrequency Eckhouse, S. (Yokneam); Onder, M. (Landau/Ankara); Fritz, K. (Landau/Bucharest) 50 Fractional Radiofrequency Halachmi, S. (Herzelia Pituach); Onder, M. (Landau/Ankara); Fritz, K. (Landau/Bucharest) 62 Minimally Invasive Radiofrequency Mulholland, R.S. (Toronto, Ont.); Halachmi, S. (Herzelia Pituach) 70 Radiofrequency Combinations Eckhouse, S. (Yokneam); Fritz, K. (Landau/Bucharest); Adatto, M.A. (Geneva) 81 Complications of Treatment with Radiofrequency in Aesthetic Medicine Duncan, D.I. (Fort Collins, Colo.) 97 Author Index 98 Subject Index V
Preface Radiofrequency (RF) current is an electrical current, typically with a frequency in the megahertz range. RF has been known to medicine since the late 19th century; however, the usage of RF in cosmetic and aesthetic medicine started only less than two decades ago. The basic idea behind using RF on the skin is its ability to deliver heat to depth. Lasers and light sources are also able to generate heat, but their energy is absorbed in a chromophore-specific manner (the theory of selective photothermolysis ). RF electrical conductivity creates heat in the tissue based on the properties of the tissue itself (like the skin temperature and water content) and is not dependent on specific chromophores. Today, RF current can be applied to the skin in various ways: unipolar or monopolar, bipolar, multipolar (multiplication of bipolar) and combinations of RF and light, ultrasound, magnetic field, vacuum, etc., all of them commonly used for tissue heating and tightening. Recently, after the introduction of fractional photothermolysis, which applies light-based techniques that enable the formation of an array of microscopic thermal ablated or coagulated wounds in the skin to induce a therapeutic healing response throughout the skin layers, several fractional RF devices have joined this armamentarium. These devices can be divided into superficial ablation systems and minimally invasive (microneedling RF) systems. The aim of this book is to introduce to the reader the variety of RF techniques currently available on the market and to evaluate the efficacy and safety of typical RF devices in rejuvenating the skin, in improving the signs of facial aging, and providing skin tightening, to better understand and to support informed decisions in choosing the right treatment options for us and for our patients. Moshe Lapidoth, Petach Tikva VI