By Robert Kotler MD, FACS
When I was writing the early drafts for my book, Secrets of a Beverly Hills Cosmetic Surgeon, we had just been made aware of radio frequency (RF) skin treatments. The first such “machine” for these treatments was called Thermage. I wanted to have some information to present to my readers, but frankly, I was not impressed with the company’s response to my request for more information, including before and after photographs.
Now, nine years later, we know more about RF skin treatments, which have been touted as non-invasive techniques to treat skin laxity, particularly on the face, neck, and upper arms. Recently, there has been some research on this technology and whether it could help reverse the signs of aging on the upper chest.
Originally, Thermage had FDA clearance for treatment of wrinkles around the mouth. Surgeons then adapted it to the full face treatments. I witnessed some of the treatment sessions and found some immediate contraction of the skin, but I questioned whether there would be meaningful changes in the long run. I doubted that such skin contraction could possibly take the place of a well-performed surgical procedure if the main issue was sagging skin. Furthermore, the technology had no effect on wrinkles, which, of course, is a major point of dissatisfaction among patients. The patients were also in pain during the procedure, despite the claims that it could be done without general anesthesia.
As time passed, technological changes were made to the delivery of RF. In addition, other devices were brought to market using variations on the physics of the technology. One of the more recent advances was adding temperature sensors, which could control the amount of heat delivered to the tissues, thus lessening patient pain. But, of course, if less energy is delivered to the tissues, there is less effect and, perhaps, a compromised result.
I think it is difficult for prospective patients to make a reasonable evaluation about what technology would be helpful with so much marketing going on. My advice, if you’re considering this treatment, is to very carefully study the before and after photos of patients who have had RF skin treatments. When considering the procedures, be sure to ask for patient references. Ask to see patients who have had RF procedures and compare the result you see with their before photos. That’s the best single bit of information you can receive when considering such procedures, which, generally are not as impressive as either the full face CO2 laser or the phenol deep chemical peel. You need to also understand costs, recovery time, risks, and complications.