Radiofrequency therapy (RF) has been in use in medicine for nearly a century. This technology uses radio waves to selectively warm tissue. Radio waves have an affinity for intracellular water molecules, causing them to vibrate, which produces heat within the cell itself.5
One key consideration is that the tip of the RF probe never gets hot. It is simply a transmitter that emits radio waves into tissue, causing cells to heat from the inside out.
At high frequencies, RF can be used to vaporize the water molecules, causing the cell to lyse and allowing tissue to be incised with a simultaneous hemostatic effect (e.g., essentially bloodless lid lesion removal with an Ellman unit or similar RF device).
In recent years, it was discovered that at lower frequencies RF selectively delivered to the epidermis and dermis to achieve temperatures of approximately 42°C can:5
• Induce collagen denaturation (i.e., contraction)
• Stimulate new collagen synthesis (neocollagenesis)
• Significantly increase the uniformity of elastin
This elective procedure consists of applying an ultrasound gel to the area receiving treatment, activating the RF probe, gently applying the probe to the skin, activating the RF generator, and moving the probe in a corkscrew pattern over the skin while subjectively and objectively monitoring tissue temperature until it reaches ~42°C (Fig. 3).
Over the course of the next four weeks post-treatment, rearrangement and reformation of collagen and elastin occurs, resulting in tightening of the skin, reduction of rhytids and malar edema, and even mild-to-moderate elevation (2 to 3 mm) of the upper lids in dermatochalasis.
Usually three to four treatments in total are necessary over a four-to six month period for maximum therapeutic effect, followed by an annual maintenance session. Note that RF is not a replacement for blepharoplasty in moderate-to-severe cases.
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