Range of nonsurgical procedures target sagging skin

"Patients need to understand that, when undergoing any of these procedures, they are unlikely to achieve a home run. These modalities are for patients who are not candidates for a facelift based on a variety of reasons and who will be satisfied with the modest improvement these nonsurgical techniques provide," says Dr. Alam, chief, section of cutaneous and aesthetic surgery, departments of dermatology and otolaryngology, Northwestern University, Chicago.

The nonsurgical techniques for lifting and tightening are not for persons with a complete loss of facial substructure and severely sagging skin or for those whose primary concerns are more related to surface problems such as crepe-like skin or pigmentary abnormalities. Patients also need to realize that the nonsurgical tightening and lifting procedures are not an adjuvant to a facelift.

Progress of radiofrequency technology

The innovator in the field of radiofrequency technology was the monopolar device (ThermaCool™, Thermage, Inc.), launched in 2002. Used initially for brow elevation and lateral face tightening, it has recently been applied for jowl and neck tightening. Efficacy achieved is variable, and an appreciable proportion of patients are likely to respond poorly.

"Various estimates suggest that between 10 and 25 percent of patients have little to no improvement," Dr. Alam tells Dermatology Times. "Candidates need to be made aware of that risk, and this technique is probably best avoided in any individuals who are likely to be very upset if they fail to get a marked change in appearance."

During the relatively short time the monopolar radiofrequency device has been available, a number of changes in the treatment parameters have been introduced to maximize efficacy and minimize adverse events. Currently, the treatment is performed without anesthesia using low energy levels and multiple passes. This approach has been successful in reducing treatment-associated pain and the risks of burns, depressions and tissue atrophy that sometimes occurred with earlier methodology.

New radiofrequency options

Newer entrants into the radiofrequency field include two devices from Syneron (Polaris, VelaSmooth) that use technology combining bipolar radiofrequency energy with light to target the dermis and epidermis. These instruments can be used to treat both deep facial and fine facial wrinkles. When combined with vacuum as a third component, cellulite can also be treated.

Outcomes data with these devices are limited so far, although a number of studies are in progress. According to available reports, this technology has resulted in clinical improvement in 90 percent of patients who underwent a series of eight biweekly treatments for buttock/thigh cellulite. It is also associated with modest improvement in persons treated for mild-to-moderate rhytids and facial laxity. Adverse events in both studies included erythema, as well as edema in patients who received facial treatment and rare bruising in patients treated for cellulite.

"FACES" (functional aspiration controlled electrothermal stimulation) is another recently introduced technology from Lumenis (Aluma) that combines vacuum with bipolar radiofrequency. It is designed to bypass the epidermis and deliver heat into the dermis to produce facial skin tightening and improvement in lines and wrinkles.

Results from one two-center study found the procedure was well-tolerated. However, there was a 10 percent incidence of adverse events that included burns and blisters as well as erythema.

Light technology

In the category of light technology, there is now an infrared light-emitting device (1100 to 1800 nm; Titan, Cutera) that is intended for tightening laxity in the submental region, jowls, abdomen and arms. So far, there is only anecdotal information available regarding its efficacy and safety.

Barbed sutures