Speaking today at the American Academy of Dermatology’s Summer Academy Meeting 2007, dermatologist David J. Goldberg, MD, JD, FAAD, clinical professor of dermatology and director of laser research at the Mount Sinai School of Medicine in New York, N.Y., discussed the rapidly expanding area of skin-tightening techniques and how they can safely and effectively treat sagging skin on the jowls, neck, arms, and stomach, as well as cellulite.
“The monopolar radiofrequency (RF) technology, which was introduced five years ago and which is credited as the first non-surgical skin-tightening device, has been the catalyst for what is now an explosion in non-invasive skin tightening with different technologies and areas of the body that we can treat,” said Dr. Goldberg. “Originally used to lift the eyebrows, monopolar RF was found to be effective in tightening the jowls and neck area with its unique approach of cooling the outer layer of skin while heating the deeper layers to cause tightening. This basic principle is what shaped many of the latest skin-tightening technologies.”
Broad-Spectrum Light Sources
Dermatologists now have their pick of several broad-spectrum light sources to treat loose skin on areas of the face and body. Using a broad band of infrared light ranging in wavelength from 850 to 1800 nanometers (nm), the new devices produce deep heating in the middle layer of skin which spurs new collagen formation over time. As with monopolar RF, the outer layer of skin is kept intact with a continuous cooling device.
“The delivery systems that these devices employ and the varying depths to which the heat is delivered are what set them apart from each other, which is what dermatologists evaluate when selecting a technology for the area of skin they’re treating,” said Dr. Goldberg. “For example, the broad-spectrum light sources and monopolar RF use different size treatment tips to deliver energy to the skin. Larger tips are better for bigger surfaces of skin, whereas the smaller tips are used for more confined areas of loose skin that require a concentrated delivery of energy.”
In some patients, skin tightening is visible following the initial treatment, while others will notice the improvement gradually over time. Dr. Goldberg added that while results vary, studies show that skin tightening with the broad-spectrum light sources typically last at least 12 months.
“These new technologies allow us to treat younger and older patients with equal degrees of success,” said Dr. Goldberg. “As long as the area being treated involves only superficial loose skin – not loose fat or muscle – no area of the body should be off limits for a skin-tightening procedure.”
Unipolar Radiofrequency for Cellulite
Dr. Goldberg spearheaded a recent study that is pending publication and was designed to determine the results of a new unipolar, volumetric radiofrequency (RF) device to treat cellulite. With its characteristic “orange peel” skin irregularity and dimpling of the buttocks and thighs, cellulite affects more than 85 percent of post-pubescent women.
Unipolar RF is different from other previously described RF devices in that this device does not produce electrical currents within skin tissue. Instead, high-frequency electromagnetic radiation is produced by this non-laser technology.
“The best way to describe how this treatment works is to think of it as a blender-like effect on the skin, involving the ultra-rapid rotation of molecules through the skin that generates heat,” said Dr. Goldberg. “The heat is dispersed to the surrounding tissue, allowing the deeper skin structures – where cellulite forms – to be effectively heated.”
In the study, Dr. Goldberg evaluated whether deep unipolar RF-induced heating could tighten the skin irregularities of cellulite when administered in six treatment sessions every two weeks. Of the 30 patients treated, 27 showed evidence of clinical improvement in their cellulite as measured by an independent evaluator. The mean decrease in leg circumference was 2.45 cm (1.2 inches), and the graded improvement on a 1 to 4 scale (4 is the highest) was noted to be 2.9. Biopsies taken of skin samples showed tightening of the dermis, and blood tests as well as magnetic resonance imaging of the areas treated showed no abnormalities.
“The improvement we saw with the unipolar radiofrequency device in tightening cellulite was greater than the results previously reported with bipolar and low-energy laser systems,” explained Dr. Goldberg. “In fact, fewer treatments were needed and better results were noted with this new approach. What remains to be seen is how long treatment results last and whether combined approaches with other modalities will lead to even better results.”
Although the latest skin-tightening technologies offer patients a range of treatment options, Dr. Goldberg stressed that it is vital for patients to seek a consultation with a physician experienced in the latest procedures.
“When deciding on what technology to use for each individual patient, I make the decision based on the findings of clinical studies using the various technologies, which of the devices’ delivery systems will work best for the treatment area, and my own personal experience with the technology,” said Dr. Goldberg. “In the right hands, these new skin tightening techniques can produce noticeable improvements.”