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Catinis et al. Plast Aesthet Res 2020;7:9 I http://dx.doi.org/10.20517/2347-9264.2019.68 Page 3 of 7

Figure 2. The applicator tip must be kept perpendicular to the treatment area while performing a very slow, large sweeping motion with
some downward pressure. The soft tissue above the mandible was treated while avoiding direct treatment over the bone itself to ensure
tolerability

total of 10 min. The contralateral forehead, temple, medial and lateral cheek, and jawline were then treated
with the same protocol. The initial area was again heated to 41-43 °C and re-treated for 6 min at therapeutic
temperature. The ultrasound gel was removed, and the patients were allowed to resume their routine
skincare after 4 h. Included patients had no skin care regimen changes for a minimum of three months and
were asked to refrain from altering their regimen until completion of the 12-month study. This protocol
was repeated after two weeks. The results were examined at 3, 6, and 12 months post second treatment.

RESULTS
In total, 30 patients (all women, age range of 40-55, mean age of 49) were treated over a 1-year period.
Patient surveys showed 100% satisfaction at three months after the initial two treatments and 93%
satisfaction at 6 months. Patients felt that their skin was “brighter” and “less saggy”. No complications were
seen. In addition, all patients found the procedure tolerable. A pain scale of 0 (no discomfort) to 5 (worst
pain imaginable) was utilized. The average rating was 1.8.

Figure 3 is an example of a patient three months after undergoing two treatments spaced two weeks apart.

DISCUSSION
The best aesthetic outcomes in the treatment of age-related skin laxity of the face and neck often arise from
a combination of modalities over time. These modalities include invasive approaches such as surgery and
noninvasive methods including RF, US, and injectable neuromodulators and fillers. The surgical facelift is
considered the gold standard in the treatment of age-related skin laxity due to its long-lasting results [9,10] .
However, technological innovation is providing physicians and patients with novel noninvasive approaches.
These new approaches have similar efficacy in combating skin laxity and have more favorable safety
profiles. Regardless of which modality is chosen, the results of both invasive and noninvasive techniques
can be enhanced and maintained by a combination of RF and US.

Radiofrequency exerts its effects by generating an oscillating electrical current within the target tissue.
The current promotes collisions between ions and molecules in the dermal layer of the skin, leading to the