Page 859 - Read Online

Farber et al. Plast Aesthet Res 2020;7:72 I http://dx.doi.org/10.20517/2347-9264.2020.152 Page 9 of 28

Dermabrasion
Dermabrasion uses an abrasive motorized wheel to create a mid-dermal wound. It is less frequently used
since the advent of laser resurfacing given its increased risk of aerosolized viral particles, dyspigmentation
and scarring. It is still an effective option in the treatment of deeper acne scars, but its indications in facial
[21]
rejuvenation are limited .

SOFT TISSUE TIGHTENING
Radiofrequency
Mechanism
Radiofrequency skin tightening works by transmission of thermal energy to the reticular dermis, triggering
a remodeling cascade with subsequent collagen, elastin, and vascular formation. It is a non-ablative
technology that specifically treats the dermis and spares the epidermis, thereby reducing scarring or
[28]
pigmentary complications and speeding recovery .

Indications and contraindications
Radiofrequency treatments been shown to be beneficial for the treatment of facial wrinkles, brow lifting,
[28]
periorbital wrinkles, nasolabial folds, jowls, marionette lines, jawline contouring, and neck laxity .
Radiofrequency skin tightening is contraindicated in patients with implantable medical devices and those
with underlying healing disorders. Multiple studies have shown it to be less effective in older patients,
either due to decreased capacity for dermal healing, decreased tissue hydration, or increased severity of
[29]
preoperative deformity .
Procedure
The administering practitioner must determine whether to treat in one session with higher energy or in
multiple sessions with lower energy. One study showed that using lower energy over more sessions was
[30]
more effective for remodeling of collagen and improvement in skin elasticity .

These modalities can be administered through monopolar devices (one electrode with body grounded
for unidirectional current flow through the skin such as Thermage ), bipolar devices (two electrodes
Ò
- one subcutaneous and one percutaneous -with current flowing between such as Body-TiteÔ), and
unipolar devices (one electrode without a grounding pad for omnidirectional field of effect administered
Ò [31]
subcutaneously such as Exilis ) . While monopolar radiofrequency penetrates through all tissue layers
and creates deeper tissue injury, bipolar radiofrequency is more localized and offers more superficial
[28]
treatment, while also being less painful . Furthermore, monopolar radiofrequency can be administered
under topical anesthetic, while unipolar and bipolar usually require tumescent or general anesthesia .
[31]
Fractional radiofrequency treatment or radiofrequency microneedling (such as Profound RF and
Ò
Ò
Morpheus ) uses microneedle electrodes to deliver fractional radiofrequency energy directly to the
[28]
reticular dermis, while protecting adnexal structures . The ablative effect of the microneedling allows
for both a resurfacing and tightening effect and can be beneficial in patients who require treatment
of both these signs of aging and are willing to accept a longer recovery than traditional, non-ablative
radiofrequency treatments.

Outcomes and complications
Patients should be instructed that full results of treatment can be expected within six months to one year.
The most common adverse events are swelling, numbness, and bruising which generally resolve within
1-2 months and can be treated expectantly .
[32]