The Use of Radiofrequency in Aesthetic Surgery

Erez Dayan, MD; A. Jay Burns, MD; Rod J. Rohrich MD; Spero Theodorou, MD


Plast Reconstr Surg Glob Open. 2020;8(8):e2861 

In This Article

Noninvasive and Minimally Invasive Skin Tightening

Minimally invasive and noninvasive correction of skin laxity have long been elusive goals of aesthetic surgery. Patient demand for nonsurgical skin tightening with little downtime and preservation of the epidermis has increased 600% in the past 15 years.[1] Numerous nonsurgical technologies have emerged, which function to reduce fat (ie, cryolipolysis, deoxycholic acid) and resurface skin (lasers, chemical peels, dermabrasion).[2,3] However, the need for safe and efficacious skin tightening has not been met by these devices.

Traditionally, ablative and nonablative lasers were the primary mechanisms to improve skin laxity nonsurgically, by injuring the epidermis and dermis with resulting dermal collagen remodeling and secondary skin tightening. In properly selected patients, lasers can provide excellent skin resurfacing and dermal remodeling.[2,3] However, the energy and subsequent heat required to generate significant skin tightening at the dermal level cannot be accomplished without injury to the epidermis—leading to complications, such as burns and irreversible pigmentation changes.[4] For this reason, lasers are limited to lighter Fitzpatrick skin types, excluding darker-skinned patients.

Newer technologies such as high-frequency ultrasound have come to market to tighten skin noninvasively using thermal energy. The best-known example is Ultherapy, which was cleared in 2009 by the Food and Drug Administration (FDA) for noninvasive eyebrow lift, noninvasive neck and submental lift, and to improve lines and wrinkles of the décolletage. However, results have been mild and patients often complain of pain associated with treatment.[5–7]