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


Aesthetic indications of RF continue to expand from facial rejuvenation to body contouring. More recently, RF has been used to target cellulite, acne vulgaris, and excess adiposity.[50] In our experience, RF bridges an important treatment gap for 3 group of patients: (1) those who are candidates for an excisional procedure but do not desire it; (2) patients who are not candidates for excisional procedures but cannot obtain sufficient skin tightening with other noninvasive techniques (ie, cryolipolysis, high-intensity focused ultrasound); or (3) patients who had a previous excisional procedure and present with recurrent laxity.

Radiofrequency energy has been shown to be a safe and effective method to obtain soft tissue tightening in both clinical and histologic studies. Few contraindications exist but may include elderly patients with thin skin, autoimmune or collagen vascular diseases, smoker, patients taking anti-inflammatory medications (which may impair collagen remodeling), and the presence of a pacemaker or other implantable device.[50]

RF does not replace or compare with ablative procedures.[4] An important role of the clinician is to identify limitation of the technology and have a keen eye for patient selection and management of expectations.[4] We know that younger patients typically respond more favorably to RF treatment. This may be possibly explained by covalent bonding of collagen that occurs as we age. Despite high patient satisfaction,[25,28] the results of nonablative RF technology are typically not always predictable and usually modest.[9,14,22,28,42] Although RF does not improve laxity to the degree of surgery, it does have the advantage of avoiding surgery-associated cost, downtime, and potential complications. We believe that RF is one option in the array of aesthetic treatments. It may in fact be the best option for the appropriately selected patient who is not a candidate and does not desire excisional procedures. Further work is needed to elucidate a number of core questions related to RF, including optimal energy levels and time of treatment as well as improved methods to measure clinical outcomes.