Hot right now — literally and figuratively — is radiofrequency (RF)-based aesthetic treatments. Part of the allure? It’s host of benefits, sans surgery. “The final frontier in aesthetic medicine is the non-surgical rejuvenation and tightening of skin along with fat reduction,” says Ryan Neinstein, MD, a board certified plastic and reconstructive surgeon in New York City. What once took multiple modalities, can now be achieved in a single step.
In the past, ultrasound and lasers have been used to induce skin injury as a means to remodel the skin firmer than it was prior to treatment, while cryolipolysis, or forced cooling, of selective tissue has been a go-to for fat reduction. “These modalities, while important in the evolution of what we use today, have fallen out of favor for best-in-class, up-to-date aesthetic medicine,” Dr. Neinstein explains. Our understanding of collagen aging and stretch, he notes, has allowed for the development of new solutions. “Building on pioneering science in the field of fat metabolism, new technologies have allowed more robust non-surgical treatments without the complications of traditional modalities,” he says.
Here, we’ll cover what radiofrequency is, how it’s used in aesthetic medicine, and some popular treatments top dermatologists and plastic surgeons are offering in-office now.
What Is Radiofrequency?
Radiofrequency (RF) energy is part of the electromagnetic spectrum. In daily life, it can be found in WiFi signals, radio and TV waves, and microwave ovens. Because RF energy can be delivered through various types of tissue (i.e. skin, fat, and muscle) to generate thermal energy, it has also been used in just about every medical speciality — including aesthetics.
Despite all of the recent buzz around RF to address cosmetic concerns, it's nothing new. In 2002, the United States Food and Drug Administration (FDA) approved the ThermaCool™ (a.k.a. Thermage®), the first monopolar RF device for wrinkle reduction. Needless to say, the technology has evolved ever since. During a radiofrequency skin tightening procedure, heat is used to encourage the production of new collagen and elastin. When RF energy is directed to subdermal adipose tissue, meanwhile, it leads to fat necrosis without burning or injuring the epidermis.
Because of the lower frequency of RF, it can safely be used on a wide range of skin tones. “The RF and RF microneedling treatments are usually safe for patients of all skin types as opposed to lasers, which work best for patients with lighter skin types,” says Jennifer Levine, MD, a double board certified facial plastic and reconstructive surgeon in NYC. For all these reasons, RF devices have earned a spot in many dermatology and plastic surgery practices.
Types of Radiofrequency Treatments
As we’ve covered, radiofrequency can be used to tighten the skin, reduce fat, or a combination of the two on both the face and body. Below is a roundup of some of the most popular RF treatments on the market today:
InMode Evoke uses RF technology to stimulate collagen and lift and tighten the skin around the cheeks, jawline, and jowls. “It uses artificial intelligence to maintain a constant temperature, which promotes collagen production,” Dr. Levine says. During a session, “radiofrequency energy is delivered to the treatment area, penetrating the layers under the skin’s surface to remodel the tissue and muscle in the area, resulting in smoother skin texture, toned, tighter skin and more defined facial features,” explains Bruce Katz, MD, an NYC-based board certified dermatologist. “It’s great for someone who wants a more youthful appearance, with a quick treatment time and no downtime.”
Dr. Levine sees Evoke as a contouring treatment and says it works best for fuller faces with mild to moderate laxity, and Dr. Katz says those who are concerned about their lower face tend to see the best results. “The procedure excels at tightening and defining the jawline area,” he shares. Who isn’t a good candidate? “If a patient needs to lose a significant amount of weight to help shape the face, Evoke is not the ideal procedure for that patient,” he adds.
2. EmSculpt Neo®
The original Emsculpt® employed high-intensity focused electromagnetic (HIFEM) technology to build muscle, and the latest iteration of the device, Emsculpt Neo®, combines HIFEM with — you guessed it — RF to simultaneously tone muscles while melting away fat in a manner that board certified dermatologist Kenneth Mark, MD, calls “unparalleled.”
As you may have heard, “the HIFEM aspect of the device causes muscles to contract at an incredibly rapid speed that no one could replicate with an at-home workout for visibly toned muscles — 20,000 in 30 minutes,” says Toronto-based board certified dermatologist Geeta Yadav, MD. “The radiofrequency works in tandem to heat the overlying fat on the muscles, which causes the fat cells to die, making the patient look even more toned.” It is meant to be used on the arms, abdomen, buttocks, and calves, she adds.
An initial series of at least four treatments (though up to six may benefit some) are needed to see results. From there, one session every few months will help maintain your toned muscles, Dr. Yadav says. Speaking of results, you will notice some of the strengthening benefits within a few weeks of your final treatment, but it takes three months for the full effect of the fat reduction to present.
All of our experts agree that Emsculpt Neo® works best for patients who are already in shape and looking to target a stubborn area. For patients with more than a little pinchable fat, Dr. Neinstein suggests performing liposuction first for maximum results. “If someone is overweight or has a BMI of over 35, Emsculpt Neo® will not deliver the desired results,” Dr. Katz notes. While it’s safe for all skin tones, Dr. Levine says it can not be used on patients who have metal near the area of treatment.
3. RF Microneedling
While radiofrequency alone has skin tightening benefits, RF microneedling combines the powers of the two minimally invasive collagen-stimulating treatments. “This procedure causes controlled trauma to the skin with microneedling, which stimulates your body's healing response,” Dr. Yadav says, adding that Infini™ RF is her technology of choice.
It is ideal for treating skin texture concerns. “We have multiple radiofrequency platforms, such as Vivace® Microneedling RF, VirtueRF, and Morpheus8,” says Paul Jarrod Frank, MD, a board certified dermatologist in NYC. “We use them to treat acne scars, enlarged pores, scars, and crepey skin on the face, neck, chest, inner arms, and above the knees.”
Another benefit? “When it comes to skin tone, most radiofrequency devices are color blind and can be used on various skin tones,” Dr. Frank adds. When treating Fitzpatrick skin types III and IV (including Asian, Indian, and melasma-prone skin), he and his team adjust the heat to avoid unwanted discoloration. “It is rare for hyperpigmentation to happen and most microneedling devices now have insulated needles, which allows consistent distribution of heat and mitigates a lot of the risk,” he explains.
Dr. Mark, who offers Infini™ RF at his practice, says multiple treatments will be needed to see results. “It stimulates collagen to help tighten the skin to reduce fine lines and wrinkles,” he explains. “When done as a series of three or four sessions spaced roughly a month apart, some lifting can also be accomplished.”
At this point you’ve hopefully gleaned that not all radiofrequency treatments are the same. “For example, some go to a different depth, some are a different temperature, some devices combine microneedling or acoustic wave technologies,” Dr. Frank says. RF alone stimulates collagen and firms the skin, but, “when combined with microneedling, it will reduce pores, scars, uneven skin tone, and fine lines,” he adds.
As with any non-surgical treatment, there are limitations. “If someone is severely wrinkled, they will not get near the benefit of a fractional ablative CO2 laser, period,” Dr. Mark cautions. With that said, RF still has value. “For the patient who is not that wrinkled and/or cannot afford the downtime of that laser, the radiofrequency, when combined with microneedling, is an awesome compromise,” he says. Consulting with a board dermatologist or plastic surgeon will help determine whether you are a candidate.
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