Weiss Robert A, Weiss Margaret A, Munavalli Girish, Beasley Karen L
Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21030, USA.
J Drugs Dermatol. 2006 Sep;5(8):707-12.
Monopolar radiofrequency skin heating coupled with cryogen cooling of facial skin for skin tightening has been utilized on over 10,000 patients since 2002. In order to establish the actual rate and degree of side effects in our clinical experience, a retrospective chart review was performed.
Charts and clinical images of over 600 consecutive patient treatments between May 2002 and June 2006 using a monopolar radiofrequency device (Thermacool, Thermage, Haywood, CA) for skin tightening at the Maryland Laser, Skin and Vein Institute were retrospectively reviewed. The primary presentation for treatment was skin laxity of the lower face. Treatment was delivered with a 1-cm2 standard tip at fluences of 81 to 124 J/cm2 (level of 12.5 to 15), a 1-cm2 "fast" tip at fluences of 62 to 109 J/cm2 (level of 72.0 to 76.0), a 1.5-cm2 "big fast" tip at fluences of 75 to 130 J/cm2 (level of 61.5 to 65), and a 3-cm2 "bigger" tip at equivalent fluences as each became available. As treatment algorithms evolved over 4 years, the algorithm of multiple passes at lower fluence associated with better clinical outcomes and greater patient acceptance has been adopted.
The most common immediate and expected clinical effects were erythema and edema lasting less than 24 hours, although 6 patients reported edema lasting for up to 1 week. There were no permanent side effects. In total, 2.7% of treatments resulted in temporary side effects, the most significant of which was a slight depression on the cheek (n = 1), which completely resolved within 3.5 months. Other side effects included localized areas of acneiform subcutaneous erythematous papules (n = 4) and a linear superficial crust (n = 1) with the original tip, all of which resolved within 1 week. One patient reported small erythematous subcutaneous nodules resolving in 17 days. Tenderness of the neck lasting from 2 weeks (n = 2) to 3 weeks (n = 1) was also reported.
Our data, obtained in an office setting without injectable anesthetic or i.v. sedation, indicate that monopolar RF for skin tightening is a very safe procedure. The treatment algorithm and tips have evolved over several years leading to increased safety and efficacy. Side effects are infrequent, self-limited, and minor, comparing favorably to other nonablative devices utilized for facial rejuvenation.
自2002年以来，单极射频皮肤加热联合面部皮肤冷冻剂冷却用于皮肤紧致，已应用于10000多名患者。为了根据我们的临床经验确定实际的副作用发生率和程度，我们进行了一项回顾性图表审查。
回顾性审查了2002年5月至2006年6月期间在马里兰激光、皮肤和静脉研究所使用单极射频设备（Thermacool，Thermage，Haywood，加利福尼亚州）进行皮肤紧致治疗的600多名连续患者的图表和临床图像。治疗的主要表现为下面部皮肤松弛。使用1平方厘米标准尖端，能量密度为81至124焦耳/平方厘米（12.5至15级）；1平方厘米“快速”尖端，能量密度为62至109焦耳/平方厘米（72.0至76.0级）；1.5平方厘米“大快速”尖端，能量密度为75至130焦耳/平方厘米（61.5至65级）；以及3平方厘米“更大”尖端（每种尖端可用时能量密度相同）进行治疗。随着4年多来治疗算法的演变，采用了低能量密度多次治疗的算法，该算法具有更好的临床效果和更高的患者接受度。
最常见的即时和预期临床效果是红斑和水肿，持续时间少于24小时，尽管有6名患者报告水肿持续长达1周。没有永久性副作用。总的来说，2.7%的治疗导致了暂时性副作用，其中最明显的是脸颊上有轻微凹陷（n = 1），在3.5个月内完全消退。其他副作用包括痤疮样皮下红斑丘疹局部区域（n = 4）和使用原始尖端出现的线性浅表结痂（n = 1），所有这些都在1周内消退。一名患者报告小的皮下红斑结节在17天内消退。还报告了2名患者颈部压痛持续2周，1名患者颈部压痛持续3周。
我们在没有注射麻醉或静脉镇静的门诊环境中获得的数据表明，单极射频皮肤紧致术是一种非常安全的手术。治疗算法和尖端在几年中不断演变，提高了安全性和有效性。与用于面部年轻化的其他非剥脱性设备相比，副作用很少，具有自限性且轻微。
