Aesthetic nurse practitioner Telisha Jenkinson provides a fundamental introduction to RF treatments for those newer to aesthetics
Ageing impacts both the face and body, highlighting the importance of self-care, healthier lifestyle choices and embracing the natural process of ageing. The ageing process affects the face and body in various ways, reflecting the passage of time and natural physiological changes.
Facial skin loses elasticity and firmness due to a decrease in the production of collagen and elastin, resulting in lines, wrinkles and sagging skin.1,2 The existing collagen fibres become fragmented and disorganised, exacerbating the signs of ageing.1,2 Age spots and uneven pigmentation can also develop due to sun exposure.1,2 The body experiences a loss of muscle mass and strength, leading to decreased mobility and increased vulnerability to injury.1,2 Bone density decreases, making bones more fragile.1,2 Additionally, the metabolism slows down, resulting in weight gain and redistribution of fat.1,2
For those new to aesthetics, it’s worth noting that radiofrequency (RF) treatments can be very effective when treating signs of ageing for a number of reasons. RF technology works by delivering thermal energy into the dermis, which houses fibroblasts.1,2 The heat causes contraction and tightening of existing collagen fibres for an immediate skin tightening effect.1,2 The heat also stimulates the fibroblasts to produce new collagen and elastin.1,2
Various factors, including intrinsic ageing, UV exposure and lifestyle choices, can accelerate the degradation of collagen and elastin. Protecting the skin from sun damage, adopting a healthy lifestyle, using skincare products and having in-clinic treatments that promote collagen synthesis can help mitigate the effects of collagen and elastin decline in skin ageing.3
Radiofrequency (RF) treatments have gained popularity in aesthetics for their effectiveness in addressing various signs of skin ageing.4 These non-invasive or minimally-invasive procedures utilise controlled RF energy to target specific layers of the skin, stimulating collagen production, tightening the skin and improving overall skin tone and texture. Depending on what type of RF is being used and what area or concern is being targeted, anything from two to six treatments is usually required, performed between one and six weeks apart.5
These non-invasive procedures target the deeper layers of the skin without damaging the outer surface. This form of RF treatment heats the skin’s layers, stimulating collagen production and skin tightening. Non-ablative RF is suitable for individuals seeking minimal downtime and can be performed on the face, neck and body. It is a desirable option for those seeking aesthetic improvements without the recovery time associated with more invasive procedures.1,6
There are multiple different forms of non-ablative RF treatments. These are explored below to provide a simple introduction for practitioners who have limited knowledge or understanding of RF.
Monopolar RF involves the use of a single electrode that delivers RF energy deep into the skin. This energy generates heat, which stimulates collagen remodelling and contraction, resulting in skin tightening. Monopolar RF treatments can be used on various areas of the body, including the face, neck and abdomen. However, it may not be the most suitable option for treating large areas because of the small applicators which could make body treatments impractical from a time standpoint.1,6
This treatment utilises two electrodes that deliver RF energy between them. The technique targets the superficial layers of the skin, making it particularly effective for improving fine lines, wrinkles and skin texture. Bipolar RF is often used for facial rejuvenation and can help tighten the skin, reduce pore size and enhance overall skin texture and tone. The treatment can also prove efficacious for treatments on the body, including on areas such as the buttocks and abdomen.1,6
Multipolar RF is used to tighten skin and stimulate collagen to reduce the effects of fine lines and wrinkles, acne scarring, stretch marks and cellulite. Multipolar RF energy heats the deeper tissues with three or more electrodes to a relatively low temperature, resulting in the dermal layer thickening without the need for excessive heating. This dermal thickening creates the effect of firmer, lifted skin. This RF treatment can be used to treat the abdomen, knees, arms and buttocks.7
This combines RF energy with ablative fractional laser technology. This procedure removes the outermost layers of the skin while delivering RF energy to the deeper layers, targeting the epidermis and sometimes the superficial dermis. Ablative RF can treat moderate to severe skin ageing concerns, such as deep wrinkles, acne scars and sun damage. It promotes collagen remodelling, skin tightening and overall skin rejuvenation.1,6
Fractional treatments combine RF energy with microneedling technology, and can be ablative dependent on the nature of the needling. Tiny needles create microscopic channels in the skin through controlled micro-injuries, allowing the RF energy to penetrate deeper layers while minimising damage to the surface. This two-pronged approach simultaneously stimulates collagen synthesis and remodelling. Such a combination allows the practitioner to address concerns such as wrinkles, acne scars, skin laxity and uneven skin texture on the face and neck, as well as certain areas of the body like the abdomen.1,6
It is important to note that the effectiveness of any RF treatment may vary depending on individual factors, including skin type, age and the specific concerns being addressed.5 Multiple treatment sessions are often recommended to achieve optimal results, and maintenance treatments may be necessary to prolong the benefits.5 This process takes time, and the final skin tightening and rejuvenation effects can take several weeks to months to appear as new collagen is formed.5
RF treatments are generally safe, with side effects typically limited to temporary redness, swelling or a warm sensation in the treated area.10 However, there are some other potential complications to be aware of.
These can include:1,6,8,9
Temporary side effects: mild redness, swelling, bruising and slight discomfort are common and usually resolve quickly.
Pigmentary changes: in rare cases, RF treatments may cause hyperpigmentation or hypopigmentation of the treated area. This risk is higher for darker skin tones.
Burns/blisters: improper use of RF devices or inadequate cooling measures can lead to burns or blisters. It is essential to ensure patient comfort throughout and select appropriate techniques and settings.
Infection: although rare, there is a small risk of infection associated with the heat generated during RF treatments. It is crucial patients follow aftercare instructions and maintain good skin hygiene to minimise this risk.
Scarring: while uncommon, scarring can occur as a result of RF treatments. This risk is typically minimal, especially with non-ablative RF procedures. However, patients with a history of abnormal scarring should be advised of this risk at their consultation.
It’s important to note that while RF treatments can improve the appearance of ageing skin, they cannot stop the ageing process. In my experience, I have found that regular treatments and good skincare habits are needed to maintain the effects.
The aforementioned range of RF treatments can be used on almost all skin types and tones, making them a versatile treatment option for most patients who will come into your clinic. However, different RF treatments may be more suitable for specific skin types. For instance, non-ablative RF treatments are generally safe for all skin types, including darker skin tones, as they do not target the epidermis on the skin’s surface.1
However, ablative and fractional RF treatments may carry a higher risk of complications and pigmentary changes for individuals with darker skin because dark skin contains more melanin in the epidermis, making it more prone to hyperpigmentation.1 To minimise the risk, it is advisable to use lower energy levels to protect the epidermis.1
An in-depth patient history is required, and any existing medical conditions, previous skin treatments, allergies and medication use needs to be ascertained. The presence of metal implants may be a contraindication for RF treatments, due to the risk of heating and conduction through the metal, causing patient discomfort and possible burns.11 Implants like pacemakers or cochlear implants also need to be taken into consideration as radiofrequency may interfere with the function of such devices.12
Patients who have undergone recent aesthetic procedures, such as chemical peels, laser treatments or injectables, may need to wait before undergoing RF treatments to mitigate the risk of negative impact on the results of recent cosmetic treatments. Undergoing multiple treatments at once may also mean it’s not possible to ascertain the true results and outcome of either treatment. Consideration regarding the timing and compatibility of previous procedures is essential to determine the appropriate interval between treatments.
Patient expectations and goals play a significant role in determining the most suitable RF treatment. Some individuals may desire minimal downtime and prefer non-invasive treatments, while others may be willing to undergo a more aggressive approach for more dramatic results. Open communication with patients regarding expectations and goals will help guide the treatment selection process.
RF treatments can vary in cost and the number of sessions required. Practitioners should consider their patients’ budgets and availability for multiple treatment sessions when determining the most suitable RF treatment to include in their treatment plans. Provide guidance on the treatment plan, including the estimated number of sessions and associated costs.
By ensuring patients understand the individual factors that can influence treatment outcomes, individuals can make informed decisions to achieve the desired results while minimising risks and ensuring their safety and wellbeing.
RF treatments can provide noticeable improvement in skin texture, firmness and overall appearance in patients with ageing skin. However, it is important to understand that individual responses may vary. The longevity of results can depend on factors such as the individual’s age, skin condition, lifestyle and ongoing maintenance. Making sure patients are aware of these factors can ensure they leave the clinic feeling happy and confident that they can expect a great end result from RF treatment.
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