Skin Tightening
The Pelleve Procedure: an Effective Method for Facial Wrinkle Reduction and Skin Tightening

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Mechanism of controlled thermal injury

The Pelleve procedure, performed using the 4.0 S5 Surgitron (Ellman International, Oceanside, NY, USA), differs from other methods of delivering RF energy because it delivers a progressive but controlled thermal injury to the dermis and subdermis and overcomes many of the shortcomings associated with pulsed and fixed dosed methods.

A 4.0-MHz high-frequency energy is used, so the difference in resistance between the dermal skin and underlying fat is maximal and results in heat generation and

Cooling controversy

After several months’ experience, using multiple passes from 40°C to 45°C, going on to an adjacent area to allow spontaneous cooling of the treated area, and then returning to the treatment area, the possibility that the progressive swelling occurring with each pass might overcome the ability for acute tissue contraction became apparent. At that time, I began cooling the treated area directly with frozen reusable cold packs to force contraction of the solid proteins that were being heated and,

Indications

The ideal candidates for the Pelleve procedure are from their late 30s to mid-40s showing some visible lines at rest, some midface laxity and upper face volume loss, and early neck softening. At this stage, with firm dermal support, all these signs of aging can be significantly reduced or erased with a single treatment or with a second treatment if complete improvement is not seen 4 to 6 months later. The typical Pelleve patients in Southwest Florida are in their early 50s to mid-60s and have

Wrinkle reduction with or without filler or neurotoxin

Surgeons encounter the dense adhesion of the base of wrinkles every time they undermine a neck and struggle with elevating the adherent base from the underlying soft tissue. The “valley” of any wrinkle is made of dense collagen, and the “shoulders” are made of less-dense collagen, creating the depth discrepancy to be lessened with neurotoxin or effaced with dermal fillers. Most experienced injectors know that some degree of subcision improves filler results by facilitating the migration of the

Skin tightening and volume contraction with or without volume replacement

The Pelleve procedure is also a valuable adjunct therapy to facial volume restoration. The midfacial skin envelope becomes lax as panfacial volume loss occurs. Contraction of the connective tissue bands that tether the skin to the deep fascia contracts and firms the soft tissue compartment. With decreased compliance, the volume delivered has a greater volumizing effect. I have used the Pelleve procedure as an adjunct to facial volume restoration for more than 3 years and seen a synergistic

Method

It should be noted that this method is consistently referred to as a procedure, not a treatment, a semantic distinction important to obtaining consistent results. Most light-based technology and other RF energy devices have set dosing protocols that define a treatment session, usually developed to be within established safe dosing parameters. The use of the continuous RF energy delivery, with the end point being an obvious clinically evident smoothing and tightening of the skin, has to be

Results

In 4 years of observing hundreds of treated areas, all patients treated had good to excellent results. Although the number of treatment sessions needed may vary with age and skin condition, all skins smoothen and tighten when heated repeatedly in each session to a visible clinical end point. Additional sessions have always yielded greater smoothing and contraction, and no adverse effect has been seen with as many as 5 sessions in 6 months. Performed properly, the procedure should be painless

Summary

The Pelleve procedure, done properly and to a truly significant clinical end point with each treatment, can reliably smooth and contract facial and neck skin without pain or downtime. The Pelleve represents a vital adjunct to filler procedures and any antiaging treatment plan, be it surgical or nonsurgical. The key to success in tightening and smoothing skin seems to be the ability to customize the dose, number of passes without concern for safety, discomfort, or cost. Additional safety in

Treatment pearls

  • Always start the procedure on the side of the face where the midface appears higher and more full, so at the half-treated point, the result is obvious.

  • Always assure you are in contact with the gel and skin before activating the electrode, and deactivate the electrode before breaking contact.

  • Use a gloved hand and 4 × 4 sponges to stretch the skin in the lateral brow and lower lateral face while heating, and maintain the tension until cooling is complete.

  • In areas, such as the midforehead, upper

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Disclosures: The author is a paid trainer of new users of the Ellman device. Training travel expenses are paid by Ellman. The author neither holds equity in Ellman nor profit sharing in company sales.

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