An innovative temperature‐controlling handpiece for face and body skin laxity and tightening treatment with radiofrequency

Dear Editor, In this study, a temperature-controlled radio frequency (RF) was used to improve tightening and skin laxity in different body areas using an innovative temperature-controlling handpiece. Despite the many choices in the scenario against signs of aging, many patients may remain unsatisfied due tomedications or treatments requiring months to be effective. This affects adherence to regimens and, therefore, compliance with treatment. In recent years, lasers, therapeutic ultrasounds, and different energy sources have been investigated for their possible role as a solution for tightening and skin laxity. Within these, there is medical RF, a form of electromagnetic energy generating heat proportionally to the electrical resistance of the tissue when applied to skin tissues. RF lays its foundations in the early 20th century as a solution for back pain and neuralgias and later on heating of the dermal tissues was considered for skin rejuvenation. Indeed, surgery has extensively used this heat source for example for homeostasis and tissue ablation (so-called electro-surgery) but, it has been recently employed for shrinking of lax connective tissues thanks to its collagen denaturation properties [1]. As a matter of fact, fibroblasts produce collagen molecules synthesizing three chains of polypeptides wrapped around one another in a triple helix. This is the first structure involved during the denaturation phenomenon of thermal shrinkage. Indeed, heat destroys all the collagen heat-labile intramolecular cross-links leading to the protein “unwinding” and change in structure from a highly ordered crystalline form to a randomly distributed and gel-like shape [2]. Fibroblasts are also implicated in neocollagenesis and consequent tissue remodeling, contributing to the desired cosmetic result whenheated. The specific connective tissueheat-inducedbehavior and shrinkage extent depend on several factors including the maximum exposure temperature and time, tissue hydration, and age. RF energy can be applied to tissue up to six points on the tip of a probe. In general, the more poles are used, the less current is required to achieve the same effect because the current passes through a much smaller volume of tissue. Moreover, an active cooling mechanism is required when a monopolar RF is used because the electrode touching the skin has to be cooled down to preserve the epidermis from thermal damage [3]. For this reason, a multipolar handpiece is typically used in most recent devices for face and body treatments. Different

possible role as a solution for tightening and skin laxity. Within these, there is medical RF, a form of electromagnetic energy generating heat proportionally to the electrical resistance of the tissue when applied to skin tissues. RF lays its foundations in the early 20th century as a solution for back pain and neuralgias and later on heating of the dermal tissues was considered for skin rejuvenation. Indeed, surgery has extensively used this heat source for example for homeostasis and tissue ablation (so-called electro-surgery) but, it has been recently employed for shrinking of lax connective tissues thanks to its collagen denaturation properties [1]. As a matter of fact, fibroblasts produce collagen molecules synthesizing three chains of polypeptides wrapped around one another in a triple helix. This is the first structure involved during the denaturation phenomenon of thermal shrinkage. Indeed, heat destroys all the collagen heat-labile intramolecular cross-links leading to the protein "unwinding" and change in structure from a highly ordered crystalline form to a randomly distributed and gel-like shape [2]. Fibroblasts are also implicated in neocollagenesis and consequent tissue remodeling, contributing to the desired cosmetic result when heated. The specific connective tissue heat-induced behavior and shrinkage extent depend on several factors including the maximum exposure temperature and time, tissue hydration, and age.
RF energy can be applied to tissue up to six points on the tip of a probe. In general, the more poles are used, the less current is required to achieve the same effect because the current passes through a much smaller volume of tissue. Moreover, an active cooling mechanism is required when a monopolar RF is used because the electrode touching the skin has to be cooled down to preserve the epidermis from thermal damage [3]. For this reason, a multipolar handpiece is typically abdomen, and thighs. The system is indicated for treating skin texture, skin laxity, body contouring, and cellulite. Apparently, 40-48 • C is the ideal epidermal surface temperature since this correlates with a dermal temperature of 70 • C required for the denaturation of collagen [5]. For this reason, after defining the optimal treatment temperature of cutaneous heating (from 40 to 45 • C), thanks to the continuous feedback from the software, the system stops and starts over the energy supply automatically never overcoming the pre-set temperature threshold.
This way, every overheating is spared and so the unwanted side effects.
Thus, the handpiece performance is maximized in every session. The heating is more homogeneous on the interested body area.
Our study has shown great skin tone and texture improvement in the patient's cheek area thanks to RF action on collagen. Overall, the treatment was well tolerated and none of the patients showed discomfort. Indeed, in this study, we demonstrated that constantly monitoring the temperature during RF treatment is highly innovative and crucial for achieving better results and minimizing side effects. This means having faster, operator-independent, and easy-manageable technology compared to standards. As a support, there are a lot of scientific data about the efficacy of using a multipolar handpiece [4] for face and body tightening and skin laxity but none have feedback about superficial body temperature in real-time [6]. Therefore, constant scientific research for updating and improving the available devices is needed.
In conclusion, thanks to RF action on collagen, our study has interestingly shown great skin tone and texture improvement on the patient's face and abdomen. Therefore, the new handpiece characteristic presented within the non-invasive and operator-independent RF system could be considered a safe, quick, and effective procedure for patients' face and body skin laxity and tightening even in subjects with a considerable percentage of lax skin tissue.