Specific RF Applications in the Surgical Practice

This is part 2 of a 2-part series

Part 1: RF for Body Contouring

The modern surgical practice combines surgery with minimally invasive and noninvasive procedures such as RF treatments and facial injectables, as well as medical skin care, lasers, microneedling, platelet-rich plasma and other adjuvant therapies. "This is more of what we're seeing now as compared to 20, 30 or 40 years ago. The traditional surgical practice is literally going the way of the dinosaurs."

Dr. Buford’s plastic surgery training did not include nonsurgical procedures, so he learned them on his own with help from colleagues and peers. In the RF category, he uses the line of Thermi devices (ThermiGen, LLC) to treat various body areas.

A 49-year-old male he treated in the submental area to an internal temperature of 70°C achieved an improved neck and jawline three months post-procedure, without liposuction or dieting. "At 90 days, he was also getting some new collagen formation. He's got a sharper chin point… He's got a sharper jawline."

Dr. Buford says he could not provide further improvement of the upper neck because the hyoid bone and cartilaginous structures prohibit pushing the tissue back any further. Nevertheless, says Dr. Buford, the patient's results have lasted three years and counting.

"ThermiTight uses an internal thermistor which heats the fat and skin. We know what the temperature is inside, but we also use an external infrared camera to identify how warm the skin is." This allows heating the skin to maximally effective temperatures without causing burns. "There's not a lot of downtime or discomfort. I use tumescent fluid. I rarely ever give patients any sedation whatsoever." Post-procedure, he adds, patients are up and around pretty quickly.

By comparison, ThermiBody uses externally applied RF energy through a series of differently sized thermistors. "The wider the paddle, the deeper the penetration. It's effective for tightening skin and melting a little fat."

CoolSculpting (Allergan) is highly effective for fat removal, he says, but not skin tightening. One patient who had abdominal skin laxity that improved with a single ThermiTight treatment performed three months after CoolSculpting.

Regarding specific body sites, Dr. Buford says, so-called bra-strap fat had previously been a tough area to treat. "This is usually not fat — it's usually lax skin," which RF energy can help to minimize.

RF treatment can also help patients with laxity who do not want a surgical breast lift, adds Dr. Buford. The treatment essentially applies ThermiTight to the breast, using four port sites (one each at the 12, three, six and nine o'clock positions) to heat the tissue from inside out, he says. Because the treatment works in the subglandular plane, it is not recommended for patients with subglandular breast implants.

"But it's fine if the patient has submuscular implants because the heat will not dissipate that deeply," he says.

The procedure provides modest results, he adds, and one must inform patients that it cannot match surgical results.

Dr. Gregory A. Buford presented "Incorporating Radiofrequency Treatments into Your Surgical Practice," last year at The Cosmetic Bootcamp. Aspen, Colo. June 21, 2019.

DISCLOSURES:

Dr. Buford has been a speaker, consultant, shareholder and Master Facial Injectables Trainer for Allergan; a speaker and consultant for Evolus and ThermiGen; a consultant for Revance; an advisor and investor for MEND Nutrition, and an advisor and investor for Fruit Street and Monj.