Radio Frequency: What is Skin Tightening?

Introduction: It has been an acknowledged surgical treatment for over 70 years. Invented by Dr. T Bowie (Harvard). In Cosmetic Medicine, the Unipolar and Bipolar modes are used.
RF basis: it is defined as electromagnetic radiations, located within the spectrum, between Infrared Radiation and Long Waves. The therapeutic range which we refer to is between the Medium and Short Wave. When applied to the tissue, it causes rapid oscillations of the electromagnetic fields, causing movement of the charged molecules, resulting in an increase in the tissue’s temperature.  The thermal effects are determined by the type of RF applied, the level of energy, duration of the treatment and the type of tissue treated.
The type of RF applied (unipolar or bipolar) and the size and shape of the electrode also influences on the physiological effect.
The optimum temperature of the tissue heating is between 55 and 62ºC (this is the range in which the describe effects take place).
First, the RF produces heating of the adipose tissue. This increases the Lymph and Arterial Venal System stimulation of the tissue. Likewise, a heating at skin depth is produced due to the spreading of heat, improving the skin quality and stimulating collagenesis.
The collagen goes through an immediate contraction and reshaping over time. Also, an increase in vascularization is observed in the cellulite tissue, which allows for an improvement in the cellular metabolism.
Insofar as the collagenesis is concerned, this occurs due to the formation of Heat Shock Proteins (HSP) that synthesizes with certain stimuli and initiate tissue repair. Specifically with the RF treatment, HSP-47 is synthesized.  This protein resides in the Endoplasmic Reticulum and clearly identifies the Collagen Triple Helix. The Type I collagen molecules can only be correctly assembled in tridimensional form in the presence of this HSP-47 protein.
Properties and effects of RF:
RF depth of penetration is subject to:
1-The tissue’s electrical characteristics (directly proportional to its resistance).
2-Type of handpiece: Unipolar-Bipolar.
3-Wave frequency.
Electrical characteristics of the tissue: the greater the tissue’s resistance as the RF passes, the higher temperature generated (fat has a resistance of 2180 Ohms, 10 times higher than that of the skin).
Handpiece type:
a) Bipolar: the electrical range is between two electrodes at a fixed distance. Both electrodes are applied to the treatment area. And the prolongation of the electrical current is limited between both electrodes.
b) Unipolar: The Unipolar or Monopolar system emits energy through one electrode with a sole contact point on the treated area. Heating depth is variable. There may be an inductive electrode and a return electrode (eg. Thermacool®) or a ground pad return electrode (eg. Accent®). With the Thermage® System, we can choose the type of heating produced, either superficial, mid-depth or deep; according to the treatment tip used (1.5 cm², superficial, 1.5 cm² mid-depth, 3 cm² mid-depth; 0.25 cm² superficial and 3 cm² deep).
The higher the wave frequency, the deeper the penetration.

RF is indicated for: localised adiposity, cellulite and flaccidity.

Main contraindications: patients with dermal alterations, pacemakers, defibrillators or cardioverters or metal implants in the area to be treated.

Side effects: intense heat sensation for a few minutes, erythema which will disappear in 1 to 2 hours and burns on very rare occasions (this is usually due to a poor application technique).

RF: Conclusions:
Gold Standard for flaccidity (whether associated or not to mesotherapy, carboxitherapy and/or vibrotherapy).
It is also used in treating cellulite and false cellulite (which accompanies flaccidity), nearly always combined with the treatments described above.
In cases of localised adiposity, treatment is usually combined with ultrasounds and/or Mechanical Massage.