Novel Approach to Facial Rejuvenation by Treating Cutaneous and Soft Tissue for Wrinkles Reduction: First Experience from Multicenter Clinical Trial.

Background: Facial aging is determined by skin quality and the condition of underlying muscles, which contribute to the overall appearance by lifting heavy facial structures. Objective: This study aims to assess the safety and effectiveness of the novel radiofrequency (RF) and high-intensity facial muscle stimulation (HIFES) technology for treating wrinkles by facial tissue remodeling. Methods: This trial assessed the 3-month data of 24 subjects seeking facial wrinkles treatment. All subjects received four treatments, with a device utilizing RF and HIFES. The evaluation included a two-dimensional photographs assessment according to the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and a three-dimensional (3D) photograph analysis for facial appearance. Therapy comfort and subject satisfaction were assessed. Results: Based on the data of 24 subjects (56.5 ± 2.0 years, skin types I-IV), the significant improvement increased up to 3 months (-2.3 points, p < 0.001) post-treatment. 3D photographs analysis documented notable cutaneous and structural rejuvenation and coincided with FWES evaluation, underlining the positive subjective appreciation of the results with 20.4% average wrinkle reduction at 1 month, further increasing to 36.6% wrinkle reduction at 3 months. Conclusion: Documented by both subjective and objective evaluation tools, the RF and HIFES procedure for facial rejuvenation was found to be effective for treatment of wrinkles and skin texture. ClinicalTrials.gov Identifier: NCT05519124.

Ultrasonic Deep-Plane Neck Lift.

Ultrasonic deep-plane neck lift is a new approach for addressing both the subsuperficial musculoaponeurotic system and subplatysmal soft tissues during facial rejuvenation procedures. This innovative surgical approach utilizes 2.2, 2.9, and 3.7 stainless steel probes that are powered by high-frequency ultrasound. Using high-frequency ultrasound in the subcutaneous spaces has been accomplished for the past 20 years with a very suitable safety profile. In this technique, emulsification of the fat layer in both the superficial and deep planes is accomplished with tumescence of the soft tissues in the same fashion as subcutaneous liposuction. In ultrasonic deep-plane neck lift, the superficial and deep layers of fat are targeted for emulsification, and this creates a loosening of these spaces for lifting and repositioning. The procedure facilitates more accurate surgery, because the tissue effects include hemostasis and scalpel- and scissor-free undermining due to the emulsification of the fat layers of the face and neck. The other advantages of ultrasound-assisted facial contouring and rejuvenation include treatment of hard-to-treat areas like the perioral region and distal neck, which can be rapidly and safely undermined utilizing this technology. The third component of ultrasound- and energy-based facial rejuvenation surgery is the long-term remodeling and tightening that occurs beginning approximately 8 weeks after the procedure. When many conventional facelifts are beginning to fall at 3 to 4 months postoperatively, the energy-based facelifts are still tightening and this remodeling continues for up to a year after the procedure. Combining technology with conventional facelift procedures is a new approach to facial rejuvenation and is the result of 15 years of research and cooperation with the aesthetic device industry. The result of this merger of technology with conventional surgery is TESLA Facelifting, the facelift of the future.

Safety and Efficacy of Renuvion Helium Plasma to Improve the Appearance of Loose Skin in the Neck and Submental Region.

BACKGROUND: Minimally invasive procedures that deliver thermal energy to subcutaneous tissue offer a solution when deciding between excisional and noninvasive options to address face and neck aging-related changes. A minimally invasive helium plasma device, Renuvion, was first utilized for subdermal tissue heating to reduce skin laxity under an FDA general clearance for cutting, coagulation, and ablation of soft tissue. OBJECTIVES: The purpose of this study was to demonstrate the safety and effectiveness of the helium plasma device for improving the appearance of loose skin in the neck and submental region. METHODS: Patients undergoing the procedure with the helium plasma device in the neck and submentum were studied. They were seen for 6 months following the procedure. The primary effectiveness endpoint for improvement in lax skin in the treatment area was determined by 2 of 3 blinded photographic reviewers. The primary safety endpoint was the level of pain after treatment. RESULTS: The primary effectiveness endpoint was met; 82.5% demonstrated improvement at Day 180. The primary safety endpoint was met; 96.9% of patients experienced no pain to moderate pain to Day 7. There were no serious adverse events reported related to the study device or procedure. CONCLUSIONS: The data demonstrate benefit to patients by improvement of the appearance of lax skin in the neck and submental region. Outcomes resulted in US Food and Drug Administration 510(k) clearance in July 2022, expanding indications for the device to include subcutaneous dermatological and aesthetic procedures to improve the appearance of loose skin in the neck and submental region.

Tesla Facelifting Using Energy Devices during Rhytidectomy.

Tesla facelifting is the process of utilizing energy devices as surgical tools during rhytidectomy and neck lifting. Devices used for Tesla face and neck lifting include fiber lasers, radio frequency devices, high-frequency ultrasound, and plasma energy devices. Advantage of Tesla face and neck lifting include better visualization for surgical intervention due to reduced bleeding, better access to hard to access facial and neck locations, and long-term skin tightening from the subdermal energy treatment.

Evaluating, Purchasing, and Incorporating High-Tech Equipment into a Facial Plastic Surgery Practice.

In this article the authors discuss and analyze technological devices also known as energy-based devices and their use in skin rejuvenation, facial contouring, skin tightening, and other applications in facial plastic surgery. Energy has been applied in some form to tissue since the beginning of recorded history. The practice of applying heat to tissue with the use of cauters was used for thousands of years as an invaluable method of controlling hemorrhage. Continuous improvement of methods for using the beneficial effects of heat on tissue eventually led to the development of the basic concepts of electrosurgery we know today.

Ultrasound-Assisted Rhytidectomy Including Sub-SMAS and Subplatysmal Dissection.

Energy-based facelifting techniques are a relatively new genre of surgery. In this approach, the energy-based device-whether laser, radiofrequency plasma, or ultrasound-can be used in the superficial plane to elevate skin flaps before performing more traditional facelift techniques involving the superficial musculoaponeurotic system (SMAS) or platysma. The initial reports of utilizing fiber lasers as surgical tools date back to approximately 2007 and initial lipolasers were used to elevate facial skin flaps. The other energy-based devices were also tested. The author has probably the largest series of energy-based facial rejuvenation procedures, having performed over 3,000 of these procedures. The advantages of laser-assisted rhytidectomy include hemostasis, facilitated dissection in areas hard to elevate conventionally such as nasolabial folds or distal neck and the remodeling and tightening of tissue that results from the activation of the wound healing cascade of neocollagenesis and wound contraction. The author currently has a preference for energy device used during rhytidectomy and it is a high frequency ultrasound energy delivered by a five-ring 2.9- and 3.7-mm probe. The use of the ultrasound dissector in both superficial and deep procedures is highlighted in this article with emphasis on its use for deep cervicoplasty and subplatysmal procedures as well as sub-SMAS elevations of the facial deep plane.

Laser-Assisted Facelifting and Energy-Based Rejuvenation Techniques During Rhytidectomy.

The use of energy-based devices as surgical tools during rhytidectomy was introduced in early 2007 to 2008 and occurred when the first fiber laser was approved for laser lipolysis. It became evident that the fiber laser-assisted rhytidectomy could offer several advantages compared with conventional rhytidectomy. The use of energy devices now includes temperature-controlled radiofrequency and helium plasma devices. Energy devices continue to offer advantages compared with knife and scissor approaches: improved hemostasis; an ability to dissect into areas without full flap elevation; and the shrink-wrap late effects of collagen remodeling after energy-based treatment, which improves the results of rhytidectomy.

Easy Platelet-Rich Fibrin (Injectable/Topical) for Post-resurfacing and Microneedle Therapy.

The process of obtaining blood biologics, including platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), can be complicated and expensive and is influenced by many vendors and proprietary techniques. The indications for PRP/PRF use remain controversial, and complicated or expensive modes of generating this biologic may lead to many facial plastic surgeons to pass on the use of these potentially useful agents. The lack of standardization of PRP procurement also has led to difficulties in assessing clinical efficacy and comparing study protocols.

Pulsed and Fractionated Techniques for Helium Plasma Energy Skin Resurfacing.

Energy-based skin rejuvenation has, like other forms of aesthetic treatments, the capability of achieving desirable end results. These end results must be balanced with the degree and duration of morbidity, which affect recovery from treatment. Renuvion skin resurfacing protocols include a free hand approach and we describe our preferred approach of pulsing and fractionating the helium plasma resurfacing energy.

Picosecond Laser: Tattoos and Skin Rejuvenation.

Picosecond laser technology was cleared by Food and Drug Administration in 2012 and enhanced our ability to clear both benign pigmentation and dermal ink through a photomechanical impact created in the tissue. This impact created is greater than comparative nanotechnology and can be accomplished with lower fluences and smaller pulse durations. The addition of a diffractive lens array (FOCUS lens) has created a new category in skin rejuvenation by stimulating elastin and collagen through photomechanical and photoacoustic effects and not only through traditional photothermal tissue effects.

Renuvion/J-Plasma for Subdermal Skin Tightening Facial Contouring and Skin Rejuvenation of the Face and Neck.

The Renuvion/J-Plasma helium based plasma device from Apyx Medical has technological features that result in a unique and effective method of action for the contraction of subdermal soft tissue. The device achieves soft tissue contraction by instantly heating tissue to temperatures greater than 85°C for between 0.040 and 0.080 seconds. The tissue surrounding the treatment site remains at much cooler temperatures resulting in rapid cooling of the tissue through conductive heat transfer. Compared to bulk tissue heating devices, this method of action results in effective soft tissue contraction with a lower risk of injury to surrounding tissue.

Perioperative Care Considerations and Management of Complications Involving Surgical and Technology Procedures.

Technology impacts the lives of everyone nowadays and has had perhaps a greater impact on the lives of facial plastic surgeons and the patients they seek to help with both surgery and procedures. This article will discuss modern technology's impact on intervening in the aging process including technology used for facial and skin rejuvenation and reconstruction concentrating on the techniques and care to minimize complications as well as dealing with complication from the treatments.

Radiofrequency Technology in Face and Neck Rejuvenation.

Three doctors discuss the current issues and controversies involving the use of radiofrequency and energy-based devices for skin tightening, facial contouring, and other indications. The use of transcutaneous monopolar-, bipolar-, multipolar-, subcutaneous-, and microneedle-based delivery methods are discussed. The controversies involved in the various devices are discussed.

Cool Atmospheric Plasma (J-Plasma) and New Options for Facial Contouring and Skin Rejuvenation of the Heavy Face and Neck.

Treating patients with heavy or thick features comes with challenges not present in those patients lacking these physical characteristics. The authors report our experience with cool atmospheric plasma for facial contouring and skin rejuvenation of the heavy face and neck including rhinophyma. Cool atmospheric plasma is generated by running helium gas over radiofrequency energy. The resulting plasma is a fourth state of matter and has enhanced clinical effects for ablation and thinning of skin and soft tissues as well of contouring and tightening of deeper soft tissues and fascia. Cool helium plasma has been a very effective tool for skin rejuvenation and skin tightening as well as using it as a tool for nonexcisional microinvasive face and neck rejuvenation. Future research may indicate that it can help treat primary or recurrent superficial cutaneous malignancies.

Association Between Patient Value Systems and Physician and Practice Attributes Available Online.

IMPORTANCE: The relative value of facial plastic surgeon personal and practice attributes is relevant to the broader health care system because of increasing out-of-pocket expenses to patients. OBJECTIVE: To determine the relative value of specific facial plastic surgeon personal and practice attributes available online from the perspective of patients. DESIGN, SETTING, AND PARTICIPANTS: This study consisted of an electronic survey sent to patients by email using choice-based conjoint analysis; surveys were sent between December 2015 and March 2016. Participants had agreed to join email registries to be sent email surveys and promotions at 3 private facial plastic and reconstructive surgery practices. The following surgeon personal and practice attributes and levels were compared: (1) outcome transparency (above average, average, not available); (2) surgical training affiliations (US News and World Reports rankings); (3) online rating site scores (2 [poor], 3, or 4 [excellent] stars); and (4) price ($1×, $2×, and $3× [× = $1500; average cost was set at $2×]). MAIN OUTCOMES AND MEASURES: The relative importance of outcome transparency, surgical training affiliations, online rating scores, and price to prospective patients. RESULTS: Overall, 291 patients participated for a completion rate of 68%. Outcome transparency was the most valued attribute (attribute utility range = 141; attribute importance = 35.2%). Price was the least valued attribute (attribute utility range = 58.59; attribute importance = 15.1%). Assuming top-tier affiliations and 4-star ratings, share of market (SOM) was 75.5% for surgeons with above-average outcome transparency priced at $3× compared with those surgeons with no outcomes available priced at $1×. Holding price constant at $2×, surgeons with middle-tier affiliations and 2-star online ratings but above average outcomes achieved 48.4% SOM when compared with those surgeons with top-tier affiliations and 4-star online ratings without available outcomes. CONCLUSIONS AND RELEVANCE: Facial plastic surgery patients most value surgeons who publish outcomes. Moreover, they are willing to discount poor rating scores and lower-ranked institutional affiliations when outcome transparency is high. This study demonstrates that outcome transparency is crucial in facial plastic surgery markets. LEVEL OF EVIDENCE: NA.

Use of a controlled subdermal radio frequency thermistor for treating the aging neck: Consensus recommendations.

INTRODUCTION: A new temperature-controlled device has been used as a percutaneous radio frequency probe to treat lax submental and other facial areas. It has significant advantages over other esthetic devices as it provides the dual benefit of fat lipolysis and skin tightening. Our goal here is to present consensus recommendations for treating the aging neck. METHODS: A panel of 11 expert physicians convened in Dallas, Texas, on October 15, 2016 to arrive at a consensus on the best current practice for submental skin tightening and contour improvement. Prior to the meeting, a comprehensive review of the literature was performed and a survey was sent to esthetic dermatologists and plastic surgeons who were queried about various aspects of neck rejuvenation. RESULTS: The literature search revealed 10 different technologies for neck rejuvenation evaluated in double-blind (n = 2) and single-blind (n = 1) clinical trials and other clinical evaluations (n = 21). The survey was sent via an email to 1248 individuals and was completed by 92 respondents. Review of the data and discussion by meeting attendees generated eight consensus recommendations. DISCUSSION: Subdermal monopolar radio frequency represents an effective means for disrupting fat volume and skin tightening of the face, neck, and jawline. For suitable patients, this treatment can be used to achieve significant esthetic improvements.

Treating Scars to the Neck.

Scarring of the neck affects millions of people every year. The appearance of neck scarring can be disturbing both physically and psychologically. Scarring of the neck can be accompanied by morbidities because of the limitation of functional motion of the neck. Treatment options and modalities for reduction and prevention of scar formation include topical steroids, intralesional steroids, interferon, 5-fluorouracil, silicone gel, radiation, laser therapy, and surgeries. There is no general consensus in the literature as to the optimal treatment of neck scarring. Patients should understand that the scar is likely to be improved but not eliminated by treatment.

Combined laser treatment of actinic sun damage and acne scarring.

Since its approval for use in 2007, many surgeons have been using the laser for subcutaneous use, primarily for lipolysis, facial neck and body contouring, and skin tightening. Techniques have recently evolved to enable use of the subcutaneous laser with concurrent skin resurfacing techniques for improvement of photoaging and acne or facial scarring. The technique shows great promise in patients with facial aging and photodamage who are not deemed candidates for rhytidectomy surgery. With strict patient-selection criteria of mild to moderate facial laxity and mild to moderate photoaging, the procedure can be gratifying for the surgeon and patient alike.