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  • 1. Synergistic Multi-polar Radiofrequency and Pulsed Magnetic Fields in the Non- Invasive Treatment of Skin Laxity and Body Contouring. R. Stephen Mulholland, MD, Plastic Surgeon, Toronto CanadaINTRODUCTION Radiofrequency energy devices have remained the most common and dominant technology in the non-Much of the surgical effort in Plastic Surgery and invasive management of skin tightening, wrinkleCosmetic Medicine is devoted to the enhancement reduction, cellulite improvement and bodyof patients with skin laxity and/or body contouring contouring enhancement, as they can treat all theseconcerns. The gold standard of skin laxity therapy conditions with relatively consistent results.has always been, and remains, skin excision. Radiofrequency (RF) devices may be mono polar,Whether facelift, breast-lift, abdominoplasty or bipolar (with or without other energy sourcesbrachioplasty, the removal of excess skin, through synergistically pulsed), tri-polar or, now, multi-polar.well-placed incisions, most often results in excellent The RF energy is high frequency alternatingclinical results and a happy patient. Similarly, the electrical current that passes into the dermis andmost consistent and impressive results in the hypodermal tissues without disruption of themanagement of multifocal lipodystrophy, with good epidermal-dermal barrier. The high frequencyskin tone, remains the various techniques of oscillating electrical current results in collisionsliposuction. However, the scars, stigmata, morbidity between charged molecules and ions and the micro-and fear of excisional and liposuction procedures molecular mechanical energy from these collisions iskeep the majority of patients looking for less transformed into heat1,2,3. This biological RF heatinvasive skin tightening and body contouring occurs irrespective of chromophore or skin type andprocedures, away from the plastic surgeons and is not dependent upon selective photothermolysis.cosmetic physician offices that do not offer these The RF heat has different biological and hence,modalities. clinical effects, depending upon the tissue targeted.The consumer demand for, and hence the sales of In the dermis, where the primary cellular element isnon-invasive devices for skin tightening, wrinkle the fibroblast and the extracellular matrix (ECM) isreduction, body contouring and cellulite comprised of collagen, elastin and groundenhancement remain very strong, despite the substances, the RF mediated thermal stimulation ofdisruptive economy of the past three years. The the ECM results in an immediate and temporaryideal technology in this space would address skin shrinkage of the collagen triple helix1,2,3. Further, thetightening, cellulite improvement and body RF thermal stimulation results in a micro-contouring in one device, with efficacious, inflammatory stimulation of the fibroblast which inexpeditious treatments and little discomfort. Such response produces new collagen (neocollagenesis)technology would have no disposables and would and new elastin (neoelastogenesis), and groundbe affordable to the physician. substances2,3. If the RF thermal dermal stimulation treatments are performed with enough frequency,BASIC SCIENCE duration and supra-physiological impact, then the dermis will exhibit, over time, enhanced tensileThe technology options in the skin tightening and strength, elastic properties from the newly producedbody contouring space have included vacuum proteins and protogylcans, and will appear clinicallymassage, infrared laser technologies, high smoother and more youthful1,2,4. RF thermalfrequency focused ultrasounds, cryolipolysis, stimulation of adipose tissue results in a thermalradiofrequency energy and various hybrid energy mediated stimulation and augmented activity ofdevice options. Lipase mediated enzymatic degradation of adipocyte derived Triglycerides into free fatty acids and glycerol4.
  • 2. This amplification of the physiologic breakdown and Theoretically then, the Synergistic RF and Pulsedegress of the Triglycerides out of the adipocyte, Magnetic Fields would create RF thermal collagenwhile keeping the adipocyte cell membrane and cell stimulation and Pulsed Magnetic Field non-thermalfunction intact, results in RF induced shrinkage of stimulation of collagen, RF thermally mediatedthe fat cells and body contouring and cellulite reduction in adipose size and Pulsed Magnetic Fieldimprovements. micro-tissue healing effects to minimize edema, swelling and downtime that are associated with pureTHE VENUS FREEZE DEVICE RF thermal therapies.This paper introduces a novel RF device, the Venus This paper reviews our clinical experience with theFreeze® (Venus Concept Ltd., Israel) that combines Freeze, synergistically utilizing Multi-polar RF andMulti-Polar RF current and Pulsed Magnetic Fields Pulsed Magnetic Fields in the treatment of skinin synergy. The company calls this synergistic Multi laxity, rhytides, as well as circumferential bodyPolar Magnetic Pulsed technology (MP)2. The contouring and cellulite.Freeze system delivers the energy through handheld applicators with Multi-polar electrodes. There is MATERIALS AND METHODSa larger Octipolar applicator with 8 electrodesarranged in a circle, designed for the treatment of The study is a cohort study of 15 patients that werelarger zones and body contouring, and a smaller treated with the Freeze Multi-polar RF and Pulsedapplicator with 4 electrodes for the treatment of face, Magnetic Fields device. 14 patients were female andneck laxity and rhytides, and smaller body 1 patient was male. The age range was 30-66 yearscontouring areas. Each magnetized electrode old. Patients were weighed and photographedsimultaneously emits RF and a Pulsed Magnetic before and after the study and were instructed toField. The RF current is produced between any two continue with their current lifestyle and not toelectrodes in the array and by rapidly alternating RF change their nutrition, caloric intake or physicalcurrent between the different electrodes, the device activity routines. 7 patients had their face and neckcan raise the temperature of treatment area quickly treated for skin tightening and rhytide reduction. 8and homogenously, without the RF focal “hot spots” patients had treatments on their abdomen and hipsand pain seen with other RF devices. for circumferential reduction. Finally, 8/15 patients also had synchronous treatments performed on anThe Pulsed Magnetic Field is induced by short additional site for cellulite.pulses of electrical current through coil in theapplicator. The magnetic field penetrates into the All study patients were treated for 8 weeks, twice theskin and results in Foucault (Eddy) electrical first week, then once weekly for 7 weeks, using thecurrents around the cell membranes of the treated following protocol. Body areas were treated for 10tissues. Foucault currents change the electrical minutes for a 20 X 25 cm area. Facial treatmentspotential of charged receptors on the bi-lipid cell were performed for 12 minutes for each side of themembrane layer of dermal cells, which results in the face and 6 minutes for each side of the neck. Thestimulation of molecular and cellular activities and patients were treated lying down comfortably, withreactions5,6,7. the treatment area exposed. After turning on theMagnetic Fields have been shown to increase device, the relevant treatment program was selectedfibroblast derived collagen production through a from the available treatment options, and correctnon-thermal mechanism of membrane stimulation, treatment head (OctiPolar or DiamondPolarand the stimulation of fibroblast mediated applicator) was selected. The treatment area wasangiogenesis, and hence facilitate and enhance cleaned with an alcohol wipe and make up waswound healing in tissues5,6,7. removed. Glycerin was applied to the treatment area.
  • 3. The energy and treatment times were adjusted CONCLUSIONSaccording to the area being treated. The startingenergy was 30% for the face and 50% for the body. The use of a synergistic Multi-polar RadiofrequencyThe applicator was applied to the skin, and the area and Pulsed Magnetic Field device (The Freeze)was treated using sweeping motions. Applicator was appears to produce consistent and demonstrablenot allowed to stop moving. The treatment skin tightening, circumferential reduction andtechnician deployed continuous sweeping motions, cellulite improvement. When compared to other RF“figure 8”, “swirls”, “snakes” and “wave” shaped devices on the market, the Freeze appears to havemovements. During treatment, the energy was the following advantages:adjusted up or down, as tolerated, to achieve at 1. Freeze works much faster to achieve the thermalleast 40-42°C epidermal temperature within the first endpoint.few minutes of treatment, and throughout the entire 2. The soft tissue heating is more uniform andtreatment. Infrared thermometer was deployed to therefore is much more tolerable by the patient.measure the epidermal temperature. Treatment 3. The device and treatments appear very safe.endpoint was 10 minutes of treatment per area with 4. The Freeze device has versatile clinicala uniform temperature of 40-42°C throughout the applications and revenue streams through thesurface area. use of the DiamondPolar and OctiPolarAll patients had before and after photography taken. applicators. Face and neck aging concerns, asThe body contouring patients had circumferential well as small and large zone lipodystrophy andmeasurements taken of the treatment zones. cellulite, can be treated. 5. Consistent and efficacious outcomes areRESULTS achieved. 6. The Ergonomically designed applicators areAll patients completed the study and follow-up friendly and easy to use by technicians.photographs were taken at 3 months following last 7. No disposable cost to the physician.treatment. The author reviewed all facialphotographs for evidence of wrinkle reduction and Synergistic Multi-polar RF and Pulsed Magneticfacial and cervical skin tightening. All skin tightening Field treatments can be a versatile, efficacious andpatients (7/7) demonstrated moderate to significant economically desirable addition to an aestheticvisual improvements in their rhytides, laxity and medical practice.facial contours (figure 1).The average circumferential reduction for the REFERENCESabdominal-hip body contour patients was 3.1cm(range 1.4cm – 4.3cm). All body contouring patients 1. Alster, TS, Lupton JR. Nonablative cutaneous(8/8) responded with some measurable remodeling using radiofrequency devices. Clincircumferential reduction (Figure 2). Dermatol 2007;25:487-91. 2. Zelickson BD, Kist D, Bernstein E, et al.For the cellulite cohort, 6/8 patients demonstrated Histological and ultrastructural evaluation of thenoticeable and pleasing improvement in the effects of a radiofrequency based non-ablativeappearance of their cellulite (Figure 2). The dermal remodeling device: a pilot study. Archtreatments were well tolerated, there were no Dermatol. 2004;140:204-9.complaints of significant pain or discomfort during 3. Hantash BM, Ubeid AA, Chang H, et al. Bipolarany treatment, no major complications reported and fractional radiofrequency treatment inducesonly two cases of minor erythema reported on face neoelastogenesis and neocollagenesis. Lasersor neck treatments that resolved within one hour. Surg Med. 2009;41:1-9.
  • 4. 4. Emilia del Pino, M, Rosado RH, Azuela A, et al. Effect of controlled volumetric tissue heating with radiofrequency on cellulite and subcutaneous tissue of the buttocks and thighs. J Drugs and Dermatol. 2006;5:714-22.5. Akira Soda et al. Effect of exposure to an extremely low radiofrequency-electromagnetic field on the cellular collagen with respect to signaling pathways in osteopath-like cells. J Med Invest. 2008;55:267-78.6. Murray JC, Farndale RW. Modulation of collagen production in cultured fibroblasts by a low- frequency, pulsed magnetic field. Biochem Biophys Acta. 1985 Jan 28;838:98-105.7. Tepper OM, Callaghan MJ, Chang EL, et al. Electromagnetic fields increase in vitro and in vivo angiogenesis through endothelial release of FGF-2. FASEB J 2004; 18:1231-3. Figure 1 Figure 2