Radiofrequency Devices Including Fractional Radiofrequency

Radiofrequency (RF) devices use electromagnetic radiation at frequencies similar to radio bands to deliver electric current and heat the skin. The biologic effects depend upon the tissue impedance and the RF characteristics. Generally, the thermal injury results in denaturated fibrils of collagen and initiates a wound healing response. Ultimately, neo-collagenesis, neo-elastogenesis and dermal remodelling is observed. RF has been used in medicine since the nineteenth century. Lately, this technology has generated great interest in the field of aesthetic medicine. Typically, a generator introduces RF current into the skin through one or more electrodes. There are monopolar, unipolar, bipolar devices and combinations of RF with light, vacuum or mechanical rollers. More recently, fractional radiofrequency was added to the devices’ armamentarium. Unlike lasers, this technology does not apply the concept of selective photothermolysis and is not chromophore targeted. Therefore, it is postulated to be safer compared to laser energy sources. The RF technology represents a dynamic field and the applications include face and body skin rejuvenation, acne, scars and cellulite. This chapter will consider the variety of RF techniques based on the current evidence. In order to maximize the efficacy and safety of the therapy, it is paramount for the operator to have appropriate knowledge of the nature of this technology and to understand potential adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic €32.70 /Month

Buy Now

Price includes VAT (France)

eBook EUR 93.08 Price includes VAT (France)

Softcover Book EUR 116.04 Price includes VAT (France)

Hardcover Book EUR 158.24 Price includes VAT (France)

Tax calculation will be finalised at checkout

Purchases are for personal use only

Similar content being viewed by others

Radiofrequency Therapy

Chapter © 2016

Ablative Radiofrequency in Cosmetic Dermatology

Chapter © 2016

Ablative Radiofrequency in Cosmetic Dermatology

Chapter © 2018

References

  1. Diffey BL. Sources and measurement of ultraviolet radiation. Methods. 2002;28:4–13. CASPubMedGoogle Scholar
  2. Jauchem JR. Effects of low-level radio-frequency (3kHz to 300GHz) energy on human cardiovascular, reproductive, immune, and other systems: a review of the recent literature. Int J Hyg Environ Health. 2008;211:1–29. PubMedGoogle Scholar
  3. Massarweh NN, Cosgriff N, Slakey DP. Electrosurgery: history, principles, and current and future uses. J Am Coll Surg. 2006;202:520–30. PubMedGoogle Scholar
  4. Henriques FC, Moritz AR. Studies of thermal injury: I. the conduction of heat to and through skin and the temperatures attained therein. A Theoretical and an Experimental Investigation. Am J Pathol. 1947;23:530–49. CASPubMedPubMed CentralGoogle Scholar
  5. Moritz AR, Henriques FC. Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous Burns. Am J Pathol. 1947;23:695–720. CASPubMedPubMed CentralGoogle Scholar
  6. Moritz AR. Studies of thermal injury: III. The pathology and pathogenesis of cutaneous Burns. An experimental study. Am J Pathol. 1947;23:915–41. CASPubMedPubMed CentralGoogle Scholar
  7. Dewhirst MW, Viglianti BL, Lora-Michiels M, et al. Thermal dose requirement for tissue effect: experimental and clinical findings. Proc SPIE--the Int Soc Opt Eng. 2003;4954:37. Google Scholar
  8. Dams SD, de Liefde-van Beest M, Nuijs AM, et al. Pulsed heat shocks enhance procollagen type I and procollagen type III expression in human dermal fibroblasts. Skin Res Technol. 2010;16:354–64. Google Scholar
  9. Mayes AE, Holyoak CD. Repeat mild heat shock increases dermal fibroblast activity and collagen production. Rejuvenation Res. 2008;11:461–5. PubMedGoogle Scholar
  10. Arnoczky SP, Aksan A. Thermal modification of connective tissues: basic science considerations and clinical implications. J Am Acad Orthop Surg. 2000;8:305–13. CASPubMedGoogle Scholar
  11. Lee SJ, Kim J-I, Yang YJ, et al. Treatment of periorbital wrinkles with a novel fractional radiofrequency microneedle system in dark-skinned patients. Dermatol Surg [Internet]. 2015;41:615–622. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med8&NEWS=N&AN=25899885.
  12. Alvarez N, Ortiz L, Vicente V, et al. The effects of radiofrequency on skin: experimental study. Lasers Surg Med. 2008;40:76–82. PubMedGoogle Scholar
  13. Ruiz-Esparza J, Gomez JB. The medical face lift: a noninvasive, nonsurgical approach to tissue tightening in facial skin using nonablative radiofrequency. Dermatol Surg 2003;29:325–332; discussion 332. Google Scholar
  14. Kennedy J, Verne S, Griffith R, et al. Non-invasive subcutaneous fat reduction: a review. J Eur Acad Dermatol Venereol. 2015;29:1679–88. CASPubMedGoogle Scholar
  15. Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol. 2007;25:487–91. PubMedGoogle Scholar
  16. Lolis MS, Goldberg DJ. Radiofrequency in cosmetic dermatology: a review. Dermatol Surg. 2012;38:1765–76. CASPubMedGoogle Scholar
  17. Weiss RA. Noninvasive radio frequency for skin tightening and body contouring. Semin Cutan Med Surg. 2013;32:9–17. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med7&NEWS=N&AN=24049924PubMedGoogle Scholar
  18. Sadick NS, Nassar AH, Dorizas AS, et al. Bipolar and multipolar radiofrequency. Dermatol Surg. 2014;40(Suppl 1):S174–9. PubMedGoogle Scholar
  19. Manstein D, Herron GS, Sink RK, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426–38. PubMedGoogle Scholar
  20. 20171121_INFINI1.2_quickguide_rev3.0.pdf - Google Drive [Internet]. [cited 2018 Jul 25]. Available from: https://drive.google.com/file/d/1DXiwsdI6lM9Rx4m9AWAwLwFntt_ecuis/view.
  21. Hantash BM, Renton B, Berkowitz RL, et al. Pilot clinical study of a novel minimally invasive bipolar microneedle radiofrequency device. Lasers Surg Med. 2009;41:87–95. PubMedGoogle Scholar
  22. Alexiades-Armenakas M, Newman J, Willey A, et al. Prospective multicenter clinical trial of a minimally invasive temperature-controlled bipolar fractional radiofrequency system for rhytid and laxity treatment. Dermatol Surg. 2013;39:263–73. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/068/CN-00912068/frame.htmlCASPubMedGoogle Scholar
  23. Ramaut L, Hoeksema H, Pirayesh A, et al. Microneedling: where do we stand now? A systematic review of the literature. J Plast Reconstr Aesthet Surg [Internet]. 2018;71:1–14. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=prem&NEWS=N&AN=28690124.
  24. Brightman L, Goldman MP, Taub AF. Sublative rejuvenation: experience with a new fractional radiofrequency system for skin rejuvenation and repair. J. Drugs Dermatol [Internet]. 2009;8:s9–13. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med6&NEWS=N&AN=19916261.
  25. Gold MH. Update on tissue tightening. J Clin Aesthet Dermatol. 2010;3:36–41. Google Scholar
  26. Lolis MS, Goldberg DJ. Assessment of safety and efficacy of a bipolar fractionated radiofrequency device in the treatment of periorbital rhytides. J Cosmet Laser Ther [Internet]. 2014;16:161–164. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med8&NEWS=N&AN=25003480.
  27. Fitzpatrick R, Geronemus R, Goldberg D, et al. Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med. 2003;33:232–42. PubMedGoogle Scholar
  28. Nahm WK, Su TT, Rotunda AM, et al. Objective changes in brow position, superior palpebral crease, peak angle of the eyebrow, and jowl surface area after volumetric radiofrequency treatments to half of the face. Dermatol Surg 2004;30:922–928; discussion 928. Google Scholar
  29. Han SH, Yoon YM, Lee YW, et al. Usefulness of monopolar thermal radiofrequency treatment for periorbital wrinkles. Ann Dermatol. 2018;30:296–303. PubMedPubMed CentralGoogle Scholar
  30. Bassichis BA, Dayan S, Thomas JR. Use of a nonablative radiofrequency device to rejuvenate the upper one-third of the face. Otolaryngol Head Neck Surg. 2004;130:397–406. PubMedGoogle Scholar
  31. Jacobson LGS, Alexiades-Armenakas M, Bernstein L, et al. Treatment of nasolabial folds and jowls with a noninvasive radiofrequency device. Arch. Dermatol. 2003:1371–2. Google Scholar
  32. Alster TS, Tanzi E. Improvement of neck and cheek laxity with a nonablative radiofrequency device: a lifting experience. Dermatol Surg 2004;30:503–507; discussion 507. Google Scholar
  33. Alhaddad M, Wu DC, Bolton J, et al. A randomized, Split-face, evaluator-blind clinical trial comparing monopolar radiofrequency versus microfocused ultrasound with visualization for lifting and tightening of the face and upper neck. Dermatol Surg. 2019;45:131–9. CASPubMedGoogle Scholar
  34. Chipps LK, Bentow J, Prather HB, et al. Novel nonablative radio-frequency rejuvenation device applied to the neck and jowls: clinical evaluation and 3-dimensional image analysis. J Drugs Dermatol. 2013;12:1215–8. PubMedGoogle Scholar
  35. Weiss RA, Weiss MA, Munavalli G, et al. Monopolar radiofrequency facial tightening: a retrospective analysis of efficacy and safety in over 600 treatments. J Drugs Dermatol. 2006;5:707–12. PubMedGoogle Scholar
  36. de Felipe I, Del Cueto SR, Perez E, et al. Adverse reactions after nonablative radiofrequency: follow-up of 290 patients. J Cosmet Dermatol. 2007;6:163–6. PubMedGoogle Scholar
  37. Vega JM, Bucay VW, Mayoral FA. Prospective, multicenter study to determine the safety and efficacy of a unique radiofrequency device for moderate to severe hand wrinkles. J Drugs Dermatol. 2013;12:24–6. PubMedGoogle Scholar
  38. Zelickson BD, Kist D, Bernstein E, et al. Histological and ultrastructural evaluation of the effects of a radiofrequency-based nonablative dermal remodeling device: a pilot study. Arch Dermatol. 2004;140:204–9. PubMedGoogle Scholar
  39. Anolik R, Chapas AM, Brightman LA, et al. Radiofrequency devices for body shaping: a review and study of 12 patients. Semin Cutan Med Surg. 2009;28:236–43. CASPubMedGoogle Scholar
  40. Ruiz-Esparza J, Gomez JB. Nonablative radiofrequency for active acne vulgaris: the use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy): a report of 22 patients. Dermatol Surg 2003;29:333–339; discussion 339. Google Scholar
  41. Emilia del Pino M, Rosado RH, Azuela A, et al. Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs. J Drugs Dermatol. 2006;(5):714–22. Google Scholar
  42. Goldberg DJ, Fazeli A, Berlin AL. Clinical, laboratory, and MRI analysis of cellulite treatment with a unipolar radiofrequency device. Dermatol Surg 2008;34:204–209; discussion 209. Google Scholar
  43. Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar radiofrequency treatment to improve the appearance of cellulite. J Cosmet Laser Ther. 2008;10:148–53. PubMedGoogle Scholar
  44. Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar versus bipolar radiofrequency treatment of rhytides and laxity using a mobile painless delivery method. Lasers Surg Med. 2008;40:446–53. PubMedGoogle Scholar
  45. Sadick NS, Alexiades-Armenakas M, Bitter PJ, et al. Enhanced full-face skin rejuvenation using synchronous intense pulsed optical and conducted bipolar radiofrequency energy (ELOS): introducing selective radiophotothermolysis. J Drugs Dermatol. 2005;4:181–6. PubMedGoogle Scholar
  46. Yu CS, Yeung CK, Shek SY, et al. Combined infrared light and bipolar radiofrequency for skin tightening in Asians. Lasers Surg Med. 2007;39:471–5. PubMedGoogle Scholar
  47. Choi YJ, Lee JY, Ahn JY, et al. The safety and efficacy of a combined diode laser and bipolar radiofrequency compared with combined infrared light and bipolar radiofrequency for skin rejuvenation. Indian J Dermatol Venereol Leprol. 2012;78:146–52. PubMedGoogle Scholar
  48. Gold AH, Pozner J, Weiss R, et al. A fractional bipolar radiofrequency device combined with a bipolar radiofrequency and infrared light treatment for improvement in facial wrinkles and overall skin tone and texture. Aesthetic Surg J [Internet]. 2016;36:1058–1067. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/619/CN-01246619/frame.html.
  49. Verner I, Kutscher TD. Clinical evaluation of the efficacy and safety of combined bipolar radiofrequency and optical energies vs optical energy alone for the treatment of aging hands. Lasers Med Sci. 2017;32:1387–92. PubMedGoogle Scholar
  50. El-Domyati M, El-Ammawi TS, Medhat W, et al. Electro-optical synergy technique: A new and effective nonablative approach to skin aging. J Clin Aesthet Dermatol. 2010;3:22–30. PubMedPubMed CentralGoogle Scholar
  51. Gold MH, Goldman MP, Rao J, et al. Treatment of wrinkles and elastosis using vacuum-assisted bipolar radiofrequency heating of the dermis. Dermatol Surg. 2007;33:300–9. CASPubMedGoogle Scholar
  52. Prieto VG, Zhang PS, Sadick NS. Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. J Cosmet Laser Ther. 2005;7:63–8. PubMedGoogle Scholar
  53. Cameli N, Mariano M, Serio M, et al. Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging. Dermatol Surg [Internet]. 2014;40:553–561. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/384/CN-01117384/frame.html.
  54. Min S, Park SY, Moon J, et al. Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-abl. Lasers Surg Med. 2017;49:341–7. PubMedGoogle Scholar
  55. van der Lugt C, Romero C, Ancona D, et al. A multicenter study of cellulite treatment with a variable emission radio frequency system. Dermatol Ther. 2009;22:74–84. PubMedGoogle Scholar
  56. Nootheti PK, Magpantay A, Yosowitz G, et al. A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the Triactive system for the treatment of cellulite. Lasers Surg Med. 2006;38:908–12. PubMedGoogle Scholar
  57. Sadick NS, Mulholland RS. A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating. J Cosmet Laser Ther. 2004;6:187–90. PubMedGoogle Scholar
  58. Romero C, Caballero N, Herrero M, et al. Effects of cellulite treatment with RF, IR light, mechanical massage and suction treating one buttock with the contralateral as a control. J Cosmet Laser Ther. 2008;10:193–201. PubMedGoogle Scholar
  59. Hexsel DM, Siega C, Schilling-Souza J, et al. A bipolar radiofrequency, infrared, vacuum and mechanical massage device for treatment of cellulite: a pilot study. J Cosmet Laser Ther. 2011;13:297–302. PubMedGoogle Scholar
  60. Sadick NS, Shaoul J. Hair removal using a combination of conducted radiofrequency and optical energies--an 18-month follow-up. J Cosmet Laser Ther. 2004;6:21–6. PubMedGoogle Scholar
  61. Sadick NS, Laughlin SA. Effective epilation of white and blond hair using combined radiofrequency and optical energy. J Cosmet Laser Ther. 2004;6:27–31. PubMedGoogle Scholar
  62. Goldberg DJ, Marmur ES, Hussain M. Treatment of terminal and vellus non-pigmented hairs with an optical/bipolar radiofrequency energy source-with and without pre-treatment using topical aminolevulinic acid. J Cosmet Laser Ther. 2005;7:25–8. PubMedGoogle Scholar
  63. Jeon IK, Chang SE, Park G-H, et al. Comparison of microneedle fractional radiofrequency therapy with intradermal botulinum toxin a injection for periorbital rejuvenation. Dermatology [Internet]. 2013;227:367–372. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/238/CN-01070238/frame.html.
  64. Kim JK, Roh MR, Park G, et al. Fractionated microneedle radiofrequency for the treatment of periorbital wrinkles. J Dermatol [Internet]. 2013;40:172–176. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med7&NEWS=N&AN=23252484.
  65. Shin J-W, Park J-T, Chae J-B, et al. The efficacy of micro-insulated needle radiofrequency system for the treatment of lower eyelid fat bulging. J Dtsch Dermatol Ges. 2019;17:149–56. PubMedGoogle Scholar
  66. Roh NK, Yoon YM, Lee YW, et al. Treatment of periorbital wrinkles using multipolar fractional radiofrequency in Korean patients. Lasers Med Sci [Internet]. 2017;32:61–66. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med8&NEWS=N&AN=27686890.
  67. Calderhead RG, Goo BL, Lauro F, et al. The clinical efficacy and safety of microneedling fractional radiofrequency in the treatment of facial wrinkles: a multicenter study with The Infini System in 499 patients. 2013 [cited 2018 Jun 8]; Available from: https://int.aesthetic.lutronic.com/assets/PDFs/INFINI-WP-multicenter-Dr.Glen-2013.pdf.
  68. Alexiades-Armenakas M, Rosenberg D, Renton B, et al. Blinded, randomized, quantitative grading comparison of minimally invasive, fractional radiofrequency and surgical face-lift to treat skin laxity. Arch Dermatol. 2010;146:396–405. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/672/CN-00743672/frame.htmlPubMedGoogle Scholar
  69. Lu W, Wu P, Zhang Z, et al. Curative effects of microneedle fractional radiofrequency system on skin laxity in Asian patients: a prospective, double-blind, randomized, controlled face-split study. J Cosmet Laser Ther. 2017;19:83–8. PubMedGoogle Scholar
  70. Seo KY, Yoon MS, Kim DH, et al. Skin rejuvenation by microneedle fractional radiofrequency treatment in Asian skin; clinical and histological analysis. Lasers Surg Med [Internet]. 2012;44:631–636. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med7&NEWS=N&AN=22936274.
  71. Park HJ, Kim HM, Oh MJ. Clinical study of facial wrinkle treatment with fractional microneedle radio frequency system. Med Lasers [Internet]. 2014 [cited 2018 Jun 8];3:59–64. https://doi.org/10.25289/ML.2014.3.2.59. Available from: http://www.jkslms.or.kr/journal/view.html?.
  72. Gold M, Taylor M, Rothaus K, et al. Non-insulated smooth motion, micro-needles RF fractional treatment for wrinkle reduction and lifting of the lower face: International study. Lasers Surg Med [Internet]. 2016;48:727–733. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=27490716.
  73. Hruza G, Taub AF, Collier SL, et al. Skin rejuvenation and wrinkle reduction using a fractional radiofrequency system. J Drugs Dermatol [Internet]. 2009;8:259–265. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med6&NEWS=N&AN=19271373.
  74. Akita H, Sasaki R, Yokoyama Y, et al. The clinical experience and efficacy of bipolar radiofrequency with fractional photothermolysis for aged Asian skin. Exp Dermatol [Internet]. 2014;23 Suppl 1:37–42. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med8&NEWS=N&AN=25234835.
  75. Jiang Y, Zhang X, Lu Z, et al. Assessment of efficacy and safety of a fractionated bipolar radiofrequency device for the treatment of lower face wrinkles and laxity. J Cosmet Laser Ther. 2018:1–6. Google Scholar
  76. Lyons A, Roy J, Herrmann J, et al. Treatment of Decolletage Photoaging with fractional microneedling radiofrequency. J Drugs Dermatol. 2018;17:74–6. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=prem&NEWS=N&AN=29320590PubMedGoogle Scholar
  77. Cho SI, Chung BY, Choi MG, et al. Evaluation of the clinical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores. Dermatol Surg. 2012;38:1017–24. CASPubMedGoogle Scholar
  78. Gold MH, Biron JA. Treatment of acne scars by fractional bipolar radiofrequency energy. J Cosmet Laser Ther [Internet]. 2012;14:172–178. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med7&NEWS=N&AN=22548644.
  79. Dai R, Xie H, Hua W, et al. The efficacy and safety of the fractional radiofrequency technique for the treatment of atrophic acne scar in Asians: A meta-analysis. J Cosmet Laser Ther. 2017;19:337–44. PubMedGoogle Scholar
  80. Kaminaka C, Uede M, Matsunaka H, et al. Clinical studies of the treatment of facial atrophic acne scars and acne with a bipolar fractional radiofrequency system. J Dermatol. 2015;42:580–7. PubMedGoogle Scholar
  81. Phothong W, Wanitphakdeedecha R, Sathaworawong A, et al. High versus moderate energy use of bipolar fractional radiofrequency in the treatment of acne scars: a split-face double-blinded randomized control trial pilot study. Lasers Med Sci. 2016;31:229–34. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/263/CN-01139263/frame.htmlPubMedGoogle Scholar
  82. Kravvas G, Al-Niaimi F. A systematic review of treatments for acne scarring. Part 2: Energy-based techniques. Scars, Burn Heal. 2018;4:2059513118793420. Google Scholar
  83. Abtahi-Naeini B, FF N, Saffaei A, et al. Treatment of primary axillary hyperhidrosis by fractional microneedle radiofrequency: is it still effective after long-term follow-up? Indian J Dermatol 2016;61:234. Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/763/CN-01141763/frame.html.
  84. Schick CH, Grallath T, Schick KS, et al. Radiofrequency thermotherapy for treating axillary hyperhidrosis. Dermatol Surg. 2016;42:624–30. CASPubMedGoogle Scholar
  85. Kim M, Shin JY, Lee J, et al. Efficacy of fractional microneedle radiofrequency device in the treatment of primary axillary hyperhidrosis: a pilot study. Dermatology [Internet]. 2013;227:243–249. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med7&NEWS=N&AN=24107595.
  86. Alexiades M, Munavalli G, Goldberg D, et al. Prospective multicenter clinical trial of a temperature-controlled subcutaneous microneedle fractional bipolar radiofrequency system for the treatment of cellulite. Dermatol Surg. 2018;44:1262–71. CASPubMedGoogle Scholar
  87. Harmelin Y, Boineau D, Cardot-Leccia N, et al. Fractionated bipolar radiofrequency and bipolar radiofrequency potentiated by infrared light for treating striae: A prospective randomized, comparative trial with objective evaluation. Lasers Surg Med. 2016;48:245–53. PubMedGoogle Scholar
  88. Di Stefano N. The idea of beauty and its biases: critical notes on the aesthetics of Plastic surgery. Plast Reconstr surgery Glob Open. 2017;5:e1523. Google Scholar
  89. www.PlasticSurgery.org. PLASTIC SURGERY STATISTICS REPORT 2017 Plastic Surgery Statistics Report. [cited 2018 Jul 15]; Available from: www.plasticsurgery.org.
  90. Dayan E, Chia C, Burns AJ, et al. Adjustable depth fractional radiofrequency combined with bipolar radiofrequency: A minimally invasive combination treatment for skin laxity. Aesthetic Surg J. 2019;39:S112–9. Google Scholar
  91. Kleidona IA, Karypidis D, Lowe N, et al. Fractional radiofrequency in the treatment of skin aging: an evidence-based treatment protocol. J Cosmet Laser Ther [Internet]. 2019. https://doi.org/10.1080/14764172.2019.1674448, 9, 25, 22.

Author information

Authors and Affiliations

  1. Department of Dermatology, 1st University Clinic of Dermatology-Venerology, Athens, Greece Ileana Afroditi Kleidona
  2. Cranley Clinic, London, UK Ali M. Ghanem & Nicholas J. Lowe
  3. College of Medicine and Dentistry, Birmingham, UK Ali M. Ghanem
  4. UCLA, Los Angeles, California, USA Nicholas J. Lowe
  1. Ileana Afroditi Kleidona