The Efficacy and Safety of Subcutaneous Radiofrequency After Liposuction: A New Application for Face and Neck Skin Tightening

A Randomized, Double-Blind, Placebo-Controlled, Multicentered Study to Evaluate the Efficacy and Safety of MEI005 in Reducing Submental Fat in Chinese Adults

BACKGROUND

Submental fat (SMF) is a common aesthetic concern traditionally treated with liposuction. Nonsurgical alternatives, like injectable deoxycholic acid, are gaining popularity. However, no related products have been clinically approved in China.

OBJECTIVES

This study evaluated the efficacy and safety of MEI005, a deoxycholic acid-based injectable formulation, in reducing SMF in Chinese adults.

METHODS

This multicenter, randomized, double-blind, placebo-controlled Phase III trial included 325 Chinese adults with moderate-to-severe SMF. Participants received MEI005 or a placebo injection every 28 days for up to 6 sessions. Primary endpoints were ≥2-grade improvements in Clinician and Patient-Reported Submental Fat Rating Scales (CR-SMFRS and PR-SMFRS). Secondary endpoints included SMF volume reductions measured by MRI; patient-reported outcomes on the Patient-Reported Submental Fat Impact Scale (PR-SMFIS) and Subject Self-Rating Scale (SSRS); and SMF thickness reductions measured by caliper. Adverse events (AEs), self-reports, clinical examinations, and checks for skin laxity were monitored.

RESULTS

At 12 weeks posttreatment, 18.9% of MEI005 recipients demonstrated simultaneously ≥2-grade CR-SMFRS and PR-SMFRS improvement vs 1.8% for placebo (P < .001). Additionally, 68.9% of MEI005 group participants achieved simultaneously ≥1-grade improvement in CR-SMFRS and PR-SMFRS, compared with 21.6% of placebo (P < .001). MRI revealed ≥10% SMF volume reduction in 50% of MEI005 patients vs 15.2% of placebo (P < .001). Scores on the PR-SMFIS and SSRSs showed greater psychological improvement and satisfaction among MEI005 recipients. Vernier caliper measurements showed a 21.42% thickness reduction vs 6.32% (P < .001). AEs were mostly mild to moderate.

CONCLUSIONS

MEI005 effectively reduces SMF, offering a safe, minimally invasive option for Chinese adults.

LEVEL OF EVIDENCE: 2

A Retrospective Evaluation of the Safety of Combining Helium-Based Plasma Radiofrequency Technology With Ultrasound-Assisted Lipoabdominoplasty

Background

Helium plasma radiofrequency (RF; Renuvion; Apyx Medical, Clearwater, FL) is cleared for use in the coagulation/contraction of subcutaneous soft tissue, in body contouring, and to address loose skin in the neck and submental region. The device instantly heats target tissue to >85 °C, causing rapid protein coagulation within 0.04 s, resulting in tissue contraction. The use of multiple energy-based devices in lipoabdominoplasty is controversial.

Objectives

To assess the safety of helium plasma RF as an adjunct to lipoabdominoplasty utilizing ultrasound-assisted liposuction (UAL; VASER, Solta Medical, Bothell, WA).

Methods

In this retrospective, single-center study, medical records for patients who underwent UAL and abdominoplasty with or without helium-based plasma RF as an adjunct for subdermal coagulation between October 2017 and March 2023 were reviewed. Primary outcomes included significant and nonsignificant adverse events (AEs). Univariate and multivariate analyses were used to identify any risk factors for AEs.

Results

A total of 40 patients treated with lipoabdominoplasty and helium plasma RF and 37 patients treated with lipoabdominoplasty alone were included in the analysis. Overall, no significant difference between groups was detected for the occurrence of significant AEs (P = .628).

Conclusions

In this study, it is indicated that the helium plasma RF device may be a safe adjunct for UAL lipoabdominoplasty. When used for subdermal coagulation in the abdominal area, the device does not appear to increase the incidence of serious AEs or introduce risk to the flap.

Level of Evidence 3 Therapeutic

Scarless Enhanced Body Contouring

BACKGROUND

A helium-based plasma device with minimal invasiveness selectively heats tissues via joule heating, ensuring safe external temperatures and eliminating the need to monitor the epidermal temperature.

METHODS

From December 2022 to January 2024, Forty-six patients without prior bariatric surgery, who had localized lipodystrophy and mild-to-moderate skin laxity in various body areas, were enrolled in this prospective work. Liposuction was paired with a helium-based plasma radiofrequency device used for all patients. Data on demographics and postoperative complications were disclosed. A patient evaluation was conducted objectively and subjectively, using an independent plastic surgeon assessment and a patient satisfaction survey, respectively.

RESULTS

Our technique was performed on 40 females (87%) and six males (13%), in various body areas: arm (fourteen cases: 30.4%), neck (ten: 21.7%), thigh (nine: 19.6%), abdomen (seven: 15.2%), back (three: 6.5%), gynecomastia (three: 6.5%), their age ranges from 23 to 57 years, and their body mass index (BMI) ranges from 24 to 34.6 kg/m2. Patients' satisfaction at 6 months after surgery was 82.6% (38) satisfied, 15.2% (7) borderline, and 2.2% (1) unsatisfied. Individual plastic surgeon evaluation was 69.6% (32) excellent, 28.3% (13) good, and 2.1% (1) fair. The overall complications rates were postoperative edema in 22 cases (47.8%), ecchymosis in 11 cases (23.9%), persistent skin laxity in one case (11.1%), mild seroma in three cases (6.5%), pain and tingling in six cases (13%), and mild subcutaneous emphysema in four cases (8.7%).

CONCLUSIONS

Combined liposuction and helium-based plasma radiofrequency device usage are a safe, efficient, and minimally invasive substitute for excisional procedures in non-bariatric patients with localized lipodystrophy and mild-to-moderate skin laxity.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Refining Liposuction Safety and Efficacy: Surgeon Learning-Curve Analysis With Helium-Based Plasma Integration

Background

The introduction of medical advancements requires ongoing critical evaluation of clinical practice and patient outcomes to improve results and safety. Since the development of minimally invasive, energy-based devices, this process has been occurring throughout the field of aesthetic medicine.

Objectives

To collect retrospective procedure and safety data of liposuction procedures with or without adjunct utilization of a helium-based plasma device, compare 3 groups, and delineate the learning curve.

Methods

A retrospective chart review at a single site included healthy patients ≥18 years of age treated by the principal investigator (PI). A total of 50 patients had an ultrasonic-assisted liposuction procedure, 50 patients had a liposuction procedure with the utilization of the helium-based plasma device, and 50 of the PI's most recent patients had a liposuction procedure with the utilization of the helium-based plasma device. All patients had at least 6 months of documented postoperative follow-up care.

Results

Totally, 150 patients were enrolled in the study. Most patients had multiple body areas treated, primarily hips and abdomen. Treatment settings varied, with significant relationships found between pain and treatment groups (P = .013). No serious or unexpected adverse events (AEs) were reported, and all AE resolved before the final follow-up.

Conclusions

The data collected support that patient outcomes and safety improve with continued use of the helium-based plasma device by the PI. The data also support the use of a helium-based plasma device as safe when used in combination with liposuction procedures.

Level of Evidence 4 Therapeutic

Combining Liposuction and Thread-Lifting for Middle-Lower Facial Rejuvenation

BACKGROUND

Thread-lifting (TL) is a minimally-invasive technique for facial rejuvenation, whereas liposuction is commonly used for facial contouring. This retrospective cohort study aims to introduce and evaluate a novel technique that combines liposuction and thread-lifting for mid-lower facial rejuvenation.

METHODS

Consecutive patients who underwent TL for mid-lower facial rejuvenation from May 2016 to May 2021 were divided into thread-lifting group (TL group) or thread-lifting plus liposuction group (TLL group) according to whether liposuction was performed adjunctively. The co-primary outcomes were the changes between the preoperative and 6-month postoperative Wrinkle Severity Rating Scale (WSRS) and Facial Aging Evaluation Scale (FAES).

RESULTS

A total of 185 patients (184 females) with an average age of 34.5±5.5 years were included. There were no significant differences in patients' age, number of threads, and preoperative WSRS and FAES between the two groups. The TLL group (n = 128) had significantly lower postoperative WSRS (1.5±0.6 vs. 1.8±0.8, p<0.001) and FAES (2.5±1.4 vs. 3.8±2.1, p<0.001) than the TL group (n = 57). The decrease in WSRS (0.8±0.6 vs. 0.2±0.7, p<0.001) and FAES (2.7±1.3 vs. 1.6±1.6, p<0.001) were greater in the TLL group. Only 3.8% patients experienced slight side effects and totally recovered.

CONCLUSIONS

The combination of TL and liposuction is an effective and safe technique for simultaneous contour improvement and facial rejuvenation in middle-aged East Asian females.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

A Retrospective Analysis of Upper Arm Rejuvenation Surgery in 50 Patients

BACKGROUND

Upper arm aesthetics often suffer from aging effects such as skin laxity and sagging due to collagen and elastin depletion. Fat loss, obesity, and weight fluctuations further exacerbate these issues. Existing classification systems for upper arm excess are complex and have practical limitations.

OBJECTIVES

The aim of this study was to develop a more concise and clearer classification of upper arm excess that can guide surgical interventions effectively and assess clinical outcomes.

METHODS

Patients undergoing upper arm rejuvenation surgery from January 2020 to January 2023 were categorized as mild, moderate, or severe. Mild cases underwent suction-assisted liposuction (SAL), moderate cases underwent radiofrequency-assisted liposuction combined with SAL, and severe cases underwent brachioplasty combined with SAL. Arm circumferences and BODY-Q questionnaires were collected pre- and postoperatively.

RESULTS

The study included 50 female patients, aged 21 to 49 years. The average follow-up time was 7.5 [2.2] months. Arm circumference reduction rates were 6.8% in mild cases, 15.1% in moderate cases, and 17.3% in severe cases. Regarding the BODY-Q questionnaire for upper arms, the average score increased by 0.9 for mild, 2.1 for moderate, and 2.9 for severe cases. Complications were minimal, including 1 seroma and 2 cases of scar widening.

CONCLUSIONS

The revised classification system for upper arm excess proved effective in guiding surgical decisions. Selecting the surgical approach based on severity resulted in satisfactory outcomes based on BODY-Q scores. This system offers a concise, objective, and practical tool for plastic surgeons.

LEVEL OF EVIDENCE: 3

Non-invasive Body Contouring Technologies: An Updated Narrative Review

INTRODUCTION

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices.

METHODS

We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring.

RESULTS

Totally 193 references were used in 11 main topics.

CONCLUSION

In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section.

LEVEL OF EVIDENCE I

This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

The Safety of Contraction of Subcutaneous Tissue Following Liposuction Procedures

This paper examines the practice of using a helium plasma radiofrequency (RF) device for contracting subcutaneous soft tissue following liposuction in all body areas. A review of the data from 6 industry-sponsor-initiated retrospective studies was performed, wherein 483 real-world patients underwent liposuction followed by contraction of the subcutaneous soft tissue with the helium plasma RF system. These data were evaluated to determine if any new or increased risks were introduced compared to the risks of liposuction alone. The totality of the real-world data demonstrates there are no new or increased risks for helium plasma RF procedures following liposuction compared to liposuction alone. These data support the safety of helium plasma RF for subcutaneous soft-tissue contraction following liposuction. There are currently no alternative therapies specifically cleared by the FDA that can claim use following liposuction for the purpose of contracting the subcutaneous soft tissue.

Level of Evidence 3

"Subzone-Counting" Method in Asian Facial Liposuction: A Retrospective Study

BACKGROUND

Facial liposuction is a popular and reliable procedure for patients with subcutaneous fat accumulation pursuing the ideal face shape. However, complications like irregularities and asymmetry are still problems for plastic surgeons. To lower the incidence of the above complications, we developed the "subzone-counting" method. In this study, this technique was introduced and evaluated.

METHODS

By several lines all parallel to the earlobe-mouth corner line, the liposuction area was subdivided into several subzones. With consistent negative pressure, the paths of the cannula trip in all subzones were also parallel to the earlobe-mouth corner line. An objective index could be obtained by counting the number of aspiration in every subzone. Based on this index, the real-time adjustment was made to achieve smoothness and symmetry.

RESULTS

This study identified 32 Chinese patients who accepted this method between January 2019 and January 2021. The follow-up ranged from 6 to 44 months. Twenty-nine and 3 patients were satisfied and somewhat satisfied with the postoperative outcome, respectively. No patient was unsatisfied with the outcome. And no major complication was reported.

CONCLUSIONS

The "subzone-counting" method is safe and effective for facial liposuction. The approach helps intraoperative judgment and adjustment. According to the real-time counting results, contour smoothness and bilateral symmetry can be easily achieved and less dependent on the surgeon's experience.

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.

Evaluation and Treatment Planning for the Aging Face Patient

Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.

Microliposuction and radiofrequency combined with the thread technique as a new method used in lower face lifting

BACKGROUND

Minimally invasive facial rejuvenation is a popular and well-established treatment for patients seeking facial lifting.

OBJECTIVE

The authors combined facial microliposuction, radiofrequency, and thread lifting technology as a comprehensive treatment (LRT) for facial rejuvenation in a case series of 57 patients.

METHODS

A total of 76 patients underwent surgery and 75% completed 6 months of follow-up (57 patients); the patients were aged 26 to 51 (33.6 ± 4.5) years. All patients were followed up for hematoma within 1 week after the operation and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. Patient satisfaction with the postoperative aesthetic effects was analyzed by Face-Q™ at 6 months after the operation.

RESULTS

The score for hematoma within 1 week was 1.21 ± 0.33, scores for postoperative skin numbness within 1 week and 3 months were 2.06 ± 0.51 and 1.17 ± 0.32, respectively, and scores for postoperative muscle paralysis within 1 week and 3 months were 1.31 ± 0.55 and 1.00 ± 0, respectively. Fifty-seven patients completed Face-Q™ (score: 22.1 ± 1.8, standard score: 82.2 ± 14.8).

CONCLUSION

LRT is a minimally invasive method that can achieve a synergistic and satisfactory result for patients with mild to moderate facial skin sagging.

A Systematic Review of Subsurface Radiofrequency Treatments in Plastic Surgery

BACKGROUND

Subsurface radiofrequency (RF) treatments produce skin contraction by causing coagulation of the underlying subcutaneous fat. This method is marketed to fill a treatment gap for patients who do not wish to have surgery. A systematic review of this subject has not been previously published.

METHODS

An electronic search was performed using PubMed to identify the literature describing subsurface RF treatments.

RESULTS

Thirty articles were evaluated. An InMode device was used in 23 studies, and a Thermi device was used in 6 studies, with or without liposuction. Treatment areas included the face, neck, body, breasts, and labia. Most studies relied on patient satisfaction scores and physician review of photographs. The most frequent complications were induration and nodules. Most patients experienced prolonged swelling and numbness. Several studies reported marginal mandibular neuropraxias. The skin response after treatment of the abdomen was poor, and seromas were common. The incidence of burns improved after modification of the InMode device. Breast treatment did not appear to be effective in treating ptosis. Patient satisfaction scores were modest. Most studies (77%) were published by authors with a known conflict of interest. In some studies, the photographs did not accurately depict the treatment result. Institutional review board approval and disclosure of off-label regulatory status were often missing.

DISCUSSION

Thermal treatment of the subcutaneous tissue introduces extra risks without a compensatory benefit. Comparisons in terms of safety, cost, recovery time, results, and complications do not favor energy-based devices. A treatment gap may be fictitious; properly informed patients may be treated with existing surgical procedures at all ages.

CONCLUSIONS

Little evidence supports the efficacy and safety of subcutaneous RF treatments as an improvement over results that may be obtained using traditional surgical methods such as submental lipectomy, liposuction, and abdominoplasty. Photographic integrity is often lacking. Financial conflict of interest is pervasive. Marketing precedes the science. Plastic surgeons need to be aware of these serious limitations and the off-label regulatory status of these devices, before purchasing expensive equipment and recommending subsurface RF treatments to patients.

The MICRO-Lift: A Ligaments-Based Anatomic Technique for Lower Face and Neck Rejuvenation Using Bipolar Radiofrequency

BACKGROUND

The aim of this paper is to present the results of a new technique for lower face and neck rejuvenation named the MICRO-lift (Minimally Invasive, Combined Radiofrequency, Outpatient lift). This technique is based on a bipolar radiofrequency treatment applied to specific ligamentous areas.

METHODS

Inclusion criteria were patients with skin laxity of the neck and jowls, with or without fat accumulation. Patients who presented platysma sag and alteration of subplatysmal structures were excluded from the study. The distribution of the energy was adapted to the ligament anatomy, differentiating three areas based on the energy concentration. In all patients, sex, age at surgery, type of anesthesia, radiofrequency parameters and complications were registered. In all cases, standard photographs and satisfaction interviews were conducted preoperatively and postoperatively. Satisfaction evaluation was also assessed.

RESULTS

Sixty-five patients underwent MICRO-lift technique for the lower face and neck. All patients in our series were female. There were no major complications. Minor complications included transient paralysis of the marginal mandibular (4,6%), infection of the submental incision that required incisional drainage (3,1%), and deep skin burn in the neck (1,5%). Fifty-nine patients were satisfied a year after the treatment (90,8%).

CONCLUSIONS

The MICRO-lift can produce outstanding and satisfying improvements in cervicofacial appearance. This new approach offers a predictable strategy to achieve the desired aesthetic results, making this procedure more reliable and reproducible for both novel and experienced surgeons with bipolar radiofrequency.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Current status and prospects of clinical application of liposuction]

OBJECTIVE

To review the characteristics and deficiencies of various liposuction methods to provide reference for choosing more suitable liposuction in clinic and ideas for the improvement and development of liposuction equipment.

METHODS

The literature related to liposuction in recent years was consulted, and the principle, indications as well as existing problems were reviewed.

RESULTS

Liposuction can be divided into two categories according to the principles of fat separation. The first type relies on physical cutting to separate fat, including suction-assisted liposuction (SAL), power-assisted liposuction (PAL), and water-assisted liposuction (WAL). SAL and PAL are simple to operate and low in price, but the effect of liposuction mainly depends on the experience of the surgeon, and complications such as uneven appearance, hematoma, and ecchymosis may occur. WAL saves time and effort, but has lower cost performance. The second type relies on energy destruction to separate fat, including ultrasound-assisted liposuction, laser-assisted liposuction, and radiofrequency-assisted liposuction. This type of surgery has the advantages of less trauma, fast postoperative recovery, and skin tightening. However, the equipment is more expensive, and has a risk of skin burns.

CONCLUSION

Liposuction can effectively reduce local fat accumulation, but it still has limitations. Equipment improvement and fat transplantation are important directions for liposuction's future development.

Extending the "Reach" of the Short-Scar Facelift with Energy Devices-An Early Report

Facial rejuvenation has become more popular. A wider breadth of the patient population is seeking procedures to preserve their youthful facial attributes and to remedy age-related deleterious changes. Along with this increasing interest in facial rejuvenation is also the expressed desire for any interventions to be relatively low risk, with limited recovery, and with achievable positive results. Many new technologies have become available in an attempt to improve age-related facial changes. The radiofrequency (RF)-based technologies are largely directed toward skin tightening and toward reducing and remodeling subcutaneous fat. It can be contemplated that the combination of RF-based technology with limited surgical procedures may extend the patient selection for less invasive procedures while improving potential results. This is a report of the combination of radiofrequency technologies-percutaneous and transcutaneous-with short scar face techniques in facial rejuvenation.