Treatment of Nasolabial Folds and Jowls With a Noninvasive Radiofrequency Device

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Abstract
We report our experience with a new noninvasive, nonablative radiofrequency device to treat redundant nasolabial folds, jowls, and marionette lines. This device likely causes collagen tightening by producing controllable volumetric heating of the deep dermis. Verbal and written informed consent regarding the potential benefits and risks of the procedure was obtained from each patient. Patients were informed that the treatment is part of a protocol and that the radiofrequency device is not approved by the Food and Drug Administration for use on the lower two thirds of the face, but has been approved for use on the forehead for periocular rhytids and laxity. Twenty-four adult patients (23 women, 1 man) with redundant nasolabial folds, marionette lines, and jowls received 1 to 3 passes using 106 to 144 J with the Thermacool system (Thermage; Hayward, Calif). Each received 1 to 3 monthly 25- to 35-minute treatment sessions on the lower two thirds of the face (extending from the lateral cheeks just inferior to the lateral canthus, along the jawline, to the chin). Each treatment session involved application of a 1 × 1-cm treatment tip to the skin for approximately 3 seconds for a total of approximately 120 application points. Five patients also received 1 to 3 passes along the lateral aspect of the neck in a single treatment session. Anesthesia included topical anesthetic cream (EMLA cream; Astra USA, Westborough, Mass) and adjunctive propofol (1 patient), oxycodone-acetaminophen (5 mg/325 mg) (10 patients), or intravenous ketorolac (3 patients). Photographs were taken before treatment and at 1 and 2 months' follow-up with the same camera and in identical positions using a specialized headrest. Two physicians (L.G.S.J., R.G.G.) evaluated the photographs to assess improvement. In addition, further quantitative analysis was performed for 2 patients using a computerized 3-dimensional microtopography imaging system (PRIMOS; GFM, Teltow, Germany).1

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