Multiple Passes, Reduced Settings Tighten Tissue With ThermaCool


SCOTTSDALE, ARIZ. — Radiofrequency tissue tightening using Thermage's ThermaCool TC system has gained favor for wrinkle reduction with the standard use of a single pass of the device, but better results and greater tolerance are seen with a multiple-passes approach using reduced treatment-level settings, said Bill H. Halmi, M.D., at a meeting sponsored by the Skin Disease Education Foundation.

The ThermaCool system, which has received Food and Drug Administration approval for smoothing wrinkles and sagging skin around the face, has yielded only modest results, and subtle changes were often not even noticeable, said Dr. Halmi, a dermatologist and owner of Arizona Advanced Dermatology in Phoenix.

Furthermore, the treatment was not without some discomfort, and early safety observations showed a 6% rate of scarring or texture change 6 months post treatment.

In a new technique introduced last year by Brian Zelickson, M.D., however, use of multiple passes in a single treatment with lower frequency showed the achievement of greater deep-collagen denaturation. In addition, the already rare risk of surface tissue damage was further decreased, as was patient discomfort.

Dermatologists including Dr. Halmi have picked up on the multiple-passes approach and report much improved results. "The newer treatment paradigm is much better tolerated, reduces the risks, and appears so far to offer better results," Dr. Halmi said.

With the multiple-passes approach, frequency should be reduced and as many as four or five passes can be used. "One pass is made over the entire surface area, then on the second pass you concentrate on the areas of interest, and you can go on to four or five passes on the face to reach a clinical point of physical tightening," Dr. Halmi said.

Since there is immediate collagen contraction, visible results are seen right away, but this response usually lasts only a matter of hours or days. It typically takes about 2 months, however, to see the maximum results of the more important secondary response showing collagen remodeling and tightening.

While radiofrequency (RF) waves have long been used in dermatology for purposes such as electrocoagulation and skin resurfacing, the ThermaCool system is unique in that it uses a patented capacitive coupling to give greater uniformity in heating and tightening deeper tissue, Dr. Halmi explained.

The device also uses cooling before, during, and after the delivery of the RF energy to protect the epidermis.

Slides presented from Dr. Halmi's practice showed dramatic improvement in areas including the nasolabial fold, the jowls, and especially the neck.

"It turns out neck tightening is probably the area this [treatment] does the best in," Dr. Halmi said. "Using the 'traditional' protocol of one pass usually achieves at least subtle results, but multiple passes appear to be yielding much better results."

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

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