Introduction:
Age-related skin wrinkling and sun radiation exposure are linked. Although the scattering of light by epidermal melanin prevents laser or broadband light from reaching the deep dermal layers, a novel device with less dispersed broadband infrared light may be able to circumvent these restrictions. In addition to being shown to encourage collagen remodeling and contraction, RF energy offers a therapy alternative that is not scattered by epidermal elements.
Recently introduced technologies that combine RF and optical energy produce clinical benefits at lower, safer energy levels, with little side effects and minor pain. To produce the required therapeutic impact, a combined infrared-RF gadget makes the most of both optical and RF technologies. The safety, efficacy, dependability, and user-friendliness of the electrooptical synergy systems have been demonstrated. Other, more powerful technologies might work well in this situation as well.
Skin laxity can be fixed through tissue tightening. Patients who do not want surgery or are not good candidates for rhytidectomy are good candidates for nonsurgical skin tightening. Additionally, some patients who have had facelift surgery have discovered that postoperative nonsurgical skin tightening improves their outcomes.
What Is the Mechanism of Collagen Shrinkage?
In the form of a triple helix, collagen is a polymer with chains connected by hydrogen bonds. Due to intermolecular cross-links, these molecules have aggregated and are arranged into fibrils having tensile characteristics. Heat causes collagen to denature, which causes the triple helices to "unwind to produce a gel of random-coil molecules."
The collagen polymer's increased rubber-elastic characteristics results in the tissue tension in human skin to rise even if the fibers get shorter. The heat-modified tissues then go through remodeling accompanied by fibroplasia and new collagen deposition. Further temperature increases cause additional fiber shortening once denaturation is complete, most likely as a result of peptide bond hydrolysis. A thorough explanation of the collagen shrinkage mechanism has been provided.
It's common knowledge that collagen shrinks at a temperature of 65 °Celsius. However, the Arrhenius equation, which has the variables k as the rate constant, A as the frequency of molecular collisions, E as the activation energy, R as the gas constant, and T as the absolute temperature, describes collagen denaturation. This equation states that collagen contraction happens at a variety of time-temperature combinations rather than at a single temperature and that collagen shrinking relies on both time and temperature.
Nevertheless, it has been hypothesized that collagen shrinkage for millisecond exposures will only happen at temperatures higher than 85° Celsius, whereas shrinking for exposures of many seconds will happen at 60° Celsius to 65° Celsius.
What Are the Non-surgical Skin Tightening Treatment Approach?
Non-surgical skin tightening treatment solutions are based on heat-induced tissue damage caused by light, radiofrequency, or both forms of energy. The most recent nonsurgical skin tightening techniques have been examined.
Devices Based on Light and Lasers:
The principle of selective photo-thermolysis, which dictates that the laser wavelength must be more strongly absorbed by the target tissue than by surrounding tissues, the amount of energy (fluence) must exceed the target's therapeutic threshold, and energy must be delivered within the thermal relaxation time, forms the basis for the design of laser and light devices. The thermal relaxation time is the amount of time it takes for the target structure to lose 50 percent of the energy that has been provided. The therapeutic threshold is the least quantity of energy needed to achieve the therapeutic goal.
It has been demonstrated that ablative CO2 or Erbium-YAG laser treatments of face skin result in collagen remodeling and contraction that tightens skin and minimizes wrinkles. Even though these treatments have remarkable efficacies, erythema, pigmentary changes, infection, dermatitis, scarring, and protracted healing durations are frequent side effects. The likelihood of side effects is based on the treating physician's experience and has been somewhat mitigated by better laser design.
Devices using non-ablative lasers and broadband light have been created to speed up healing and lower the possibility of side effects from ablative procedures. These devices' beams cause heat injury to the dermis' lowest layers and promote the creation of collagen, but they spare the epidermis. Intense Pulsed Light (IPL) and wavelengths between 532 and 1540 nm have both been applied with different degrees of success.
Although collagen remodeling has been histologically demonstrated to occur following laser or light-based treatments,12,14 there has been inconsistent evidence linking remodeling to clinical benefit.12,15 Full-face IPL or laser treatments using a mix of devices with wavelengths of 532 nm and 1064 nm appear to stimulate overall collagen remodeling and increase patient satisfaction.
Technology using Fractional Ablative RF:
The treatment tip carves craters in the skin that resemble cones using a variety of sharp RF conductive needles. The papillary and reticular dermis showed profound ablation and collagen rearrangement according to histological findings. Similar to the outcomes of fractional ablative CO2, the authors claimed that the amount of skin tightening and decrease in wrinkles was obtained.
Re-epithelialization took place in each case within 4 to 7 days, never causing substantial negative side effects such as hypopigmentation, PIH, or hypertrophic or hypo-trophic scars. The direct energy delivery approach made possible by microneedles led the authors to the conclusion that the fractional RF multi-needle technology was efficient and safe with minimal danger of hyper- or hypo-pigmentation on Asian skin.
Conclusion:
Few would contest the fact that energy-based technologies have been used in aesthetic surgery and medicine. Patients who have had previously received RF treatment have reported some loss of pigmentation (medial arm skin) and linear subcutaneous arm fat atrophy. The 407 Energy-Based Surgical Tools experiment was unsuccessful. However, individual differences in chemical and physical properties, such as tissue stiffness, fat architecture, water content, heat absorption, and many other factors, are to blame for the variability in tissue response to restructuring by energy-based devices. This variability can occasionally affect consistency. There is no question that more research will establish evidence assisting in the best selection, even while certain physically dissimilar modalities (for example., use of heat for lipolysis vs use of cool) seem to yield a similar clinical outcome.
