By the Dr Nathalie Fournier

Radiofrequency (RF) is used in aesthetic medicine to tighten and regenerate the tissues. It is a very appealing, non-invasive alternative to a face or body lift, filler injections, tensor threads, liposuction and other treatments. Its many variations are used on the face, body and intimate area, with very good results. The current trend is to combine this technology with other methods to optimise their effects.

There are several types of radiofrequency configurations:

Bipolar RF (Multipolar RF works along the same lines but with multiple electrodes): The dermis is treated by heating up the superficial tissue. The heat is created by the current that circulates between the two electrodes, and its power scale is restricted according to the distance between the electrodes.
Unipolar RF: This does not require an earthing plate but offers limited control over the current’s power.
Monopolar RF: This penetrates the tissues better. The current runs through the tissues to the earthing plate. The energy delivered is better regulated.
Regardless of the delivery method, these radiofrequency treatments all lead to the reorganisation of the collagen and elastin fibres. The thermally-focused energy disrupts and modifies the collagen and elastin fibres that have become disorganised and rigid with aging. The controlled heat delivered to the site quickly and efficiently separates the targeted structures of collagen and elastin. Next, the natural healing process calls upon the dormant fibroblasts to actively produce collagen and elastin fibres and rebuild tissue with a more organised structure.

Fractional radiofrequency with microneedling, the latest generation of RF, has a specific way of working. It leads to the fractional heating of the epidermis and dermis. The time that the tissues are exposed to very high temperatures is very short, thanks to the use of special needles – which may or not be insulated – that deliver the current into the tissues to be treated. By stimulating and producing fibroblasts, in a few days it leads to the production of new collagen and elastin, a process that lasts for several weeks. Suitable indications are skin with reduced fibroblast activity and numbers, deteriorated skin with a loss of collagen and elastin fibres, and low hyaluronic acid levels.

The latest generation of devices often combine radiofrequency with other technologies for a synergic effect on the targeted tissue.
Combining monopolar RF with focused ultrasounds (US) potentiates the effects of both techniques. The US produce energy that has a two-fold mechanical and thermal component. The mechanical energy of US leads to the even heating of the tissues with increased blood flow, tissue conductivity and increased cell permeability. The response of the targeted tissue is therefore faster, more intense and more predictable. In the case of sagging skin on the body or face, with this type of hybrid machine we can achieve up to a 35% reduction in skin sagging in the dermis and epidermis, a 35% reduction in wrinkles, 33% reduction in the severity of photoaging, and a 19% increase in skin density. Using biopsies and scans, we also observe an increase in collagen and elastin volumes, as reported by D. McDaniel and R. Weiss.

This blended technique has gradually made a name for itself as the gold-standard non-invasive treatment in my practice, parti- cularly for skin sagging. The most frequently requested treatment zones are the oval of the face, along with the jowls, inner arms, inner thighs and abdomen. When the indication is reducing fatty deposits and tightening the skin, this combination also offers pleasing results, whether on the abdomen, love handles or saddlebags.

There is an increasing demand for radiofrequency, either on its own or combined, to treat the body. The aim is to help patients feel better in their own skin, to improve their overall appearance, and to combat excess fat and weak muscles, cellulite and sagging skin. Patients seek an “all-in-one” treatment for fat, muscle and skin, for a quick, comprehensive and effort- less body contouring treatment.
In the patients’ eyes, only resolving problems in one of these three tissues does not offer a satisfactory transformation. Reducing fat (e.g. cryolipolysis) wit- hout treating the muscles or skin will leave behind cellulite and a saggy bottom, for example. Similarly, treatments that target only the skin (e.g. radiofre- quency on its own) will not remove any fatty deposits or address muscle laxity in the abdomen. Similarly, the results obtained in the muscles alone will be concealed by any fat stores.

The answer is to combine these treatments with RF.

Here are the options I previously used on their own:
– For muscle: HIFEM (High Intensity Focused Electromagnetic Fields) technology that causes supramaximal contractions in the muscle, which quickly builds and tones the muscles in the treatment areas.
– For fatty deposits: Monopolar RF technology combined with focused ultrasounds in the subcutaneous fat, which leads to cellular apoptosis to reduce fatty deposits.
– For skin sagging and cellulite: A technology that combines another type of focused monopolar RF in the skin and shock waves (Targeted Pressure Energy). Despite the good results, using three different devices on one area is very time-consuming and often too expensive for the patient.

The protocols I use today:

The recent introduction of a technology that simultaneously delivers HIFEM and bipolar RF (NEO-BTL) in one single treatment allows us to treat the skin, fat and muscle in one 30-minute session per zone, instead of the previous hour to 90 minutes depending on the treatment zone. It causes lipolysis of the adipocytes in the target area by maintaining a high temperature – 43 to 45°C – in the fatty tissue.

This new technology is suitable for most patients, such as those who do not want to undergo invasive techniques to reduce their fat mass, patients with a high BMI who want to reduce their fat mass and increase their muscle mass, patients with a low BMI who want to reshape their muscles, those that want a non-invasive bum lift, athletes who want to improve their performance, etc. This technique allows us to treat the abdomen, all four sides of the thighs, buttocks, arms and calves.

The results achieved 3 months after the last session: around 30% reduction in fatty deposits, 25% muscle growth, 19% reduction in the diastasis recti, 5.9cm average reduction of the waist measurement.

For patients who have more cellulite, we carry out two steps in a single, one-hour session. The first phase of the session involves building muscle and reducing fat with a machine that combines bipolar RF with HIFEM. The second phase of the session is designed to improve the appearance of cellulite and skin texture with another machine (Emtone-BTL) that combines monopolar thermal RF with shock waves (TPE), for mechanical targeted pressure energy. This technique is becoming the gold-standard cellulite treatment. The simultaneous emission of the two energies has a greater impact than if they were applied consecutively on the conjunctive tissue.
The mechanical stimulation breaks up the rigid and disorganised collagen fibres. The thermal stability of the collagen is vastly reduced. This thermal instability leads to the breakdown of the collagen, and the intense proliferation of the fibroblasts. It is followed by major collagen and elastin synthesis, then increased production and reorganisation of the new fibres. It creates a 59% increase in collagen in the targeted tissue, 64% more elastin, and a 44% increase in dermal thickness, according to Kinney et al. 2021.

This combined treatment halves the treatment time for both the patient and the operator. It requires no needles, no anaesthetic and no downtime.
We recommend checking the quality and the number of clinical studies carried out for any given device, as the versatility of the emission modes and frequencies can lead to disappointment for patients and practitioners. It is best to use platforms that combine RF with other technologies, for better patient results.

Références :

• Deletion of adipocytes induced by a novel device simultaneously delivering synchronized radiofrequency and hifem: Human histological study, Goldberg DJ, JCosmetD 2021 jan

• Activation of Skeletal Muscle Satellite Cells by a Device Simultaneously Applying High-Intensity Focused Electromagnetic Technology and Novel RF Technology: Fluorescent Microscopy Facilitated Detection of NCAM/CD56, Halaas Y, Duncan D, Bernardy J, Ondrackova P, Dinev I , ASJ 2021


By the doctor Nathalie Fournier
Aesthetic dermatologist.
Founder of the Aesthetic Laser Centre for Dermatology and Phlebology.
Member of the American Society for Laser Medicine and Surgery, French Society for Laser Medicine, French Society for Lasers in Dermatology.
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