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Radiofrequency RF is a new technique to treat facial wrinkles. This study was designed to assess the efficacy of Accent RF in wrinkle reduction of different areas of the face. Patients with mild to severe facial wrinkles were treated with Accent using RF energies of W. The average energy used in this study was Patients received four subsequent weekly RF sessions. Wrinkle improvement was rated by two physicians comparing 6-month post treatment photographs with pretreatment photos. Moreover, patient satisfaction was assessed at 1 and 6 months after the last session of the treatment.
A total of 45 women participated in this study. In terms of patient satisfaction one month after the last treatment, 8. At 6 months, patient satisfaction was as follows: 4. The results of this study suggest that Accent RF may be considered as a possible effective option for facial skin rejuvenation although its efficacy and safety needs to be evaluated further in randomized controlled trials.
Wrinkle reduction has increasingly become a common cosmetic procedure. Several methods are available for skin rejuvenation including dermabrasion, chemical peeling, autologous cultured fibroblasts transplantation, and ablative and nonablative laser therapy. Despite lasers that target selective chromophore to produce heat, tissue resistance to electron movement in RF field is the source of heat generation in nonablative RF. The average treatment sessions were for monopolar and for bipolar mode.
Careful patient selection and real expectation are the key points in a successful treatment. The optimum RF parameters is a controversial issue despite the considerable evidence of its efficacy and safety in removing periorbital, chin and neck wrinkles and eyebrow lifting. The main objective of this study was further assessment of Accent RF and its parameters for treatment of skin laxity and reducing wrinkles in Iranian patients. A total of 45 patients with facial wrinkles were recruited from Jordan dermatology Clinic in Tehran and Novin Laser, Isfahan for this study.
All patients signed informed consent form after complete explanation of the study design. Patients that meet any of the following conditions were excluded from the study: History of taking oral isotretinoin, Botox injection, injection of any filling agent, laser, chemical peeling, dermabrasion or cosmetic surgery within last 12 months for perioral area and within last 6 months for the rest of the face, pregnancy, lactation, history of severe cardiac disease, collagen and vascular disease, immunosuppressive disease or taking immunosuppressive drugs, patients with history of a dermatologic disease or active dermatologic problem such as herpes, history of keloid, having pacemaker or any metal pieces in body.
Baseline photographs were taken from all patients using Canon, Digital camera, 8. All photos were taken by the same person using the same angle and distance of the light source.
For all areas of the face, passes of 30 seconds were performed except for the periorbital area, which was limited to 4 passes. Energy level of initial passes was 80 W for monopolar handpiece, W for bipolar handpiece, and 74 W for periorbital area. Five circular movements were made during each 30 second pass of the handpiece. Follow up visits were done 1 and 6 months after the last session and all patients were asked and assessed for any adverse effects.
Follow up photography was taken 6 months after the last session. Mean percentage agreement among the three physicians was assessed. A total of 21 patients Other characteristics of the patients are summarized in [ Table 1 ]. Demographic characteristics of the skin of the patients treated with accent radiofrequency. A total of RF sessions were performed on anatomical areas of the face in 45 treated patients.
The mean energy level was W in Fourteen patients were treated in the frontal area for sessions with the energy level of W. RF with the rage of W was done on periorbital area of 42 patients. There was a total of sessions on laugh area of 39 patients, sessions on cheek area of 43 patients, and sessions on chin area of 44 patients with the energy level of W in all these three areas [ Table 2 ]. The applied mode of Accents RF is summarized in [ Table 3 ]. Energy level and number of accent treatment sessions performed on different areas of the face.
Mode of Accent radiofrequency and level of energy applied on different areas of the face. Mean percentage agreement for physician assessment was Adverse effects of Accent therapy one month after the treatment were erythema There was no report of fat atrophy in patients of this study.
There was no side effect 6 months after the last session. Skin rejuvenation has shifted from ablative methods toward fractional ablative and nonablative procedures during past 15 years. RF is a safe effective procedure for reducing skin wrinkles.
The results of this study were different in terms of wrinkle improvement and patient satisfaction from similar studies. For physician assessment, Friedman et al. Several factors such as energy level, number of passes, interval between treatment sessions and mode of RF could be involved in different achieved responses in the rate of wrinkle improvement and patient satisfaction. Applied energy level in the Friedman study for monopolar RF was similar to previous studies. In our study both monopolar and bipolar RF were used at laugh lines while in the Friedman et al.
For cheek area, in In our study, the range of applied energy in periorbital and chin area was less than the Friedman et al. Most of the sessions in chin area and laugh lines in our study were bipolar W and W, respectively. In contrast to the results of our study, Hsu and Kaminer reported a significant relationship between energy level and clinical response.
In our study both modes were initiated with W, 20 seconds and the maintenance energy level was selected based on the treatment area. Average number of passes in the Friedman study was 5 for all facial areas compared with 5. Some studies have estimated passes to achieve clinical improvement. Possible explanations for this difference are higher energy level and application of monopolar mode in cheek area, higher energy level in periorbital area, application of both modes in frontal area, and different duration of outcome assessment 6 months versus 1 month posttreatment in the Friedman study.
Previous studies have shown greater clinical results for RF in young patients. Greater patient satisfaction 6 months posttreatment versus 1 month in our study may be attributed to induction of fibroblast and continued collagen synthesis. Significant pain and fat atrophy is reported following RF performance with a similar device. Both RF modes in our study were performed without using local anesthetic and it was considered as a moderate, tolerable discomfort by the patients.
Although the efficacy of RF for facial wrinkle improvement is confirmed by the recent published reviews, more careful scrutiny on the included trials of these reviews reveals that these reviews mostly have summarized company-sponsored trials.
Few experiences have examined RF-induced histological changes. Such histological changes may not be consistent in older patients with advanced photo aging skin problems. Currently, the clinical consensus on optimum RF parameters to achieve the best clinical results is not available. As an overall conclusion several aspects needs to be included in initial RF consultation sessions. RF should be introduced to the patients as a technology to reduce — and not remove — fine facial wrinkles, with less efficacy and side effects than ablative procedures.
The immediate results after RF are due to collagen contraction and edema which are temporary and there are modest final permanent results. It should be emphasized that the efficacy of nonablative methods including RF cannot be compared with ablative procedures.
Nonablative methods are good choices for the patients who want to minimize posttreatment pain and downtime period. Combination treatment of RF and other procedures such as Botox, filling agents and fractional laser is increasingly used for skin rejuvenation. This was a pilot clinical study of Accent efficacy and safety for facial skin wrinkles and all its limitations including small sample size and lack of standard group should be considered in any interpretation of the results.
Randomized clinical trials comparing the effect of Accent RF with standard comparators for facial wrinkle reduction and evaluation of optimum contributing factors such as mode, energy, pass and number of treatment sessions should be further designed following such pilot studies. Heidari for data entry and Dr. Hosseini for his comments in data analysis. The authors do not have any conflict of interest.
Conflict of Interest: None declared. National Center for Biotechnology Information , U. J Res Med Sci. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: ri. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
Abstract Background: Radiofrequency RF is a new technique to treat facial wrinkles. Materials and Methods: Patients with mild to severe facial wrinkles were treated with Accent using RF energies of W. Results: A total of 45 women participated in this study. Conclusion: The results of this study suggest that Accent RF may be considered as a possible effective option for facial skin rejuvenation although its efficacy and safety needs to be evaluated further in randomized controlled trials.
Keywords: Accent radiofrequency, facial wrinkles, patient satisfaction. Table 1 Demographic characteristics of the skin of the patients treated with accent radiofrequency. Open in a separate window. Table 2 Energy level and number of accent treatment sessions performed on different areas of the face.
Table 3 Mode of Accent radiofrequency and level of energy applied on different areas of the face. Table 4 Physician assessment of clinical improvement at 6 moths posttreatment. Table 5 Patient satisfaction 1 and 5 months after last accent treatment session. Energy delivery devices for cutaneous remodeling: Lasers, lights, and radio waves.
Arch Dermatol. Nonablative treatment of rhytids with intense pulsed light.
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