• Daniel I. Schlessinger
  • Joel Schlessinger
  • Heidi A. WaldorfEmail author


Although recent research in cosmetic procedures has allowed for great advances in both surgical and nonsurgical advances in skin rejuvenation, there is a greater demand in the United States for the latter. From 1997 to 2011, the number of surgical procedures nearly doubled from 939,192 to 1,638,524, whereas the number of nonsurgical procedures increased more than tenfold from 740,751 to 7,555,986 [1]. Among members of the American Academy of Facial Plastic and Reconstructive Surgery, the top cosmetic trend in 2011 was the increased use of nonsurgical cosmetic procedures, to essentially delay invasive surgical procedures [2].


Focal Depth Coupling Fluid Soft Tissue Augmentation Mild Erythema Corneal Abrasion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 5.1

(MP4 85736 kb)


  1. 1.
    15th Annual Cosmetic Surgery National Data Bank Statistics. The American Society for Aesthetic Plastic Surgery, 2011.Google Scholar
  2. 2.
    2011 AAFPRS Membership Study. American Academy of Facial Plastic and Reconstructive Surgery, 2011.Google Scholar
  3. 3.
    Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol. 2007;25(5):487–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Dierickx CC. The role of deep heating for noninvasive skin rejuvenation. Lasers Surg Med. 2006;38(9): 799–807.PubMedCrossRefGoogle Scholar
  5. 5.
    Alam M. Cosmetic dermatology for skin of color. New York: McGraw-Hill Medical; 2009. 186 p.Google Scholar
  6. 6.
    Bäck LJJ, Hytönen ML, Roine RP, Malmivaara AOV. Radiofrequency ablation treatment of soft palate for patients with snoring: a systematic review of effectiveness and adverse effects. Laryngoscope. 2009; 119(6):1241–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Blumen MB, Dahan S, Fleury B, Hausser-Hauw C, Chabolle F. Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea. Laryngoscope. 2002;112(11):2086–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Casal RF, Tam AL, Eapen GA. Radiofrequency ablation of lung tumors. Clin Chest Med. 2010;31(1):151–63; Table of Contents.PubMedCrossRefGoogle Scholar
  9. 9.
    Dib RE, Touma NJ, Kapoor A. Review of the efficacy and safety of radiofrequency ablation for the treatment of small renal masses. Can Urol Assoc J. 2009; 3(2):143–9.PubMedCentralPubMedGoogle Scholar
  10. 10.
    Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg. 2006;141(2):181–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Wiesfeld ACP, Tan ES, Van Veldhuisen DJ, Crijns HJGM, Van Gelder IC. Radiofrequency ablation of atrial fibrillation. Int J Cardiol. 2004;93(2–3):231–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Chaudhari M. Radiofrequency techniques in pain management. Anaesth Intensive Care Med. 2011; 12(2):63–5.CrossRefGoogle Scholar
  13. 13.
    Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar versus bipolar radiofrequency treatment of rhytides and laxity using a mobile painless delivery method. Lasers Surg Med. 2008;40(7):446–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Lolis MS, Goldberg DJ. Radiofrequency in cosmetic dermatology: a review. Dermatol Surg. 2012;38(11): 1765–76.PubMedCrossRefGoogle Scholar
  15. 15.
    Chan NPY, Shek SYN, Yu CS, Ho SGY, Yeung CK, Chan HHL. Safety study of transcutaneous focused ultrasound for non-invasive skin tightening in Asians. Lasers Surg Med. 2011;43(5):366–75.PubMedCrossRefGoogle Scholar
  16. 16.
    Sukal SA, Geronemus RG. Thermage: the nonablative radiofrequency for rejuvenation. Clin Dermatol. 2008;26(6):602–7. Epub 2008/10/23.PubMedCrossRefGoogle Scholar
  17. 17.
    Wu WT. Achieving optimal results with thermage using mesoanesthesia and revised treatment parameters. Aesthet Surg J. 2007;27(1):93–9. Epub 2007/01/01.PubMedCrossRefGoogle Scholar
  18. 18.
    Zelickson BD, Kist D, Bernstein E, Brown DB, Ksenzenko S, Burns J, et al. Histological and ultrastructural evaluation of the effects of a radiofrequency-based nonablative dermal remodeling device: a pilot study. Arch Dermatol. 2004;140(2):204–9. Epub 2004/02/18.PubMedCrossRefGoogle Scholar
  19. 19.
    Polder KD, Bruce S. Radiofrequency: thermage. Facial Plast Surg Clin North Am. 2011;19(2):347–59. Epub 2011/07/19.PubMedCrossRefGoogle Scholar
  20. 20.
    Kleinerman R, Whang TB, Bard RL, Marmur ES. Ultrasound in dermatology: principles and applications. J Am Acad Dermatol. 2012;67(3):478–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Email interview with Michael Floegel. 2010.Google Scholar
  22. 22.
    Suh DH, Chang KY, Son HC, Ryu JH, Lee SJ, Song KY. Radiofrequency and 585-nm pulsed dye laser treatment of striae distensae: a report of 37 Asian patients. Dermatol Surg. 2007;33(1):29–34. Epub 2007/01/12.PubMedGoogle Scholar
  23. 23.
    Suh DH, Shin MK, Lee SJ, Rho JH, Lee MH, Kim NI, et al. Intense focused ultrasound tightening in asian skin: clinical and pathologic results. Dermatol Surg. 2011;37(11):1595–602.PubMedCrossRefGoogle Scholar
  24. 24.
    Elsaie ML, Choudhary S, Leiva A, Nouri K. Nonablative radiofrequency for skin rejuvenation. Dermatol Surg. 2010;36(5):577–89. Epub 2010/04/14.PubMedCrossRefGoogle Scholar
  25. 25.
    Ruiz-Esparza J. Nonablative radiofrequency for facial and neck rejuvenation. A faster, safer, and less painful procedure based on concentrating the heat in key areas: the ThermaLift concept. J Cosmet Dermatol. 2006;5(1):68–75.PubMedCrossRefGoogle Scholar
  26. 26.
    Anolik R, Chapas AM, Brightman LA, Geronemus RG. Radiofrequency devices for body shaping: a review and study of 12 patients. Semin Cutan Med Surg. 2009;28(4):236–43. Epub 2010/02/04.PubMedCrossRefGoogle Scholar
  27. 27.
    England LJ, Tan MH, Shumaker PR, Egbert BM, Pittelko K, Orentreich D, et al. Effects of monopolar radiofrequency treatment over soft-tissue fillers in an animal model. Lasers Surg Med. 2005;37(5):356–65. Epub 2005/10/22.PubMedCrossRefGoogle Scholar
  28. 28.
    Goldman MP, Alster TS, Weiss R. A randomized trial to determine the influence of laser therapy, monopolar radiofrequency treatment, and intense pulsed light therapy administered immediately after hyaluronic acid gel implantation. Dermatol Surg. 2007;33(5):535–42. Epub 2007/04/25.PubMedGoogle Scholar
  29. 29.
    Shumaker PR, England LJ, Dover JS, Ross EV, Harford R, DeRienzo D, et al. Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model: part 2. Lasers Surg Med. 2006;38(3): 211–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Thermage Treatment Reference Guide. Hayward, CA: Solta Medical; 2010. p. 1–37.Google Scholar
  31. 31.
    Alam M, White LE, Martin N, Witherspoon J, Yoo S, West DP. Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study. J Am Acad Dermatol. 2010;62(2):262–9. Epub 2010/02/02.PubMedCrossRefGoogle Scholar
  32. 32.
    Alster TS, Tanzi EL. Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound. Dermatol Surg. 2012;38(5): 754–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Burns AJ, Holden SG. Monopolar radiofrequency tissue tightening—how we do it in our practice. Lasers Surg Med. 2006;38(6):575–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Weiss RA, Weiss MA, Beasley KL, Munavalli G. Our approach to non-ablative treatment of photoaging. Lasers Surg Med. 2005;37(1):2–8. Epub 2005/07/22.PubMedCrossRefGoogle Scholar
  35. 35.
    Atiyeh B, Dibo S. Nonsurgical nonablative treatment of aging skin: radiofrequency technologies between aggressive marketing and evidence-based efficacy. Aesthetic Plast Surg. 2009;33(3):283–94.PubMedCrossRefGoogle Scholar
  36. 36.
    Helfrich YR, Sachs DL, Voorhees JJ. Overview of skin aging and photoaging. Dermatol Nurs. 2008;20(3):177–83; quiz 84. Epub 2008/07/25.PubMedGoogle Scholar
  37. 37.
    Burns JA. Thermage: monopolar radiofrequency. Aesthet Surg J. 2005;25(6):638–42. Epub 2005/11/01.PubMedCrossRefGoogle Scholar
  38. 38.
    Pope K, Levinson M, Ross EV. Selective fibrous septae heating: an additional mechanism of action for capacitively coupled monopolar radiofrequency. Hayward, CA: Thermage, Inc.; 2005.Google Scholar
  39. 39.
    Hsu TS, Kaminer MS. The use of nonablative radiofrequency technology to tighten the lower face and neck. Semin Cutan Med Surg. 2003;22(2):115–23. Epub 2003/07/25.PubMedCrossRefGoogle Scholar
  40. 40.
    White WM, Makin IR, Slayton MH, Barthe PG, Gliklich R. Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound (IUS). Lasers Surg Med. 2008;40(2):67–75. Epub 2008/02/29.PubMedCrossRefGoogle Scholar
  41. 41.
    Hruza GJ. Rejuvenating the aging face. Arch Facial Plast Surg. 2004;6(6):366–9. Epub 2004/11/17.PubMedCrossRefGoogle Scholar
  42. 42.
    Kim KH, Geronemus RG. Nonablative laser and light therapies for skin rejuvenation. Arch Facial Plast Surg. 2004;6(6):398–409. Epub 2004/11/17.PubMedCrossRefGoogle Scholar
  43. 43.
    Kirsch KM, Zelickson BD, Zachary CB, Tope WD. Ultrastructure of collagen thermally denatured by microsecond domain pulsed carbon dioxide laser. Arch Dermatol. 1998;134(10):1255–9. Epub 1998/11/05.PubMedCrossRefGoogle Scholar
  44. 44.
    Ross EV, Naseef GS, McKinlay JR, Barnette DJ, Skrobal M, Grevelink J, et al. Comparison of carbon dioxide laser, erbium:YAG laser, dermabrasion, and dermatome: a study of thermal damage, wound contraction, and wound healing in a live pig model: implications for skin resurfacing. J Am Acad Dermatol. 2000;42(1 Pt 1):92–105. Epub 1999/12/22.PubMedCrossRefGoogle Scholar
  45. 45.
    Fitzpatrick R, Geronemus R, Goldberg D, Kaminer M, Kilmer S, Ruiz-Esparza J. Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med. 2003;33(4):232–42. Epub 2003/10/23.PubMedCrossRefGoogle Scholar
  46. 46.
    Narins DJ, Narins RS. Non-surgical radiofrequency facelift. J Drugs Dermatol. 2003;2(5):495–500. Epub 2003/10/16.PubMedGoogle Scholar
  47. 47.
    Alster TS, Tanzi E. Improvement of neck and cheek laxity with a nonablative radiofrequency device: a lifting experience. Dermatol Surg. 2004;30(4 Pt 1):503–7; discussion 7. Epub 2004/04/02.PubMedGoogle Scholar
  48. 48.
    Bassichis BA, Dayan S, Thomas JR. Use of a nonablative radiofrequency device to rejuvenate the upper one-third of the face. Otolaryngol Head Neck Surg. 2004;130(4):397–406.PubMedCrossRefGoogle Scholar
  49. 49.
    Fritz M, Counters JT, Zelickson BD. Radiofrequency treatment for middle and lower face laxity. Arch Facial Plast Surg. 2004;6(6):370–3. Epub 2004/11/17.PubMedCrossRefGoogle Scholar
  50. 50.
    Laubach HJ, Makin IR, Barthe PG, Slayton MH, Manstein D. Intense focused ultrasound: evaluation of a new treatment modality for precise microcoagulation within the skin. Dermatol Surg. 2008;34(5):727–34. Epub 2008/04/24.PubMedGoogle Scholar
  51. 51.
    White WM, Makin IR, Barthe PG, Slayton MH, Gliklich RE. Selective creation of thermal injury zones in the superficial musculoaponeurotic system using intense ultrasound therapy: a new target for noninvasive facial rejuvenation. Arch Facial Plast Surg. 2007;9(1):22–9. Epub 2007/01/17.PubMedCrossRefGoogle Scholar
  52. 52.
    Fatemi A. High-intensity focused ultrasound effectively reduces adipose tissue. Semin Cutan Med Surg. 2009;28(4):257–62. Epub 2010/02/04.PubMedCrossRefGoogle Scholar
  53. 53.
    Fatemi A, Kane MA. High-intensity focused ultrasound effectively reduces waist circumference by ablating adipose tissue from the abdomen and flanks: a retrospective case series. Aesthetic Plast Surg. 2010;34(5):577–82. Epub 2010/04/13.PubMedCrossRefGoogle Scholar
  54. 54.
    Gadsden E, Aguilar MT, Smoller BR, Jewell ML. Evaluation of a novel high-intensity focused ultrasound device for ablating subcutaneous adipose tissue for noninvasive body contouring. Aesthet Surg J. 2011;31(4):401–10.PubMedCrossRefGoogle Scholar
  55. 55.
    Jewell ML, Desilets C, Smoller BR. Evaluation of a novel high-intensity focused ultrasound device. Aesthet Surg J. 2011;31(4):429–34.PubMedCrossRefGoogle Scholar
  56. 56.
    Jewell ML, Weiss RA, Baxter RA, Cox SE, Dover JS, Donofrio LM, et al. Safety and tolerability of high-intensity focused ultrasonography for noninvasive body sculpting: 24-week data from a randomized, sham-controlled study. Aesthet Surg J. 2012;32(7):868–76. Epub 2012/09/04.PubMedCrossRefGoogle Scholar
  57. 57.
    Lee HS, Jang WS, Cha Y-J, Choi Y-H, Tak Y, Hwang E, et al. Multiple pass ultrasound tightening of skin laxity of the lower face and neck. Dermatol Surg. 2012;38(1):20–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Narins RS, Tope WD, Pope K, Ross EV. Overtreatment effects associated with a radiofrequency tissue tightening device: rare, preventable, and correctable with subcision and autologous fat transfer. Dermatol Surg. 2006;32(1):115–24.PubMedCrossRefGoogle Scholar
  59. 59.
    Abraham MT, Chiang SK, Keller GS, Rawnsley JD, Blackwell KE, Elashoff DA. Clinical evaluation of non-ablative radiofrequency facial rejuvenation. J Cosmet Laser Ther. 2004;6(3):136–44. Epub 2004/11/17.PubMedCrossRefGoogle Scholar
  60. 60.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9. Epub 1965/11/19.PubMedCrossRefGoogle Scholar
  61. 61.
    Binder A, Baron R. Utility of transcutaneous electrical nerve stimulation in neurologic pain disorders. Neurology. 2010;74(2):104–5. Epub 2010/01/01.PubMedCrossRefGoogle Scholar
  62. 62.
    Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010; 74(2):173–6. Epub 2010/01/01.PubMedCrossRefGoogle Scholar
  63. 63.
    Vibration therapy for pain. Lancet. 1992;339(8808): 1513–4. Epub 1992/06/20.Google Scholar
  64. 64.
    Smith KC, Comite SL, Balasubramanian S, Carver A, Liu JF. Vibration anesthesia: a noninvasive method of reducing discomfort prior to dermatologic procedures. Dermatol Online J. 2004;10(2):1. Epub 2004/11/09.PubMedGoogle Scholar
  65. 65.
    Alam M, Levy R, Pajvani U, Ramierez JA, Guitart J, Veen H, et al. Safety of radiofrequency treatment over human skin previously injected with medium-term injectable soft-tissue augmentation materials: a controlled pilot trial. Lasers Surg Med. 2006;38(3):205–10. Epub 2006/03/15.PubMedCrossRefGoogle Scholar
  66. 66.
    Weiss RA, Weiss MA, Munavalli G, Beasley KL. Monopolar radiofrequency facial tightening: a retrospective analysis of efficacy and safety in over 600 treatments. J Drugs Dermatol. 2006;5(8):707–12. Epub 2006/09/23.PubMedGoogle Scholar
  67. 67.
    Gliklich RE, White WM, Slayton MH, Barthe PG, Makin IR. Clinical pilot study of intense ultrasound therapy to deep dermal facial skin and subcutaneous tissues. Arch Facial Plast Surg. 2007;9(2):88–95. Epub 2007/03/21.PubMedCrossRefGoogle Scholar
  68. 68.
    Phone interview with Dr. Thomas Hitchcock. 2012.Google Scholar
  69. 69.
    Badgwell Doherty C, Doherty SD, Rosen T. Thermotherapy in dermatologic infections. J Am Acad Dermatol. 2010;62(6):909–27; quiz 28. Epub 2010/05/15.PubMedCrossRefGoogle Scholar
  70. 70.
    Rusciani A, Curinga G, Menichini G, Alfano C, Rusciani L. Nonsurgical tightening of skin laxity: a new radiofrequency approach. J Drugs Dermatol. 2007;6(4):381–6. Epub 2007/08/03.PubMedGoogle Scholar
  71. 71.
    Stampar M. The Pelleve procedure: an effective method for facial wrinkle reduction and skin tightening. Facial Plast Surg Clin North Am. 2011;19(2):335–45.PubMedCrossRefGoogle Scholar
  72. 72.
    Section 5 - 510(k) Summary For EXILIS. In: DHHS, editor. 2009. p. 6.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Daniel I. Schlessinger
    • 1
  • Joel Schlessinger
    • 2
  • Heidi A. Waldorf
    • 3
    • 4
    Email author
  1. 1.Northwestern University School of MedicineChicagoUSA
  2. 2.Advanced Skin Research CenterOmahaUSA
  3. 3.Laser & Cosmetic Dermatology, Mount Sinai Medical Center, and Associate Clinical Professor IcahnSchool of MedicineNew YorkUSA
  4. 4.Waldorf Dermatology & Laser Associates, PCNanuetUSA

Personalised recommendations