A Proposed Method for Upper Eyelid and Infrabrow Tightening Using a Transcutaneous Temperature Controlled Radiofrequency Device With Opaque Plastic Eye Shields

November 2016 | Volume 15 | Issue 11 | Original Article | 1302 | Copyright © November 2016


Douglas J. Key MD and Lauren Boudreaux DO

Key Laser Institute for Cosmetic Regenerative Medicine, Portland, OR

Abstract
BACKGROUND: Laxity of the eyelid and periorbital area, a common manifestation of aging, is usually addressed via blepharoplasty and/ or fat transfer. Given the trend toward safer, less invasive treatments preferred by those patients reticent to undergo more invasive procedures, viable alternatives have been sought. Transcutaneous temperature controlled radiofrequency (TTCRF) integrates non- invasive super cial RF treatment with automatic temperature feedback control of energy deposition, as a stimulator of overall collagen remodeling; however, the globe of the eye is particularly sensitive to RF energy. The purpose of the study was to propose a method by which TTCRF and other non-ablative modalities could be used to treat eyelid and infrabrow laxity, with autoclavable opaque black haptic scleral contact lenses protecting the globe of the eye. METHODS: Subjects (n=40, 36 women and 4 men, age range, 33-72) with mild to moderate laxity of the eyelid and infrabrow were treated with TTCRF using black plastic eye shields (Oculoplastik, Montreal, Quebec, Canada) to protect the globe of the eye from heat and RF energy. With the shields in place subjects were treated with the 10 mm small monopolar emitter of the ThermiSmooth device (Thermi, Irving, Tex.), using small circular looping motions to safely elevate the temperature of target tissue to the therapeutically rel- evant range for approximately 6 minutes; tissue temperature was measured in real time using the device’s forward-looking infrared imaging. RESULTS: No major adverse events were recorded. Treatment was safe and tolerable for all subjects. CONCLUSION: The use of autoclavable opaque black plastic eye shields provides a safe method of treating the upper eye lid and infrabrow using TTCRF. J Drugs Dermatol. 2016;15(11):1302-1305.

INTRODUCTION

Laxity of the eyelid and periorbital region is a universal and early manifestation of aging which increases over time, often addressed by blepharoplasty and/or transfer of autologous fat to remove lax skin and restore lost volume.1 While safe, effective, and commonly performed, many younger patients may be reticent to undergo these invasive procedures, especially in the presence of safe, effective alternatives with reduced risk and downtime.1-2 Trends such as these across the industry regarding the advent of less invasive methods have, in fact, been noted.3 Less invasive modalities such as intense focused ultrasound (IFUS)1,4 and fractional CO2 laser5 have been demonstrated to be valid alternatives for upper lid and periorbital treatment.A brief review of blepharoplasty alternatives by Bae-Harboe and Geronemus5 suggested RF as a potential non-invasive therapy with low downtime but variable degree of improvement limited to tightening and lifting. RF technology works by harnessing the impedance of skin when electrical current is passed through it, generating thermal energy to stimulate collagen contraction and neocollagenesis.6 Subsequent inflammatory response leads to other beneficial effects, ultimately causing collagen remodeling and a tightening effect. The technology has been demonstrated safe and effective for tightening in younger patients or as adjunct to facelift surgery (as a touch-up or maintenance treatment). Javate and colleagues used non-ablative, non-invasive RF for periorbital rhytides with some success in a 2014 study.7One potential RF-based alternative is transcutaneous temperature controlled radiofrequency (TTCRF). The ThermiRF device (Thermi, Irving, TX) is designed to perform different iterations of radiofrequency (RF) treatments; ThermiSmooth is a transcutaneous mode of the device. Using the ThermiSmooth small probe with its 10 mm active tip monopolar RF emitter (requiring a grounding pad), skin temperature in small areas such as the periorbital region might be elevated to and held at the scientifically determined, therapeutically relevant temperature range of 40°C to 45°C to stimulate collagen remodeling and tightening. Integrated temperature monitoring allows automatic adjustment of RF energy emission by the device based on real time tissue temperature readings, which promotes
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