Experts offer consensus statement on fourth-generation non-microneedling monopolar radiofrequency

Skin quality and degree of laxity are more important than chronological age when choosing a candidate for fourth-generation non-microneedling monopolar radiofrequency for skin tightening, according to a consensus recommendation statement.

Brian S. Biesman, MD, clinical assistant professor of ophthalmology, dermatology and otolaryngology at Vanderbilt University Medical Center in Nashville, Tennessee, and past president of the American Society for Laser Medicine and Surgery, and colleagues suggested that demands for noninvasive methods of facial and body rejuvenation have increased in recent decades. It is for this reason that the panel convened to create recommendations for this procedure.

The panel included eight international experts who participated in three rounds of consensus building, according to the findings.

There were 32 statements initially developed, which the experts ultimately pared down to 19. Those statements dealt with a range of topics, including patient selection, outcomes, treatment settings and practical use of this technology.

“A version of a scientific process known as the Delphi process was used to come up with the statements,” Biesman told Healio. “Some of the original statements were included, others rejected and still others modified.”

The document also includes additional explanatory guidance to support 12 of those statements.

As for specific recommendations, beyond the point that chronological age is less important than skin quality and degree of laxity, the second statement suggests that patients with no more than mild to moderate skin laxity are ideal for fourth-generation non-microneedling monopolar radiofrequency. Conversely, those with extreme sun damage are not viable candidates. Patients who have or will have neurotoxins, dermal fillers, and fractionated skin resurfacing ablative and/or non-ablative laser modalities are also candidates.

Clinicians are encouraged to discuss expectations for the procedure. The panel suggested that more than 90% of properly selected patients may benefit and that this benefit may be seen after one treatment. In addition, patients may expect to see some contouring, as well. While the authors noted that the procedure should be repeated every 12 months to maintain optimal results and prevent future sagging, the waiting period between treatments should be based on clinical decision-making between the physician and patient.

The procedure can be used to treat the eyes, face, submentum and body, the authors added.

Clinicians may use patient feedback data to adjust settings on the heat sensation scale for future treatments. To that point, energy settings may be titrated up and down accordingly.

Any clinician who uses this procedure is encouraged to view the document for the full list of statements.

“The consensus guidelines are just that: guidelines compiled from a group of experts with extensive experience,” Biesman said. “They are intended to provide guidance for best practices and let the aesthetic community as a whole understand how a group of experienced experts thinks about and uses this device. However, as each individual clinical scenario is unique, physicians need to use their best judgment when making a decision about how to best care for any individual patient.” – by Rob Volansky

Disclosure: All authors were compensated by Solta Medical, a division of Bausch Health, for their work in developing this document.