The most recent celebrity to admit having radio frequency facial rejuvenation is Gwyneth Paltrow. She underwent Thermage treatments and said “I went out to dinner right afterward and I didn't look crazy, but it's quite painful.” Other brands of radio frequency facial rejuvenation devices that use pure RF energy include Accent and Pelleve. This article looks at how radio frequency treatments change the skin, who can benefit from treatment, what to expect and the potential risks and complications involved.

Recently Gwyneth Paltrow’s cosmetic facial rejuvenation method made it into the news: Thermage, a non-invasive cosmetic treatment that is popular among those who, like Gwyneth, spurn cosmetic surgery and injectables.

Thermage is just one of the many devices that use radiofrequency technology to achieve skin tightening.

These are mainly used to correct skin laxity, and are best suited for those who have mild or moderate sagging in the forehead, mid-face, neck and jaw line and around the eyes. This usually means people in their 30s, 40s and 50s.

How Radio Frequency treatments work

Radio frequency devices produce an electric current using electromagnetic radiation falling within the frequency range of 3 to 300GHz. When this current passes through a tissue layer it produces heat. Skin rejuvenation occurs as a result of the thermal or heat damage to the dermis, the skin layer beneath the epidermis. Because it impedes the passing current more than most other tissue in the skin, the subcutaneous fat layer below the dermis generates greater amounts of heat and paves the way for deeper thermal effects.

Heating the dermis modifies the original properties of collagen fibers. They thicken and contract in response to the heat. This is what leads to immediately visible improvements. Heat also causes long-term collagen remodeling, which is how skin improvements and tightening continue a number of weeks after treatment. The inflammatory response of the skin to the wounds induced by heat leads to additional collagen synthesis as part of the healing process.

Radio frequency is not a new technology. It’s been used for medical applications involving tissue heating for more than a century. Since gaining US FDA approval in 2002, it has been widely used as a non-ablative skin rejuvenation method.

Although different devices produce varying results, with most current RF technologies it is possible to see at least some improvement in the skin tightness in the majority of people undergoing treatment.

Reasons for choosing to have an RF rejuvenation treatment

People in their 20s considering anti-ageing treatments and maintenance procedures may find radio frequency facial rejuvenation an attractive proposition. It is quick, relatively affordable and requires little down time.

Those who, like Gwyneth Paltrow, would rather stay away from invasive cosmetic surgery and anti-wrinkle and dermal filler injection treatments opt for radio frequency as it is a non-invasive treatment option.

Radio frequency treatments improve skin quality and tightness. They are suitable for those who have mild to moderate skin laxity in the face. People of any skin colour can be treated with radio frequency devices.

You are a candidate for radio frequency treatments if you desire any of the following:

• To lift the brows and tighten the skin on the forehead
• To thicken and tighten the skin under the eyes
• To lift the upper cheeks
• To lift (slightly) and diminish enlarged pores on the cheeks and mid-face
• To reduce jowls and sagging along the jaw line
• To tighten skin and diminish wrinkling on the neck

Things to consider once you’ve decided to have an RF treatment

Your choice of branded device or technology and your service provider are key in this process. Check out the section on potential risks and complications to understand why your choice of service provider is a critical decision in obtaining RF facial rejuvenation treatments.

You will also be given a choice about how to minimise pain and discomfort during and after treatment sessions.

What to expect

Just before the treatment, you will wash your face with soap and warm water. This helps remove any makeup and oil from the skin that could interfere with the application of the RF treatment.

Usually a topical anaesthetic cream will be applied to your skin to numb it slightly. The cream will be removed using an alcohol cleanser immediately before the treatment begins.

Although different devices use different methods, a “treatment grid” ink transfer may be applied over your face. This helps your service provider to navigate around your face while delivering the RF energy to the necessary areas. It also helps to ensure an even application and prevents overlapping treatments.

There are different types of radio frequency devices. Monopolar or unipolar devices have one pole or electrode. Thermage is a monopolar RF device. Biopolar refers to a device having two poles or electrodes. If you are being treated with a monopolar device, a single-use, self-adhesive return pad will be attached to your stomach or back in order to ground you. This pad is not necessary with bipolar devices.

Before treatment, a coupling gel may be applied over your face. This creates an additional barrier between the surface layers of your skin and the handpiece of the radio frequency device.

When preparations are complete, your service provider will work across your face until all areas needing treatment have been covered.

You will feel a zap, followed by brief deep heating sensations each time the RF energy is delivered. This is what Gwyneth Paltrow referred to in her description of the Thermage treatment as “It feels like someone’s smacking your face with a rubber band that has an electric shock in it” and as “quite painful”.

Everyone’s pain threshold is different. You will usually be given a number of analgesic options such as anaesthetic creams to be applied before treatment, pain management drugs or relaxants. These will help minimise discomfort during and immediately after treatment.

After the treatment has been completed, a lotion or soothing gel is applied to the treated skin.

You will experience skin tightness immediately after treatment. More tightening and improvements will occur gradually over weeks and months following treatment.

Although specifics vary by device as well as with individuals and their skin thickness, RF treatment results may last up to a couple of years. A single treatment is sometimes enough, but most people need more than one for optimal results. How follow up treatments should be scheduled depends on your specific needs as well as the device used in treatment. Your service provider will be able to give you an idea about what is best for you.

Before and after treatment

Immediately before treatment avoid doing anything that could irritate your skin. Sun bathing and tanning booths should be strictly avoided. Most service providers will not treat someone with sunburn because it intensifies the pain. An existing tan should not be an issue.

Certain women become more sensitive to light just before and during menstruation. Try to avoid scheduling treatments on those days.

Your service provider will discuss your reasons for wanting the treatment and get a good idea about your expectations. Be sure you know what this treatment can deliver and what you want like to look afterwards before signing up.

Usually your medical history will be reviewed to make sure there are no reasons why you should not undergo treatment. You may be asked to sign consent forms to the effect that you have understood the potential benefits to be gained and the risks and complications associated with the treatment.

You may be asked to have clinical photographs taken that could be used for “before and after” comparisons.

Mild redness similar to a sunburn effect is possible, but usually disappears in a day. Most people are able to return to work and normal activities immediately after treatment.

No special care is necessary after treatment. Just follow the instructions given on the use of soothing lotions, gels or creams to protect skin and reduce discomfort. You may be advised to use moisturising mists if needed. Cool water rinses or ice packs can also soothe skin and minimise discomfort.

If you feel you need it, ask your service provider to recommend camouflage and concealer products that you can use until the redness subsides.

Possible risks and complications

Although RF treatments have minimal risks and downtime compared to surgery, they are not entirely risk free.

Swelling, redness, blisters and bumps on and around the treated area are the most commonly reported side effects. These typically go away in a few days or weeks. Mineral make up will help hide the most common sign, redness, until it subsides.

Tissue overheating may lead to fat atrophying and/or excessive tightening that may result in a sunken or depressed appearance in the skin in some treated areas. This complication is believed to arise in the hands of inexperienced device operators who lack the understanding and skill to deliver the frequency levels specified by the manufacturer’s guidelines.

You can significantly reduce such risk by selecting a service provider who has adequate training, certification and experience in delivering each specific RF treatment.

Rough costs involved

Prices for radiofrequency facial tightening treatments depend on the area(s) treated and the device used. It will also depend on where you are. Different doctors and other providers may also have varying rates for the same treatment.

This information is correct as of 2019.