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Photographs of nasolabial folds of a representative patient with a baseline Wrinkle Severity Rating Scale score of 3 (a) before treatment, (b) 4 weeks after treatment, (c) 12 weeks after treatment, and (d) 24 weeks after treatment with intradermal radiofrequency prior to injection of hyaluronic acid fi ller.
Source publication
Within the last few years, hyaluronic acid (HA) fillers and radiofrequency (RF) devices have shown significant promise for skin rejuvenation. But the effects of HA only lasted for a relatively short duration. Therefore, we tried a new combination therapy of intradermal RF and HA filler.
To evaluate the clinical efficacy of combination therapy of in...
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Purpose
Patients seeking treatment for the midface are individuals with different objectives and characteristics of skin and soft tissue. In this study, patients were treated in the midface with one of three products with different properties; HARV, HARD, or HARL, using a treatment algorithm based on primary need for treatment (volumizing, lifting...
Tissue fillers injections remain to be one of the most commonly performed cosmetic procedures. The aim of this meta-analysis was to systematize and present available data on the aesthetic outcomes and safety of treating the nasolabial fold area with tissue fillers. We conducted a systematic review of randomized clinical trials that report outcomes...
Facial injections with cosmetic fillers can lead to local artery occlusion. The bilateral nasolabial folds of a 39-year-old woman were injected with hyaluronic acid at another hospital. After the righthand injection, the patient immediately felt pain that ran from the right nasolabial fold to the nasal alar. The injecting doctor suspected embolism...
Injection of synthetic fillers for soft tissue augmentation is increasing over the last decade. One of the most common materials used is hyaluronic acid (HA) that is safe and temporary filler for soft tissue augmentation. We present a case of 54-year-old female who experienced vascular occlusion and nasal alar necrosis following HA injection to the...
Aim: Dermal fillers are increasingly popular procedures. Inadvertent intraarterial injection of fillers, particularly with calcium hydroxylapatite (CaHA), can result in devastating consequences. A systemic review was performed to summarize management strategies to treat CaHA-associated vascular complications.
Methods: The methodology of this review...
Citations
... A small randomized blinded study showed that intradermal RF treatment before hyaluronic acid filler injection may improve and extend the longevity of nasolabial fold wrinkle reduction, compared with filler injection alone [11]. ...
... Several studies, all of which used crosslinked HA fillers, have reported that radiofrequency treatment prior to HA filler injection may provide synergistic and long-lasting effects for the reduction of nasolabial fold wrinkles [40], marionette lines [41], and forehead lines [42]. One study used a radiofrequency hydro-injector device to simultaneously deliver microneedle intradermal radiofrequency and a non-crosslinked HA to the periorbital area [43]. ...
Background:
Age-associated changes in epidermal hydration, pigmentation, thickness and cell renewal influence skin appearance and can lead to laxity, dryness and poor skin tone. The aim of this pilot study was to assess the synergistic effects of a new bipolar radiofrequency plus non-crosslinked hyaluronic acid (HA) mesotherapy protocol compared with radiofrequency alone on skin appearance and markers of epidermal function.
Methods:
This prospective, single-center, split-face pilot study recruited women aged 25-65 years with dryness and laxity of the facial skin defined by a trans-epidermal water loss (TEWL) value of ≥26 g/m2/h. Subjects were treated with a bipolar radiofrequency device on both sides of the face. This was immediately followed by needle hyaluronic acid (HA) treatment on one side of the face with 2.5 mL of a non-crosslinked HA. Photographic documentation, analysis of epidermal barrier function parameters, and high frequency (HF) ultrasound analysis were performed prior to treatment and at 28 days.
Results:
Twenty female subjects with a mean age of 46 (range 29 to 54) years and dry and lax facial skin were included. TEWL was reduced and skin hydration improved to a greater extent with the combined radiofrequency plus mesotherapy protocol compared with radiofrequency alone (-5.8% vs. +3.9% and +23.1% vs. +1.0%, respectively). The combined protocol was also associated with greater improvements in melanin (-7.5% vs. -1.5%) and erythema values (-7.2% vs. +3.0%), respectively. Ultrasound measures of epidermal thickness and epidermal density were greater after the combined protocol compared with radiofrequency alone (12.0% vs. 5.6% and 57.7% vs. 7.1%, respectively). Both treatments were well-tolerated.
Conclusions:
The combined bipolar radiofrequency and HA mesotherapy protocol provided greater improvements in skin hydration, firmness and tone compared with radiofrequency alone. The combination treatment was also associated with greater epidermal thickness and density and increased keratinocyte differentiation suggesting a synergistic effect of both treatments on epidermal homeostasis and barrier function. Both treatments were well-tolerated and led to improvements in facial appearance.
... Several studies have evaluated the effect of a combination treatment of both modalities to overcome the individual limitations of HA filler injections and RF treatment [19][20][21]. England et al. [19] reported no adverse reactions or impact on the residence time of various fillers after multiple passes of RF treatment directly over filler-injected skin in an animal model. Goldman et al. [20] suggested the safety profile of RF treatment applied immediately after HA gel implantation in a human model. ...
... Goldman et al. [20] suggested the safety profile of RF treatment applied immediately after HA gel implantation in a human model. Choi et al. [21] reported synergistic effects of a combination therapy of intradermal RF and HA filler to reduce nasolabial fold wrinkles. ...
... The RFHI device delivers RF energy directly to the dermis, before injecting HA filler with the same needle electrodes. Choi et al. [21] proposed that the formation of "autologous containment collagen canals", induced by microneedle RF treatment, could provide protection from external oxygen radicals and hold the injected HA filler so it does not spread away from the targeted area. Thus, a combination treatment of microneedle intradermal RF and HA filler injection could have several advantages. ...
In recent years, variable rejuvenation techniques, such as hyaluronic acid (HA) fillers and radiofrequency (RF) devices, have become popular. We evaluated the RF hydro-injector (RFHI) device that simultaneously delivers both a microneedle intradermal RF treatment and a HA filler injection to overcome the disadvantages of HA filler and RF devices alone. This study aimed to assess the efficacy and safety of the RFHI device for the rejuvenation of the periorbital area, including the lateral canthal lines (LCLs) and the infraorbital area. A total of 24 subjects were enrolled in this study and underwent 2 to 3 treatments using the RFHI device. The investigator’s global assessment of the lateral canthal line (IGA-LCL) and the global esthetic improvement scale (GAIS) were used to evaluate the improvement in the LCL. Cutometer® was used to evaluate the skin’s elasticity, and the Antera 3D image capture system® was used to evaluate the degree of wrinkles, roughness, and pore volume. At the 8 week follow-up after the first treatment session, both the IGA-LCL and GAIS showed significant improvement. The improvement in the wrinkles, roughness, and pore volume, measured by the Antera 3D image capture system®, was statistically significant. No serious adverse event was reported. This RFHI device, which delivers both microneedle intradermal RF treatment and HA filler injection, is effective and safe for periorbital rejuvenation.
... Similar results were reported by Choi et al. in ten Korean female volunteers with mild-to-severe nasolabial fold treated with a combination therapy of intradermal RF and HA filler [68]. This study found that intradermal RF treatment prior to HA filler injection may provide synergistic and long-lasting effects for the reduction in nasolabial fold wrinkles [68]. ...
... Similar results were reported by Choi et al. in ten Korean female volunteers with mild-to-severe nasolabial fold treated with a combination therapy of intradermal RF and HA filler [68]. This study found that intradermal RF treatment prior to HA filler injection may provide synergistic and long-lasting effects for the reduction in nasolabial fold wrinkles [68]. ...
Background
Facial aging is a process that involves many different changes. Therefore, in many patients, it may be necessary to perform a combined treatment. Botulinum toxin A and dermal fillers are the two most popular nonsurgical cosmetic procedures performed globally to treat age-associated changes. However, there are not many studies reporting the concomitant use of dermal fillers and laser technology for facial rejuvenation. This review aims to assess the concomitant use of dermal hyaluronic acid (HA) fillers and laser technology for facial rejuvenation.
Methods
The present updated consensus recommendations are based on the experience and opinions of the authors and on a literature search.
Results
If a combined procedure (HA and light treatments) is to be performed, on the same day, the panel recommends starting always with the light treatments, avoiding skin manipulations after having injected HA. To customize the therapeutic management, it is crucial to establish a precise diagnosis of the photodamage and loss of volumes suffered by the patients.
Conclusions
The currently available scientific evidence about the combined use of HA fillers and laser–radiofrequency–intense pulsed light (laser/RF/IPL) is limited and encompasses mainly small and nonrandomized studies. Nevertheless, most of these studies found that, on average, the concomitant use (same day) of laser and HA fillers for facial rejuvenation represents an effective and safe strategy which improves clinical results and patient’s satisfaction. Future well-designed clinical studies are needed regarding the effectiveness and safety of combination filler/laser treatments.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... Although HA IDF have shown significant promise and have been extensively used for skin rejuvenation, but their longevity is not established yet. To deal with this problem, some researchers investigated the effect of combination therapy of intradermal radiofrequency and HA filler on mild-to-severe NLFs [61]. Results revealed that combination treatment may provide synergistic and long-lasting effects for cosmetic correction of NLFs [61]. ...
... To deal with this problem, some researchers investigated the effect of combination therapy of intradermal radiofrequency and HA filler on mild-to-severe NLFs [61]. Results revealed that combination treatment may provide synergistic and long-lasting effects for cosmetic correction of NLFs [61]. In contrast, another study was conducted to evaluate the efficacy of combined treatment using a nonablative infrared (IR) device and HA filler. ...
Hyaluronic acid (HA) plays multifaceted role in regulating the various biological processes such as skin repairmen, diagnosis of cancer, wound healing, tissue regeneration, anti-inflammatory, and immunomodulation. Owing to its remarkable biomedical and tissue regeneration potential, HA has been numerously employed as one of the imperative components of the cosmetic and nutricosmetic products. The present review aims to summarize and critically appraise recent developments and clinical investigations on cosmetic and nutricosmetic efficacy of HA for skin rejuvenation. A thorough analysis of the literature revealed that HA based formulations (i.e., gels, creams, intra-dermal filler injections, dermal fillers, facial fillers, autologous fat gels, lotion, serum, and implants, etc.) exhibit remarkable anti-wrinkle, anti-nasolabial fold, anti-aging, space-filling, and face rejuvenating properties. This has been achieved via soft tissue augmentation, improved skin hydration, collagen and elastin stimulation, and face volume restoration. HA, alone or in combination with lidocaine and other co-agents, showed promising efficacy in skin tightness and elasticity, face rejuvenation, improving aesthetic scores, reducing the wrinkle scars, longevity, and tear trough rejuvenation. Our critical analysis evidenced that application/administration of HA exhibits outstanding nutricosmetic efficacy and thus is warranted to be used as a prime component of cosmetic products.
... 67 Choi et al evaluated the clinical efficacy and safety of combination therapy comprising intradermal radiofrequency application and HA filler for the reduction of nasolabial folds wrinkles and demonstrated synergistic and long-lasting effects. 68 A nasojugal groove or infraorbital hollow appears in the early stages of aging and is considered one of the landmarks of aging. It is characterized by a sunken appearance of the globe that results in the casting of a dark shadow over the nasal lower eyelid, giving the patient a fatigued appearance. ...
Hyaluronic acid (HA) is a major component of the extracellular matrix of the skin and plays an important role in the metabolism of the dermis. It has a key position in wound healing and tissue repair processes owing to its ability to maintain a humid environment favorable to healing and the stimulation of growth factors, cellular constituents, and the migration of various cells essential for healing. This review aims to describe briefly the physical, chemical, and biologic properties of HA, together with some details of the dermatologic indications of this unique molecule.
... After RF reached 40°C, subjects received a 2-min application on the selected dorsal area. One application of RF was run per week during 4 weeks [24]. After the application period of 4 weeks, subjects were anesthetized and a sample of 2 cm 2 from the controlled dorsal area was removed from each for analysis. ...
... RF is a technique based on electric current, which produces heat generated by resistance by the components of the dermis and subcutaneous tissues. This hyperthermia stimulates an increase in the expression of TGF-beta-1 (transforming factor beta-1 growth) as a response and stimulates HSP 47, causing fibroblasts to respond by increasing collagen production [24,25]. Another common and effective therapy is the use of hydrolyzed collagen (HC) [23]. ...
Radiofrequency (RF) treatment appears to be involved in production of new collagen fibrils and the improvement of existing collagen structures; however, the molecular bases of the effect of non-invasive RF on the skin tissue have not been fully elucidated. This study reports the effects of RF associated or not with hydrolyzed collagen (HC) in the skin tissue. Wistar rats were randomly divided into four groups, according to the treatment received: control group (G1, n = 5), no treatment; subjects in group G2 (n = 5) were treated with HC; and capacitive RF was applied to the back of each subject in G3 (n = 5) and RF associated with HC in G4 (n = 5). Biopsies were taken 30 days after treatment and then were histologically processed and studied for inflammatory cell counting, collagen content, and morphometry. In addition, FGF2, CD105, and COX-2 expression was assessed by immunohistochemical staining. The most relevant changes were the increase in cellularity and accumulation of intercellular substance in RF-treated animals (G3 and G4). The greatest dermis thickness rate was observed in G4, followed by G3 and G2 (p < 0.05). RF-treated skins (G3 and G4) exhibited a significant overexpression of FGF2 (p < 0.0001) and increased microvessel density (p < 0.0001) in comparison with G1 and G2. Moreover, the amount of COX-2 was significantly higher (p < 0.0001) in dermis of RF-treated areas compared to G1 and G2, and demonstrated differences in G3 (RF) compared to G4 (RF + HC) (p < 0.0001). Our results suggests that RF treatment associated or not with HC induces FGF2 overexpression, promotes neoangiogenesis and modulates the COX-2 expression, subsequently promotes neocollagenesis, and increased thickness rate of dermis.
... To assess wrinkle severity, Calabaro et al. [9] have investigated the WSRS which was used by blinded investigators and reported that this scale is a valid quantitative assessment with good intra-and interobserver agreement. Furthermore, Choi and collaborators, using only subjective methods, have shown that it is important to validate the treatment assessment by developing objective methods [4]. Oee et al. have used a subjective assessment based on photographs and an 8-grade wrinkle scoring, but they have not specified if the evaluators were blinded or not. ...
... Four articles used both the WSRS and the GAIS to assess the clinical efficacy of intradermal injection of hyaluronic acid on the correction of nasolabial folds (Table 1) [3,4,7,8,15]. The GAIS has also been used to assess the efficacy of platelet-rich fibrin matrix (PRFM) on the correction of deep nasolabial folds [8]. ...
Background
In the field of cosmetic medicine, patient satisfaction is an important and common indicator used to measure the efficacy of the treatment. However, it is insufficient to prove objectively that the benefit of the specific factors involved in the cosmetic outcomes. The practitioner should be aware of these assessment tools, in particular in case of demanding or litigious patients. Objective
The aim of this review was to establish a list and discuss the subjective and objective methods used to assess facial aesthetic rejuvenation treatments. MethodsA systematic literature search was performed using the Pubmed search engine. Studies published over the last 5 years, i.e. between January 2010 and January 2015 were considered for review. The following keywords were used: “aesthetic treatment”, “facial rejuvenation”, and “subjective evaluation” or “objective evaluation”. ResultsOf the 446 articles identified by the search strategy, 47 articles focused specifically on facial rejuvenation and on the efficacy of aesthetic medical treatments were retrieved for review. Thirty-seven articles used quantitative methods to assess aesthetic treatment outcomes and only 12 used subjective methods. The different assessment methods were listed according to the tools used and treatment indications. Conclusion
This review will help in choosing adequate methods to assess facial rejuvenation medical treatment. It is important to combine these tools adequately to improve the assessment. There is no current consensus on assess facial rejuvenation treatments but we noted that objective assessment methods seem helpful. No Level AssignedThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... [31] Recently, HA has been combined with radiofrequency (RF) devices to prolong the duration of action of HA, reducing the need for maintenance injections. [31,32] RF treatment has been found to play a crucial role in collagen remodeling, skin tightening, and collagen deposition, but has a limited capacity to restore lost volume. [32] Combination therapy in which RF is used immediately prior to treatment with a HA can compensate for both products' limitations while providing better treatment. ...
... [31,32] RF treatment has been found to play a crucial role in collagen remodeling, skin tightening, and collagen deposition, but has a limited capacity to restore lost volume. [32] Combination therapy in which RF is used immediately prior to treatment with a HA can compensate for both products' limitations while providing better treatment. Combination therapy was evaluated in both animal and human clinical studies where RF was delivered through an intradermal needle to creat tunnel-like setting inside the dermis and hypodermis. ...
The ever-increasing interest in retaining a youthful physical appearance has facilitated the development of various minimally invasive dermatological techniques. The use of intradermal fillers can be incorporated into dermatological practices with minimal overhead costs. This strategy addresses facial volume loss and dynamic lines, which are the main features of facial aging. Moreover, intradermal fillers provide an array of flexible treatment options for a balanced and holistic result to dermatological practitioners. This paper reviews the different intradermal fillers categorized by biodegradable and non-permanent fillers including collagen based materials, hyaluronic acid and autologous fat, semi-permeant fillers including poly methyl methacrylate, poly-L-lactic acid and calcium hydroxyapatite microspheres, and permanent fillers including silicone. A discussion is provided of the commercial products made of these materials and their clinical efficacy in the treatment of facial aging. Xin Zhao is an associate professor at Xi'an Jiaotong University, China. Prior to starting this appointment, she was a postdoctoral fellow at Medical School and School of Engineering and Applied Sciences at Harvard University. Her research involves engineering the micro-and nanoscale systems for tissue regeneration and drug delivery.
... However, they have a relatively shortly lived effect, necessitating frequent injections for maintenance 2 . To compensate for the short effect of HA fillers, combination therapies with radiofrequency (RF) regimens are currently being developed [3][4][5] . However, there is no evidence that combination therapy is better than injection of HA filler alone in forehead augmentation. ...
... The experimental procedure was well tolerated by all subjects, none of whom reported any serious adverse events other than pain. Choi et al. 5 report RF treatment prior to HA filler injection may provide synergistic and long-lasting effects for the reduction of nasolabial fold wrinkles. Needle-type RF is capable of delivering high RF energy directly to the dermis and can also pass injection materials via a needle electrode. ...
