How does a doctor guard against facial nerve damage in the thermitight procedure?

Thank you for your question and I appreciate your concern. The ThermiTight device uses radiofrequency energy to heat the underlying dermal layers and connective tissue, which constricts the tissue and leads to an increase in collagen production. Because the probes used to deliver the energy are inserted beneath the skin, there is little risk of nerve damage to the facial nerve because it is deeper in the tissue. There is a nerve, the marginal mandibular nerve, located in the jowl a bit more superficially. Care must be taken to avoid treating the area where this nerve is most exposed. This risk, however small, underscores the critical importance of working with an experienced, board-certified dermatologist with expertise in using this device and knowledge of the anatomy to ensure the procedure is both safe and effective.

ThermiTIGHT is performed under the skin in the neck and lower face area where the marginal mandibular nerve is.  I normally map it out before the procedure starts and then avoid it during the procedure.  I'm a board certified Plastic Surgeon so I've seen this nerve and dealt with it directly many times in my career.  So its definitely something to be very careful with.  That being said, if you do get some weakness afterwards, it is usually limited to a few days or so if the proper precautions were taken before hand.  If it happens to you just stay in close contact with your surgeon to make sure that it improves.

Several Layers of protection prevent permanent facial nerve damage.  1.  The heat at the tip if the probe is at a safe level.  Most treatments are at 55-70 degrees.  We have learned from the ThermiRase treatments that it takes 85 degrees at several spots along the nerve to intentionally disrupt the nerve.2. The thermal camera gives your surgeon a second level of temperature monitoring to keep the treatment at a safe level. 3. Having a well trained, experienced plastic surgeon who knows facial anatomy adds a layer of safety to keep the probe out of danger zones. If any weakness of a nerve does show up, it is usually a very temporary nuisance.  

Thank you for the important question. The facial nerve, specifically the marginal branch that controls the corner of the mouth, is in the area that is heated with ThermiTight when the jawline and jowls are treated. Careful attention to the anatomy, placement of the heat evenly and slowly, and observation of the patient's face and sensation are the best way to monitor this nerve. No sharp instruments are used and nothing is cut. Risk is very low. 

Protecting the facial nerve is an important consideration during the ThermiTight procedure. There are several ways to minimize the risk of nerve injury. The most commonly employed method involves having knowledge of the anatomy and location of the nerve so that the treatment avoids these areas. This means staying approximately 1cm away from the marionette smile lines at all times during the procedure, treating parallel to the nerve itself, and ensuring that the target temperature is not excessive. If there have been previous surgical procedures performed in the area that may have rearranged or altered the natural anatomy, then a nerve stimulator can be used to determine the exact location of the nerve. However, despite all appropriate precautions, the nerve can potentially still be damaged. This damage is temporary and 100% function is typically restored in about 6-8 weeks with no lasting side effects.

Safe use of #ThermiTiteLike every procedure, the skill and knowledge of the surgeon is important. The nerve can be mapped out.  The probe should be in the right layer.  The temperature is monitored in a way to be safe.

When used appropriately by a board certified surgeon this is a safe procedure as it is used superficial to the facial nerves. The key is to make sure that the RF (heating) probe is in the proper fat layer which is superficial to the facial nerve branches. The heat is also monitored to prevent nerve injury.

Thermitight is an excellent procedure for skin tightening. During Thermitight, the temperature is monitored both from the inside and outside to avoid over heating. The temperature needed to damage a nerve is much higher than the temperature needed for skin. However, occasionally, some patients experience temporally numbness. . In our ThermiTight training facilities, all the doctors that come here to learn are instructed on safety and how to avoid nerve injury. We perform about 5 - 10 ThermiTight treatment per week. The best way to avoid problems is to make sure that your plastic surgeon is well trained and experienced in ThermiTight. Good luck

We have completed over a thousand energy based facelifts. First with laser (Smartlifting) and then with Thermi. What we know about nerve injury when we are trying to create it is you must stay on the nerve with a temperature of 85 degrees C to ablate it. The temperatures in thermitight treatment never exceed 65-70 degrees. The other surgeons have pointed out that the facial nerves run deeper than the subcutaneous space where thermi is utilized and so the position of thermi catheter as well as the temperature do not induce problems with the facial nerves.

Nerve injury is rare with ThermiTight and although it can occur in facelifts, facial liposuction, Ultherapy and ThermiTight, it is not known to be permanent at this time after ThermiTight. Blunt force and heat can temporarily make a nerve "go to sleep" and the time it takes to recover is variable, from weeks, to months or longer.Physicians who perform these procedures need to know the important anatomy of the area to avoid direct nerve treatment. However, there is a great variability of the pathway of the nerve for different patients, a fact proven in the literature with anatomic dissections. One advantage of the ThermiTight equipment is that a nerve stimulator is supplied for ThermiRaze (which treats frown lines of the forehead) and I have used this in my NYC practice to outline the nerve pathway of my ThermiTight patients prior to performing this great procedure for facial tightening.