Facetite - Safety of Subdermal Wand?

The makers of FaceTite have produced a device that measures the amount of energy applied to the subdermal and fat layer as well as the temperature continuously and in real time.  There is never a moment in which your surgeon has to unsure about how the device is heating the tissue.  In the face and neck, we focus on keeping the device above the muscle and in the subcutaneous fat and in the subdermal plane.  If the device is truly kept in that layer in the capable hands of a well trained surgeon, then there should be little if any risk to a facial nerve branch.  We use the device primarily in the neck as that is the area of greatest need and improvement from what we have seen.  We have yet to have suffered complications with the use of the device.  Since we often combine the use of the FaceTite with liposuction, we are removing fat at the time of the surgery.  Your result should be fairly clear and stable by 3-6 months after surgery in this area of the body (can take longer, as long as 6-12 months after a larger body area such as the abdomen).  Having said this, our skin and fat can change as we age and with body weight and hormonal fluctuations.

Your concerns are entirely reasonable, and yes there is risk with any procedure. There is risk of temporary facial nerve injury, and I have not heard of a permanent injury reported yet. The fat layers can respond differently in different areas and depending the technical skill with which the procedure is performed. If this device is in the hands of an experienced surgeon, who is accustomed to passing cannulas under the skin, all these risks are minimized. InMode (the founding company) for this reason has limited the high powered (40watt) devices to Plastic Surgeon use only. 

Facetite was first used with IRB studies around 2007 in the US.  Since then the product has cleared the way for other subdermal RFdevices such as Thermi to be made available.  These devices are new in concept in that the devices work under the subcutaneous skin, dermal matrix, and fat to attempt to contract fat and skin.  Answers to your specific questions:Is it possible that as this device is moved *under* skin, a facial nerve will be damaged?  Any procedure including Facetite, Thermi or Kybella has the potential to injure a facial nerve.  The safety in Facetite is that the radiofrequency energy is directed between the probe and the external sensors making the energy unidirectional.  Thermi is omnidirectional which means it theoretically is harder to utilize in the face.  I have used Facetite since October 2016 and have not had any nerve injuries to date.Loss of facial fat with RF activity?  The device can be used in several layers of the face including the subdermal matrix or the subcutaneous fat.  In the face, typically the device is used along the subdermal scaffolding for the tightening effect rather than to remove facial volume.  It can be used to reduce the appearance of jowl fat with a deeper application.  The device has been used worldwide and studies do not suggest continual loss of fat.  

Your concerns are valid and obvious red flags. Do not be the first on your block to get this procedure. Not only can it kill the fat but the degree of kill is not easy to control. I had a patient come to the office who underwent RF destruction of fat for lower eyelid puffiness at a university medical center. This was done without an incision or surgery. The problem was much more fat was killed on one side than the other. The result was asymmetry that is almost impossible to fix. If you kill more fat on the one side the patient would have an increasingly sunken eye appearance.

To prevent this I assume the surgeon would focus the RF at the undersurface of the skin. This is dangerous because the blood supply to the skin has already been partially severed by the act of putting the wand under the skin. Damaging the undersurface of the skin in an attempt to shrink it is misguided. This action has led to numerous cases of uncontrolled scarring that is often felt more than it is seen. Scar comes from the deeper layers of the skin. Just think of a scalding skin burn where the deeper burns create worse scars.

FaceTite is a great way to tightening skin with minimal downtime. There are always risks to every procedure and whether it is right for you depends on an examination. I think the focal energy delivery helps to minimize some of the complications of fat loss that we were seeing in some of the other RF technology. I prefer to use it on the neck where volume reduction is desired and Fractora (different energy delivery of RF) for the face.