What is the best RF treatment for delicate eye area?

Question

Hi there I am 42 with olive skin and not a lot of wrinkles but definitely some developing around/under my eyes and just some thinning of skin in the area in general. I'm interested in doing an rf procedure and am going between pelleve and thermi. Is one better than the other for going into the delicate eye area? Can either be used on the top lid as well? Is there more risk with thermi because it can get hotter? Thanks!

Georges Kaado, MD · Answer

Hello, I have used both Thermismooth and Pelleve', both have good results that are temporary but effective.  It really helps if you have botox before the treatment it helps relax the muscle .  Neither of the RF machines can go directly over the eyelid, but you can go above the orbital rim.
Best of luck to you.

Amiya Prasad, MD · Answer

Thank you for your question. You submitted a question without a photo, but you describe yourself as 42 with olive skin, and developing some fine wrinkles around your eyes. You’re trying to decide which radiofrequency device you want to have for this problem between Pelleve and Thermi. You’re also asking whether the procedure can be done to the upper eyelid area, and if there is greater risk from Thermi because you believe the Thermi works in a way that the temperature is hotter.
I can give you some guidance as to how I answer questions like this in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I have used technology for skin rejuvenation since the early days of the original CO2 lasers in the early to mid-90s, and the evolution of different options has grown to a significant level, ultimately causing a lot of confusion amongst people who want to solve the usual issues of facial aging.
At 42 with olive skin, you probably already learned that ablative devices where the laser is used to remove skin may not be ideal for you because of potential risks related to pigmentation. I find it interesting that you’re phrasing the question about the best RF for the fine lines and your eyes because it assumes that radiofrequency technology is the only solution for the under eye wrinkles. Let’s understand what the concept is, and I’ll tell you how I discuss with my patients the risks and benefits, and what I try to convey to my patients about what to do with fine lines.
These devices use radio waves or radiofrequency to convert energy from radio to heat. With heat, you are inducing a certain target temperature in the skin to elicit a collagen remodeling response. Essentially, the technology for inducing the heat whether it’s Pelleve or Thermi are the same. For full disclosure, I’ve had Pelleve in my practice for years and I don’t have Thermi. When you watch people doing either procedure, it looks pretty much the same because essentially, they’re the same. 
When you think about how manufacturers promote procedures and devices, they literally bypass the practitioner. What I’ve observed with laser and technology manufacturers is they are trying to create the demand without using the real experience of physicians who are at the ground level treating patients and getting feedback. Like drug companies that used to market to physicians about the benefits of a certain drug are now marketing directly to consumers; the same thing happens with different devices, injectables, and pharmaceuticals.  People learn about these devices and feel like this is the best thing that can ever be, and go chasing after the device as a solution, as opposed to meeting with qualified, competent physicians who can give a perspective overall.
Radiofrequency technology is valid and does have value. However, when I counsel my patients, I begin first with asking what kind of outcome are they looking for? How do they define success? I begin with explaining it’s essentially impossible to eliminate all the fine lines. There are multiple dynamics in what causes these fine lines to occur. When you think of the fine lines under your eyes, there are dynamic lines which occur when you smile as you activate muscles, and there are static lines that are present at rest. 
Any thermal energy device or laser basically treats static lines. The challenge is those lines can still form after treatment because of the activity of facial movement. Very often, I will counsel my patients on a multiple approach to reduce muscle activity with a neurotoxin like Botox® or Dysport®. We also use something to build collagen from underneath the skin such as PRP or platelet-rich plasma, then consider the use of a thermal energy device, possibly even a limited ablative device like a fractionated Erbium laser or something to help improve the surface. Under eye skin is only half a millimeter in thickness, so there are a lot of variables affecting how a person responds to any of these modalities. 
When you think about these procedures, you have to think what kind of result will likely be achieved, and is it worth the time and expense. What I find is when people want very dramatic improvement, and they don’t want to spend a lot of time waiting for it.This is one of the challenges for a thermal energy device whether it’s one brand or another because there is a certain amount of collagen the body can respond with, and there’s a certain limit every individual has. There are also other factors affecting  how much collagen is generated - it’s kind of a holy grail to stimulate the body to generate collagen.
If I were to rephrase your question, it would be what’s the best way to improve fine lines and wrinkles, which in your situation requires a proper examination. It also involves a real understanding of who you are, what your expectations are, and what kind of time frame you are willing to commit to, understanding the different ways to treat this area, and what kind of cost you are comfortable with. 
This is why there is no one solution for one problem. There are multiple solutions, so it’s the art of medicine that a physician can develop a plan with you working together on making these things happen. I always tell my patients that besides doing surgical procedures, lasers, injectable fillers, and other things, I become essentially their primary doctor for beauty. I guide them not only for solutions, but also to educate about what the latest device or fad is in terms of hype. If you just look back at the history of non-invasive medical technologies, look at what’s trended over the past 5 years at different times. Each time, you’ll notice there’s a huge surge of interest in a new device, then it just drifted away because that device never delivered what it originally claimed through very well designed marketing.These devices were very aggressively marketed, then faded away as practitioners and patients became disenchanted with them. It’s very important you think through these factors and don’t shop devices, but shop the right physician- that’s the take home message. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Michael P. Goodman, MD, FACOG · Answer

Pelleve and Thermi are EXACTLY THE SAME TECHNOLOGY, just different companies. Get whichever one has the best deal. The weblink below has more info..Cheers!Michael P Goodman, MDDavis, CA USA

What is the best RF treatment for delicate eye area?

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What is the best RF treatment for delicate eye area?

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Everything you need to know about Pelleve

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