What is Radiage?

Radiage is a novel skin tightening treatment that has been in use in Europe and is now pending FDA approval in the US.

It is not a laser. It is a radiofrequency-based system that is based on a completely different idea than photothermal reactions, which are important in laser technology. It works by using electrical current to generate heat, which passes through the epidermis (outer layer of the skin) and into the dermis (deeper layer of the skin) to cause some degree of thermal or heat injury. The body then reacts to this "injury" and regenerates, thereby tightening the skin.

You need to understand that this is a pain-free nonsurgical method of skin tightening, but is not a "home run." The best results for skin tightening come from a surgical procedure. The next is from a laser (either ablative or nonablative). This technology is well-below the effect of a laser. It is capable of some mild tightening of the skin and can give somewhere between 25-40% improvement in most patients.

There will still be patients who do the treatment with very little (if any) benefit. It is a good tool for those who would like to do something for skin tightening, but don't want to go through the downtime/pain of laser treatments.

Approved for use for several years years already in Europe, Radiage was recently FDA cleared and entered the American market several months ago as Peleve (Ellman International). It is one of a couple of devices that employs radiowaves, the kind of waves that your am/fm radio receives, to treat skin laxity and crepeyness.

Radiowaves work by generating an electric current, which then enters the skin and in so doing generates heat. The heat produced serves to break up and shrink old and damaged collagen fibers leading to shrinkage and in time to regeneration of new, fresher, tighter collagen and smoother overlying skin. Thermage is another radiofrequency device, which has been available for several years. Considered more aggressive than Peleve, Thermage has yielded inconsistent results in the past and is more uncomfortable for the patient to undergo.

Radiofrequency skin tightening is not a laser technique. Lasers work by light energy being converted to heat via a photochemical reaction. Radiosurgical skin tightening is a fairly simple technique. The skin is first cleaned and then covered with a conductive gel, akin to the kinds of gels that are used prior to ultrasound examinations. Immediately afterward the treatment wand is rolled sequentially over the areas to be treated until the desired level of heating is obtained, which just borders on, but does not reach discomfort. I have performed Peleve on myself and personally find the sensation of warmth to be relaxing.

Treating a whole face takes about a half an hour. During this time, each facial region is treated at least two to four times. In between each cycle, the treated sites is iced for about twenty seconds. The idea here is felt to be analogous to preparing a hard boiled egg. First you heat the egg sufficiently to denature its proteins and then you bathe it in cold water to further promote protein contraction. Repeated skin temperature measurements are generally taken during the course of the procedure to ensure that the skin gets heated to at least 40 degrees Celsius, which is necessary in oder to achieve the desired contraction and long-term effects. A series of four treatment sessions at a minimum of monthly intervals is typically recommended in order to achieve maximal results.

Results are indivicual and have ranged from subtle to as much as twenty to forty percent improvement following the series. In contrast to many other devices that are limited to use on the face, Peleve may be safely used to rejuvenate the neck and decollete, as well as other areas. Peleve can be useful as a stand-alone treatment for people not interested in more aggressive chemical peels, laser, or lifting procedures and who are willing to achieve less dramatic results in exchange for a no pain, no dowtime, relatively inexpensiveness and mild, but gratifying improvements in skin lasity, crepeyness and crinkliness.

I have found this approach particularly useful when combined with other nonsurgical facial, neck, and chest rejuvenation procedures, such as Botox and Dysport, fillers, and volumizers. In my opinion, radiofrequency skin tightening works especially well when combined with microneedling (Dermaroller), which improves the appearance of the surface of the skin, while the radiowaves improve the fibers below.