title: Exploring channeling optimized radiofrequency energy: a review of radiofrequency history and applications in esthetic fields.
abstract: BACKGROUND
  Because of its high efficiency and safety, radiofrequency (RF) energy is widely used in the dermatological field for heating biological tissue in various esthetic applications, including skin tightening, skin lifting, body contouring, and cellulite reduction. This paper reviews the literature on the use of nonablative RF energy in the esthetic field and its scientific background. The purpose of this article is to describe in detail the extensive use of medical devices based on RF technology, the development of these medical devices over the years, and recent developments and trends in RF technology.
  
  
  METHODS
  The authors conducted a systematic search of publications that address safety and efficacy issues, technical system specifications, and clinical techniques. Finally, the authors focused on their own clinical experiences with the use of patented Channeling Optimized RF Energy technique and mechanical massage. An in-vivo study was conducted in domestic pigs, with a thermal video camera. Twenty-seven female patients participated in a cellulite and body shaping study. The treatments were conducted according to a three-phase protocol. An additional 16 females participated in a skin tightening case study. All of the patients underwent three treatment sessions at 3-week intervals, each according to a protocol specific to the area being treated.
  
  
  RESULTS
  The review of the literature on RF-based systems revealed that these systems are safe, with low risks for potential side effects, and effective for cellulite, body contouring, and skin tightening procedures. The in-vivo measurements confirmed the theory that the penetration depth of RF is an inverse function of its frequency, and using a vacuum mechanism makes an additional contribution to the RF energy penetration. The heating effect of RF was also found to increase blood circulation and to induce collagen remodeling. The results from the cellulite and body shaping treatments showed an overall average improvement of 55% in the appearance of cellulite, with an average circumferential reduction of 3.31 cm in the buttocks, 2.94 cm in the thighs, and 2.14 cm in the abdomen. The results from the skin tightening procedure showed moderate improvement of skin appearance in 50% and significant improvement in 31%. At the follow-up visits the results were found to be sustained without any significant side effects.
  
  
  CONCLUSIONS
  Of all tissue heating techniques, RF-based technologies appear to be the most established and clinically proven. The design and specifications of the described vacuumassisted bipolar RF device fall within the range of the specifications currently prescribed for esthetic, nonablative RF systems.
authors.affiliation: Clinical Department, Viora, Inc., Jersey City, NJ 07306, USA. inna@vioramed.com
authors.forename: Inna
authors.initials: I
authors.lastname: Belenky
authors.forename: Ariel
authors.initials: A
authors.lastname: Margulis
authors.forename: Monica
authors.initials: M
authors.lastname: Elman
authors.forename: Udi
authors.initials: U
authors.lastname: Bar-Yosef
authors.forename: Silviu D
authors.initials: SD
authors.lastname: Paun
mesh_terms: D000273:Adipose Tissue; D000818:Animals; D003357:Cosmetic Techniques / Q000295:instrumentation* / Q000639:trends; D005260:Female; D006801:Humans; D000078702:Radiofrequency Therapy; D012867:Skin; D013552:Swine