This demonstration that no one could forget
Dr. Lauren Greenberg, who practices plastic surgery in Palo Alto, talks about going to a training where a representative from the company went through Ul therapy live. This caused the cheeks to look sunken. The amount of facial fat that Dr. Greenberg estimates the exhibitor lost was about 15cc - something a surgeon would add when performing fat grafting to counteract loss of facial volume due to aging.
There are distinct fat compartments of the face, the malar fat pad, the buccal fat pad, and the sub-orbicularis oculi fat, that each provide support to the overlying skin, and the smooth transition between features. As the compartments get smaller, the skin on top of them has nowhere to lie. It droops, caves in and folds.
Why wrinkles often get worse
Most patients have an initial improvement after an RF or laser treatment. Inflammation, due to thermal injury, leads to temporary swelling. The skin is tighter. However, during the next few months, that swelling goes away. When fat loss occurs, the skin will be less supported than before the treatment. Reduced swelling from temporary wrinkles is reversed, sometimes more acutely than before.
A cosmetic surgeon in NYC has written about this phenomenon in patients who have received several laser or RF treatments. The reason for the fat loss is the culprit," he notes. The collagen that is stimulated by the treatment isn't doing anything to replace the volume lost below. In another patient resource, the Tweakments Guide also points out that aesthetic treatments using RF "can and does" impact facial fat, with those over 40 more prone as they may have less fat than younger individuals.
This results in a vicious cycle. The face appears sunken. One other treatment is scheduled to "tighten up" what appears slack. There is increased fat burning. The Natural Look Institute says that the one thing these energy devices have in common is that they offer only temporary, limited results, as the changes that cause aging in the face - fat loss, bone loss, and ligament laxity cannot be corrected by heating the surface of the skin.
Which individuals are most likely to be at risk?
Not all patients will see a reduction in fat, but there are some factors that may make this more likely. Older patients have less fat in the face, and the same amount of energy that can be absorbed without being noticed in a younger patient can cause a visible hollowing in an older patient. The risk is high in naturally lean patients, in patients who have been treated in the same energy zone previously and in patients treated by a person who has no clinical experience in facial anatomy and treated at a high energy setting.
How to recover. How recovery will be experienced.
Although it is not as simple as the initial treatment, there are options for patients who have already lost weight. Autologous fat grafting, transferring fat from the abdomen or thighs to the face is the most direct correction. It is a surgical procedure which is performed under anesthesia and the percentage of fat survival is in between 40-70 percent. Tissue beds with previous energy therapy may not be as susceptible to graft placement as unaffected tissue because repeated thermal injury may make it harder to return the tissue to a viable state to support graft survival, says Dr. Greenberg.
There are risks, however, with dermal fillers used in areas of previous energy treatments, and they can be used to treat localized hollowing. It is more difficult, more costly and less predictable to reverse fat loss caused by treatment than to prevent it.
Questions to ask before any treatment using energy
- To what depth will this device be able to penetrate and which tissue layers will be affected?
- What's the chance of fat loss for a person of my face type & age?
- For how long will the tightening hold? Once it wears off, what occurs?
- Can I receive this procedure or fat transfer instead of or in addition to this procedure?
- Who is doing this and what are their anatomical training qualifications?
If they can't give you answers to those questions, even in terms of your face, not speculating with before and after photos, not promising, just answering, that's something to know before you book.
The skin tightening will be TEMPORARY. The fat loss is PERMANENT.
Energy-based devices aren't necessarily dangerous. When performed correctly, at the proper settings, in the proper patient, RF microneedling and laser treatments can truly improve the texture of the skin. The issue is that they are often marketed as a safe and non-invasive option to surgical interventions, with no warning that the structural fat beneath can not endure the treatment.
