We report here a case and show that subdermal induction heating technology also known as endodermal radiofrequency is one of the most effective applications of this treatment method.

Possible contraindications should be considered and written down. The application of endodermal radiofrequency therapy (S.I.H.Technology) requires a comprehensive training, because to the current knowledge, the experience of the physician in the use of high-frequency devices is most important for a successful outcome.

Introduction

The desire to improve the appearance is growing steadily. Thus, the demand for non-invasive or minimally invasive treatments in aesthetic medicine is increasing rapidly. These include in particular moderate fat reduction and skin tightening. Radiofrequency therapy is one of the most effective methods for this application. There are currently several platforms based on this method. We report here a double-chin case and describe the effective method of reducing the smallest fat deposits in the submental fat associated with tightening of the skin. The effectiveness of the therapies was important to us as it forms the basis for long-term patient satisfaction. This is a factor that should not be underestimated. Therefore, we report a treatment system that covers both indications fat reduction and skin tightening and is versatile, so that the user has a variable tool available [1,2].

One of the most commonly used procedures is Non-Invasive Radiofrequency (RF). This is used in particular for the treatment of skin flaccidity [3]. The temperature and depth of heating depend on the energy used and the impedance of the biological tissue [4]. The aim is to induce thermal damage to stimulate changes in the collagen composition and induce collagen neogenesis in deep layers of the skin and subcutaneous tissue [5-7].

Fig. 1: Sideview on preplatysma fat.

Case

A 60-year-old female patient was treated with age-appropriate findings in the area of the chin and neck. A double chin consisting of a submental fat depot and skin flaccidity showed up. In addition, sporadically showed "age spots". She was classified as Fitzpatrick Skin Type II.

Pathological skin manifestations did not appear in the area of the area to be treated. Allergies to local anesthetics and contraindications to radiofrequency treatment, such as pregnancy, lactation, cardiac pacemakers or step maker any kind, were negative.

The patient had so far had no skin-rejuvenating treatments in this upper and lower skin area in the sense of dermal fillers, thread-lifting previously performed.

Anatomy of double chin – submental fat

What we call a double chin is a layer of submental fat on the ventral neck that creates a fold that shows the appearance of a second chin.

In the submental region, the deep layers of muscle and fascia are formed above it a subcutaneous fat layer. This superficial layer of fat is shared by the platysma, a caudal continuation of the superficial muscular aponeurotic system (SMAS).

The boundaries of the compartments are formed by fascia septids emanating from the deep fascia or the periosteum and inserting themselves into the dermis. The general attractiveness and the juvenile appearance of an asthenic neck are due to this submental fatness. Bitner et al. developed a classification scheme to assess the degree of turkey-eating deformity in the submental region based on changes in the skin, fat, platysma, and underlying bone. This classification serves as an invaluable tool for evaluation and subsequent intervention [8-10].

Fig. 2: Left before treatment; Right 8 weeks after treatment.

Subdermal Induced Heat (S.I.H.) Technology – the application

The patient was treated with the S.I.H.T System. This is technically a monopolar, controlled heating of tissue layers of different depths with high-frequency current, voltage and frequency modulation. This application can be controlled by a thermal imaging camera via a monitor platform. It is recommended to apply before treatment a local anesthetic injection in the area of the entry point of the probe of the RF. Topical anesthesia cream, nerve block or tumescent anesthesia are not necessary in such a therapy. The insertion of the probe itself is almost painless. Only the point of entry will be painful, so local anesthesia is necessary at this entry point. The heat in the tissue leads to a uncomforting burning sensation. This can not be prevented by larger amounts of anesthetic.

A direct reintegration into social life was possible and she returned to work. An immediate result was not visible. The treatment was very well tolerated with only a few mild side effects. Only a burning sensation was reported as a major side effect. However, this was well tolerated by the patient. The minimal side effects such as erythema or bruising disappeared spontaneously after a few days. No major complications (eg infectious processes, necrosis, embolism, overcorrection, allergies) were observed.

Discussion

When using this high frequency device, the choice of treatment depth can be treated either subdermally or subcutaneous fat tissue. The effects in these different tissues are very different. In the treated fat layers, apoptosis is induced, i.e. the medium-term breakdown of fat cells. On the other hand, the system on the dermis has an influence on the function of the cell activity as well as on the extracellular matrix in order to achieve a tightening by restructuring the collagen fibers and stimulating the fibroblasts. Here is this system unique. Unlike other devices, heat does not pass through all layers of the skin, but directly from the bottom of the dermis. In this way, no heat loss occurs at the destination (treatment point) because the probe applies the desired temperature to the target site [11,12].

The principle of RF skin tightening treatments is not new as it is known that the dermis and subcutaneous tissue will heat up and stimulate the remodeling of dermal collagen. It is well documented that heating the skin causes an immediate change in collagen structure, followed by long-term stimulation of neocollagenesis [13]. We took advantage of these thermal effects to improve the appearance of wrinkles, the flaccidity of the skin and the contours around the face [14].