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Thank you for your question.
You submitted a question without a photo but in this question, you described yourself as
42 with olive skin and you're developing some fine wrinkles around your eyes.
And you're trying to decide which radiofrequency device you want to have for this problem between
Pelleve and Thermi.
And you're also asking whether the procedure can be done to the upper eyelid area and you're
asking is there greater risk from Thermi because you believe that the Thermi actually works
in a way that the temperature is hotter.
Well, I can give you some guidance as to how I answer questions like this in my practice.
A little bit of 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
back in the early to mid-90s and the evolution of different options has grown to a significant
level and ultimately is causing a lot of confusion amongst people who want to solve the usual
issues that concern people with facial aging.
So at 42 with olive skin, you are 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.
But I find it interesting that you're phrasing the question what it is the best RF for the
fine lines and your eyes.
It's assuming that radiofrequency technology is the only solution for the under eye wrinkles
and you're looking for the best one.
So let's just understand what the concept is and I'll tell you how I discuss with
my patients the risks and benefits of anything as well as what my global understanding when
I try to convey to my patients about what to do when they see fine lines.
So let's start what radiofrequency technology is.
Basically it is the use of radio waves or radiofrequency to convert energy from radio
to heat.
And with heat, you are inducing a certain target temperature in the skin to elicit a
collagen remodeling response.
And so, essentially, the technology for inducing the heat whether it's Pelleve or Thermi,
and just full disclosure, I have Pelleve in my practice and I've had it for years and
I don't have Thermi, I would say that essentially when you watch people doing either procedure,
it looks pretty much the same.
And it's because essentially, it is the same.
When you think about how manufacturers promote procedures and devices, essentially, they
literally bypass the practitioner.
What I've observed with laser and technology manufacturers is that because they are essentially
trying to create the demand without using the real experience of physicians who are
at the ground level treating patients and getting the feedback.
So like drug companies that used to market to physicians about the benefits of the drug
are now marketing directly to consumers.
The same thing happens with different device and injectables and pharmaceuticals.
And so, 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.
So I would say that radiofrequency technology is valid and does have value.
However, when I counsel my patients, I begin first with asking what kind of outcome are
you looking for?
How do you define success?
I begin with explaining that it's essentially impossible to eliminate all the fine lines.
When you see fine lines, you have to understand there are multiple dynamics in what causes
these fine lines to occur.
An important dynamic is simply the activity of facial movement.
So when you think of the fine lines under your eyes, there are dynamic lines which occur
when you smile and when you activate muscles and there are static lines, the lines that
are there at rest.
Any type of device such as a thermal energy device or laser is basically to treat static
lines.
What's the challenge?
Well the challenge is that those lines can still form because of the activity of facial
movement.
So very often, I will actually counsel my patients on a multiple approach so that we
do something such as reduce muscle activity with a neurotoxin like Botox® or Dysport®,
we use something to build collagen from underneath the skin such as the use of PRP or platelet-rich
plasma and then consider also the use of a thermal energy device and even possibly even
a limited ablative device whether it's a fractionated Erbium laser or using something
to try to help improve the surface.
When you think of under eye skin, this is skin that's half a millimeter in thickness.
There are a lot of variables that affect how a person responds to any of these modalities.
So when you think about these procedures, you have to also think what kind of result
will I ultimately likely achieve and is it worth the time and the expense that I would
putting into doing these procedures.
And what I find is that when people want very dramatic improvement and they don't want
to spend a lot of time waiting for that dramatic improvement.
And I think that 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 that the body can respond
with but there's a certain limit every individual has and then there are other factors that
affect how much collagen is generated.
It's kind of a holy grail is to stimulate the body to generate collagen.
So I would say your question really, if I were to ask you to rephrase it, what's the
best way to improve fine lines and wrinkles in your situation and that requires a proper
examination.
And a real understanding of who you are, what your expectations are and what kind of time
frame you are willing to commit to and understanding the different ways to treat this area and
what kind of cost you are comfortable with.
So this is why there is no one solution for one problem.
There are multiple solutions and it's the art of medicine that a physician who you work
with can actually develop a plan with you and you work together on making these things
happen.
I always tell my patients that basically, besides doing surgical procedures, lasers
and other things that we do, injectable fillers, I become essentially their primary doctor
for beauty to 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 this specialty of non-invasive medical technologies,
all you have to do is to just look at what's trended over the past 5 years at different
times.
And each time, you'll notice there's a huge surge of interest in a new device and
then it just drifted away because that device never delivered what it originally claimed
or implied through very well designed marketing.
And essentially, these devices were very aggressively marketed and then they faded away and practitioners
became disenchanted with them and patients became disenchanted.
So it's very important that you really think through these factors and don't shop devices.
Shop the right physician.
I think that's probably the take home message here.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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