ThermiRase: RF Targeting for Enervation and Wrinkle Reduction

I'm a skeptic, at heart,” says Z. Paul Lorenc, MD. “That's just me. I need some science. Whenever I purchase a piece of equipment, I always do my homework.” So when he was considering the Thermi platform for his New York City practice, he reviewed the research and was confident about the theory behind the technology. What sold him on the system was the positive feedback from peers. “I spoke to a couple of people who had the devices, and they were all in favor,” he says. “It does exactly what it was said to deliver, if not more.”

Dr. Lorenc purchased the system and started to introduce Thermi by rolling out the ThermiTight procedure. For more than two years now he has offered ThermiTight, ThermiSmooth, ThermiVa, and ThermiRase.

ThermiRase is a unique technology, he says, that uses radio frequency to enervate muscles, similar in many respects to the action of injectable neuromodulators. However, the device offers some specific benefits over injectables and may be poised to gain prominence in the near future, Dr. Lorenc predicts.

Whole Body/Whole Practice

The Thermi platform, “really has integrated well into my practice,” Dr. Lorenc says. “I know that it's a bold statement, but it almost changed the character of my practice when it comes to facial rejuvenation. That's because it broadens the spectrum of what I can do.” As a surgeon, Dr. Lorenc sees benefit to being able to offer a device-based treatment to those patients who are not quite ready for surgical intervention, such as a face lift, or those who want improvement but simply won't agree to surgery.

Alternatively, the device can freshen up a patient who has had surgery in the past but is beginning to see new laxity. Consider a patient who had a face left roughly 12 years ago who recently underwent ThermiTight in Dr. Lorenc's office, “just to tweak or tighten the skin and the jowls and the neck. It works both ways.” As Dr. Lorenc notes, ThermiTight is appropriate for, “patients who are not quite ready for a surgical approach and patients post-surgically where you can augment the results and maintain their surgical results.”

He also likes that he can use the device to expand the treatment options for a given patient. “Just yesterday I did ThermiTight on a patient on both the knees, and also on the face.”

The Thermi platforms all provide a high degree of operator control. “The thing that attracted me to this system and that continues to get me excited and the reason that I do so many Thermi procedures, is that the feedback loop gives me control,” Dr. Lorenc says. Depending on the platform being used, an infrared camera measures the surface temperature or a thermocouple measures the temperature underneath the skin when using the probe. “With ThermiTight and ThermiSmooth there is a measurement of the temperature where the device gets the skin to a particular set temperature. I like that control because it's not a just a haphazard way of delivering energy,” he adds.

Now comes ThermiRase, which further expands the types of treatments that Dr. Lorenc can offer. The treatment delivers targeted radiofrequency energy to weaken muscles in the forehead or the platysma, with results similar to that from injectable neuromodulators. “As a surgeon I'm very familiar with the enervation of the platysma and the corrugators and procerus, plus, I do a lot of anatomical studies. I am very much in favor of using radio frequency to achieve enervation of the muscles.”

Dr. Lorenc says he especially likes the results using ThermiRase on the neck. “I love using ThermiRase for the platysma. For the medial platysma, specifically, in combination when I do ThermiTight to the neck.”

ThermiRase treatment is technically driven. The duration of effect depends on the proper placement of energy and the total energy delivered. The physician maps the nerve prior to treatment and determines a treatment plan. The probe is inserted and applied to the nerve; placement is verified by stimulating the nerve. Dr. Lorenc predicts ongoing training and education to allow more physicians to adopt the procedure.

The duration of effect is much longer than with injectable neuromodulators, Dr. Lorenc reports. “I have a patient who I did a ThermiRase treatment close to two years ago. I did a glabella treatment in the D-11 and she maintained the correction for two years now. She still has the correction. She's still better off than baseline at two years, which is pretty impressive.”

Expanding Options

Even when he or she presents to a surgeon's office, a patient is not necessarily convinced of the need for surgery. “Every time the patient comes in, even if they're coming in for a face lift, the first question is, ‘Is there anything else you can do outside of surgery?'” Dr. Lorenc says. “That's just a natural. Obviously that's part of the discussion.” It's in those discussions—ascertaining the patient's concerns and their treatment goals—that the surgeon can best understand the patient's need and the right course of action to balance efficacy, downtime, and costs. But that's not to say that patients don't need to come to the conversation informed of their options.

“We do internal marketing obviously to our patients,” Dr. Lorenc notes. For a platform like Thermi that offers multiple platforms to address a wide range of aesthetic concerns, patients benefit from knowing their options. ThermiRase is not widely promoted to the public just yet, so internal messaging to patients is helpful. It sets the stage for a frank discussion between the patient and surgeon.

“Now, certain patients, obviously, are just candidates for surgery—not candidates for non-surgical,” Dr. Lorenc says. With advancements in minimally- and non-invasive interventions, “this has been a moving base,” he adds. Thermi has become a go-to in the minimally-invasive realm for his patients.