Thermitight: Precise Subcutaneous RF for Optimal Tissue Tightening

The use of radio frequency (RF) delivery through the skin to stimulate tissue tightening is not entirely new. Nor, for that matter, is the notion of percutaneous RF delivery via microneedle RF devices. But Ardmore, PA facial plastic surgeon Jason Bloom, MD wasn't impressed with the results of older devices. Then he found ThermiTight, which he says, “has a wonderful place in my office and for a particular type of patient.” That patient? The “Tweener.”

“It's that mid-to-late 40s to the early 50s population,” Dr. Bloom explains. “The nice thing is they can get real results in the office.” About 85 percent of his patients that are in their mid-to-late 50s through their 60s and even early 70s are good candidates for lower face and neck surgery. “They have a significant amount of laxity in their neck and in their jowl areas. And they really want results,” he says.

The “Tweeners,” in contrast, tend to be in their 40s to early 50s. “Maybe they've tried some of the topical radio frequency devices or even some of the other nonsurgical noninvasive treatments for the lower face and jowls, and they've been unhappy. They want some results, because they just started to see some of the signs of aging in their lower face and neck, but they're certainly not ready for a lower face lift or a neck lift,” Dr. Bloom says.

“ThermiTight is a probe that's delivered underneath the skin under local anesthesia,” explains Z. Paul Lorenc, MD of New York City. “It delivers radiofrequency energy to heat up the collagen in the skin. The great thing about Thermi is that we have this feedback loop of external temperature. We have an infrared camera that looks at the area—whether it's the knees, the arms or the face—which gives me guidance of how much energy I need to deliver. It's a very controlled way of delivering energy.” The precise energy delivery avoids superficial skin injury.

Courtesy of Jason Bloom, MD

Few of his patients are treatment naïve, and are therefore familiar with injectable fillers and neurotoxins, Dr. Bloom notes. They understand the concepts of weakening the muscles that cause facial wrinkles and placing volume and shape to the face or plumping the lips with injectables. “Now, I tell them we can tighten the soft tissues of your neck and jowl,” he explains. “One of the most difficult areas that we've ever had to treat as facial plastic surgeons is the neck and lower face. Now we have an option that's nonsurgical. There's no scalpel, no surgery, and no stitches. And that has been a huge win in my practice for treating these patients.” Treatment takes about an hour and a half.

Courtesy of Z. Paul Lorenc, MD

Dr. Bloom estimates that ThermiTight allows him to achieve 30 to 40 percent of the improvement that he can with a surgical procedure. For many patients, that means being able to delay surgery for a period of years. And in some cases, Dr. Bloom will credit a portion of the cost of the Thermi procedure toward a subsequent surgery. “When they're 65 and they're looking to have a face lift, I want them to come back to me and say, ‘You know what, that ThermiTight that we did when I was 50 was money well spent.' And now it's like they have a down payment towards using me as their surgeon, and I want them to come back to me when they're thinking about face lift surgery.”

Having undergone a ThermiTight procedure would not preclude a patient from undergoing surgery in the future. Dr. Bloom has performed surgeries on patients who have undergone deoxycholic acid injection, crylipolysis, and RF treatment and noted no anatomical changes. “I have not seen a difference. It doesn't preclude anything.”

ThermiTight can be useful for patients who are not interested in surgery but want a treatment that can be performed in-office. Some patients are simply disinterested in surgery. Nonetheless, they may have laxity in their neck and want a little bit of improvement. “That's the other group that I treat with the device,” Dr. Bloom says.

Courtesy of Jason Bloom, MD

Greg Buford, MD, of Englewood, CO, agrees. “Often times, we actually have to do this crazy thing called listening to the patient. I've learned over the years that some of my patients are actually very happy with some of the results that I thought were good, but I wish could have been better,” he says. For patients who may be candidates for surgical intervention but don't want an operation, ThermiTight is a viable option, he insists. “We really do have to pay attention to what the patients want because often times they are actually happy with less of a result than we envision from surgery. The critical part of the patient interview of the consult is identifying what that patient really wants and really trying to predict what change that they're going to be pleased with.”

Patients will see results soon after Thermi treatment, but the benefits of treatment increase over time. “My protocol is to see patients back in one week just to make sure they're doing okay. And then I see them at one month, three months, and six months. And you can see the progression,” Dr. Bloom says. “At three months, they're just starting to really see the tissue contraction. And by five or six months, it's really amazing. “It takes a while for the fibro-septal network between the muscle and the skin to contract via neocollagenesis. When I see patients back around three months and they're looking really good, I say, ‘I cannot wait to see you in six months because it's going to be even more amazing.'”

As new injectable and energy-delivery devices continue to emerge for the neck area, increased marketing is driving patients into aesthetic practices. “They don't necessarily know which one will be good for them. But that's the job of the practitioner to explain to them the risks and benefits of each of these procedures,” Dr. Bloom says. Among key considerations is the number of treatments required and the potential benefit of treatment.

ThermiTight is a, “one and done kind of treatment,” Dr. Bloom says, which offers two important benefits. “Patients like that. For the most part, they don't want to come back in for multiple treatments. And so to have something that can address these concerns about their lower face and neck in one treatment is a huge win.” An additional benefit is persistent result. “I tell patients face and neck surgery lasts about seven to 10 years, based on the surgeon and multiple different factors. I tell them I've had ThermiTight in the practice since 2014, and I've never had to re-treat a patient. Thermi likely keeps working.”