(BQ) Part 2 book "Lasers in dermatological practice" presentation of content: Sexually transmitted diseases, keratinising and papulosquamous disorders, connective tissue disorders, bullous disorders, sarcoidosis, amyloidosis, diseases of blood vessels and lymphatic system, diseases of pigmentation,. | Chapter 8 Nonsurgical Tightening Simal Soin, Kabir Sardana Introduction Numerous attempts have been made at counteracting the signs of aging, such as redundant facial and neck skin. In terms of skin laxity specifically, the gold standard of treatment remains rhytidectomy or surgical redraping. However, with the recent advances in technology, conditions that once required major surgical intervention may not always require aggressive intervention. Though nonablative lasers (long pulse 1,064 nm Nd:YAG), and fractional lasers have been used, radiofrequency (RF), infrared, and ultrasound devices are probably better, though the last is yet to find universal acceptance (Table ). Radiofrequency energy works to tighten and lift tissue by delivering heat to dermal structures without adversely affecting the epidermis, thus making it an ideal choice for the nonsurgical face-lift. This energy is produced by an electric current that does not diminish by tissue scattering or absorption by a chromophore. Light-based treatments such as lasers and infrared devices rely on chromophores to produce antiaging effects. Ultrasound waves induce molecules in deep tissue to vibrate, resulting in tissue heating. Like RF energy, the ultrasound waves spare the epidermis Table Overview of devices for skin tightening Device Skin tightening mechanism ThermaCool TC Monopolar RF Accent Bipolar RF and unipolar RF Refirme ST IR and bipolar RF Polaris WR Monopolar RF and diode laser (910 nm) Titan IR Lux-IR Fractional IR GentleYAG Long-pulse Nd:YAG USG Ulthera Nonsurgical Tightening 295 and cause selective heating of the deeper tissues. We will focus on minimally invasive, nonablative tissue tightening techniques, including radiofrequency, light and ultrasound-based devices. These devices are not a replacement for surgical procedures and appropriate patient selection remains key to overall satisfaction. Radiofrequency Therapeutic use of RF technology was first introduced
