There are many positive reviews of radiofrequency facial treatments. They are considered safe and effective for tightening skin, improving the appearance of wrinkles, and reducing pore size. However, a number of people have reported facial fat loss after radiofrequency treatments leaving them with skin that appears older than before the treatment. For this reason, it is important to understand the risk of side-effects from radiofrequency treatments. After all, you don’t want to spend a small fortune on a treatment that may make your skin condition worse!

Now, no anti-aging or cosmetic treatment comes without the risk of side-effects. Whether they are common side effects (e.g. redness and swelling), or rarer side effects, (e.g. facial fat loss), some people will experience them. Therefore, you need to take these risks into consideration before going forward with a treatment.

Radiofrequency treatments are widely advertised as safe ‘non-surgical facelifts’ and promise tighter, younger-looking skin. They are a non-invasive anti-aging treatment marketed towards people who want minimal recovery time. Often, radiofrequency treatments can be performed during a ‘lunch-break’, making them more appealing to people with busy lifestyles.

So, why do some people experience facial fat loss after radiofrequency treatments? To answer this question, we first need to know how radiofrequency treatments work.

How is Radiofrequency Used as an Anti-Aging Treatment?

Radiofrequency is often used as a non-ablative skin rejuvenation treatment. Non-ablative treatments improve the appearance of skin by causing a dermal injury response without injuring the epidermis. More specifically, they cause a low-level thermal injury to the dermis and/or blood vessels that encourages a wound repair response and boosts collagen [1][2][3].

In other words, the treatment heats up the lower levels of the skin, causing some minor damage and leading the body to try to ‘heal’ that damage. This process is known as thermolysis which is the term given to the breaking down of a substance by heat.

Although radiofrequency energy has been used for a long time for various medical purposes, its use as a skin tightening treatment is much more recent [4][5]. Radiofrequency energy has been used successfully to tighten skin on the face and abdomen, as well as other bodily areas [6].

How Does It Work?

Radiofrequency treatments heat the deeper dermis in a controlled manner [7] to between 65°C and 75° without heating the epidermis enough to cause damage [8]. This temperature alters the natural qualities of collagen in the dermis, allowing collagen production and remodelling, as well as an immediate skin tightening [8].

Do Radiofrequency Treatments Tighten Skin?

One radiofrequency treatment that was approved by the FDA to treat eye wrinkles in 2002, and for full-face treatment in 2004, is Thermage [9]. FDA approval was based on a large study that evaluated the treatments ability to reduce eye wrinkles in 79 women and 7 men.

In this study, a single Thermage radiofrequency treatment reduced wrinkles in the eye area and provided a lift to the brow area without damaging the epidermis [8][10]. This indicated a heat-induced tightening effect that became more pronounced with time – which is consistent with a thermal wound-healing response [10].

However, it has been argued that the study’s measurement of the brow-lifting effect was subjective and unstandardized [11].

Other studies support the brow-lifting benefits of radiofrequency treatments. For example, in a study of 24 patients treated with Thermage, there was a noticeable brow-lift effect. However, when asked, the majority of the patients did not feel they had any improvement from the treatment [12].

Thermage radiofrequency rejuvenation is often claimed to be a ‘nonsurgical face-lift’ by practitioners who offer the treatment (although the manufacturing company strongly oppose this claim) [11]. These claims are misleading and patients expecting results similar to those from surgery will end up disappointed [11].

Misleading claims aside, non-ablative radiofrequency rejuvenation treatments show promise in their ability to tighten skin and improve the appearance of fine lines and wrinkles. Although, in order to establish solid evidence for the effectiveness of radiofrequency treatments more research is needed [11].

What are the Risks of Radiofrequency Treatment?

While radiofrequency is widely considered to be safe and an effective skin tightening treatment [13]. Some patients may still experience adverse reactions or unwanted side-effects, such as second-degree burns, headaches, scarring, swelling, and facial fat loss. Although these adverse reactions are uncommon [9].

Facial Fat Loss After Radiofrequency

Of these, the facial fat loss is possibly the most worrisome. This is because facial fat volume naturally decreases with age and is one of the internal reasons we appear to age [14]. Therefore, it seems counterproductive for a rejuvenating treatment to reduce tissue that provides a more youthful appearance.

In one instance, a 47-year-old man underwent a radiofrequency facial treatment and noticed that the skin on his left temple was left indented two-months after his treatment. This led researchers to try, and successfully, replicate this fat loss in pigs [15].

In another case, a 57-year-old woman received a radiofrequency facial treatment to treat mild skin sagging that was particularly focussed on her ‘jowl’ area. One month after the treatment, the patient developed facial fat loss with visible skin depressions on her cheeks. It is theorised that this facial fat loss was due to the selective heating of the subcutaneous fat layer by radiofrequency energy. The patient’s skin indentations were treated with pulsed-dye laser (PDL) and skin massage which led to an 80% improvement in the appearance of the facial fat loss after one year [16].

A further case of facial fat loss after radiofrequency was seen in a 56-year-old woman who experienced skin depressions to both temples that developed two months after treatment. This occurred as a result of excessive heating by radiofrequency energy [16].

How Does Heat Cause Fat Loss?

Fat tissue has a high electrical resistance and may be heated more freely than the dermis. In fact, it is estimated that the temperature of fat can increase at seven times the rate of the dermis when heated through radiofrequency [15][17].

Heat from radiofrequency devices is generated due to Ohm’s law – where the natural resistance of tissue to the movement of electrons within a radiofrequency field creates heat relative to the amount of current and time [11]. Skin structures with higher resistance are more vulnerable to heating and thus to damage/wounding [11][18].

In addition to radiofrequency treatments, other laser treatments that work by thermolysis have demonstrated facial fat loss as an undesired side-effect. In fact, often the laser parameters that are used for facial rejuvenation are very close to those used in fat reduction treatments [19]. In some cases, these adverse reactions may be avoided by using lower treatment settings. However, facial fat loss can still occur when the appropriate treatment parameters are used [16].

One group of researchers refers to this process as the active thermal bystander effect (ATBE) and highlights how heat exposure can cause an increase in cell death in the heated target cells as well as non-heated ‘bystander’ cells [20].

It should be noted that there are few documented cases of facial fat loss from radiofrequency and laser treatments in the currently available literature. However, there are a number of support groups online with people who have experienced facial fat loss after radiofrequency or laser treatments. Often, the affected individuals explain how their concerns were dismissed by the practitioners who performed their treatments. This may explain why this side-effect is rarely acknowledged or discussed in the medical literature.

In addition, multiple plastic surgeons have reported an increasing number of patients coming to them for procedures to correct facial fat loss from previous laser and radiofrequency treatments.

Correcting Facial Fat Loss After Radiofrequency

One plastic surgeon who has highlighted the increase in patients with facial fat loss caused by radiofrequency and laser is Dr Ricardo L Rodriguez, MD. Due to the risk of facial fat loss, Dr. Rodriguez rarely uses these methods, instead opting for fat grafting – where the stem-cells in fat tissue help regenerate the skin.

He explains on his blog that:

“Anytime you introduce an energy source into the body, whether it be radiofrequency, or laser, or even CoolSculpting – which is specifically designed to injure fat cells – the cells that are damaged release what’s called DAMPs (Damage Associated Molecular Pattern Molecules, aka Danger Associated Mollecular Pattern Molecules) and those DAMPs signal other cells. If the signals are severe enough, or a particular kind, the DAMPs can trigger a process called apoptosis, which is programmed cell death, and that keeps on going for weeks or months after the original injury so that patients that have had laser, or patients that have had radiofrequency, or patients that have had CoolSculpt, will continue to have subcutaneous fat tissue loss as a result of that radiofrequency.”

Ricardo L Rodriguez, MD.

So What’s the Verdict?

To sum up, radiofrequency rejuvenation treatments are a relatively new and promising treatment with multiple studies supporting their use in tightening skin and improving the appearance of fine lines and wrinkles. However, results are variable and often patients do not see the stated benefits. Furthermore, the treatment is not free from side effects or possible adverse reactions.

One particular adverse-reaction is facial fat loss after radiofrequency treatment, which can worsen the appearance of fine lines and wrinkles due to loss of volume. There is little report of this in the available literature, but many plastic surgeons have reported an increase in patients with facial fat loss after radiofrequency or laser treatments.

It is, perhaps, not the best treatment for older skin that is already lacking facial fat volume. People considering radiofrequency treatment should be aware of this potential side-effect and adjust their expectations accordingly.

Have you experienced facial fat loss after radiofrequency or laser treatment? Tell us about your experience in the comment section below.

References

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2. Pham, R. (2001). ‘Nonablative laser resurfacing’. Facial Plastic Surgery Clinics of North Americ, 9, 303-310.
3. Newman, J. (2001). ‘Nonablative laser skin tightening’. Facial Plastic Surgery Clinics of North America, 9, 343-349.
4. Weiss, R., Weiss, M., Beasley, K. & Munavalli, G. (2005). ‘Our approach to nonablative treatment of photoaging’. Lasers in Surgery and Medicine, 37, 2-8.
5. Ruiz-Esparza, J. (2006). ‘Painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients’. Dermatology Surgery, 32, 601-610.
6. Biesman, B. & Pope, K. (2007). ‘Monopolar radiofrequency treatment of the eyelids: a safety evaluation’, Dermatologic Surgery, 33, 794-801.
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11. Atiyeh, B. & Dibo, S. (2009). ‘Nonsurgical Nonablative Treatment of Aging skin: Radiofrequency Technologies Between Aggressive Marketing and Evidence-Based Efficacy’. Aesthetic Plastic Surgery, 33, 283-294.
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16. Wiley, A., Anderson, R., Apiazu, J. et al. (2006). ‘Complications of Laser Dermatologic Surgery’. Lasers Surg Med, 38, 1-15. Available at: https://www.dermatologyandlasersurgery.com/wp-content/uploads/2011/12/2006-LSM-38-1-15.pdf
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19. Avci, P., Nyame, T., Gupta, G., Sadasivam, M. & Hamblin, M. (2013). ‘Low-Level Laser Therapy for Fat Layer Reduction: A Comprehensive Review’. Lasers Surg Med, 45(6), 349-357. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769994/
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