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ACTION MECHANISM

The conduct of the connective tissue induced by the heat and the amount of tissue contraction depends on several factors including the highest temperature reached (peak temperature), the radiofrequency exposure time and the mechanical stress applied to the tissue during the heating process. The thermal properties of the tissue can also vary depending on the species, age, pH, concentration of atmospheric electrolytes, concentration and orientation of the collagen fibres and the levels of moisture in the tissue.

The selective thermolysis that produces the radiofrequency depends on the electric properties of the tissue, as opposed to optical energy which depends on the skin’s amount of chromophore to obtain selective destruction of the target tissue. (Del Pino- Rosado)19, (Sadick)22. Applying radiofrequency to the skin, the energy waves induce a high speed molecular oscillation and cause a displacement of the charged particles, implying the production of rotational movements of the heated up water molecules. The hot water molecules scatter their energy to the adjacent tissue in dependence of their thermal conductivity. When tissue is therapeutically heated, better localised blood flow is produced that favours the drainage of the areas affected by the oedema, swollen by fluids and retained catabolites. (Del Pino- Rosado)19, (James J. Childs Pd D)²¹

This technology can also induce the disruption of the adipocytes by increase in their temperature. (Del Pino- Rosado)¹⁹, (Ruiz Esparza)²⁰.

A controlled thermal lesion can lead to a retraction of the tissue followed by an inflammatory response accompanied by fibroblast migration in the area. Intentional and guided infiltration of fibroblasts in the fine layer of tissue including the transition, can be used to reinforce its structural integrity, resulting in an improvement or elimination of the subdermal fat protrusion that causes skin swelling which characterises the cellulite and improving the flaccid component. The area is reinforced with additional connective tissue deposits as part of the tissue repair and healing stage. This stage is followed by a period of maturing of the new deposit of connective tissue, causing contraction and tending of the damaged tissue and with transition of the dermis-epidermis.

This new matrix of connective tissue deposit can be used to reinforce the natural fibrous layer between the dermis and the subcutaneous tissue. Heat trauma (disintegration of the cell membrane) of the fat cells can cause the liberation of triglycerides from the fat cell. These triglycerides probably breakdown into free fatty acids and glycerol through the lipoprotein-lipase enzyme (LPL). The free fatty acids (insoluble in fat) are linked to the albumin and are slowly transported to the liver. Glycerol (water soluble) is transported to the liver through the interstitial liquid compartments and blood liquid. Apoptosis of the adipocyte plays an important role in tissue homeostasis and can alter under various physiological and pathological condition such as hyperthermia¹⁵.

Radiofrequency energy produces a heating of the dermis and septa of the adipose tissue, without heating the epidermis. Heating is generated by the induction of the rotation of the water molecules due to the appearance of alternate magnetic fields and the corresponding electromagnetic wave as well as the tissue’s resistance to conduction. The rotational movement of the water molecules generates a mechanical effect of friction that generates heat. This heat provokes tensing of the fibrous septa as well as generating a temporal vasodilation and drainage effect from the fat deposits to the lymph system and partially inducing adipocyte by thermal effect on the fat cells since these are highly thermolabile.

The effect of controlled thermal lesion induces an inflammatory response that favours the migration of fibroblasts that reinforce the collagen structure giving way to an improvement in the skin texture and a decrease in body contour. The procedure is accompanied by an intense heat sensation and moderate erythema that remits within a few hours, burns are rare.

The aim of treatment is to increase the temperature of the tissue aimed at reaching a local temperature of 55º to 62 ºC, which unchains a cascade of very interesting physiological reactions: heating of the fat tissue induces the appearance of local vasodilation and stimulation of the formation of new collagen or neocollagenesis.

In reality there are two types of effects on collagen:

• An immediate contraction of the existing collagen takes place at the moment of treatment.
• A remodelling and renovation of it takes place in the mid-term. (It is important to emphasise that local vasodilation has a direct improvement effect on microcirculation, which improves cell interchange capacity as a complementary biological effect).

Neocollagenesis is produced as a consequence of the induction of the liberation of the Heat Shock Proteins (HSP). The HSPs are always present in the cells but increase their presence in stress situations such as a rise in temperature (an increase of 5 ºC unchains an elevation of the synthesis of these proteins which reach 20% of the total proteins of the cells), lowering of the temperature, traumatisms, ischemia, ionising radiations, presence of harmful substances, changes in osmotic pressure or acute pH. The function of the HSPs is to help preserve or degrade the proteins that are denatured by the effect of a stress situation such as heat. The proteins are altered by the effect of the heat and its tertiary structure is affected, some of the amino acids unfold and the hydrophobic amino acids are exposed to water and the protein losses its function, becoming denatured. The proteins come together by aggregation of their hydrophobic amino acids. The HSPs are added to the altered proteins by the heat to avoid them coming together, maintaining the amino peptide chains that have unfolded in a competent situation so they can return to their normal structure and recover their properties when the stress situation has ceased or marking them for later destruction. (Yoshimune K)²³, (Tavaria)²⁴

The HSPs that are synthesised under certain stress conditions start the tissue repairing process. In particular with radiofrequency the formation of HSP-47 is induced. This is a protein that houses the endoplasmic reticulum and identifies the collagen’s triple helix. The Collagen I molecules are correctly assembled three-dimensionally only in the presence of HSP-47. The presence of sufficient heat stimulus seems to liberate the TGF Beta-47 (Transforming Grow Factor Beta-1) is highly linked to the connective tissue repair process, basically with the accelerator role of the production of extracellular substance (collagen) that induces HSP-47 formation, which the fibroblasts recognise as a stimulus to initiate new collagen synthesis. (Kawada)25, (Díaz Fernández)26, (Andrades)²⁷.