Radiofrequency Ablation: A Botulinum Toxin Substitute for Frown Lines?

The development of botulinum toxin revolutionized the treatment of the frown lines. Prior to that surgeons often cut the muscles that caused frowning, but they frequently reattached. Next came the use of fillers, particularly Zyderm (collagen), to fill in the lines caused by frowning, but the frown itself persisted and the filler was relatively short lived. Then, with the development of botulinum toxin, the frown itself could be blocked, but the treatment initially needed to be repeated eveyr 3 months, although  with time these treatments could be stretched out to 5-6 monthly intervals. Now researchers are attempting to use radiofrequency current to injure the nerves that are blocked by botulinum toxin, and provide longer intervals between treatments.

A report of these studies was published in "Dermatologic Surgery" in 2009. First, there were several steps taken to control pain. A local anesthetic cannot be used in the area to be treated because it would block the contraction of the muscle, and this was used to determine if the needle was in the right place. The radiofrequency needle was inserted through the skin and slowly advanced as mild current was applied until contraction of the appropriate muscle was noted. Then an ice pack was placed over the skin, and the intensity of the current was increased for 21-35 seconds. This was accompanied by considerable pain. A total of 4-6 nerve sites were treated this way until the muscles could no longer be stimulated. Subsequent to the treatment there was swelling and bruising.

Twenty nine patients were treated, and in 90% there was a marked decrease in frowning. The effect lasted 4 months or longer in 69% of patients, 6 months or longer in 41% of patients and 1 year or longer in 10%. Aside from the swelling and bruising, an area of temporary numbness was seen in one patient and temporary weakness of the forehead muscle was seen in another.

While the radofrequency technique cleary works, its invasive nature and accompanying pain and side effects make it unlikely to replace botulinum toxin at this point. It is possible that longer lasting botulinum toxin products, such as has been suggested with Dysport, or artificial derivatives of botulinum toxin will eliminate the need for such a device. On the other hand the radiofrequency device may be further improved to give a much longer benefit with fewer side effects and pain. Probably at least 2 years of benefit would be necessary to make this device a viable alternative to boulinum toxin.

Gerald N Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Comments

[John Albert]

Botulinum toxin vary for each individual depending on injection technique, suboptimal dosing, and patient biology, but results can be from six weeks to six months.

Unless the patient is a true non-responder, 6 weeks usually means a poor injector. 6 months is infrequent but does occasionally occur if the person has been consistent with their treatments.
GNB

[San Diego Plastic Surgery]

Wow, this is a good reason to advise patients to use treatments that have been well vetted rather than volunteering to be a test subject. With only 10% achieving a lasting effect beyond the 1 year mark, I'm sure Botox injections every few months will continue to be the most attractive option for now. Or, the inventors of this nerve injury technique might come up with an effective anesthetic that doesn't block contraction but at least makes the pain more bearable.

Daisy McCarty
San Diego Plastic Surgery

[renamer]

Thats pretty cool. Thank you very much for sharing.