References and Scientific Literature HISTORICAL RADIOFREQUENCY TECHNOLOGIES FOR TREATMENT OF GLABELLAR FROWN LINES Highlights• 500+ patients treated (commercial use and clinical trials) using radiofrequency for treatment of glabellar frowning • Clinical trials demonstrated radiofrequncy treatments for the reduction of hyperdynamic facial lines to having superior longevity over chemodenervation (neurotoxins) • Significant reductions in glabellar frowning and improved brow aesthetic achieved for greater than 6 months and greater than 1-year. Improvements in eyebrow position have been noted due to selectivity of some procedures • Effects of radiofrequency treatment for hyperdynamic lines not observed to be permanent • No major adverse events reported in clinical studies; No neuromas or aberrant nerve growth observed [1.] J.P. Newman: Radiofrequency Energy for Denervation of Selected Facial Muscles: Clinical Experiences at Six Months. The Internet Journal of Plastic Surgery. 2009 Volume 5 Number 2. DOI: 10.5580/13be [2.] Foster, K. W., Fincher, E. F. and Moy, R. L. (2009), Radiofrequency Ablation of Facial Nerve Branches Controlling Glabellar Frowning. Dermatologic Surgery, 35: 1908–1917. doi: 10.1111/j.15244725.2009.01352.x [3.] Newman J. (2010), Radiofrequency (GFX) Ablation for the Reduction of Glabellar Frowning. Facial Plastic Surgery, Aug;26(3):266-73. doi: 10.1055/s-0030-1254332. Epub 2010 Jun 3. [4.] Newman, James. (2008). Radio Frequency Selective Efferent Nerve Ablation (SENA) for the NonPharmacological Reduction of Glabellar Furrowing. San Mateo, CA [5.] Newman, J.P. (2009). Radiofrequency ablation for the Reduction of Glabellar Frowning. Techniques in Aesthetic Plastic Surgery Series: Minimally-Invasive Facial Rejuvenation with DVD (pp. 37-46). Elsevier Health Sciences. [6.] Kim J.H., et al. Percutaneous Selective Radiofrequency Nerve Ablation for Glabellar Frown Lines. Aesthetic Surgery Journal September 2011 31: 747-755, doi:10.1177/1090820X11416807 [7.] Ultley DS, Goode RL. Radiofrequency ablation of the nerve to the corrugator muscle for elimination of glabellar furrowing. Arch. Facial Plastic Surgery. 1999 Jan-Mar; 1(1):46-8 THERMAL EFFECTS OF RADIOFREQUENCY ENERGY ON NERVES Highlights- • The predominant mechanism of tissue injury by RF ablation is thermally mediated. • The In rabbits, applying radiofrequency energy to the trigeminal ganglions, the expressions of NF200, ACHE, and M receptor decreased more significantly at 70 degrees C versus 60 degrees C. However, no significant difference between 70 and 80 degrees (P>0.05). • Transient nerve injury has been observed at a temperature of 47±3°C. Extended duration of effect occurred at temperatures of 51±6°C. • Studies have demonstrated that by adjusting power to maintain temperatures between 6070°C coagulum formation and hence impedance rise can be prevented • Effect of thermal radiofrequency energy on nerves is immediate [8.] Yin HM, et al. Effects of radiofrequency thermocoagulation on trigeminal ganglions in rabbits. Zhonghua Yi Xue Za Zhi 91:1718-21. 2011 [9.] BUNCH, T. J., BRUCE, G. K., MAHAPATRA, S., JOHNSON, S. B., MILLER, D. V., SARABANDA, A. V., MILTON, M. A. and PACKER, D. L. (2005), Mechanisms of Phrenic Nerve Injury During Radiofrequency References and Scientific Literature Ablation at the Pulmonary Vein Orifice. Journal of Cardiovascular Electrophysiology, 16: 1318–1325. doi: 10.1111/j.1540-8167.2005.00216.x [10.] Nath S., Barber M., Update on the Biophysics and Thermodynamics of Radiofrequency Ablation. Cardiac Electrophysiology Review. 1997 Nov; Volume 1, Issue 4, pp 407-411. [11.] Huang, Shoei K. Stephen; Wood, Mark A. Catheter Ablation of Cardiac Arrhythmias (2nd Edition). St. Louis, MO, USA: Saunders, 2010.p146. http://site.ebrary.com/lib/medtronic/ Doc?id=10493323&ppg=167. Copyright © 2010. Saunders. [12.] Burnett MG, Zager EL (2004) Pathophysiology of peripheral nerve injury: a brief review. Neurosurgical focus 16: E1. [13.] Podhajsky RJ, Sekiguchi Y, Kikuchi S, Myers RR. The histological effects of pulsed and continuous radiofrequency lesions at 42 degrees C to rat dorsal root ganglion and sciatic nerve. Spine. 2005;30:1008– 1013. doi: 10.1097/01.brs.0000161005.31398.58. ANATOMY / NERVE INJURY PHYSIOLOGY Highlights• Nerve injury repair goes through a predictable process: Wallerian degeneration and regeneration. • Axonal regeneration is not synonymous with return of function. A process of maturation precedes functional recovery. The morphological changes of maturation proceed along the regenerating axon at a slower rate than axon regrowth and continue for a protracted period—as long as 1 year [14.] Recknor JB, Mallapragada SK. Nerve regeneration: Tissue Engineering Strategies – Biomedical Engineering Handbook: Tissue Engineering and Artificial Organs. Bronzion JD, Ed. 2006, Taylor & Francisc: New York. [15.] Dolenc V, Janko M. Nerve regeneration following primary repair. Acta. Neurochirurgica – Jan. 1976; 34(1) 223-224. [16.] Arkhipova EG, Greten AG, Krylov VN. Dynamics of repair regeneration of rat cutaneous nerves after traumas of different severity. Neurosci and Behav. Physiol. 2008; 38(6); 579-582. [17.] Caminer DM, Newman MI, Boyd JB. Angular nerve: New insights on innervation of the corrugator supercilii and procerus muscles. J. Plastic Reconstructive Aesthetic Surgery. 2006: 59(4): 366-72. [18.] Hwang K, Kim YJ, Chung IH. Innervation of the corrugator supercilii muscle. Ann. Plastic Surgery. 2004; 52: 140-143. [19.] Ellis DA, Cousin JN. Denervation of corrugator supercilii muscle. A surgical maneuver for frowning. Facial Plastic Surgery Clin. North America. 2000; 8; 355-360. [20.] Burnett MG, Zager EL (2004) Pathophysiology of peripheral nerve injury: a brief review. Neurosurgical focus 16: E1.
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