Various treatments for the management of facial aging have been performed among which noninvasive radio-frequency (RF; i.e. , thermage) treatment and minimally invasive treatments are on the rise. The purpose of this study was to analyze trends of the treatment of facial aging in Korea and to investigate relationships between the use of noninvasive RF and minimally invasive treatments. A retrospective analysis conducted on data from 4021 patients showed that thermage treatment increased by 134.9% over 5 years. As a person ages, the rate of facial treatment with both the botulinum toxin (for the masseter and lines of the glabella, lateral canthus, and forehead) and the PDO thread lift increases. The use of the treatments , nasolabial fold filler and Silhouette Soft Thread, however, was not associated with aging. The patients receiving thermage treatment were less likely to undergo any of the other treatments including PDO thread lift, Silhouette Soft Thread, nasolabial fold filler, or any of the botulinum toxin treatments. Overall, the results showed that patients who had received noninvasive RF tended to receive less minimally invasive treatment.
Today, a growing number of people aspire to have a younger face and cosmetic surgery is becoming increasingly popular worldwide [
Facial cosmetic surgery focuses on improving facial appearance vis-à-vis injectable fillers, neural modulators, lasers, and other treatments aimed at rejuvenating skin [
Traditional surgical intervention and ablative skin resurfacing have been performed to improve facial rhytids from skin laxity, although new methods have evolved that are less invasive and tend to minimize recovery time and risk of postoperative complications. The application of noninvasive radiofrequency (RF) treatment has been steadily increasing over the past several years to accommodate the paradigm shift in facial aging treatment to noninvasive [
In clinical practice, a wide variety of treatments for the management of facial aging have been conducted. Patients normally have the option to receive one of these procedures or to combine procedures. However, there has been limited data analysis in general of the use of noninvasive RF treatments, and, more specifically of the relationships between the use of minimally invasive and more invasive treatments. This study analyzed the Korean population trends in treatments for the management of facial aging by year and age group exploring correlations between patient use of noninvasive RF and minimally invasive procedures.
Data were collected from chart records of outpatients who were treated from January 2013 to December 2017 for the management of facial aging. The charts of 9110 patients who visited a clinic for facial aging treatment during the study period were reviewed to narrow the study group to those 4201 patients who had been administered thermage (Thermage® Inc., Hayward, CA), Polydioxanone thread (PDO) thread lift, Silhouette Soft Thread (Poly-I-lactic acid or sculptra solid form), nasolabial fold filler, and botulinum toxin treatments for the masseter and lines of the glabella, forehead, and lateral canthus and fulfilled other criteria (age, gender, date of treatment, detail of treatment) important to the study. The ethical part of this study was approved by the Korean Public Institutional Review Board, which is designated by the Korean Ministry of Health and Welfare (report IRB No. P01-201808-21-013).
Statistical analyses were performed using SPSS 23.0 software (IBM, Somers, USA). The characteristics of patients who received facial aging treatment were summarized using descriptive statistics. Differences between the number of noninvasive RF treatments and minimally invasive treatments by year and age group were analyzed using t-tests and ANOVAs. In addition, a multiple logistic regression was performed of the relationship of the independent predictors of age, gender, year, and type of past treatment PDO thread lift, Silhouette Soft Thread, nasolabial fold filler, and botulinum toxin treatments for the masseter and lines of the glabella, forehead, and lateral canthus, with the general treatment class, being either noninvasive RF or minimally invasive. Data were presented as an odds ratio (OR) with a 95% confidence interval (CI). A value of p < 0.05 was considered statistically significant for all tests.
The general characteristics of the study subjects are presented in
Number of subjects | (%) | ||
---|---|---|---|
Age (years) | 42.5 ± 9.6 (mean ± SD) | ||
20 - 29 | 353 | 8.4 | |
30 - 39 | 1301 | 31.0 | |
40 - 49 | 1601 | 38.1 | |
50 - 59 | 758 | 18.0 | |
≥60 | 188 | 4.5 | |
Gender | Male | 286 | 6.8 |
Female | 3915 | 93.2 | |
Treatment year | 2013 | 701 | 16.7 |
2014 | 789 | 18.8 | |
2015 | 776 | 18.5 | |
2016 | 936 | 22.3 | |
2017 | 999 | 23.8 |
majority of the patients were in their forties; 93.2% of the patients were women, and the overall number of patients increased by 42.5% from 2013 to 2017.
The type and number of facial treatments from 2013 to 2017 are presented in
The type and number of treatments for the management of facial aging by age group over the five-year period are presented in
The type and number of minimally invasive thermage treatments are presented in
The results of the logistic regression analysis of the relationship of the independent predictors in terms of the class of thermage treatment (noninvasive RF vs minimally invasive) are shown in
As age increases, the reduction in skin elasticity due to facial aging creates wrinkles which become more prominent with time. For patients seeking to reduce these wrinkles, surgical facial plastic surgery treatments include brow lifting with an autologous fat transfer, face and neck lifting, laser resurfacing of the skin envelope, and chemical peeling [
However, contemporary patients are looking for minimally invasive procedures using, for example, botulinum toxin, filler, and thread lift [
Year | Total n = 4201 | p-value | ||||||
---|---|---|---|---|---|---|---|---|
2013 n = 701 | 2014 n = 789 | 2015 n = 776 | 2016 n = 946 | 2017 n = 999 | ||||
Thermage | Xa | 529 | 607 | 521 | 549 | 595 | 2801 | p < 0.001 |
75.5% | 76.9% | 67.1% | 58.7% | 59.6% | 66.7% | |||
O | 172 | 182 | 255 | 387 | 404 | 1400 | ||
24.5% | 23.1% | 32.9% | 41.3% | 40.4% | 33.3% | |||
Eye thermage | X | 679 | 761 | 759 | 900 | 963 | 4062 | 0.360 |
96.9% | 96.5% | 97.8% | 96.2% | 96.4% | 96.7% | |||
O | 22 | 28 | 17 | 36 | 36 | 139 | ||
3.1% | 3.5% | 2.2% | 3.8% | 3.6% | 3.3% | |||
PDO thread lift | X | 642 | 720 | 705 | 888 | 986 | 3941 | p < 0.001 |
91.6% | 91.3% | 90.9% | 94.9% | 98.7% | 93.8% | |||
O | 59 | 69 | 71 | 48 | 13 | 260 | ||
8.4% | 8.7% | 9.1% | 5.1% | 1.3% | 6.2% | |||
Silhouette soft thread | X | 701 | 781 | 751 | 914 | 956 | 4103 | p < 0.001 |
100.0% | 99.0% | 96.8% | 97.6% | 95.7% | 97.7% | |||
O | 0 | 8 | 25 | 22 | 43 | 98 | ||
0.0% | 1.0% | 3.2% | 2.4% | 4.3% | 2.3% | |||
Nasolabial fold filler | X | 611 | 703 | 705 | 847 | 915 | 3781 | .030 |
87.2% | 89.1% | 90.9% | 90.5% | 91.6% | 90.0% | |||
O | 90 | 86 | 71 | 89 | 84 | 420 | ||
12.8% | 10.9% | 9.1% | 9.5% | 8.4% | 10.0% | |||
Masseter botulinum toxin | X | 427 | 531 | 536 | 702 | 688 | 2884 | p < 0.001 |
60.9% | 67.3% | 69.1% | 75.0% | 68.9% | 68.7% | |||
O | 274 | 258 | 240 | 234 | 311 | 1317 | ||
39.1% | 32.7% | 30.9% | 25.0% | 31.1% | 31.3% | |||
Glabella lines botulinum toxin | X | 607 | 617 | 620 | 604 | 636 | 3084 | p < 0.001 |
86.6% | 78.2% | 79.9% | 64.5% | 63.7% | 73.4% | |||
O | 94 | 172 | 156 | 332 | 363 | 1117 | ||
13.4% | 21.8% | 20.1% | 35.5% | 36.3% | 26.6% | |||
Horizontal forehead lines botulinum toxin | X | 622 | 665 | 654 | 671 | 680 | 3292 | P < 0.001 |
88.7% | 84.3% | 84.3% | 71.7% | 68.1% | 78.4% | |||
O | 79 | 124 | 122 | 265 | 319 | 909 | ||
11.3% | 15.7% | 15.7% | 28.3% | 31.9% | 21.6% | |||
Lateral canthal lines botulinum toxin | X | 622 | 676 | 687 | 715 | 715 | 3415 | p < 0.001 |
88.7% | 85.7% | 88.5% | 76.4% | 71.6% | 81.3% | |||
O | 79 | 113 | 89 | 221 | 284 | 786 | ||
11.3% | 14.3% | 11.5% | 23.6% | 28.4% | 18.7% |
Xa, X: untreated case; O: treated case.
Age (years) | Total n = 4201 | p-value | ||||||
---|---|---|---|---|---|---|---|---|
20 - 29 n = 353 | 30 - 39 n = 1301 | 40 - 49 n = 1601 | 50 - 59 n = 758 | ≥60 n = 188 | ||||
Thermage | Xa | 331 | 890 | 1011 | 460 | 109 | 2801 | p < 0.001 |
93.8% | 68.4% | 63.1% | 60.7% | 58.0% | 66.7% | |||
O | 22 | 411 | 590 | 298 | 79 | 1400 | ||
6.2% | 31.6% | 36.9% | 39.3% | 42.0% | 33.3% | |||
Eye thermage | X | 352 | 1267 | 1540 | 721 | 182 | 4062 | 0.001 |
99.7% | 97.4% | 96.2% | 95.1% | 96.8% | 96.7% | |||
O | 1 | 34 | 61 | 37 | 6 | 139 | ||
.3% | 2.6% | 3.8% | 4.9% | 3.2% | 3.3% | |||
PDO thread lift | X | 339 | 1241 | 1511 | 684 | 166 | 3941 | p < 0.001 |
96.0% | 95.4% | 94.4% | 90.2% | 88.3% | 93.8% | |||
O | 14 | 60 | 90 | 74 | 22 | 260 | ||
4.0% | 4.6% | 5.6% | 9.8% | 11.7% | 6.2% | |||
Silhouette soft thread | X | 352 | 1283 | 1571 | 717 | 180 | 4103 | p < 0.001 |
99.7% | 98.6% | 98.1% | 94.6% | 95.7% | 97.7% | |||
O | 1 | 18 | 30 | 41 | 8 | 98 | ||
.3% | 1.4% | 1.9% | 5.4% | 4.3% | 2.3% | |||
Nasolabial fold filler | X | 327 | 1162 | 1442 | 682 | 168 | 3781 | 0.479 |
92.6% | 89.3% | 90.1% | 90.0% | 89.4% | 90.0% | |||
O | 26 | 139 | 159 | 76 | 20 | 420 | ||
7.4% | 10.7% | 9.9% | 10.0% | 10.6% | 10.0% | |||
Masseter botulinum toxin | X | 93 | 766 | 1206 | 644 | 175 | 2884 | p < 0.001 |
26.3% | 58.9% | 75.3% | 85.0% | 93.1% | 68.7% | |||
O | 260 | 535 | 395 | 114 | 13 | 1317 | ||
73.7% | 41.1% | 24.7% | 15.0% | 6.9% | 31.3% | |||
Glabella lines botulinum toxin | X | 311 | 1073 | 1127 | 472 | 101 | 3084 | P < 0.001 |
88.1% | 82.5% | 70.4% | 62.3% | 53.7% | 73.4% | |||
O | 42 | 228 | 474 | 286 | 87 | 1117 | ||
11.9% | 17.5% | 29.6% | 37.7% | 46.3% | 26.6% | |||
Horizontal forehead lines botulinum toxin | X | 331 | 1105 | 1175 | 554 | 127 | 3292 | p < 0.001 |
93.8% | 84.9% | 73.4% | 73.1% | 67.6% | 78.4% | |||
O | 22 | 196 | 426 | 204 | 61 | 909 | ||
6.2% | 15.1% | 26.6% | 26.9% | 32.4% | 21.6% | |||
Lateral canthal lines botulinum toxin | X | 340 | 1157 | 1230 | 568 | 120 | 3415 | p < 0.001 |
96.3% | 88.9% | 76.8% | 74.9% | 63.8% | 81.3% | |||
O | 13 | 144 | 371 | 190 | 68 | 786 | ||
3.7% | 11.1% | 23.2% | 25.1% | 36.2% | 18.7% |
Xa, X: untreated case; O: treated case.
Variables | Adjusted odds ratio | 95% C.I. | p-value | |
---|---|---|---|---|
Lower | Upper | |||
Age (years) | ||||
20 - 29 | 1 | p < 0.001 | ||
30 - 39 | 4.471 | 2.671 | 7.483 | p < 0.001 |
40 - 49 | 5.371 | 3.222 | 8.952 | p < 0.001 |
50 - 59 | 6.921 | 4.074 | 11.759 | p < 0.001 |
≥60 | 7.866 | 4.221 | 14.659 | p < 0.001 |
Gender (female) | 1.698 | 1.199 | 2.405 | 0.003 |
Year of treatment | ||||
2013 | 1 | p < 0.001 | ||
2014 | 0.837 | 0.624 | 1.122 | 0.235 |
2015 | 1.243 | 0.931 | 1.658 | 0.140 |
2016 | 2.738 | 2.067 | 3.626 | p < 0.001 |
2017 | 3.697 | 2.778 | 4.920 | p < 0.001 |
PDO thread lift | 0.081 | 0.055 | 0.118 | p < 0.001 |
Silhouette Soft thread | 0.063 | 0.035 | 0.112 | p < 0.001 |
Nasolabial fold filler | 0.049 | 0.035 | 0.068 | p < 0.001 |
Masseter botulinum toxin | 0.031 | 0.025 | 0.040 | p < 0.001 |
Glabella lines botulinum toxin | 0.206 | 0.165 | 0.256 | p < 0.001 |
Horizontal forehead lines botulinum toxin | 0.309 | 0.244 | 0.390 | p < 0.001 |
Lateral canthal lines botulinum toxin | 0.258 | 0.202 | 0.329 | p < 0.001 |
and minimally invasive treatments in 2017 increased by 42.5% compared to 2013. Patients receiving thermage treatment increased by 134.9% during the 5 years, with the patient group aged 20 - 49 years receiving the most thermage treatments. A previous study in China also reported a striking increase in thermage treatment whereby patients aged 35 - 50 years accounted for the largest population taking advantage of this procedure [
The noninvasive RF treatment minimizes the recovery time and risk of postoperative complications that are common with invasive treatment. The RF treatment is performed to treat tissue laxity in the periorbital areas, forehead, and middle and lower face. In previous studies, promising results of nonablative RF treatment to tighten tissue in the periorbital areas were reported. A multicenter study of 86 patients submitted to this treatment demonstrated measurable brow elevation and modest clinical improvement in periorbital rhytids in 80% of the subjects [
Botulinum toxin injection, which affects muscular activity to correct upper face wrinkles, is most commonly performed clinically [
The nasolabial wrinkles that occur because of aging are a problem for many persons. There are two causes of nasolabial wrinkles: 1) defective muscle and skin defects caused by repeated skin folds, and 2) the downward migration of the malar cheek pads; however, the origin of nasolabial wrinkles in many patients is often mixed [
Signs of aging in the lower face are manifested as a poor definition of the mandibular margin as the facial soft tissue shifts downward due to gravity. The PDO short suture thread treatment creates a skin meshwork over the marionette line and the SMAS plane to improve the skin-tightening and rejuvenation of the lower facial area including the jawline. The Silhouette Soft Thread treatment improved the marionette line and the jawline by using the long suture technique to trap the exit point toward the insert point and the marionette line from the hairline side [
The limitation of this study is that causal relationships between variables cannot be identified because of the particular characteristics of the retrospective study and because there was no time series analysis on the different procedures. Future studies should analyze whether the noninvasive RF treatment improves the “skin-to-time relationship” in relation to other treatments, and, due to its superior skin improvement capability, whether it reduces the need for treatments involving botulinum toxin, filler, or thread lift. Nonetheless, this study is important since it supports the recent facial anti-aging trend in which facial treatments have moved from invasive to minimally invasive and noninvasive.
This study provides evidence that patients who undergo noninvasive RF treatment are less inclined to use botulinum toxin, filler, and thread lift procedures. These results suggest that noninvasive RF treatment is increasingly being selected by patients because of their increased rejection of invasive treatments based on their perception that they can be painful and produce side effects, especially the common botulinum toxin, filler, and thread lift procedures.
The authors declare no conflicts of interest regarding the publication of this paper.
Kim, S. and Kim, M. (2019) Trends of Noninvasive Radiofrequency and Minimally Invasive Treatment for the Management of Facial Aging. Journal of Cosmetics, Dermatological Scien- ces and Applications, 9, 30-40. https://doi.org/10.4236/jcdsa.2019.91003