Adverse reactions after nonablative radiofrequency: follow-up of 290 patients

Monopolar radiofrequency has been Food and Drug Administration approved for the noninvasive treatment of periorbital rhytides and wrinkles in 2002 and for full-face treatment in 2004. In order to establish the degree of side effects in our practice, a retrospective review was done.

Seven hundred fifty-seven treatments of nonablative monopolar radiofrequency were done on 290 patients. Two hundred sixty-four patients were women (91%), and 26 were men (9%). Two hundred fifty-nine of these patients were treated for facial lifts. Patients were treated with an average energy setting of 81 J/cm(2). Treatments were all done with a 1-cm(2) tip that gives a 2.3-s pulse, and 11.49% of treatments were particularly painful for the patient. The appearance of second-degree burns occurred in 2.7% of the treatment sessions. Other less frequent adverse reactions were persistent erythema (1.22%), headache, scarring, edema, fat atrophy, burn in the return pad site, neuralgia, and facial palsy. The occurrence of facial palsy might be a coincidence.

In comparison with other studies, we have found a very low incidence of posttreatment erythema and edema. On the other hand, the incidence of second-degree burns is somewhat higher. This might be due to the fact that in other studies higher energy settings have been used but without overlapping pulses. Monopolar radiofrequency is a safe method of treating the skin of the face and neck, and it should be done at moderated energy settings with no immediate overlapping in order to avoid overheating and undesirable side effects.