Radio frequency treatments

All you need to know 

Radio frequency

The ultimate technology for anti-ageing, skin tightening, non-surgical butt lifting, non-surgical face lifting and cellulite removal

What is radio frequency treatment?
How do radio frequency treatments work?

 What is radio frequency treatment? 

“Radio frequency diathermy”: the term to remember

Most RF treatments focus so much on the epidermis, they are not true radio frequency

Where does the name radiofrequency derive from? Does RF have anything to do with radiation, radioactivity or microwaves?

How does (proper) radio frequency treatment work?

How does ‘destructive’ RF treatment works

The exact mechanism

Molecular movement = heat

What is the best radio frequency treatment?

What determines the efficacy of a radio frequency treatment?

Bipolar, tripolar, tetrapolar, octapolar, multipolar, unipolar or monopolar radio frequency function  

Resistive or capacitive radio frequency treatment

Maximum radio frequency power, in watts

Radio frequency treatment with superficial cooling

Radiofrequency current frequency, in kHz, MHz or GHz 

Radio frequency treatment contact gel/cream/oil used 

Adjustable RF equipment settings

Simultaneous combination of radio frequency with other treatment modalities

Therapeutic active ingredients used in treatment gels/creams/oils

Radio frequency treatment protocol design by the head therapist at the clinic/salon

Operator experience and specialisation

Monopolar or bipolar radio frequency:
what is the best for skin tightening?

 What is best for skin tightening?

What is monopolar radio frequency?

What is bipolar radio frequency?

Tripolar, tetrapolar, octipolar and other multipolar radio frequency 

Unipolar radio frequency

 Machines with monopolar and bipolar options

If monopolar is so much better, why do bipolar machines exist? 

How do I know what kind of RF treatment I am receiving?

Deep/superficial RF treatment: important, but not the whole picture

Resistive or capacitive RF treatment? 

Which is the best for cellulite and skin tightening?

What is resistive radio frequency?

What is capacitive radio frequency?

Deep vs superficial RF

How do I know what kind of RF treatment I am receiving?

Home radio frequency machines: are they worth it? Do they work?

What is the most effective radio frequency machine for home use?

Right equipment

Affordable machine

Safe use

Every day?

In summary: no, home radio frequency machines do not work

Radio frequency vs infrared treatment 

Superficial tissue heating vs deep tissue heating 

Bipolar radio frequency and infrared are quite similar: both heat the skin too superficially

Infrared and tissue healing at low intensities 

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Radio frequency

The ultimate technology for anti-ageing, skin tightening, non-surgical butt lifting, non-surgical face lifting and cellulite removal

High intensity, deep tissue radio frequency is widely accepted as by far the strongest body skin tightening/lifting treatment known today and arguably the best facial skin tightening technology and cellulite reduction technology too. Radio frequency is also a powerful anti-ageing treatment that not only firms the skin but also boosts circulation and is proven to stimulate collagen and elastin production, for firmer, more elastic skin and overall skin rejuvenation.

As our specialisation at the LipoTherapeia clinic is facial skin tightening and body skin tightening/cellulite, we have worked for more than 9 years with radio frequency treatment. In order to know exactly what I am talking about and to offer the best to my clients, I have extensively studied the physics of radio frequency treatment, reviewed all the research and assessed/tried hands-on most important RF machines - having studied physics at university in the past came quite handy.

On this page I would like to share some of my knowledge with you, so in the next several weeks and months I will be adding more and more information about radio frequency, especially technical information to help you decide what is the best radiofrequency treatment for yourself as a client or for your clinic as a practitioner.

However, for legal and practical reasons and for the sake of neutrality, I will not be able to suggest / provide information about a specific machine, treatment or clinic, neither reply to emails with specific technical queries about radio frequency. Such emails will not be answered.

I hope this page will prove helpful to you. If you are happy with what you read, please feel free to link to this page from your blog/website/social media.

Georgios Tzenichristos | LipoTherapeia, London


Please note that this guide is based on my research and clinical experience on this subject but it is not guaranteed to be totally accurate or impartial and contains my own personal views as a practitioner on radio frequency treatment and the best way to apply it. Of course, this guide is information only and does not aimed to diagnose/treat any medical condition or replace medical treatment or advice.

All articles on this page: © 2017-2019 Georgios Tzenichristos & LipoTherapeia Ltd
Any reproduction prohibited without written notice.

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What is radiofrequency treatment?
how does radio frequency treatments work?

What is radio frequency?

Radio frequency treatments have been used for more than five decades in physiotherapy and for two decades in aesthetic treatments. Radiofrequency treatments refer to high frequency electrical currents, 300kHz-40MHz.

Applied on the body or face at a lower frequency, electrical currents may produce muscle contraction or other effects. At "radio" frequencies, electrical currents produce just heat.

Depending on the machine you have, the protocols you apply and even the skin products you use (cream, gel, oil etc), heat can be very superficial (e.g. focusing on epidermis for acne treatment), very deep (e.g. focusing in joints or muscles for physiotherapy) or anywhere in between.

For aesthetic treatments, and depending on the machine, protocols and products used, radio frequency may be applied on the:

epidermis, the most superficial skin layer (acne/pore reduction, superficial skin tightening, skin rejuvenation)

dermal/epidermal junction (superficial skin tightening)

dermis, the middle skin layer (medium depth skin tightening, lifting, skin rejuvenation)

dermal/hypodermal junction (deep skin tightening)

hypodermis, the deepest skin layer (deep skin tightening, lifting, cellulite)

superficial fascia, the connective tissue layer between skin and subcutaneous fat (very deep skin tightening)

subcutaneous fat, the fat layer under the skin (spot fat reduction, very deep skin tightening)

deep fascia, the connective tissue layer under subcutaneous fat and above muscles (very deep skin tightening)



“Radio frequency diathermy”: the term to remember

True radio frequency skin treatments involve the selective heating of the deeper skin layers with high frequency electrical currents. In this case we are talking about radio frequency diathermy. This type of heating is called diathermy because it can heat deeper tissues without affecting the superficial ones (diathermy literally means "heating through" in Greek).

As applying heat on the epidermis can be achieved by all sorts of other means, including infrared lamps, laser, hot water and even a hot pack, there is not much point in providing superficial radio frequency per se, except in the case of acne.

The idea of RF is to mainly affect the deep tissues (dermis, subdermis, subcutaneous fat), while largely bypassing the epidermis. Affecting mainly the epidermis, while leaving the deeper tissues largely unaffected, is pointless, because as a result such treatment will burn the epidermis before the dermis or subdermis experience any therapeutic levels of heat.

In summary, deep RF, scientifically known as radio frequency diathermy, is real RF. Superficial RF is not much better than applying a very hot pack on the skin.


Most RF treatments focus so much on the epidermis, they are not true radio frequency

Unfortunately, however, this is what many radio frequency machines provide: very superficial heating - hence all these burning/scarring cases you see on websites such as after radio frequency treatment. True radiofrequency never causes superficial burning (unless it is applied specifically for ablation/resurfacing of the skin, as in the case of acne scarring). If RF burns the skin it is so superficial, it’s pointless. True radio frequency should leave the epidermis alone and focus deep in the skin - that was the reason why it was first invented. I will discuss this issue in more detail in other parts of this guide.



Where does the name radio frequency derive from? Does RF have anything to do with radiation, radioactivity or microwaves?

The electrical currents used for beauty treatments (300 kHz to 3 GHz) happen to be part of the so called "radio frequency spectrum", i.e. the frequencies used for radio communications (3 kHz to 300 GHz). Hence aesthetic treatments using electric or electromagnetic currents of such frequency have been named radio frequency treatments.

However, there is nothing else common between radio communications/radiation/radioactivity and radio frequency treatments.



How does (proper) radio frequency treatment work?

As we discussed above, radio frequency is a smart way to provide deep heating to tissues, without burning or irritating the epidermis in the process. According to research, intense (43-47º) heating on deep tissues has quite a few benefits, as it helps:

stimulate healthy collagen and elastin synthesis by fibroblasts/collagen cells (skin firming and elasticity)

stimulate fibroblast proliferation (more collagen cells)

contract existing collagen fibres (skin tightening)

contracts skin pores (“open” pore reduction)

blood circulation (anti-ageing/skin rejuvenation, cellulite reduction)

contracting sebaceous glands (acne reduction/prevention)

releasing fat from adipocytes (cellulite reduction)

stimulate adipocyte apoptosis (less fat cells)

This is how intense heat RF works: by stimulating the above processes over several intense - but never extreme - sessions and this is the RF we use at the clinic: safe, NEVER painful, natural and effective.

How does ‘destructive’ RF treatment works

However, there is another way to use RF: by damaging (= burning, coagulating) skin tissue with extreme (up to 62ºC), VERY PAINFUL high heat and then hoping that the skin will try to repair the damage and regenerate itself, by depositing unhealthy scar tissue collagen to heal the burn/coagulation.

This is how the first ever radio frequency treatment worked and how a couple of similar RF treatments work today.

The problem with this approach is that instead of stimulating the synthesis of natural, healthy, properly linked, high quality collagen and elastin that normal radio frequency does, it stimulates the creation of badly linked, unhealthy scar tissue collagen - and no elastin. This means that you do not get skin tightening, you get skin hardening - or what I call “scar-tissueing”.

The other problem with this approach is that some people’s skin does not react satisfactorily to heal the inflammation and damage caused by the ‘destructive’ RF approach, leaving the person with more skin looseness, paper-thin skin, a visible scar tissue lump or a visible burn.

BTW this is exactly how high-power (destructive) HIFU works and it causes exactly the same side effects (low power HIFU is largely ineffective compared to proper RF and that’s why we don’t do any HIFU at the clinic).

Sometimes, the skin reacts just to repair the damage, resulting to neither paper thin skin nor hard/tightened skin, i.e. no results, despite the extremely high cost of this approach.

The idea behind this type of RF is to offer the client an impressive skin tightening (well, skin hardening to be precise) after a few months with just one very expensive session and make the maximum amount of money per hour at the clinic.

We find this type of RF (and HIFU) pathetic and we would never consider using it at the clinic.



The exact mechanism

With radio frequency treatment, electrical current enters the skin from one pole, which is charged positively, and then exits the skin from another, which is charged negatively. A split of a second later, the polarity changes and what used to be a plus pole becomes minus and vice versa. This happens hundreds of thousands or millions of times a second.

Now if the frequency of the current was much lower, for example 100Hz (one hundred such polarity alternations per second) then we would have muscular contraction. Indeed such low frequencies are used in TENS machines for pain relief and in other physiotherapy machines for muscle rehabilitation etc.

As I mentioned earlier, at higher frequencies we do not have muscular contractions, we just have heat. This is because the frequency is so high that so called "motor nerves" are not fast enough to sense the polarity alternation, so no muscular contraction occurs.



Molecular movement = heat

Now the question is: how is heat being produced with radio frequency?

The answer is simple. if you remember from high school physics, heat is random molecular movement. With RF currents, the alternation of the current is so fast that no charge or no molecules ever really move towards one pole or the other. As a result, molecules just vibrate around a central position or simply rotate. This random molecular movement (vibration or rotation) manifests macroscopically as heat.

In a nutshell, this is how radio frequency treatment works: it vibrates our molecules, producing heat.


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What is the best radio frequency treatment?

What determines the efficacy of a radio frequency treatment?

There are hundreds of RF machines in the market today and they all vary in power and other specifications. There are also tens of thousands of RF operators around the world and they are all different in terms of their training and the technique they utilise. Therefore, not all radio frequency treatments are the same.

The best RF treatment is the one applied with the highest specification equipment and products AND provided by the best trained therapist. Radiofrequency treatment effectiveness depends on the following important factors:

Monopolar / bipolar RF technology

Resistive / capacitive RF function

Maximum RF output power

Cooling function

RF frequency

RF treatment cream/gel/oil used

Adjustable settings for custom RF treatment

RF combined with other modalities, such as ultrasound or infrared

RF treatment protocols

Operator experience and specialisation


Bipolar / tripolar / tetrapolar / octapolar / multipolar / unipolar / monopolar radio frequency

This mainly determines the penetration depth of the treatment. Bipolar radio frequency is very superficial, while monopolar radio frequency may be able to target deeper tissues, depending on other settings (not all monopolar treatments are deep acting).

There are also machines that offer so-called tripolar, quadripolar, octipolar or other multipolar options. However all these machines are in essence bipolar machines and thereby very superficial, contrary to all the marketing hype. As you may remember from school physics, there are only two electrical poles, plus (+) and minus(-). The extra “poles” in tripolar, tetrapolar, octipolar etc treatments are just alternation of the plus and minus poles over three, four or eight electrodes every few milliseconds. Pure gimmick.

Unipolar radio frequency is neither monopolar nor bipolar and works at the superficial to medium deep level.

However, a lot depends on all the other settings on this list, and ultimately on the knowledge of the person that will design your treatment protocols.


Resistive or capacitive radio frequency

Resistive/capacitive RF function primarily determines if the treatment is deep or superficial. Resistive RF is almost always deep, while capacitive RF may be anything from deep to very superficial, depending on several other factors.


Maximum radio frequency power, in watts

Higher intensity means better treatment, but too high intensity may also cause irritation or even injury. A good therapist will be able to treat at just the right intensity, maintaining a fine balance between effectiveness and comfort/safety. For example, on a deep-acting monopolar machine high power is very important, while on a superficially acting bipolar machine very high power is either unnecessary or simply dangerous.

Unfortunately, most RF machines are designed for face use, with body use being a mere add-on. This means that most body RF equipment is simply not strong enough: they have such low power that you wait and wait and wait and you never reach therapeutic temperatures. Or, if you work on a smaller area at a time, it may take two hours to do a proper treatment that would only need forty minutes with a high-powered equipment .

Typically, machines with 200 Watt power are just about good enough for petite women for body skin tightening / cellulite reduction. Unfortunately the vast majority of machines - even many of the big names on the market - have <200 Watts of power. For body, 300 Watt maximum output power is ideal (don’t confuse the operating input power of the machine with output power).

For face, an 120-150 Watt output power makes sense. Although normally less than 100 Watts of power are used for a typical face treatment, having a low power machine that operates on its limits at 100 Watts may lead to overheating and malfunction.



Radio frequency treatment with superficial cooling

This allows the surface of the skin to remain unaffected while deeper tissues are heated intensely.

It can be indispensable with more superficially-acting technologies (i.e. the majority of RF technologies) in order to avoid skin burning. Very deep-acting RF treatment does not really need skin cooling.

Finally, excessive skin cooling can actually mask excessive deep heating, resulting in deep tissue skin burning.

So with cooling, more is not always better.

Radiofrequency current frequency, in kHz, MHz or GHz

Low frequency (kHz) RF affects totally different tissues in relation to high frequency (MHz) RF and again works in a quite different way to ultra high frequency (GHz) RF.

kHz radio frequency tends to affect more the fatty tissues, while MHz and GHz radio frequency affects more the watery tissues.

However, that’s a generalisation, as many other factors come into play, such as the actual structure of fat tissue, the monopolar/bipolar/unipolar arrangement and the presence or lack of cooling.


Radio frequency contact medium used (gel, oil or cream)

This allows the current to pass through the skin but also affects the quality of the treatment itself by altering the characteristics of the current as it passes through it and into the skin. For different types of RF treatments different products are needed both for effectiveness and safety - not all skin products can be used with all RF treatments.

The uninitiated think that the product used has no impact on the treatment, but that could not be further from the truth. The contact product used for RF treatment can have a huge impact.


Adjustable RF equipment settings

Some machines allow the operator to adjust many different parameters to create a custom treatment. Others have very simplistic controls, suited for foolproof use by staff without extensive treatment. Obviously the latter are not very helpful and only allow generic treatment options.

The more settings an experienced operator has on their hands, the more advanced and customised treatment they can provide.


Simultaneous combination of radio frequency treatment with other treatment modalities

Ultrasound cavitation, infrared, acoustic wave (shockwave), electrical muscle stimulation and vacuum suction are some of those modalities.

Some improve treatment effectiveness, while some actually make the treatment more cumbersome, more ineffective or even more dangerous. Why some of those modalities used then? Either due to ignorance (yes, there is plenty of that even in manufacturers) or simply for commercial reasons/marketing hype (yes, hype).

Therapeutic active ingredients used in treatment gels/creams/oils

Again, the uninitiated will dismiss this, but research has shown time and again that radiofrequency and other currents, as well as ultrasound, boosts the absorption of active ingredients by up to 500%, so it makes sense to use a highly concentrated treatment medium (cream, gel or oil) to boost the effectiveness of the treatment. If you can use vitamin C, hyaluronic acid, caffeine a peptide combined with radio frequency to boost its effectiveness, why not do it?

Unfortunately though, most such contact media contain nothing and the very, very few ones that do, contain actives at very low concentrations.

(At our clinic we use highly concentrated actives in our contact products and they are indeed absorbed very, very effectively by both RF and ultrasound treatment.)


Radio frequency treatment protocol design by the head therapist at the clinic/salon

Usually the head therapist of the salon/clinic creates the basic protocol to be followed for each client or for all clients. Even the best machine in the world will not be put to good use if the person that sets the parameters and designs the treatment does not have a good knowledge of the biophysics of radio frequency treatment. Furthermore, customised protocols for each client will be more effective than one-size-fits all protocols.

Unfortunately such protocol design and customised treatment based on the science of radio frequency is non-existent in the beauty industry and only rarely found at doctor-led clinics. At most places, from small salons to Harley Street clinics, users just follow the basic manufacturer instructions after one day’s training.

Operator experience and specialisation

Obviously operator experience and specialisation is very important.

A very busy clinic where hundreds of RF treatments are provided every month allows its staff to gain more experience on the treatment and provide better results. Staff that perform a dozen other treatments, from massage to laser hair removal, will not provide the best possible treatment and results.

Also, specialisation on a specific type of RF treatment (e.g. face, body, bipolar, monopolar, resistive, capacitive etc.) can play an important role.

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Monopolar or bipolar radio frequency:
what is the best for skin tightening?

Monopolar or bipolar: What is best for skin tightening?

A very common question I am asked is what is the difference between unipolar, monopolar, bipolar and multipolar (i.e. tripolar, tetrapolar, octipolar) radio frequency? Which one is best for skin tightening?

First of all, let's make it clear: there are only two poles in electricity: plus and minus. That's basic Physics from high school. So all these names (tripolar, tetrapolar/quadropolar, octipolar whatever-polar) are a misnomer and a little bit of a gimmick, especially when it comes to eight poles, which is an overkill and unnecessary (more on that later). Let me first explain what is monopolar and bipolar, and then I will move to multipolar and unipolar.

But to answer the question on the title of this paragraph, let me just say that for both deep and superficial skin tightening, monopolar radio frequency wins hands down.



What is monopolar radio frequency treatment?

In monopolar RF the (+) and (-) poles are located quite far apart from each other. As a result, the current has no other choice but to traverse through ALL skin layers after entering the skin, travel through the body to the other pole, and exit there.

This means that with monopolar RF, and depending on some other factors too, we can treat not only the skin surface (epidermis) but also the middle skin layer (dermis), the deepest skin layer (hypodermis/subdermis) and even the subcutaneous fat deposits below the skin itself.

As I mentioned above, how deep we treat depends on some other factors too, not just on bipolar/monopolar arrangement. However, in most setups monopolar RF allows us the opportunity to go quite deep. Unfortunately this is not the case with bipolar RF, which is restricted to quite superficial treatment, no matter what gimmicks are used to make the current "go deeper".

This is the reason that we do not use bipolar/multipolar RF at our clinic, even though our machine provides that option. We don't even use bipolar RF for superficial treatment, e.g for acne, as we can fine-tune our monopolar machine to work superficially in a much better way than bipolar can ever do.



What is bipolar radio frequency treatment?

With bipolar radiofrequency the plus (+) and minus (-) poles are located very close to each other - too close for deep treatment.

Because the poles are close to each other (in most machines they are almost adjacent to each other), the current has no other choice but to briefly and superficially penetrate the skin (as little as one millimetre (i.e. the maximum depth of epidermis) and then exit the skin again from the other pole, not very far from where it entered. Quite often the "trajectory" of the current spans just the epidermis.

This means that if we want to properly treat the dermis (and even more so if we want to treat the hypodermis or subcutaneous fat), we must first literally burn the epidermis, which is in the way and absorbs almost all of the current. Because nobody would even want to burn the epidermis, treatment intensity is adjusted at lower levels. This keeps the epidermis happy but deeper skin layers are not treated properly.

Epidermal heating gives the impression of a very strong treatment, with lots of redness and quite often irritation, and there is some superficial tightening. However, not much collagen/elastin production is stimulated in the dermis/subdermis below and definitely no cellulite fat or deep fat reduction (which is located even deeper) ever occurs.

If intensity is increased, in order to work on deeper skin layers and produce some skin firming/lifting, the epidermis is burned/irritated and/or severe pain is experienced, hence some of these burn pictures and extreme pain stories in review websites.

Indeed there are gimmicks such as numbing creams, surface cooling and vacuum suction, to provide deeper treatment with bipolar RF. However, none of those really work well and they also have their own problems: numbing creams cover the intense pain and increase the likelihood of tissue injury/burning; there really is no point providing superficial cooling to avoid excess superficial heat, as the two negate each other and the whole exercise is just a waste of energy; and vacuum suction causes skin stretching/loosening, thread/spider veins and in addition does not allow for the use of active ingredients, which if used can enhance the skin tightening effects of radio frequency.

In a few words, bipolar RF is just too superficial. Period.



Tripolar, tetrapolar, octipolar and other multipolar radio frequency

As I mentioned earlier, there are only two poles in electricity. So how come there exists a tripolar radiofrequency machine?

The answer is simple: with tripolar radio frequency, there are three electrodes, with the two poles (the plus and the minus), always alternating between the three electrodes. At any given time one of them is a minus, the other is a plus and the other is inactive.

With tetrapolar RF, the two poles alternate between four electrodes, with two being inactive at any given time. With octipolar it is two active and six inactive. And so forth...

In theory, this alternation of poles results to more uniform and/or deeper heating. In practice, all you would need to produce deeper heating would be to move just two pole apart - you don't need all this multipolar gimmick. And in any case, you would still not go as deep as with monopolar. With regard to heating uniformity now, this is also pointless. With almost all RF treatments the therapist continuously moves the handpiece, which provides plenty of uniformity without the need of all those "poles".

All in all, I find multiple poles a marketing gimmick. Of course the manufacturers of these machines would disagree. But Physics is Physics. Monopolar means going through all skin layers, while bipolar/multipolar means staying largely on the surface. In nature, electrical current, or any other energy potential differential, will choose the shortest possible distance to travel. Simple.



Unipolar radio frequency treatment

Unipolar RF is neither bipolar nor monopolar - it is based on an electromagnetic field created by the tip of the handpiece, which is applied on the skin.

Unipolar can be anything from medium superficial to medium deep, depending on cooling and other settings used.



Machines with monopolar and bipolar options

Luckily, the better machines on the market offer two or more choices: monopolar or bipolar (or any of the varieties, mentioned above). If you are a practitioner and bought one of those machines, my advice is to just use monopolar. Focus on it, train on it and use it well, and it will be much better than any bipolar arrangement, even if you wish to offer very superficial treatment.

If you are a client, I would definitely advise you to go for monopolar. Some bipolar machines may work well for some applications, but in three words, "monopolar is king".



If monopolar is so much better, why do bipolar machines exist?

The reason is simple: cost. Monopolar machines need to employ higher intensities, as they heat the skin deeply. This means bulk, heavy weight, almost no portability and cost. You can't find a good monopolar machine for less than £20,000.

On the other hand, you can make a pretty cheap, small, light and portable bipolar machine which is also called "radio frequency" machine for as little as £700, while useless "home use" bipolar machines can cost as little as £200. Since the public does not know the difference and thinks all radiofrequency machines do the same thing, you get the main idea behind bipolar machines.

Due to just superficial heating, even a cheap bipolar machine, may in some cases appear to be very hot and powerful and impress the client, while in reality it is not so powerful at all, and does not treat the deeper skin layers. Obviously, you should not expect much in the way of results from those, either for your clients, as practitioner, or for yourself, as a client.



How do I know what kind of RF treatment I am receiving?

The answer is very simple. If a metal or self adhesive pad is used to connect you to the machine, then you are having a monopolar RF treatment. If your only contact with the machine is the operator handpiece, then you are having a bipolar-type treatment.



Deep/superficial RF treatment: important, but not the whole picture

Of course, depth of treatment is not the only important thing in radio frequency, neither it is only affected by the arrangement of poles, and these are subjects that I am discussing in other parts of this guide.


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Resistive or capacitive RF treatment? 

Which is the best for cellulite and skin tightening?

I have already discussed one variation of radio frequency treatments, i.e. monopolar vs bipolar RF. On this page I will be discussing two other aspects of the technology: capacitive versus resistive radiofrequency treatments. This aspect is not as well known as bipolar vs monopolar, but it is equally important if you wish to choose correctly the best RF radiofrequency machine for your clients/patients or the best radio frequency treatment for yourself.



What is resistive radio frequency?

When the radiofrequency handpiece that gets in contact with the body is made of stainless steel, and thereby allows electricity to pass through to the skin relatively unimpeded, then we are talking about resistive radiofrequency. This is because in this case the surface of the skin (epidermis) acts as a resistor.

As the skin has quite low impedance/resistance , the surface of the skin does not get too hot, allowing RF to work deeper, especially if we use monopolar RF. So resistive RF and monopolar RF both result in deeper treatment.



What is capacitive radio frequency?

When the radiofrequency handpiece that gets in contact with the body is made of ceramic, plastic or other material that does not conduct electricity, and thereby necessitates electricity to "jump" through the skin, then we are talking about capacitive radio frequency. This is because in this case epidermis, as well as the ceramic/plastic material on the handpiece, act as capacitors.

In this case, heat develops in the interface between skin and handpiece, so treatment is unavoidably more superficial, and the epidermis gets very hot. This means that capacitive RF treatment is more superficial, especially when a bipolar/unipolar/multipolar arrangement is used. So capacitive and bipolar RF both result in more superficial treatment.



Deep vs superficial RF

Nothing wrong with superficial/epidermal treatment, but it's a bit of a waste. You do not need a multi-thousand pound machine to heat the epidermis: you can do that with an infrared lamp, hot pack, sauna or even hot water, at a much lower cost. However, it pays to remember that radio frequency was developed in order to helps us provide deep treatment.

On the other hand capacitive RF is a valuable addition to a system that also provides a resistive option, but only in a monopolar RF system. This allows the operator to switch between deep, medium or superficial treatment, according to the needs of the client. A handful of quality machines offer both a capacitive and a resistive option to offer full flexibility to the operator.



How do I know what kind of RF treatment I am receiving?

The answer is very simple. If the handpiece makes contact with your skin via a stainless steel tip, then you are having resistive treatment. if the tip is made of ceramic or plastic, then treatment is capacitive.

The issue between capacitive vs resistive is of less importance than the issue between bipolar and monopolar. IMHO, monopolar is far superior to bipolar, while a good therapist may do a good job with either a capacitive or resistive machine.

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Home radio frequency machines:
are they worth it? Do they work? 

What is the most effective radio frequency machine for home use?

This a question people ask me all the time. Radio frequency treatment - with the right equipment - can indeed be very effective for skin tightening. Therefore many people would like to buy an affordable machine to safely use at home every day.

You may have noticed, however, that I have used italics in four instances in the above paragraph - and there are good reasons for that.



'Right equipment'

The truth is that quite often even professional RF treatments do not offer any significant benefits, simply because they are provided with the wrong equipment, usually cheap chinese low-power, bipolar machines, which are too superficial, too weak and, quite frankly, not very safe or sturdy to use in a professional setup.

However, home-use equipment is even worse than cheap professional equipment, as it is even lower spec, so there is not a chance in hell it will ever “work”.

On the other hand, if you are tempted to buy a cheap chinese RF “professional” machine on eBay, Alibaba or similar outlets, think again. In addition to buying into a serious health and safety hazard (I am not exaggerating here, there is a reason proper clinics splash out tens of thousands of pounds to buy machines with “medical certification” and ensure their clients’ safety), using strong RF at home is a very bad idea, as we will see below.



'Affordable machine'

As we mentioned on a previous article, there is a reason that good, powerful, high specification monopolar machines cost a lot of money (anything between £20,000-£70,000) and are heavy and bulky. Because that's exactly what is needed to provide good results to a clinic’s clients in a reasonable number of sessions.

Now if professional salons and clinics fail to provide good results to their clients with relatively cheap professional equipment (anything from a super cheap £1,000 to a relatively cheap £10,000) even after a course of 10 sessions, how do you expect to have good results with a toy-specification, £300 home-use radio frequency machine?

It is not going to happen and you are going to be disappointed.

Now if you are easily pleased and are happy with the tiny results a home RF use machine can offer you, then you will probably be even happier with a plain facial self-massage provided with a nice cream followed by some facial exercises, and spare yourself all the cost and hassle.



‘Safe use’

There is another reason, apart from cost, that proper, high-power, effective, professional machines are not sold to the public: because most people get obsessed, crank up the volume and end up burning themselves or causing some other type of injury to themselves. And then they are quick to sue the manufacturer/seller who sold them such a powerful machine while knowing that there is a danger of a non-professional getting injured by it.

So, for this reason only, and regardless of cost, you will not see a real, effective radio frequency machine sold to the public, EVER.

No company wants to deal with injured clients, no company wants to get sued and no company wants all the bad publicity that follows.

Furthermore, to protect the public, no such machine can be cleared by the regulatory authorities (FDA in the US, CE in the EU) for consumer use.

Finally, if any company salesman is stupid enough to offer you a professional machine, even though you are untrained and unqualified, you should resist the temptation of thinking that you are smarter than you are and that you can use a professional machine without proper training and qualifications.



‘Every day’

"But what if I buy a low power machine and use it every day instead", I can hear you asking. Good point.

Well, things don't work that way. To reach a therapeutic outcome with any treatment, you need a minimum of intensity. For radio frequency that is a temperature of 43-47ºC in the deeper tissues and 39-43ºC on the epidermis - which is in the border of painful. No home use machine (they are always bipolar) can produce 43ºC on the dermis or subdermis - it will just burn the epidermis. You need a bulky, expensive, powerful monopolar machine for that.

Furthermore, the way all therapeutic treatments work is by providing some stimulation/irritation - which needs to be followed by several days of rest, during which time the body reacts to the stimulation/irritation and tries to become stronger and more efficient.

This is how weight training works, how endurance exercise works, how ultrasound works, how radio frequency works and basically everything that aims to improve something in the body. In the same way you should not expect to do chest presses with an 1kg dumbbell on each hand and expect to build big chest muscles anytime in the next century, you should not expect to tighten up your skin with a gentle, superficial temperature increase with a home RF machine.



In summary: no, home radio frequency machines do not work

So for all these reasons, home radio frequency - as well as home ultrasound cavitation - treatments do not work. Knowing what I have learned by working with radio frequency every day for several years, I would never buy a home-use RF machine if I was a member of the public.

Clients we see at the clinic who have previously bought such machines, are simply disappointed and wonder why their machines didn't work. And then we have to explain all the above to them. Don’t be one of them.

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radio frequency VS infrared treatment 

Superficial tissue heating vs deep tissue heating

Both radiofrequency treatments and infrared treatments (either IPL/intense pulse light, laser or LLLT/low level laser therapy) are used to heat the body for therapeutic reasons.

In aesthetics, intense heating can improve circulation, stimulate the production of collagen and elastin and contract the existing collagen fibres, for an immediate as well as long term rejuvenation and skin tightening/lifting effect.

The main difference between radio frequency and infrared treatment is that radio frequency (RF), depending on the equipment used, the products applied and the settings/protocol applied, can selectively heat the deeper layers of the skin (dermis, subdermis), without overheating the epidermis (most superficial layer of the skin).

In contrast, infrared treatment focuses on the epidermis, penetrating very little beyond the uppermost layer of the skin, and as a result it cannot reach the deeper layers of the skin in therapeutic amounts without overheating (burning) the epidermis first.



Bipolar radio frequency and infrared are quite similar: both heat the skin too superficially

Bipolar radio frequency treatments are also very superficial and cannot reach the deep skin layers without burning the epidermis first. This depends on the equipment and settings used.

On the other hand, some monopolar radiofrequency treatments (depending on equipment and protocols) can penetrate the skin very deeply to affect the subdermis and the subcutaneous fat for the purposes of lipolysis (fat release from fat cells), adipolysis (fat cell breakdown) and cellulite reduction.



Infrared and tissue healing at low intensities

Infrared treatment is known to stimulate tissue healing, even at the low intensities infrared radiation reaches the dermis and epidermis. So in that respect, infrared still makes some sense, but it far inferior to radio frequency for skin tightening.

Perhaps monopolar RF combined with some infrared (but not so strong that it can burn the epidermis) would be ideal.

On the other hand, the low intensities used in anti-ageing infrared face masks mean that not much difference is seen in terms of anti-ageing with them. Clearly, higher infrared intensities are needed, and ideally they should be combined with monopolar RF treatment for maximum results.


In conclusion...

...we could say that infrared treatment is largely limited to the epidermis (very superficial treatment), while different RF treatments can work on different skin depths, from superficial to very deep, depending on the design of the treatment.

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