“I have researched, studied and practised for 14+ years radiofrequency and ultrasound for skin tightening and cellulite reduction and assessed / used all the major machines on the market and I can now teach you how to make the most of your equipment by accurately applying these technologies exactly with the exact right intensity and at the exact right depth.”
When radiofrequency/cavitation doesn’t work: too little, too much, too superficial, too deep | The Pro Series
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Ultrasound, radiofrequency and tissue depths
When ultrasound / RF is applied too superficially
When RF / cavitation is applied too deeply
Trying too hard / taking too many risks / thinking one is too smart
Knowing which tissue is located at which depth and which equipment/setting can reach that depth is essential
The right technology at the right depth and right intensity
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Ultrasound, radiofrequency and tissue depths
I have specialised in skin tightening and cellulite for more than two decades and over the years we have assessed practically and theoretically all relevant technologies, including the biggest current gimmicks, i.e. HIFU and RF microneedling.
After all these years I have found that deep-acting, high-power radiofrequency and high-power ultrasound cavitation are by far the strongest SAFE technologies for skin tightening and cellulite and that’s why I use them at the clinic and teach their application to other therapists and clinic owners.
However, not all cavitation or RF treatments are the same. In fact…
because every clinic individual therapist practises those technologies differently, even with the exact same equipment;
and because there is a huge variety of RF and ultrasound equipment on the market, ranging from very low spec to very high spec
…we can say that there are as many RF/cavitation treatments on the market as there are clinics in the world - probably tens of thousands of them.
As a result, radiofrequency and cavitation treatment can be:
Spot-on, when it is applied with the right mix, at the right intensity and when focusing at the right skin depth for each specific indication and person
Ineffective, when it is of too low intensity and/or when it is applied at the wrong skin depth
Unsafe, when it is of too high intensity and/or when it is applied at the wrong skin depth
The whole picture is further complicated by the widespread ignorance regarding how deeply the different anatomical structures are located, i.e. epidermis, dermis, hypodermis, SMAS (superficial musculoaponeurotic system), superficial fascia, intermediate fascia, deep fascia and subcutaneous adipose tissue (commonly mistaken even by most aesthetic doctors, let alone beauty therapists).
For example, I have been told recently by a HIFU equipment “clinical” trainer that 4.5mm is where the dermis is and that 9mm is where cellulite is. Both were totally off, of course, by several millimetres.
Things are also complicated by the widespread ignorance regarding how deeply different technologies reach or should reach (commonly mistaken even by equipment manufacturers themselves, let alone machine buyers and machine operators).
These errors and misunderstandings are way off the charts, hence the poor quality of radiofrequency / cavitation treatment, leading to poor results and/or adverse reactions.
Let’s now see in detail what happens in different scenarios where treatment depth and/or treatment intensity are wrong.
When ultrasound / RF is applied too superficially
When treatment is applied too superficially (usually on the epidermis or superficial dermis) we may have:
either poor results (if intensity is not too high)
or skin injury (if intensity is too high)
Such skin injury usually manifests as crepey skin, paper-thin skin or a skin burn
Such skin injury usually occurs with RF microneedling and HIFU, which we are not examining on this article, but it can also occur with ultrasound or RF, when used by poorly trained therapists, with wrong protocols or with poor equipment.
When RF / cavitation is applied too deeply
When treatment is applied too deeply (usually on the subcutaneous adipose tissue on body and face; or adipose tissue below and above the SMAS on the face) we may:
also have poor results (if intensity is not too high)
or fat tissue / connective tissue injury (if intensity is too high)
Fat tissue / connective tissue injury usually manifests as:
a “bump” (temporary mild swelling due to mild burn on deep fat or other deeper tissue)
an externally visible burn/inflammation (more serious burn on the deep fat or other deeper tissue)
skin hardness/fibrosis (more serious burn on the deep fat or other deeper tissue)
skin laxity (more serious burn on the deep fat or other deeper tissue)
fat loss (facial fat loss can be devastating for some people but buttock fat loss is also usually unwanted)
Such skin injury usually occurs with with RF microneedling and HIFU, which we are not examining on this article, but it can also occur with ultrasound or RF, when used by poorly trained therapists, with wrong protocols or with poor equipment.
Trying too hard / taking too many risks / thinking one is too smart
Many therapists are too enthusiastic and tend to think that the stronger the treatment the better the results, trying to impress their clients while disregarding safety.
Similarly, many machine manufacturers also make machines that attempt to to “get rid of” cellulite or skin laxity in 1-4 very painful, very dangerous and very expensive sessions (of course, this never, ever happens).
The attitude of both is equivalent to someone trying to do an 100kg bench press when they can normally lift only 60kg: it is just not going to work. The best outcome of such attitude is failure and the worst outcome is injury. It is just plain stupid.
Proper RF / cavitation works as gym training for the skin and this necessitates multiple regular sessions, not the equivalent of one super-strong, super-risky gym session.
Nature doesn’t work like that and trying to violate nature by deliberately causing an injury, with a so-called controlled (😂) tissue burn at 60-90ºC and with the naive hope that the body will always respond with better quality tissue is just reckless.
So, in terms of intensity, the safe AND effective way is to use the exact right level of power: not too strong to cause adverse reactions and not too light to render the treatment ineffective.
This depends both on equipment choice and good training.
I have seen people who have one of our machines at the clinic using said machine in totally the wrong way and consequently making treatment both painful AND ineffective at the same time (it takes a special kind of bad training to achieve that)
And I have seen people doing a pretty good job with lesser equipment, just because they have had better training
Knowing which tissue is located at which depth and which equipment/setting can reach that depth is essential
There is huge confusion about the names of the different tissue layers and their location within the skin, even between different experts.
The picture is further complicated by the fact that many of those tissue layers are thinner in some areas and thicker in some others, even on the same person.
Some skin layers have a different structure on different body areas and on different people. And some are missing altogether or fuse with each other tissues in different body areas.
If you apply a decent treatment intensity the worst thing that can happen by getting the depth wrong is just reduced treatment effectiveness. Not great but at least not a disaster.
However, if you apply extreme intensity (as in the instant miracle procedures mentioned above that attempt to give results in 1-4 sessions) then getting your skin layers wrong can be disastrous.
This is usually the case with therapists attempting to target the SMAS on the face (i.e. the tissue depth facelift surgeons work on) with high intensity RF microneedling, high intensity HIFU or extreme intensity RF.
In these cases, if things go wrong people lose facial fat or get swelling/burns/fibrosis. This swelling / burn / fibrosis occurs:
Because the SMAS is located at different skin depths even in the same person
And because no equipment accurately targets the same specific depth in all people and even in all different anatomical areas of the same person
A depth of 1.5mm can be on facial fat on one part of someones’s face and on the SMAS on another part, just a couple of centimetres away of the same person’s face. Just a difference of 0.5mm in depth can lead to disaster and it is very easy to get things wrong.
The only reason there are not that many disfigured people with such treatments is usually due to treatment intensity being too low to cause damage (but also too low to offer the promised miraculous results, which are usually so-so, despite all the pain and the expense).
In some cases, people’s fat/connective tissue is more resilient, despite the extreme intensity applied at the wrong place and that also helps avoid injury/burn.
And in some cases sheer luck helps avoid adverse reactions too.
The right technology at the right depth and right intensity
All in all, by knowing:
which technologies to combine (ultrasound, RF, phototherapy etc) for each indication (skin firmness, anti-ageing, cellulite etc)
how to target the correct treatment depths
how to recognise when intensity is too low or too high for different people and different body areas on the same person
…you can offer the most effective possible treatment with a:
realistic number of sessions: usually 6-12 sessions (and definitely not 2-3 neither 20-30)
great safety profile: currently 99.5%+ at our clinic (with the 0.5%- of the cases being temporary and/or mild irritation, i.e. insignificant)
And this is what we teach at LipoTherapeia.
The Cellulite School™: Get advanced training in cellulite reduction and skin tightening
Why train with The Cellulite School™?
We all know that training in cellulite reduction and skin tightening is as basic as it gets. It is typically a 4-6 hour training, involving only basic instruction from the manufacturer on how operators can use the machine; lots of myths, erroneous information and misconceptions; and some basic health and safety on how to use the machine.
There is no proper, real training in the science or cellulite, skin tightening, radiofrequency, ultrasound and all related technologies is non-existent - worldwide.
Do you want to deeply understand radiofrequency, ultrasound cavitation, LED phototherapy, cellulite and skin tightening?
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Now you can get instant access to our expertise and save yourself literally thousands of pounds, dollars or euros of expensive mistakes and thousands of hours of study, research and practical application by attending one of our half-day, 1-day, 2-day or 3-day professional consultancy / training courses.
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At LipoTherapeia we have specialised 100% in skin tightening and cellulite reduction for more than two decades and 20,000+ sessions.
This is all we study and practise every day and have researched and tried hands-on all the important skin tightening equipment and their manufacturers.
As strong, deep acting radiofrequency and deep-acting, high-power ultrasound cavitation are the technologies of choice for skin tightening and cellulite reduction, we have invested in the best RF/ultrasound technologies in the world.
(Of course, we keep looking for new technologies every day and if/when a better technology materialises we will be the first to provide it. However, we will never follow the latest ineffective gimmick, just because it’s good marketing to offer the latest hyped up - yet ineffective and/or unsafe treatment.)
Furthermore, over the last two decades we have developed advanced RF and cavitation treatment protocols in order to make the most of our technologies, for maximum results, naturally and safely.
And for even better, faster results, we now combine our RF/ultrasound treatments with high-power red/infrared light LED treatment.
Our radiofrequency/ultrasound/LED treatments are comfortable, pain-free, downtime-free, injection-free, 99.5%+ safe and always non-invasive.
(No unsafe and ineffective RF microneedling or HIFU and no safe but ineffective acoustic wave therapy, superficial RF (bipolar/tripolar/multipolar etc), low power RF/cavitation, electrical muscle stimulation, lymphatic massage, cupping, dry brushing and no ridiculous bum bum creams.)
Our focus is on honest, realistic, science-based treatment, combined with caring, professional service, with a smile.
We will be pleased to see you, assess your cellulite, skin laxity or fibrosis, listen to your story, discuss your case and offer you the best possible treatment.