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Stanford Report, November 13, 2002

Stanford Hospital & Clinics tests innovative cosmetic treatment technique

By AMY ADAMS

Karen Dresden intended to age gracefully, "but then I grew old," said the 51-year-old professional. Dresden is participating in a study on a new form of cosmetic treatment called ThermaCool being tested at the medical center. The technique relies on heating the skin rather than surgery to achieve results similar to those of an eyebrow lift.

Dresden, whose name has been changed to protect her privacy, just finished her fourth treatment with ThermaCool as part of a Stanford trial. "You want to look as good as you feel," she said. "I don’t think I’m going to run out and start wearing mini-skirts," she added, but she’s glad to have smoothed over some wrinkles around her eyes while firming up her brow.

ThermaCool is being tested by R. James Koch, MD, assistant professor of surgery, as part of a nationwide trial of the first noninvasive brow-lift technique. He has used the device on 40 patients at Stanford — the lead site and the only trial center on the West Coast.

R. James Koch tests the ThermaCool device to remove wrinkles around the eyes and firm up the brow of a patient at Stanford, the only site on the West Coast to offer the procedure. PHOTO: AMY ADAMS

The participants, including two men and people of differing races, were divided into two groups before treatment. Volunteers in one group received only one treatment while those in the other group received up to four treatments — each treatment would normally cost around $2,000. Photographs throughout the process and up to nine months after the final procedure were taken to document the effects of the procedure.

"I think it’s nice in that you can gradually get improvements with each treatment," Koch said. He added that some patients walk away from their first treatment with raised eyebrows and fewer crow’s feet while others see gradual changes over one to six months.

For each treatment, the patient receives a dose of numbing cream. Nurses remove the cream after an hour and ink a grid across the patient’s forehead and down the side of the face to about the level of the eye. This grid helps Koch track which portions of the face have been treated.

Koch then administers a six-second zap in each square with a handheld wand. The tip of the wand first tests the skin’s resistance to energy before cooling the skin to 32 degrees F. It then delivers an amount of radio frequency energy that is sufficient to heat the region beneath the skin to 167 degrees F for 2.5 seconds. A follow-up cooling period prevents the surface of the skin from becoming red or burned.

Koch said that because the composition of the skin changes in each quadrant, it’s important for the device to test the region first to calibrate how much energy is required to reach the appropriate temperature. Koch also dials the dosage up or down depending on the patient’s skin. Delicate skin next to the eyes gets less energy, while the skin across the forehead gets more.

Although ThermaCool heats the layers under the skin, the pre- and post-treatment cooling keep the pain to a minimum, said Kimberly Griffin, a study participant who completed four treatments. "The pain sort of increases then dissipates," Griffin, 45, said. She added that if the pain grows too severe Koch offers a nerve block.

A registered nurse at Stanford Hospital, Griffin had done some research into treatment options when she heard about Koch’s trial. "I thought it would be great to get a little freshening up," Griffin said.

Of the treatment options she’d read about, ThermaCool seemed like the best choice because it involved no surgery and no downtime after the treatment. "It’s a great alternative," she said. Aside from a brief period of mild redness lasting up to an hour, Griffin said she could go back to work immediately and because there is no scarring nobody would know she’d had anything done. Koch added that some patients have mild swelling that disappears after treatment.

Koch said the minimal redness following treatment is a result of the cooling phase following the pulse of energy. Heating the lower layers of the skin encourages fibers called collagen to shorten. The heat may also kick off a wound-healing response that further improves the collagen. But heat alone would burn the skin — hardly the beautifying look his patients seek. By cooling the skin he can direct the heat to beneath the skin while safeguarding the visible layers.

Although the trial is ongoing with some patients still finishing up their final treatments, the participants seem satisfied. "It’s so easy," said Dresden. "I just had a treatment then went on with my life." If the results of this study continue to look promising, Koch intends to test the device on the jaw line — another common area for surgery. If that happens, Dresden said she would be first in line for the trial.

The trial was funded by Thermage, Inc., based in Hayward, which developed ThermaCool.




Treatment zeroes in on unsightly scars (4/3/02)