**4.2 How much soft tissue contraction can RFAL applicators deliver?**

Excellent peer reviewed studies show that, depending upon characteristics of the patient's soft tissue, anatomic location (high or low FSN zones) and degree of dermal and skin elastosis, *soft tissue contraction and skin tightening of 35–70% (30–40% FSN + 20–30% sub-dermally and dermally) can be achieved (Figure 17). WOW, and with exquisite and elegant thermal control leading to a very, very low incidence of thermal injury* [10–15, 22, 23].

In the next chapter, Part 2 of the RFAL phenomenon, we will explore the external RFAL applicator, or "Outside-In" RFAL, the Morpheus 8 and how it works. Part 2 will also synthesize the combination of the Inside out RFAL and outside in Morpheus 8 RFAL to deliver an amplified Lipocoagulation and "enhanced Liposuction.

#### **Figure 17.**

*Excellent peer reviewed articles, from multiple authors and continents have confirmed that RFAL can deliver 40–70% soft tissue area contraction, through combination of adipose coagulative ablation, FSN contraction and non-ablative dermal remodeling.*

### **4.3 My experience with other enhanced liposuction devices**

The modern face and body contouring surgeon must embrace energy-based devices to offer advanced "enhanced" liposuction and soft tissue contouring through the face, neck and body. The ability to deliver adipose, FSN and dermal modeling with or without fat aspiration has emerged as a critical factor in the treatment of both delicate face and neck rejuvenation as well as body contouring in challenging soft tissue envelopes. Like the editor and the world renown authors, I have deployed energy-based technologies in offering "enhanced liposuction for over 20 years. The evolution in my "enhanced" liposuction work mirrored the development of more sophisticated energy-based technologies that minimized the trauma of fat extraction and optimized the contraction and, hence control of the overlying soft tissue envelop.

For a number of years, Ultrsonic Liposuction (Vaser) and Water-assisted Lipoplasty (Waterjet) offered my patients less bruising and ecchymosis and viable stem cells, but both lacked efficient, predictable and significant soft tissue contraction. The emergence of thermal assisted lipo-contouring, with laser lipolysis (Smart Lipo, Cynosure and Lipolite, Syneron) combined the coagulation of small vessels, minimized ecchymosis, edema and recovery, while offering, for the first time, a subdermal and FSN thermal contraction and was my favored technology for a number of years. However, the suboptimal efficiency of laser transmission in adipose resulted in only modest soft tissue contraction and the lack of integrated external and internal thermal controls resulted in thermal complications is less trained hands. Thermigen's monopolar RF coagulation device ushered in radiofrequency "enhanced" liposuction in the USA. Although small and less effective for most moderate to large zone "enhanced" liposuction zones, the i incorporation of a 3rd party infrared monitor on the skin and internal thermistor temperature monitoring made this technology safe in small zone and facial contouring, as well, as motor nerve to the corrugator ablation. The FDA pathway with Thermi opened the regulatory door for the FDA's approval of BodyTite and RFAL. BodyTite's integrated, automated RF controlled thermal adipose and dermal bulk heating lead to industry soft tissue contraction and control. The addition of the Morpheus to the BodyTite workstation, with external RFAL, fractional superficial fat and dermal contraction (see next chapter, Part 2) has allowed me total thermal control of the skin dermis and superficial subdermal fat tightening, as well as the well document deeper FSN and adipose contraction. In my hands, the BodyTite experience offers, a truly versatile face, neck and body "enhanced" liposuction and contour system. While all the "enhanced" liposuction technologies I have used and covered so expertly in this book offer undeniable advantages over traditional SAL, we must control **BOTH THE ADIPOSE AND SKIN** contraction to produce the most consistent and optimal results from the eyelids down to the inner and anterior thighs and all lax and suboptimal soft tissue in between. In my hands, the BodyTite experience offers, the most versatile and successful face, neck and body "enhanced" liposuction and contour system.
