1. Introduction

For decades, the ability to reshape the human body was limited to dermolipectomy-based excisional procedures with long scars. Consumer demand for a minimally invasive alternative has been driven by interest in risk reduction, reduced scarring in the treatment region, and significant lessening of recovery time so that patients can return to work or regular activity within a short time span. Liposuction appeared to be the golden solution for many. While this minimally invasive procedure is a common approach, limitations can include residual skin laxity, an irregular skin contour, and little improvement in regions that were pendulous prior to the procedure. Subcutaneous tone is generally not improved with traditional suction-assisted lipectomy (SAL). Goals other than fat reduction include significant skin and soft tissue contraction in a smooth and even manner. While

ultrasound and laser-assisted lipoplasty have been recommended for this purpose following liposuction, consistent outcomes have not been able to be achieved. The current literature suggests that radiofrequency (RF) energy is superior in achieving non-excisional soft tissue and skin shrinkage without surgical skin resection. By targeting the subcutaneous collagen matrix instead of just the skin, practitioners of body contouring are able to achieve up to 36% measured skin surface area contraction at 1 year following treatment with RF-assisted liposuction. While monopolar and bipolar radiofrequency-based devices for this purpose have been available for 10 years, only recently has a plasma-driven radiofrequency device been in introduced. The Renuvion device is FDA cleared for the purpose of soft tissue coagulation. The device is a modification of a standard Bovie electrocautery unit. The new configuration has a pressurized helium tank attached to the energy delivery system, so that helium plasma-driven energy is emitted from a hollow cannula when the device is activated. The handpiece is moved in the subdermal plane in a manner similar to that of a liposuction cannula. Emitted energy is fractional. Small fragments of stromal collagen are heated very quickly to 85°C, causing a reduction in fiber length of 40–50%.

Because the measured skin temperature rarely exceeds 38°C, the safety profile of the device is optimized. Soft tissue treatment is usually performed following liposuction, but it can also be used in the subcutaneous plane without liposuction when skin contraction alone is desired. The use of the device for these purposes is considered off label.
