8. AccuTite®: injectable RF and skin tightening

The AccuTite® is the newest and smallest of the BodyTite® RFAL applicators and can be deployed on any of the BodyTite® workstations (the 20 W and the 40 W BodyTite® Pro as well as the new Embrace RF workstation). The AccuTite® has all the thermal, impedance and contact automated monitoring and feedback as the BodyTite®, FaceTite® and CelluTite® applicators, but it is very versatile by nature of its tiny size. The internal solid, silicone coated electrode is only 0.9 mm in diameter and is 8 cm long. The entire Bipolar RFAL applicator can fit easily into the palm of your hand (Figures 29, 30). The AccuTite® is smaller than most of the conventional microcannulas being used to inject soft tissue fillers in the deep subcutaneous and supra-periosteal space (Figures 29, 30). The AccuTite® appeals to virtually every physician, both the surgeon and non-surgeon users who are looking for safe, predictable, non-excisional methods of coagulating fat and tightening skin. Physician users can think of AccuTite® as Injectable RF and Injectable skin tightening.

The small size of the AccuTite® allows the physician us use a small #21-gauge port creation needle anywhere on the face, neck and body where skin needs to be tightened, with or without lipoaspiration. Once under the skin, the stamping and moving techniques for thermal coagulation are deployed, with the cut off temperatures of 69° internal and 38–40° external being deployed. When used subdermally for skin tightening, no aspiration is required.

The AccuTite® can be used to coagulate fat and tighten the FSN prior to liposuction and aspiration in very small zones. The #21-gauge port needle site need not be closed with a suture and the physician can simply "pop in and out" of lax skin zones all over the body, including the upper and lower lid and perioral, jawline and neck (Figure 31).

#### Figure 29.

The AccuTite® is the smallest of the RFAL hand pieces. It is 0.9 mm in diameter and can fit into the palm of your hand. The internal electrode is inserted under the skin to remodel the deep reticular dermis to 70°, while the external electrode will move along the surface of the skin and heat to 40–42°. The AccuTite® is shown above, next to a commonly used 22 gauge microcannula and the internal AccuTite® electrode is actually smaller. A 21-gauge needle is used to create an insertion port for the AccuTite®, which is then inserted under the skin and RF is injected under the dermis, resulting in skin and soft tissue tightening, hence, the term injectable RF.

BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL)… DOI: http://dx.doi.org/10.5772/intechopen.83446

#### Figure 30.

The AccuTite ®is small and easy to control. Above it is being used to tighten the para-nasiolabial smile line tissue and, following that, Juvederm is being injected through the same plane at a deeper level. The AccuTite® can be used under local anesthesia together with your soft tissue fillers and at the same time, often using many of the same tactics and skill sets.

#### Figure 31.

The small, compact size of AccuTite® and the small size of the internal and external electrode, allows this versatile RFAL applicator to gain access to areas of loose skin all over the face, neck and body. Despite its small size, the sub-dermal space is heated quickly and effectively to the same thermal endpoints as are used by BodyTite ® and FaceTite®, with the thermal endpoint of the subdermal space being 70° and the skin cut-off of 40°C. Skin tightening is significant and the small port access means a suture is not even needed for an access port.

#### 9. Morpheus: external RFAL

The Morpheus is an externally applied fractional radiofrequency assisted lipocoagulation (RFAL) device that has been developed to help tighten and contract soft tissue, and contour superficial fat and skin texture at the time of liposuction, or as a stand-alone procedure. For the liposuction surgeon, once the BodyTite®, FaceTite®, AccuTite® or CelluTite® device has been deployed and the aspiration of the fat completed, a final step of lipocoagulation can be performed using the Morpheus, from "outside the skin in". The Morpheus is an external applicator, loaded on the BodyTite® and Embrace RF workstations that delivers 24 silicone coated pins into the superficial, subdermal layers of the fat. Think of each pin-triangular exit point as a tiny BodyTite electrode system. Each pin is 300 microns in diameter, has an uncoated tip and is positively charged. The physician can control the depth of the pin extrusion and a 100 ms RF pulse of positively charged current is emitted upon

#### Figure 32.

The Morpheus is an external applied micro bipolar RFAL device, that emits a 24 pin, positively charged array into the adipose tissue under the skin. Each needle, like RFAL, is a positively charged electrode that penetrates the fat and then releases ablative RF energy that flows up to a negative electrode on top of the skin.

#### Figure 33.

The tiny, coated, positive charged electrodes are inserted into the superficial fat, and, when the RF energy is released, a zone of ablation and adipose coagulation is created with each pulse, leading to FSN contraction and soft tissue contouring and tightening. The RF flows up to the negatively charged triangular shaped electrodes which creates a strong, non-ablative dermal remodeling effect of the each of the.

BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL)… DOI: http://dx.doi.org/10.5772/intechopen.83446

maximal extrusion. The triangular shaped exit point of the pin, is negatively charged and acts as the primary return electrode for the flow of RF from the tip of the pin, created a bipolar lipocoagulation system similar to BodyTite® (Figure 32).

Like BodyTite®, the Morpheus emits RF energy is ablative and coagulative near the uncoated tip of the pin and then, the RF energy flows strongly up the coated pin to a triangular shaped negative electrode. The RF pulse creates a zone of ablation several hundred microns in diameter that coagulates the fat and tightens the FSN (Figures 33, 34). The RF current then flows up the pin to the negatively charged, triangular electrodes located at pin exit sites on the tip to provide a bipolar, non-ablative thermal stimulation effect on the reticular and papillary dermis (Figures 33, 34). RF also flows form the positively charged, mono polar pin tip to the widely space negatively charge rails on the sides of the tip for a gentle subnecrotic heating and the entire zone (Figures 33, 34).

Basically, each of the 24 needles acts like a mini-BodyTite® internal electrode. Because the needle is silicon coated, there is no thermal epidermal-dermal effect

#### Figure 34.

The zone of ablation and adipose coagulation contracts the FSN and contracts the soft tissue. The flow of RF up to the negative electrodes creates a more gentler, sub-necrotic, non-ablative heating and tightening of the dermis.

#### Figure 35.

Multiple pass and variable depth Morpheus will lead to vertical sequential FSN contraction, contouring and skin tightening.

and the ablation occurs around the positively charted, uncoated tip and is within the superficial fat using the FSN as the main vehicle for soft tissue contouring and tightening (Figures 33, 34).

The physician can set the pin penetration depth to periocular (approx. 2 mm), face (3 mm) and body (4 mm) and treat at multiple sequential depths to create a vertical and horizontal fractional thermal stimulation and optimal contraction. The Morpheus is an excellent final step in BodyTite®, FaceTite®, AccuTite® and CelluTite® treatment to obtain superficial liporeduction, lipocoagulation and soft tissue tightening.

Like with BodyTite®, multiple passes of the Morpheus will allow the physician to create a vertical thermal lipocoagulation with skin tightening and remodeling. This horizontal and vertical thermal lipocoagulation leads to excellent skin tightening and can be done in contraction (Figure 35, 36).

### Figure 36.

Multiple pass, sequential vertical and horizontal Morpheus RFAL will lead to 3D soft tissue contraction and tightening.

#### Figure 37.

The Morpheus can afford the liposuction surgeon, an external mini RFAL device that delivers 24 tiny mini BodyTite RFAL thermal injury injuries and can result in significant skin contraction. This can provide a nonexcisional face and necklift like result.

BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL)… DOI: http://dx.doi.org/10.5772/intechopen.83446

Figure 38. CelluTite® or BodyTite®, FaceTite® and AccuTite® can be combined with Morpheus to enhance the overall soft tissue contraction and skin tightening with an "inside out" and "outside in" thermal sandwich approach.

The Morpheus can be offered on the face, or body, and after a treatment with a BodyTite® liposuction procedure for enhanced contraction and skin tightening after liposuction (Figures 36, 37).

When Morpheus is used on the face, multiple pass, multiple depth approach is used. The deep pass is ablative and coagulative in the deep layer, often the frontalis, orbicularis, SMAS and platysmal. The next pass coagulated the subdermal fat and the final pass into the fat of the subdermal space (Figure 37).

The Morpheus can be combined with BodyTite RFAL liposuction to improve overall soft tissue contraction and skin tightening (Figure 38).
