From the Wall Street Journal
By Laura Johannes

For people looking to combat wrinkles and sagging skin resulting from sun damage, smoking and the ravages of time, some doctors are offering an increasingly popular treatment: Just apply heat.

The treatments involve machines that heat the tissue using radio-frequency or ultrasound energy. The heat they generate stimulates the growth of collagen, a fibrous protein important in maintaining the face’s youthful look, physicians say. A growing menu of options include a treatment that uses 10 tiny needles to deliver the energy; one that feels like a hot-stone massage; and another that applies extreme heat for an effective, though painful, lifting.

Results range from great to modest, says Washington, D.C., dermatologist Tina Alster. “Some people look five to 10 years younger. Other people you say ‘Oh yeah, they look better’ but it’s not like they turned back the clock.” There are no major clinical trials, though, comparing treatments by efficacy, physicians say.

Unlike with face-lifts, or older-style laser resurfacing, which destroys the top layer of skin, a person treated with a radio-frequency or ultrasound machine doesn’t have to stay in hiding until the face heals. Side effects may include a mild burn, bruising or a blister.

The treatments are popular with women looking for an overall more youthful look and men who want to rehab sagging jawlines, physicians say. If your main problem is wrinkles all over your face, laser resurfacing is still more effective, say Dr. Alster and others.

Costs vary, from $300 to $1,200 a session for a full-face treatment that must be repeated several times, to up to $5,000 for a powerful one-time procedure with long-lasting results.

Using radio frequency to zap wrinkles kicked off in 2002 with an eye-wrinkle treatment called Thermage, and expanded two years later to include the whole face. The newest Thermage system, which hit the market in 2009 from Solta Medical Inc., SLTM Hayward, Calif., has an improved cooling mechanism and a pleasant vibration to distract patients from the heat, the company says.

PellevĂ© from Ellman International Inc., Oceanside, N.Y., feels like a “warm massage,” says Amy Forman Taub, an assistant clinical professor of dermatology at Northwestern University Medical School in Chicago who once received an honorarium from Ellman. The company recommends four sessions, 40 minutes each, spaced a month apart.

The evolastin treatment from Israel’s Syneron Medical Ltd. ELOS penetrates the skin with 10 tiny needles to deliver the heat energy and create additional injury that the company says stimulates production of both collagen and elastin, a protein that helps skin to be more supple. The treatment was found in a published clinical trial to achieve 37% of the skin-tightening effects of a surgical face-lift. To dull the pain, anesthetic is injected in the face. The upside: Only one treatment is needed.

The hottest option available is an ultrasound treatment from Ulthera Inc. in Mesa, Ariz., which hit the market in 2010. The machine heats to around 150 degrees Fahrenheit compared with 104 to 130 degrees for most radio-frequency therapies. Also, Ultherapy penetrates 4.5 millimeters under the skin to treat the superficial muscular aponeurotic system, a layer of fibrous tissue that helps give the face its shape.

Ultherapy, done in a single treatment, is among the most painful of the options but is especially effective for sagging necklines and jowls, doctors say. To ease the pain, some doctors give narcotics or ibuprofen. With Ultherapy, a nerve can become irritated and cause facial drooping but that happens very rarely and is temporary, the company says.

A software upgrade being released at the end of the month will allow for lower energy settings that are equally effective and less painful, says Matthew Likens, Ulthera’s chief executive.

Several companies have trials that show the efficacy of their devices, but results can be subjective because there are few scientifically validated scales to measure the youthfulness of a face, physicians say. “They all will tout themselves as the best thing since white bread. I tell people show me the science, show me the peer-reviewed studies,” says Michael Gold, professor of dermatology at Vanderbilt University School of Medicine in Nashville and a paid consultant to many companies in the field.

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