Nanotechnology and Artificial Intelligence: An Emerging Paradigm for Postoperative Patient Care.

BACKGROUND: An increasing number of aesthetic surgery procedures are being performed in an ambulatory fashion in office-based settings. Postoperative monitoring of these patients has historically required paid private-duty nurses measuring vital signs, encouraging ambulation, and monitoring overall comfort level. Recently, advancements in nanotechnology have permitted high-acuity data acquisition of multiple clinical parameters that can be transmitted to the surgeon's mobile device in a continuous fashion. OBJECTIVE: The aim of this study was to describe the authors' early experience with this emerging artificial intelligence technology in the postoperative setting. METHODS: Twenty-three consecutive patients underwent radiofrequency-assisted liposuction and Brazilian butt lift surgery, and were placed in a monitoring garment, SimpleSense (Nanowear Technologies, Brooklyn, NY) postoperatively. The primary outcome was device usability, reflected by compliance with wearing the device and completeness of data collection. RESULTS: During the first 48 hours, 91% of patients wore the device for more than 12 hours per day. Only 39% were compliant with postoperative positioning. No postoperative events were detected. CONCLUSIONS: The quality of data collected enables detection of clinical derangements and can alert the surgeon in real time, prompting interventions such as drug administration, position changes, or presentation to the emergency room.

Clinical Evaluation of Safety and Efficacy of Radiofrequency-Assisted Lipolysis on Breast Envelope and Nipple-Areola Complex Position.

BACKGROUND: Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics, and weight loss is a common complaint among women visiting a plastic surgeon. This study sought to evaluate the utility, efficacy, and safety of radiofrequency-assisted lipolysis on the breast and nipple-areola complex position in women with breast ptosis. METHODS: This was a single-center (i.e., Maxwell Aesthetics) study of women desiring tightening of the breast envelope and elevation of the nipple-areola complex. Each patient underwent one treatment with radiofrequency-assisted lipolysis in the operating room. Radiofrequency-assisted lipolysis was applied to each breast with a BodyTite Pro handpiece. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 12 months by means of manual and three-dimensional computer-generated measurements (i.e., Vectra). RESULTS: Ten female patients were enrolled. Ages ranged from 23 to 54 years. Follow-up was 12 months. Data were captured for seven measurements from the nipple longitudinally at five time points. The sternal notch-to-nipple distance, the nipple-to-inframammary fold distance, and the nipple-to-nipple distance improved statistically at 6-week follow-up, which persisted through the 12-month follow-up ( p < 0.05). Patient questionnaires revealed moderate to excellent satisfaction. CONCLUSIONS: Radiofrequency-assisted lipolysis with a bipolar device to deliver radiofrequency energy to the breast is an effective modality to moderately improve breast ptosis. This study demonstrates that this treatment improves breast measurements across time, regardless of measurement type (manual versus Vectra). This modality affords a minimally invasive, effective method to improve mild to moderate breast ptosis with minimal scarring and high patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A Prospective Trial: Handsfree Thermoregulated Bipolar Radiofrequency for Face and Neck Contouring.

Background: The use of radiofrequency in aesthetic surgery has evolved significantly since it was first introduced in the early 2000s. Nonexcisional correction of the lower one-third of the face and neck has long been a challenging problem. The purpose of this prospective study was to assess the safety and efficacy of the first handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. Methods: This prospective multicenter (New York, Nevada) IRB-approved study evaluated healthy candidates who desired noninvasive correction of their lower face and neck laxity. The primary objective of this study was to evaluate safety and soft tissue remodeling pretreatment and at 1-, 3-, and 6-months post last treatment. Assessment was made using blinded evaluators, 3D photographic analysis (Quantificare, France), and volumetric measurements. Investigator and subject assessments were obtained using a 0-4 point Likert scale. Results: A total of 34 patients completed both the cheek and chin applicator treatment series. Average age of patients was 38 (STD 3.4), BMI 27 (STD 2.2), average Baker Face & Neck classification 2.6 (STD 1.1), and average Fitzpatrick type 2.4 (STD 1.2). Mean treatment time was 41 min (STD 3.5) with a temperature of 42°C-43°C. Patient discomfort data were statistically very low based on t-test analysis. Satisfaction metrics measured at 1- and 3-month follow-up demonstrated a significant change in subject skin appearance, subject overall satisfaction, and investigator improvement perception. More patients were satisfied at the 3-month follow-up compared with the 1-month follow-up for all three measures. Volumetric data demonstrated an average change of -3.2 cm3 (STD ±1.2 cm3) per side for the cheek applicator and -4.1 (STD ±2.3) for the submental applicator. Of note there were cases where volume increases were noted that were believed to be related to soft tissue contraction. Conclusions: This is the first prospective study to evaluate a handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. This device demonstrates a significant advance in the control and delivery of radiofrequency for aesthetic purposes. With a favorable safety and comfort profile, this device is able to concentrate thermal energy consistently at a depth that allows for fibroseptal network tightening to improve lower third of face and submental soft tissue contraction.

Two-stage Radiofrequency-assisted Lipoabdominoplasty.

Decades of lipoabdominoplasty safety, reliability, and efficacy have permitted more aggressive contouring of the abdominoplasty flap without increased risk for wound healing complications. However, the recent introduction of unrestricted liposuction of all vascular zones and high-definition liposculpting continue to challenge the vascularity of the abdominoplasty flap, particularly in high-risk patients. The present study reviews the authors' approach to abdominal lipodystrophy, and introduces a technique which maximizes fat extraction and skin excision while reducing risk of complication (two-stage radiofrequency-assisted liposuction and abdominoplasty).

Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic requires us all to re-evaluate aesthetic practices to ensure optimal patient safety during elective procedures. Specifically, energy-based devices and lasers require special consideration, as they may emit plume which has been shown to contain tissue debris and aerosolized biological materials. Prior studies have shown transmission of viruses and bacteria via plume (i.e., HIV and papillomavirus). The purpose of this study was to evaluate plume characteristics of the Er:YAG resurfacing laser (Sciton; Palo Alto, CA) and compare it to the Morpheus8 fractional radiofrequency device (InMode; Lake Forest, CA). METHODS: Five patients who underwent aesthetic resurfacing and/or skin tightening of the face and neck were treated with the Er:YAG (Sciton Joule, Palo Alto, CA) and/or fractional radiofrequency (Morpheus8, Lake Forest, CA) between April 1 and May 11, 2020. Data collected included patient demographics, past medical history, treatment parameters, adverse events, particle counter data, as well as high magnification video equiptment. Patients were evaluated during treatment with a calibrated particle meter (PCE; Jupiter, FL). The particle meter was used at a consistent focal distance (6-12 inches) to sample the surrounding environment during treatment at 2.83 L/min to a counting efficiency of 50% at 0.3 µm and 100% at >0.45 µm. Recordings were obtained with and without a smoke evacuator. RESULTS: Of our cohort (n = 5), average age was 58 years old (STD ±7.2). Average Fitzpatrick type was between 2 and 3. Two patients received Er:YAG fractional resurfacing in addition to fractional radiofrequency during the same treatment session. Two patients had fractional radiofrequency only, and one patient had laser treatment with the Er:YAG only. There were no adverse events recorded. The particle counter demonstrated ambient baseline particles/second (pps) at 8 (STD ±6). During fractional radiofrequency treatment at 1-mm depth, the mean recording was 8 pps (STD ±8). At the more superficial depth of 0.5 mm, recordings showed 10 pps (STD ±6). The Er:YAG laser resurfacing laser had mean readings of 44 pps (STD ±11). When the particle sizes were broken down by size, the fractional radiofrequency device had overall smaller particle sizes with a count of 251 for 0.3 µm (STD ±147) compared with Er:YAG laser with a count of 112 for 0.3 µm (STD ±84). The fractional radiofrequency did not appear to emit particles >5 µm throughout the treatment, however, the Er:YAG laser consistently recorded majority of particles in the range of 5-10 µm. The addition of the smoke evacuator demonstrated a 50% reduction in both particles per second recorded as well as all particle sizes. CONCLUSION: Re-evaluation of the plume effect from aesthetic devices has become important during the COVID-19 pandemic. Further studies are required to characterize viability of COVID-19 viability and transmissibility in plume specimens. Based on this pilot study, we recommend that devices that generate little to no plume such as fractional radiofrequency devices be used in Phase I reopening of practice while devices that generate a visible plume such as Er:YAG laser resurfacing devices be avoided and only used with appropriate personal protective equipment in addition to a smoke evacuator in Phase IV reopening.

Second Generation Radiofrequency Body Contouring Device: Safety and Efficacy in 300 Local Anesthesia Liposuction Cases.

BACKGROUND: Suction-assisted lipectomy has undergone significant improvements in technique, outcomes, and safety. The local anesthetic option has an excellent safety profile, and energy-based modalities such as radiofrequency-assisted liposuction (RFAL) devices were developed to enhance soft-tissue contraction. The purpose of this study was to report a single center's experience with two surgeons using the second-generation RFAL device compared with the first-generation device in terms of safety and efficacy. METHODS: In total, 300 consecutive operations were performed under local anesthesia. Following tumescent injection, the RFAL device was used to heat the skin and underlying collagen network. Subsequently, areas to be contoured were followed with suction-assisted lipectomy to remove excess fat and fluid. RESULTS: An estimated 300 operations were performed on 240 patients in 421 anatomic areas. Treated areas included the face, trunk, and extremities. The average maximum temperatures were 38.6°C externally and 65.6°C internally. The average total and fat aspirate volumes were 1264 and 648 mL. There were no major complications or mortalities, and 3 minor complications treated locally. CONCLUSIONS: The data indicated statistically significant lower proportions of major, minor, or cumulative complications compared with the patients who received first-generation RFAL treatment. Major complications were exhibited for 6.25% of the first-generation group and 0% for the second-generation group. The first-generation group exhibited 8.3% minor complications, with 0.7% in the second-generation group. In sum, the data from the second-generation series of RFAL device operations indicate a statistically, as well as clinically, significant reduction in the overall complication rates compared with the first-generation device.

Aesthetic Applications of Radiofrequency: Lymphatic and Perfusion Assessment.

BACKGROUND: The use of radiofrequency in aesthetics has increased in popularity since the early 2000s. To date, there have been limited studies investigating the effect of thermal energy secondary to radiofrequency treatment. The purpose of this study was to evaluate perfusion and lymphatic assessment tools pre and post bipolar and fractional radiofrequency treatment. METHODS: A retrospective IRB-approved study was conducted between January 2019 and April 2019. Patients who were independently deemed appropriate candidates for radiofrequency soft tissue remodeling were evaluated. Diagnostic perfusion and lymphatic imaging obtained were reviewed using indocyanine green (SPY, Stryker) and optical coherence tomography (Vivosight OCT). RESULTS: A total of 63 patients were treated during the study period, of which 37 had diagnostic perfusion and lymphatic imaging. Average patient age was 47 (STD 12), 95% (35/37) of patients were women, and no patients were active smokers. In total, 27% (10/37) of patients were post-surgical patients with recurrent laxity, 32% (12/37) did not have enough skin laxity to justify traditional excisions procedures, and 41% (15/37) may have been candidates for excisional procedures but were willing to accept more moderate results to avoid excisions surgery. Indocyanine green perfusion and lymphatic assessment for bipolar and fractional radiofrequency, as well as optical coherence tomography pre and post radiofrequency, did not show compromise from thermal injury. CONCLUSIONS: This study supports safety of radiofrequency in terms of preservation of tissue perfusion and lymphatic drainage. This correlated to our low clinical incidence of burns, prolonged swelling, or tissue ischemia.

The Use of Radiofrequency in Aesthetic Surgery.

The use of radiofrequency for soft tissue tightening has increased over the past 10 years. Both minimally invasive and noninvasive devices are frequently in use. This article describes the different types of radiofrequency technology and the current evidence behind their safety and efficacy.

Multimodal Radiofrequency Application for Lower Face and Neck Laxity.

Nonexcisional facial skin tightening has long been an elusive goal in aesthetic surgery. The "treatment gap" includes cases who are not "severe" enough for excisions surgery but not "mild" enough for most traditional noninvasive aesthetic modalities. In this retrospective review, we present the largest evaluation to date of radiofrequency (RF) skin tightening technology combination including bipolar RF (FaceTite; InMode) and fractional bipolar RF (Fractora modified to Morpheus8; InMode). METHODS: A multicenter retrospective study was conducted between January 2013 and December 2018 using a combination of bipolar RF and fractional bipolar RF for the treatment of facial aging. Data collection included demographic information, Baker Face/Neck Classification, amount of energy used, adverse events, and patient satisfaction. Four cadaver dissections were also conducted to correlate the underlying neuromuscular anatomy with RF treatment of the lower face and neck. RESULTS: Two hundred forty-seven patients (234 women and 13 men) were included in the study. Average age was 55.1 years (SD, ±8), body mass index was 24.3 (±2.4), and 9% (23/247) of patients were active smokers at the time of treatment. Patients had an average Baker Face/Neck Classification score of 3.1 (SD, ±1.4). The procedure was performed under local anesthesia in 240/247 cases (97.2%). Patients objectively improved their Baker Face/Neck Classification score by 1.4 points (SD, ±1.1). Ninety-three percent of patients indicated that they were pleased with their results and would undergo the procedure again. Complications recorded for our cohort included prolonged swelling >6 weeks (4.8%, 12/247), hardened area >12 weeks (3.2%, 8/247), and marginal mandibular neuropraxia (1.2%, 3/247), which all resolved without further intervention. When considering possible control variables, age seems to be a significant factor. That is, older patients were more likely to benefit from a larger magnitude of the treatment effect (as demonstrated by a decrease in the Baker rating from pre- to posttreatment) when compared with younger patients. However, both groups did demonstrate significant improvements across time. CONCLUSION: While this combination RF treatment (FaceTite bipolar RF and fractional bipolar RF) does not aim to replace a facelift/necklift in appropriate candidates, it does broaden the plastic surgeons' armamentarium to potentially fill a treatment gap.

Radiofrequency Treatment of Labia Minora and Majora: A Minimally Invasive Approach to Vulva Restoration.

Labiaplasty has rapidly increased in popularity over the past 5 years.Traditional labiaplasty is associated with potential complications, such as dehiscence, hematoma, flap necrosis, narrowed introitus, pain, and asymmetry. Minimally invasive techniques such as radiofrequency (RF) have emerged as viable alternatives to traditional labiaplasty through a temperature-controlled bipolar mechanism to heat tissues to target temperatures of 40°C-45°C. This controlled energy delivery leads to an inflammatory cascade initiating neocollagenesis, angiogenesis, and elastogenesis over the coming 3-4 months. A single surgeon series of labia minora and majora treatment by RF (InMode, Lake Forrest, Calif.) was reviewed between April 2018-October 2018. Demographic data were collected as well grade of hypertrophy (pre/posttreatment), number of vaginal deliveries, and reason for treatment. Procedural parameters were recorded, including internal/external temperatures, total energy used, and time of treatment. All adverse events were recorded. Objective and subjective data points were obtained in the form of patient surveys and photographic evaluation by lay persons as well as plastic surgeons objective to the treatment. Ten consecutive patients were treated with bipolar RF (InMode, Lake Forrest, Calif.) between April 2018-October 2018. Mean age was 44 (29-54). Average number of pregnancies was 2 (STD 1.1). Three patients were treated for aesthetic concerns, 3 for functional complaints, and 4 desired improvement in both. Overall graded improvement in labia size/contour was +50% (STD ±15.3). Patient satisfaction scale data demonstrated 9.5/10 (±1.7). All patients (10/10) stated that they would undergo treatment again. In all cases, the surgeon observed tightening of the clitoral hood, introitus, forchett, as well as improved distribution of dark pigmentation of the labia minora. There were no significant complications and no need for additional procedures. Average recovery time was 14 days (STD 2.2). Treatment of labia hyperplasia and laxity with bipolar RF may potentially fill a treatment gap of women seeking aesthetic and functional improvements without surgical labiaplasty. A powered prospective randomized double-blinded study is needed to further elucidate the role of this technology.

Role of Radiofrequency (Votiva, InMode) in Pelvic Floor Restoration.

BACKGROUND: Postpartum pelvic floor disorders are estimated to impact 24% of women in the United States. This study describes the use of a radiofrequency device (Votiva, InMode) for postpartum pelvic floor restoration using an electrostimulator to objectively measure treatment effect. METHODS: A retrospective evaluation was conducted between April 2017 and May 2018 of consecutive patients undergoing vaginal radiofrequency treatment. Inclusion criteria were patients at least 6 weeks postvaginal delivery with symptoms of pelvic floor dysfunction. Resting pelvic floor muscle tone and maximal pelvic floor contraction were measured. RESULTS: Fifty women were included in the study with an average age of 32 (29-40) years old, average of 2.6 pregnancies, and 1.8 vaginal deliveries. Two patients were lost to follow-up and excluded. Three complete radiofrequency treatments were performed in 31/50 patients, whereas 19 patients received 1-2 treatments. There were no adverse events from the radiofrequency treatment. No changes were found in resting pelvic muscle tone after Votiva treatment [Wilks' lambda = 0.98, F (1, 45) = 0.86, P = 0.36]. The quantity of treatments seemed to impact mean values of maximal pelvic floor contraction [F (1, 45) = 105.14, P < 0.001]. On the patient questionnaire, patients felt subjective improvement correlated to number of treatments. CONCLUSIONS: Radiofrequency is safe for the treatment of pelvic floor dysfunction. This study showed no changes in resting pelvic muscle tone but an improvement in maximal pelvic floor contraction. A prospective randomized study is being conducted to further evaluate the efficacy of this technology.

Adjustable Depth Fractional Radiofrequency Combined With Bipolar Radiofrequency: A Minimally Invasive Combination Treatment for Skin Laxity.

Increasingly, patients are seeking minimally invasive methods to tighten skin and remodel adipose tissue. A large treatment gap exists among 3 types of patients: (1) the younger demographic, who increasingly desire soft tissue tightening without traditional operations, scars, and downtime; (2) patients with soft tissue laxity who are not "severe enough" to justify an excisional procedure, but not "mild enough" to rely on liposuction with soft tissue contraction alone; and (3) those with recurrent laxity who already underwent traditional excisional procedures. In these populations, plastic surgeons risk under- or overtreating with traditional methods. The purpose of this supplement is to describe the utility of radiofrequency (RF) microneedling (Fractora modified to Morpheus8 InMode Aesthetic Solutions, Lake Forest, CA) in combination with bipolar RF (FaceTite/BodyTite, InMode Aesthetic Solutions). By combining these procedures, the aforementioned treatment gap can be addressed. The RF microneedling allows for subdermal adipose remodeling and skin tightening. Addition of bipolar RF also tightens the skin by contraction of the underlaying fibroseptal network in addition to induction of neocollagenesis, elastogenesis, and angiogenesis at skin surface temperatures of 40° to 50°C. In our experience, these technologies have been effective and safe in these patient populations. Level of Evidence: 4.

"Brazilian Butt Lift" under Local Anesthesia: A Novel Technique Addressing Safety Concerns.

BACKGROUND: The gluteal lift ("Brazilian butt lift") has improved significantly in technique and in outcomes. Some postulate that fat embolism occurs because of damage to veins superficial to the gluteus muscles and that fat must be injected intramuscularly to achieve satisfactory aesthetic results. The purpose of this article is to present data where gluteal lift is performed under local anesthesia, address safety concerns, and clarify these speculations. METHODS: All patients underwent gluteal lift under local anesthesia using oral medications and tumescent infiltration. Fat was harvested by closed-system liposuction, separated by gravity, injected using a peristaltic pump and reticulating basket cannulas. RESULTS: Thirty-two female patients with an average age of 38.6 years and a body mass index of 24.8 kg/m underwent 47 gluteal lift operations under local anesthesia over 52 months. The average volume of injected fat was 359 ml per buttock. There were no deaths or complications. CONCLUSIONS: Recent concerns regarding buttock injections have been raised due to death from fat embolism. Despite numerous theories on the mechanism of entry, the fact that venous injury occurs with the introduction of boluses of fat in enough quantities to cause mechanical disruption of the cardiopulmonary circuit is not in dispute. The authors believe this cannot occur in the awake patient without the surgeon being acutely aware of a misguided cannula. These data suggest that buttock fat grafting under local anesthesia is a safe and effective procedure with an excellent safety profile and durable results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Soft Tissue Contraction in Body Contouring With Radiofrequency-Assisted Liposuction: A Treatment Gap Solution.

Radiofrequency-assisted liposuction is a relatively new concept in energy-assisted body contouring techniques and has received instrument approval. This supplemental article reviews the clinical application of electromagnetic energy via the BodyTite (InMode Corporation, Toronto, Canada) device on soft tissues during suction lipectomy, its effect on soft tissue contraction, and its use in aesthetic body contouring in various clinical scenarios.

1000 Consecutive Cases of Laser-Assisted Liposuction Utilizing the 1440 nm Wavelength Nd:YAG Laser: Assessing the Safety and Efficacy.

BACKGROUND: Liposuction remains one of the most popular aesthetic surgery procedures performed today, and it has undergone continuous refinements over the past four decades. Advancements in anesthesia, improvements in instrumentation, better understanding of fluid dynamics and the addition of energy to liposuction have led to better outcomes with improved safety and efficacy. OBJECTIVES: The purpose of this study is to review 1000 consecutive laser-assisted liposuction (LAL) cases utilizing the 1440 nm wavelength. Emphasis was placed on complication rates and the need for revision procedures. METHODS: The charts of 611 patients who underwent 1000 consecutive LAL operations were reviewed. All cases were performed either under general anesthesia or under local with sedation, and the cases were performed alone or in conjunction with other procedures. All patients went to presurgical testing and had preoperative laboratory and additional clearance by a specialist when indicated. Before and after medical photographs were obtained of all patients. All operations were done in an accredited office-based operating room. Demographic information, tumescent volume, aspirate volume, surgical time, complications and other data were reviewed. RESULTS: There were one minor complication and no major complications such as burns, hospitalizations or mortalities. One patient developed a small hematoma, which was likely caused by the patient self-aspirating edema fluid during the immediate post-op period. The hematoma resolved with non-surgical management. The average laser energy applied was 15,756 J with an average total aspirate volume of 1256 cc. Fourteen anatomic areas were treated with LAL, and 59 operations were combination cases. CONCLUSION: Energy-assisted liposuction using the 1440 nm wavelength has been shown in this series to have a very low complication rate when performed alone or in combination with other aesthetic operations under local and general anesthesia. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evidence-Based Medicine: Liposuction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Review the appropriate indications and techniques for suction-assisted lipectomy body contouring surgery. 2. Accurately calculate the patient limits of lidocaine for safe dosing during the tumescent infiltration phase of liposuction. 3. Determine preoperatively possible "red flags" or symptoms and signs in the patient history and physical examination that may indicate a heightened risk profile for a liposuction procedure. 4. Provide an introduction to adjunctive techniques to liposuction such as energy-assisted liposuction and to determine whether or not the reader may decide to add them to his or her practice. SUMMARY: With increased focus on one's aesthetic appearance, liposuction has become the most popular cosmetic procedure in the world since its introduction in the 1980s. As it has become more refined with experience, safety, patient selection, preoperative assessment, fluid management, proper technique, and overall care of the patient have been emphasized and improved. For the present article, a systematic review of the relevant literature regarding patient workup, tumescent fluid techniques, medication overview, and operative technique was conducted with a practical approach that the reader will possibly find clinically applicable. Recent trends regarding energy-assisted liposuction and body contouring local anesthesia use are addressed. Deep venous thromboembolism prophylaxis is mentioned, as are other common and less common possible complications. The article provides a literature-supported overview on liposuction techniques with an emphasis on preoperative assessment, medicines used, operative technique, and outcomes.

Radiofrequency-Assisted Liposuction Compared with Aggressive Superficial, Subdermal Liposuction of the Arms: A Bilateral Quantitative Comparison.

BACKGROUND: Liposuction of the arms alone may be inadequate for aesthetic improvement because of skin laxity. Radiofrequency-assisted liposuction (RFAL) and aggressive superficial liposuction (SupL) have been described to stimulate soft tissue retraction to improve results. We compare the techniques and describe a classification scheme that factors skin laxity, skin quality, and Fitzpatrick type to provide treatment recommendations. METHODS: Ten consecutive female patients underwent RFAL of 1 arm and SupL on the contralateral arm. All patients had Fitzpatrick skin types of III, IV, or V with an average body mass index of 26.0. Using fluorescent tattooing, key points on the arm skin were measured preoperatively and postoperatively to indicate changes in surface area. RESULTS: There were no complications in the group, and all patients reported satisfaction with the aesthetic results. All patients showed reduction of measured skin surface areas and skin distances postoperatively. At 1 year, the measured surface area reductions on the anterior arms averaged 15.0% for RFAL and 10.9% for SupL on the anterior arm skin. Posteriorly, RFAL showed 13.1% reduction and SupL 8.1% reduction in the surface areas at 1 year. Linear reduction for RFAL averaged 22.6% and 17.8% for SupL 1 year postoperatively anteriorly. CONCLUSION: Both RFAL and SupL of the arms showed quantifiable and sustained reductions in skin surface. Good contour and soft tissue contraction were achieved with both techniques but RFAL with its safety features presents an alternative to SupL, which has a higher complication rate, risk for contour deformities, and steeper learning curve.