Therma Cool TC: For Skin Tightening, Active Acne, and Scars Sherry S. Collawn, MD, PhD Radio frequency treatments with the nonablative Thermage Therma Cool TC system have been used to tighten lax skin, decrease wrinkles, treat active acne, improve acne scars and other scars, and treat axillary hyperhidrosis in a total of 36 patients since October 2003. Seven of these patients have had multiple treatments. The patients who have undergone full face Therma Cool treatments for wrinkles and skin laxity have at two months post treatment demonstrated a reduction in lateral canthal lines, with an increased tightness of the skin of the periorbital region, cheeks and neck. Along with the skin tightening and improved skin texture there has been a decrease in hyperpigmentation and telangiectasia. Patients often show eyebrow elevation after a single treatment and this has been more pronounced after two treatments. Patients with active acne have shown improvement in their acne after one treatment and with two treatments the improvement in the inflammatory acne and acne scars has been dramatic. In one patient treatment of the axilla with Thermage lessened the symptoms of axillary hyperhidrosis for three months. Complications (blisters) have been few and have resolved quickly. Method: Patients presenting with laxity of the facial skin, wrinkles, acute inflammatory acne and acne scars have undergone single and multiple treatments with Thermage Therma Cool TC. The treatment parameters used in these first 36 patients were those recommended by Thermage and consisted of two to three passes at high energy settings using the standard treatment tip. In addition to topical anesthetics, full face treatments often also required nerve blocks. After the American Society for Laser Medicine and Surgery meeting in April 2004, Thermage recommended using lower energy settings for 4 to 5 passes. This is the protocol currently being used with the new fast tip and usually requires no more than topical anesthetics. Results: The patient shown in figure 1A underwent one treatment of the forehead and cheeks with 2 passes of Therma Cool TC at high settings of 14 and 15(106 and 124 joules). In 2B she is shown 2 months after the procedure and she demonstrates increased skin tightness of the periorbital and cheek region with improved skin pigmentation. Some eyebrow elevation has occurred and there is an increase in the vertical aperture of her eyes. The patient in figure 2A underwent 2 treatments of Therma Cool TC around the eyes. The second treatment was at 1 month and she is shown in figure 2B at two months. Lateral eyebrow elevation has occurred. The patient in figure 3A presented with acute inflammatory acne and acne scarring. In figure 3B three months after two treatments given one month apart he shows good improvement in the acute inflammatory acne and reduced acne scarring. Conclusion: The Thermage Therma Cool TC has been helpful in tightening lax skin, and in the treatment of wrinkles, active acne, and scars. In addition, other skin conditions such as axillary hyperhidrosis respond to radio frequency therapy. Figure 1A. Pre-Treatment. Figure 1B. Two months after one Therma Cool TC treatment of the Forehead and Cheeks. Figure 2A. Pre-Treatment. Figure 2B. Two months after two Thermage Therma Cool TC treatments of the periorbital region. Figure 3A. Pre-Treatment Figure 3B. After two Thermage Therma Cool TC treatments. References 1. Ruiz-Esparza, J. and Gomez, J.B. Nonablative Radiofrequency for Active Acne Vulgaris: the use of Deep Dermal Heat in the treatment of Moderate to Severe Active Acne Vulgaris (Thermotherapy): a report of 22 cases. Dermatol. Surg. 29: 333-339, 2003.