Abstract
Backgrounds and aims
Submental skin laxity (SSL), manifesting as sagging skin and double chin, can significantly affect patients’ self-perception and social interactions. While surgical treatments exist, non-invasive methods are increasingly sought for their minimal recovery time. This study assesses the safety and effectiveness of a novel microwave-based device for treating SSL, aiming to provide long-term improvements in skin tightness and appearance.
Materials and methods
Ten female patients with moderate to severe SSL underwent two treatments spaced 30 days apart using a 2.45 GHz non-invasive microwave device, with a specific handpiece. Treatment sessions lasted 10 min each, targeting the submental region. The Submental Skin Laxity Grade (SMSLG) was assessed before treatment and 12 weeks after the final session. Safety was monitored, and standardized photographs were taken for clinical evaluation.
Results
All patients showed a significant reduction in SSL, with SMSLG scores improving from a mean of 3.6 at baseline to 2.3 after 12 weeks. No adverse effects were reported, and patients experienced minimal discomfort during and after the treatment sessions. Photographs revealed visible improvements in skin tone and tightness across all cases.
Conclusions
The microwave-based treatment demonstrated significant efficacy in reducing SSL and improving skin tone with minimal side effects, offering a promising alternative to surgical interventions. This non-invasive approach provides effective outcomes in fewer sessions and may represent a new standard for non-surgical skin tightening in aesthetic dermatology.
Keywords: Facial aging, Microwaves technology, Skin laxity, Submental fat, Skin tightening
Introduction
Sagging skin and double chin are the main consequences of submental skin laxity (SSL), and often negatively influence patients’ aesthetic self-perception and social life; additionally, exercise and diet al.one may not easily improve skin tone in the neck and submental areas. For body and facial contouring, several solutions have been developed [1] that are predominantly surgical and invasive, carrying significant risks and often requiring extended postoperative downtime.
In contrast, non-invasive treatments like laser therapies, microwaves, cryolipolysis, high-frequency focused ultrasound, and radiofrequency are gaining popularity as safer alternatives with reduced downtime for patients [2].
Among these options, microwave technology has recently proven effective on fat tissue and body contouring by causing lipolysis of fat cells, [3–4] while also enhancing skin appearance through subcutaneous adipose tissue heating, which induces collagen fibers shrinkage in the dermis [5].
Confirming this, Bennardo et al. [6] evaluated the efficacy of microwaves for aesthetic interventions, such as body contouring and cellulite reduction [6–9], with promising results.
However, there has not yet been a long-term assessment of the efficacy and safety of this method. From this perspective, this study aims to evaluates these aspects using a new non-invasive system that delivers microwave energy for the treatment of submental fat and skin laxity.
Materials and methods
This prospective study investigated the safety and efficacy of a non-invasive microwave system for SSL treatment (ONDA, Deka M.E.L.A. S.r.l., Florence, Italy) at a frequency of 2.45 GHz, featuring specifically designed handpieces (“Shallow,” “Deep,” and “Pocket”) that deliver energy directly to the selected target.
In this study, we used the “Pocket” handpiece, applied perpendicularly to the skin to allow selective absorption of heat by the collagenous dermal layer because of its specific superficial action. Superficial heating and localized controlled hyperthermia were generated [10], acting directly on the dermal and hypodermic fibrous collagen and inducing the shrinkage of the superficial collagen fibers, in order to obtain a tightening clinical effect and aesthetic remodeling of the superficial connective tissue. All the device’s handpieces are equipped with a continuous cooling system (at 5 °C), which preserves the superficial skin layers from undesirable overheating, and a thin film of Vaseline oil is applied to the treated area to ensure optimal skin-handpiece contact and movement fluidity.
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Central Calabria (protocol code 373/19; date of approval 17 December 2019). After receiving a comprehensive explanation of all aspects of the study, including expected outcomes and potential side effects, all patients provided written informed consent to participate in the study, including for photographs taken before and after treatment. The same settings, shooting choices, identical flash, illumination, and camera (Nikon 5600d, Nikon Corporation, Minato City, Tokyo, Japan) were used for the before and after. Data analysis (mean, standard deviations, and rate calculations) was done using Statistica 14.0 (TIBCO Software, Palo Alto, CA, USA).
Patients with following conditions were excluded from the study: history of any submental fat treatment procedures (such as liposuction, surgery, or lipolytic drugs); past trauma involving the chin and neck region; evidence indicating a reason other than localized submental fat for the enlargement in the submental region, such as thyroid enlargement or cervical adenopathy; BMI over 40 kg/m2; past or present dysphagia symptoms; bleeding disorders evidenced by coagulation test; any illness (such as thyroid dysfunction, respiratory, cardiovascular, hepatic, or neurological conditions); treatment in the neck/chin region with radiofrequency, laser treatments, chemical peels, or dermal fillers within a year before treatment; injections of botulinum toxin administered to the neck and chin within six months.
The device was applied on the skin for a total of 10 min, with several passes in the submental region. Every patient underwent two sessions of treatment with an interval of 30 days.
The Submental Skin Laxity Grade (SMSLG) [10–11] was determined at baseline and after 12 weeks from the last treatment session. The clinical aim was the significant reduction of the submental fat (Table 1).
Table 1.
Submental Skin Laxity Grade [11]
| Scale | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| Skin Laxity | None | Mild | Moderate | Severe |
| Description | None or minimal superficial wrinkles | Mild superficial wrinkles | Moderate superficial wrinkles | Superficial wrinkles present, may be marked |
Results
A total of ten female patients were treated with microwaves for skin laxity of the submental area. The participants had a mean age of 56,3 (± 6,6) and a mean Body Mass Index (BMI) of 26,8 (± 1,1). Four patients were Fitzpatrick phototype II, four were phototype III, and two were phototype IV (Table 2 shows patients’ characteristics).
Table 2.
Patients’ characteristics
| Patient | Age | Fitzpatrick Phototipe | Body Mass Index (BMI) | Submental Skin Laxity Grade before | Submental Skin Laxity Grade After |
|---|---|---|---|---|---|
| 1 | 53 | 2 | 27,5 | 4 | 3 |
| 2 | 60 | 2 | 26,6 | 4 | 3 |
| 3 | 54 | 2 | 27,0 | 4 | 3 |
| 4 | 58 | 2 | 26,4 | 3 | 1 |
| 5 | 55 | 3 | 26,7 | 3 | 2 |
| 6 | 63 | 3 | 27,2 | 4 | 3 |
| 7 | 50 | 3 | 26,8 | 3 | 2 |
| 8 | 61 | 3 | 27,1 | 3 | 2 |
| 9 | 52 | 4 | 26,7 | 4 | 3 |
| 10 | 57 | 4 | 26,0 | 4 | 2 |
All patients underwent two treatment sessions, and, based on patient discomfort levels, a tightening effect was achieved by delivering energy between 35.000 and 45.000 J and power between 70 W and 90 W. Patients did not take any additional fat-reducing supplements and did not change exercise or diet routine, maintaining the current body weight.
No side effects were reported during or after the treatment sessions or over the 12-week follow-up period.
The Submental Skin Laxity Grade (SMSLG) demonstrated significant improvement, with the average score decreasing from 3.6 out of 4 at baseline to 2.3 out of 4 after 12 weeks from the last treatment session, as shown in Fig. 1.
Fig. 1.
The Submental Skin Laxity Grade (SMSLG) was used to assess the neck skin tone before the treatment (baseline) with the Onda Pocket handpiece and after 12 weeks of follow-up (12WFU). A considerable decrease at 12WFU from the last treatment was registered
Discussion and conclusions
The two most common effects of SSL are double chin and sagging skin, which frequently have a severe impact on the patient’s social life and aesthetic self-perception. It is known that diet and exercise alone cannot fully improve skin tone around the neck; thus, as facial skin laxity progresses, signs such as reduced skin elasticity, connective tissue loosening, and deepened skin folds make submental and submandibular tissues more prominent [12].
Various conventional solutions for body and facial contouring have been developed, but they are often invasive, surgical options (like liposuction or fat excision) that carry different risks and long recovery times. However, non-invasive treatments are growing in acceptance and include botulinum toxin injections for dynamic platysmal bands, micro-focused ultrasound, or fractional ablative lasers for mild-to-moderately loose skin. Percutaneous radiofrequency, radiofrequency-helium plasma, deoxycholic acid injections, and cryolipolysis are among the options for submental preplatysmal fat [12]. While these technologies can offer benefits for skin laxity, results may not always be maintained over six months, making it essential to provide patients with accurate information on skin tightening procedures [13].
Microwaves delivered by the innovative microwave technology used in this study showed promising results with fewer sessions compared to other technologies investigated in other studies. [6–7]
When applied to adipose body regions, these non-invasive, high-energy 2.45 GHz microwaves specifically target subdermal fat, inducing selective heating of adipocytes without impacting the more superficial dermal and epidermal layers. Additionally, the action on collagen septa may contribute to cellulite reduction, while the contraction of dermal collagen fibers enhances overall skin appearance and tone [5, 9].
In this study, we treated ten female patients with microwaves, administering two treatment sessions that yielded excellent results with minimal pain or discomfort. Overall, the treatment was well tolerated (see Fig. 2 for pre- and post-treatment images of a patient), with no significant adverse events reported. As the results indicated, the efficacy of the treatment was not related to Fitzpatrick phototype or age, but rather to the severity of laxity, with all treated patients experiencing significant improvement. Notably, when comparing treatment duration with data from Salsi et al. (2022) [10], we observed that treatment with this particular handpiece was almost twice as fast as other handpieces, reducing patient discomfort.
Fig. 2.
An example of a middle-aged woman unsatisfied with the appearance of her anterior cervicomental triangle and eligible for the treatment is reported. For this patient, power:70 W and energy:35.000 were used. Pre-treatment (A) and post-2-session-treatment (B) photographs are shown. In B, the patient’s skin laxity is sensibly reduced, and neck wrinkles and general tightening are visible
Finally, the main advantage of this technology lies in its non-invasive nature and lack of consumable requirements, delivering rapid results in a highly safe and controlled manner.
We demonstrated that this treatment is effective even in comparison to more invasive procedures, such as injectables or plastic surgery, though a comparative analysis would be necessary to provide additional information regarding superiority. Compared to other non-surgical technologies, microwaves require fewer treatment sessions and produce visible results that persist for at least 12 weeks post-treatment.
In conclusion, the microwave-based system used in this study is innovative due to its specific frequency of 2.45 GHz, which has been shown to effectively target subdermal fat tissues while sparing superficial layers like the dermis and epidermis. This targeted heating allows for selective adipocyte heating and lipolysis, making it more efficient in body contouring and skin tightening compared to other non-invasive methods. Additionally, the handpiece design facilitates precise energy delivery to specific submental areas, enhancing control and reducing treatment time. Furthermore, the system incorporates a continuous cooling mechanism, maintaining the surface skin temperature at a safe level of 5 °C. This cooling feature not only prevents overheating of the epidermis but also enhances patient comfort and safety. These features differentiate this system from other non-invasive technologies, making it a promising option for treating submental skin laxity with fewer sessions and faster results. It is important to acknowledge the limited sample size of this study, which included only ten patients. While the results provide initial evidence of efficacy, further studies with larger cohorts are required to validate these findings and determine long-term outcomes.
Declarations
Competing interests
Authors declare no competing interests or funding for this study.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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