Objectives: This lecture aims to provide evidence-based guidance on return electrode positioning in monopolar radiofrequency (MRF) procedures. Attendees will learn how spatial positioning affects thermal diffusion, impedance dynamics, and treatment depth, and how to apply physical and mathematical models to optimize safety and clinical outcomes.

Introduction: In monopolar radiofrequency treatments, the positioning of the return electrode is a critical yet often overlooked factor influencing impedance stability, thermal profile, and energy penetration. Despite its importance, standardized, accurate guidelines for optimal electrode placement remain absent. This study addresses this gap using theoretical modeling to inform practical recommendations.

Materials / method: Triggered by a clinical case involving superficial burn injury, this study employed physical and mathematical models, including electric field simulation, impedance variation (IV), impedance variation rate (IVR), and energy penetration depth analysis. Various return electrode distances (0.15–0.7 m) were analyzed to evaluate their effect on energy dispersion and thermal safety.

Results: The proximity of the return electrode (<0.2 m) amplified superficial heating and elevated the risk of thermal injury. Conversely, positioning beyond 0.5 m reduced treatment efficacy. An intermediate distance of approximately 0.45 m achieved optimal impedance control, uniform heat diffusion, and therapeutic depth without compromising safety.

Conclusion: For commonly used systems such as Thermage FLX, return electrode placement at ~0.45 m from the target zone—typically on the patient’s back or abdomen—offers the best balance between efficacy and safety. As results depend on specific device parameters, clinicians must re-calculate placement strategies when using different RF platforms. Clinical validation studies are warranted.

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Objectives: Understanding the Role of Facial Muscles in the Aging Process and Combination Interventions.

Introduction: Facial aging affects all five layers of the face. Laxity and sagging are inevitable for everyone and are among the most common concerns presented by patients. Facial mimetic muscles also contribute to age-related sagginess.

Materials / method: Consider reducing the activity of depressor muscles and enhancing the tone or strength of levator muscles to achieve better lifting effects through the combined use of different devices and treatments. Injecting fillers at various areas and depths can modulate muscle activity mechanically, either by reducing or enhancing it (mechanical myomodulation).

Results: Combining injectable toxins and fillers to target depressor muscles, along with high-intensity facial electromagnetic stimulation (HIFES) and fillers to enhance levator muscles, can be achieved through precise injection techniques and an appropriate treatment sequencing protocol.

Conclusion: The combination of injectable toxins, fillers, and high-intensity facial electromagnetic stimulation (HIFES) can produce a clinically synergistic effect, resulting in enhanced facial lifting and rejuvenation.

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Objectives: Despite the theoretical safety of high-intensity focused ultrasound in rejuvenation, adverse events continue to be reported. This study aimed to elucidate the mechanisms underlying adverse events associated with HIFU treatment.

Materials / method: A nationwide survey was conducted among 1,792 institutions in Japan utilizing HIFU, requesting them to complete a detailed questionnaire on adverse events. To identify patterns, we analyzed differences in adverse events by anatomical site and examined the characteristics of HIFU settings associated with these events. Numerical simulation was conducted to further validate our findings.

Results: A total of 139 valid cases were reported, involving 165 adverse events, as some cases involved multiple occurrences. The adverse events were categorized as follows: burns (n = 61), neuropathy (n = 49), purpura/subcutaneous hemorrhage (n = 19), hyperpigmentation (n = 10), wheals (n = 10), prolonged redness (n = 3, induration (n = 3, scars/hypertrophic scars (n = 2), and edema/swelling (n = 2), floaters (n = 2), cataracts (n = 2), facial spasticity (n = 1), and salivary gland cysts (n = 1).
The most frequently implicated transducer depth for adverse events was 4.5 mm, accounting for 78 cases.

Conclusion: Transducers reaching deeper tissues must avoid areas anatomically at risk, such as nerves, vessels, eyes. Heat generated in the bone may damage adjacent nerves, while reflected and refracted ultrasound waves may refocus and cause burns. To minimize adverse events in HIFU therapy, it is critical to have a thorough understanding of HIFU characteristics, local anatomy, and imaging-based evaluation of subcutaneous tissues.

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请注明名称（个人，公司，学会等等）: Health and Labour Sciences Research Grant

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Objectives: Since years the focus in aesthetic medicine was on volumizing the face using fillers, obviously more we fill increasing the volume of the zygomatic area & the middle cheek more the face is lifted following the simple physics’s rules. The results on our patients is the overfilled syndrome commonly known as pillow face
The new trend is to stop the aging process with autologous regenerative medicine. Almost all the energy based devices are supposed to have an action on the dermis or on the fat layers what about the muscles’ aging?

Introduction: Considering that face muscles represent 60% of the face form, them there is 20% skin, 10% fat and 10% bone.
As a consequent face muscle restoration would be the main antiaging procedure.Working on muscles is the new trend in face contouring

Materials / method: I have been using since the last 3 years the diathermocontraction : a Simultaneous Generation Bipolare Radiofrequency & muscles contractions Acknowledging perfectly face muscle anatomy, we can focus while using the diathermocontraction on the lifting muscles of the face and on the retaining ligaments. RF diathermy treatment reduces wrinkles and cutaneous ageing, with selectively treating the deeper dermal and subdermal layers, while muscle contraction can cause a 20% increase in the thickness of the zygomatic major muscle, with an improvement of skin texture as wrinkles and skin hydration.

Results: Overall, combined effects of diathermy and contraction can also stimulate both satellite cells activation, able to regenerate and strengthen the existing muscle fibers through differentiation, and the release of Heat Shock Proteins (HSP), signaling molecules promoting muscle protein synthesis and muscle hypertrophy. The effects of the radiofrequency are well known: the improvement of the blood microcirculation leading to the increase of tissue oxygenation and the release of the IGF insulin growth factors, the FGF Fibroblast growth factor and VEGF vascular endothelial growth factor

Conclusion: The new trend in aesthetic medicine is a conservative and regenerative approach. Volumizing the muscles using diathermocontraction is very effective to naturally lift the mid and lower face improving the jawline contouring and the v shape. This innovative technique has no side effects is painless and has long term results.
The future of regenerative medicine is also regenerative energy base devices focusing on muscle ageing.

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