Definition, Uses, and Side Effects
F ocused Cold Therapy, also known as cryoneuromodulation is one of the most recent non-invasive treatments for improving the appearance of facial wrinkles and fine lines depending on highly pressurized nitrous oxide. This treatment is designed for people who do not want to get Botox and do not like the concept of injecting a toxin, Botulinum toxin, into their skins to remove wrinkles.
Focused Cold Therapy is toxin-free. It is designed to smooth out wrinkles, especially frown lines and forehead creases, depending on the effects of cold rather than the effects of a neurotoxin.
Up till now, only one approved and widely marketed Focused Cold Therapy treatment available, which is Iovera.
Myoscience Inc, the Iovera manufacturer, is the first company to depend on the concept of Focused Cold Therapy in the treatment of wrinkles. The treatment is still new and in its early stages, but the results are promising.
- What Is Focused Cold Therapy?
- How Does Focused Cold Therapy Work?
- Focused Cold Therapy Cosmetic Uses
- What Happens During Focused Cold Therapy Session?
- The Risks and Side Effects of Focused Cold Therapy
- Focused Cold Therapy Aftercare Instructions
- Who Should Not Have a Focused Cold Therapy Treatment?
- Who Can Perform a Focused Cold Therapy Session?
- What Is the Average Cost of a Focused Cold Therapy Session?
- FAQ about Focused Cold Therapy
- How QOVES Studio Can Help
Figure 1 – Glabellar rhytids are most commonly seen when frowning the brows inwards but can form to be visible at rest and are a more advanced form of skin wrinkle.
What Is Focused Cold Therapy?
Focused Cold Therapy, also known as Cold Tox or Frotox, is a minimally invasive treatment designed to remove wrinkles and fine lines on the forehead and between the eyebrows.
It depends on focused cold nitrous oxide to make the nerves in the targeted areas numb, which subsequently relaxes the muscles responsible for the appearance of wrinkles and fine lines.
Focused Cold Therapy’s major benefit is that the results appear immediately after the procedure without any toxins or chemicals left in your body.
Botox injections take between 24 hours to 4 days to work. Therefore, Focused Cold Therapy can be the best alternative for people who need the results immediately.
The treatment usually lasts between 3 to 4 months, which is great when compared with other non-surgical treatments such as Botox and dermal fillers. Of course, the results are better and more permanent than wrinkle-free skincare products. (1, 2)
How Does Focused Cold Therapy Work?
Focused Cold Therapy depends on stimulating a process called second-degree Wallerian degeneration, which happens when nerve fibers are cut or crushed. This process causes a neural conduction block, which makes the muscles relax since they cannot contract anymore because the contraction signals cannot be conducted anymore. Within 24 hours, the regeneration process of nerve cells begins and within 3 to 4 months, the signals will be conducted, and the muscles can contract again.
Focused Cold Therapy for forehead creases and frown lines targets the temporal branch of the facial nerve leading to the relaxation of the frontalis muscles, which is responsible for raising the eyebrows. Once this muscle relaxes, the appearance of wrinkles and fine lines decreases.
After the procedure, the temporal branch of the facial nerve and other nerves experience a period of effective hibernation. The connections will start and keep growing until the nerve functions are completely restored.
The application of pressurized nitrous oxide to a small area has other effects too. Focused Cold Therapy may increase the production of collagen in the treated areas, which increases skin firmness and reduces the appearance of fine lines and wrinkles. Besides, it can flush away toxins in the treated area and decrease inflammation. Furthermore, it reduces the size of skin pores, which keeps toxins and dirt out.
The treatment is still new. Therefore, more research is needed to confirm its effects. (3)
Focused Cold Therapy Cosmetic Uses
Focused Cold Therapy is new. Therefore, it is still used to treat small areas only such as between the eyebrows.
They are also used for forehead creases because the entry point of the nerves that get blocked are close to the temples.
Immediately after the procedure, you will notice a great reduction in the severity of both vertical and horizontal fines lines and wrinkles between the eyebrows and on the forehead. The results last for 3 to 4 months until the nerves restore their full functionalities.
It is worth mentioning that some people may need more sessions and others may require more focused therapy to block the targeted nerves completely in order to achieve the optimal results. Also, some people may not respond to the treatment at all, but it is a very small percentage.
You should have a good discussion with your healthcare provider about the reasons why you want to undergo Focused Cold Therapy and the other treatment options that can be used for your condition. This discussion is essential to make sure that Focused Cold Therapy is the right treatment for you and that it will provide you with the desired results. Your healthcare provider should have the proper knowledge and experience to provide you with all the answers you need. (4)
Figure 2 – . Improvement in wrinkle severity at 30, 60, and 90 days after treatment. Subject at rest, full glabellar contraction,
and full frontalis contraction.
What Happens During Focused Cold Therapy Session?
Your healthcare provider will take a complete medical history from you to make sure that you can undergo this treatment. A consent form will be given to you to sign, which means that your healthcare provider gave you all the information and you are completely aware of the benefits, risks, and side effects associated with Focused Cold Therapy.
Besides, your practitioner may take some pictures to show you the results.
The treatment session takes about 15 minutes. First of all, your doctor or a nurse will cleanse your face thoroughly. Then a machine called Transcutaneous Electrical Nerve Stimulation or TENS will be used to detect the exact locations of the facial nerve and its branches. Once the machine is applied, the facial nerve and the branches will twitch, which helps your doctor to mark where the treatment will be applied correctly.
After that, your practitioner will inject local anesthesia into your skin to numb the targeted area where he/she will apply the device. Then, the treatment will begin.
The Focused Cold Therapy device has closed tip needles at one end, these needles will be inserted into the skin at targeted points which are located in the nerve path.
To completely deactivate the nerve, the device is turned on and the liquid nitrogen is passed into the closed tip needles. The needles are closed-tipped so they do not go inside the skin.
When the liquid nitrogen reaches the needle tip, it turns into a gaseous form, which is nitrous oxide. Nitrous oxide draws the heat from the surrounding skin, which creates a zone of cold. This cycle lasts 60 seconds.
People who underwent the treatment say that they do not feel cold in the targeted area. The most experienced feeling is the pressure at the site of injection. Some people report that they experienced pain, but the level is tolerable.
Once the procedure is done, your doctor will give you topical cream to soothe any discomfort or redness around the injection sites. Once all the previous steps are over, you will be free to go for the rest of the procedure day.
Figure 3 – Epidermal cold injury image (slight crusting of the epidermis around the insertion positions of probes) at 3 days
(left) and 30 days (right) after treatment.
The Risks and Side Effects of Focused Cold Therapy
Studies show that there are no serious side effects to Focused Cold Therapy. The most common side effects include redness, tenderness, pain, bruising, and inflammation at the injection sites.
Other side effects include:
- Eyebrow drooping
- Eyelid or eyebrow heaviness
All these side effects resolve on their own during the follow-up. No medications or interventions are needed to resolve these side effects. (5)
Focused Cold Therapy Aftercare Instructions
It is essential to follow your doctor’s Focused Cold Therapy aftercare instructions to achieve the desired results.
- You should clean the injected areas gently for several days after the procedure.
- Avoid applying heavy makeup and facial products on the injected areas, especially if you have side effects such as redness, tenderness, or inflammation.
- If the local pain, swelling, or inflammation do not disappear within few days from the day of the procedure, your doctor may prescribe anti-inflammatory, pain management medications such as Ibuprofen to decrease the pain and relieve the swelling and inflammation.
Who Should Not Have a Focused Cold Therapy Treatment?
Focused Cold Therapy is a minimally invasive treatment. Therefore, most people can undergo this procedure as long as their general health is good, and the expectations are reasonable.
However, Focused Cold Therapy is not recommended for treating either very deep wrinkles or very superficial wrinkles. A licensed healthcare provider will be able to determine whether Focused Cold Therapy is good for you or not. He/she will provide you with all the information you need to decide whether this treatment option will benefit you or another option may be better.
Focused Cold Therapy does not work for some people. In these cases, the treatment does not deactivate the nerves completely, which means that the muscles causing the wrinkles do not relax enough. These people should try other treatment options that can effectively relax the wrinkle-causing muscles.
Who Can Perform a Focused Cold Therapy Session?
Focused Cold Therapy should be performed by a fully trained and qualified doctor. Cosmetic and plastic surgeons are currently the only healthcare providers who are allowed to perform this procedure.
Before the treatment begins, you should ask your doctor about his/her training and qualifications.
What Is the Average Cost of a Focused Cold Therapy Session?
Focused Cold Therapy for wrinkles is still new and not widely available. Therefore, the cost of the treatment varies depending on many factors including the level of the practitioner’s experience and the number of sessions required.
The average cost is £300 per session according to many practices and people who underwent this treatment.
FAQ about Focused Cold Therapy
What Are the Different Types of Focused Cold Therapy Available?
Up till now, only one type of Focused Cold Therapy is available, which is Iovera created by Myoscience. It is approved by the FDA for peripheral nerves treatment.
Iovera device has a patented smart tip with 3 closed-tipped needles. The needles are used to deliver the nitrous oxide to the treated area. Besides, the device has a skin warmer that keeps the skin of the patient in a comfortable temperate to prevent pain during the procedure.
More research is done, and more applications are waiting for approval for cosmetic purposes.
How Long Will It Take to Recover after Focused Cold Therapy?
Focused Cold Therapy is a minimally invasive procedure. Therefore, there is no recovery time after the procedure.
Is Focused Cold Therapy Covered by Insurance?
In general, no. Focused Cold Therapy is not covered by insurance. However, you should check with your healthcare provider to see if it can be insured or not.
What Do Studies Say about Focused Cold Therapy?
Most studies and clinical trials that have been conducted about Focused Cold Therapy say that it is effective for most people as a non-surgical option for wrinkles. It is already approved in the United States and Europe as a treatment for facial wrinkles and fine lines.
One of the main studies about Focused Cold Therapy was done by Dr. Brauer and his team who evaluated the results of applying focused cold to the temporal branch of the facial nerve in 63 patients.
32 of the participants were chosen randomly to receive immediate focused cold treatment and the other 31, the control group, received delayed treatment.
Evaluators blindly assessed the participants with a 5-point scale for wrinkles. They found that the treatment group had immediate improvement after the procedure and 30 days later. After 30 days, 93% of the treatment group reported that they notice at least 25% improvement in the appearance of wrinkles and fine lines. Besides, 84% of the treatment group reported that they notice 50% improvement.
The 5-point scale for wrinkles showed ≥1 point improvement for 96.9% of the treatment group and 6.5% of the control group. Besides, it showed ≥2 points improvement for 93.8% of the treatment group and 0% of the control group. (6)
Will My Nerves Be Permanently Damaged?
Typically, when healthcare providers use Focused Cold Therapy to treat wrinkles and fine lines, they should be careful to deactivate the nerves without damaging them.
Researchers have been developing the procedure for a while. Now, they use hollow needles to focus the cold and drop the temperature around the nerve. The effects start immediately after the procedure.
Besides, the procedure allows the healthcare provider to select the frontalis muscle nerve. This allows your doctor to avoid dropping the eyebrows, which is one of the most common side effects of Botulinum toxin.
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- Hsu M, Stevenson FF. Reduction in muscular motility by selective focused cold therapy: a preclinical study. J Neural Transm (Vienna). 2014;121(1):15-20. doi:10.1007/s00702-013-1077-y
- Palmer FR 3rd, Hsu M, Narurkar V, Munyon T, Day D, Karnik J, Tatsutani K. Safety and effectiveness of focused cold therapy for the treatment of hyperdynamic forehead wrinkles. Dermatol Surg. 2015 Feb;41(2):232-41. doi: 10.1097/DSS.0000000000000155. PMID: 25654195.
- Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?. World J Clin Cases. 2021;9(17):4116-4122. doi:10.12998/wjcc.v9.i17.4116
- Bleakley CM, Bieuzen F, Davison GW, Costello JT. Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access J Sports Med. 2014;5:25-36. Published 2014 Mar 10. doi:10.2147/OAJSM.S41655
- Zhang S, Duan E. Fighting against Skin Aging: The Way from Bench to Bedside. Cell Transplant. 2018;27(5):729-738. doi:10.1177/0963689717725755