\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-signs-new-contract-with-cepiec-china-for-distribution-of-open-access-books-20210319",title:"IntechOpen Signs New Contract with CEPIEC, China for Distribution of Open Access Books"},{slug:"150-million-downloads-and-counting-20210316",title:"150 Million Downloads and Counting"},{slug:"intechopen-secures-indefinite-content-preservation-with-clockss-20210309",title:"IntechOpen Secures Indefinite Content Preservation with CLOCKSS"},{slug:"intechopen-expands-to-all-global-amazon-channels-with-full-catalog-of-books-20210308",title:"IntechOpen Expands to All Global Amazon Channels with Full Catalog of Books"},{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"}]},book:{item:{type:"book",id:"3724",leadTitle:null,fullTitle:"Distributed Generation",title:"Distributed Generation",subtitle:null,reviewType:"peer-reviewed",abstract:"In the recent years the electrical power utilities have undergone rapid restructuring process worldwide. Indeed, with deregulation, advancement in technologies and concern about the environmental impacts, competition is particularly fostered in the generation side, thus allowing increased interconnection of generating units to the utility networks. These generating sources are called distributed generators (DG) and defined as the plant which is directly connected to distribution network and is not centrally planned and dispatched. These are also called embedded or dispersed generation units. The rating of the DG systems can vary between few kW to as high as 100 MW. Various new types of distributed generator systems, such as microturbines and fuel cells in addition to the more traditional solar and wind power are creating significant new opportunities for the integration of diverse DG systems to the utility. Interconnection of these generators will offer a number of benefits such as improved reliability, power quality, efficiency, alleviation of system constraints along with the environmental benefits.\r\n\r\nUnlike centralized power plants, the DG units are directly connected to the distribution system; most often at the customer end. The existing distribution networks are designed and operated in radial configuration with unidirectional power flow from centralized generating station to customers. The increase in interconnection of DG to utility networks can lead to reverse power flow violating fundamental assumption in their design. This creates complexity in operation and control of existing distribution networks and offers many technical challenges for successful introduction of DG systems. Some of the technical issues are islanding of DG, voltage regulation, protection and stability of the network. Some of the solutions to these problems include designing standard interface control for individual DG systems by taking care of their diverse characteristics, finding new ways to/or install and control these DG systems and finding new design for distribution system. DG has much potential to improve distribution system performance. The use of DG strongly contributes to a clean, reliable and cost effective energy for future. \r\n\r\nThis book deals with several aspects of the DG systems such as benefits, issues, technology interconnected operation, performance studies, planning and design. Several authors have contributed to this book aiming to benefit students, researchers, academics, policy makers and professionals. We are indebted to all the people who either directly or indirectly contributed towards the publication of this book.",isbn:null,printIsbn:"978-953-307-046-9",pdfIsbn:"978-953-51-5889-9",doi:"10.5772/203",price:139,priceEur:155,priceUsd:179,slug:"distributed-generation",numberOfPages:416,isOpenForSubmission:!1,isInWos:1,hash:"9383c05ece5ed76feff7645f261830ba",bookSignature:"D N Gaonkar",publishedDate:"February 1st 2010",coverURL:"https://cdn.intechopen.com/books/images_new/3724.jpg",numberOfDownloads:71077,numberOfWosCitations:42,numberOfCrossrefCitations:29,numberOfDimensionsCitations:74,hasAltmetrics:0,numberOfTotalCitations:145,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 4th 2013",dateEndSecondStepPublish:"January 25th 2013",dateEndThirdStepPublish:"May 1st 2013",dateEndFourthStepPublish:"July 30th 2013",dateEndFifthStepPublish:"August 29th 2013",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,editors:[{id:"112984",title:"Dr.",name:"Dattatraya",middleName:null,surname:"Gaonkar",slug:"dattatraya-gaonkar",fullName:"Dattatraya Gaonkar",profilePictureURL:"https://mts.intechopen.com/storage/users/112984/images/system/112984.jpg",biography:"Dattatraya N. Gaonkar (dngaonkar@ieee.org) is with the National Institute of Technology Karnataka, Surathkal, India. P is a Student Member of the IEEE, and Gaonkar is a Senior Member of the IEEE. This article first appeared as “Voltage Estimation in Smart Distribution Networks with Multiple DG Systems” at the 2015 IEEE India Conference (INDICON-2015). 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There are many established applications of ELISA in clinical medicine, including diagnostic assays measuring human chorionic gonadotropin (HCG), estrogen, hepatitis B antigen, and various antibodies, to name but a few.
\r\n\r\n\tThe book is intended to include all chapters related to ELISA, its applications in various fields of science and research. As mentioned above, ELISA is a robust test that has good sensitivity and specificity so it is very helpful in the detection and confirmation of diseases. There are many forms and types of tests available. With the use of monoclonal antibodies in the formation of ELISA kits, now it is widely used and has much better detection. So the book is intended to highlight its uses, possible application as well as the benefits of tests for the laboratory. It is also intended to give future perspectives for the use of ELISA.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"27b605bbd0c5cfe1f733980b97250605",bookSignature:"Dr. Muhammad Abubakar",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10243.jpg",keywords:"Serology, Laboratory, ELISA, Epidemiology, Genetics, Residue Testing, Detection of Pesticides, Enzyme Detection, Conventional and Molecular tests, Sequencing, Diagnosis, Molecular Detection",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 16th 2020",dateEndSecondStepPublish:"July 7th 2020",dateEndThirdStepPublish:"September 5th 2020",dateEndFourthStepPublish:"November 24th 2020",dateEndFifthStepPublish:"January 23rd 2021",remainingDaysToSecondStep:"9 months",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Dr. Abubakar has published numerous research papers, review articles and book chapters on different areas of veterinary sciences and currently he is supervising two journals in the area of veterinary sciences (Research journal for Veterinary Practitioners and Veterinary Sciences; Research and Reviews) as an editor-in-chief.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"112070",title:"Dr.",name:"Muhammad",middleName:null,surname:"Abubakar",slug:"muhammad-abubakar",fullName:"Muhammad Abubakar",profilePictureURL:"https://mts.intechopen.com/storage/users/112070/images/system/112070.jpeg",biography:"Dr. Muhammad Abubakar, senior scientist from the National Veterinary Laboratory, Islamabad, Pakistan, has over 15 years’ experience in various areas of veterinary sciences. His expertise in transboundary animal diseases (TADs) at national and international levels is well known. He has established various diagnostic laboratories for the diagnosis of TADs. He has been involved in the organization and conduct of various trainings for field and laboratory staff. He has published numerous research papers, review articles, and book chapters on different areas of veterinary sciences. He has also worked in academia teaching and research supervising at graduate and undergraduate levels. He is currently supervising two journals in the area of veterinary sciences (Research Journal for Veterinary Practitioners and Veterinary Sciences and Research and Reviews) as an editor-in-chief.",institutionString:"National Veterinary Laboratory",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"5",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"6",title:"Biochemistry, Genetics and Molecular Biology",slug:"biochemistry-genetics-and-molecular-biology"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"194667",firstName:"Marijana",lastName:"Francetic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/194667/images/4752_n.jpg",email:"marijana@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"7023",title:"Ticks and Tick-Borne Pathogens",subtitle:null,isOpenForSubmission:!1,hash:"733dc7d7724a77a929f274703361982f",slug:"ticks-and-tick-borne-pathogens",bookSignature:"Muhammad Abubakar and Piyumali K. Perera",coverURL:"https://cdn.intechopen.com/books/images_new/7023.jpg",editedByType:"Edited by",editors:[{id:"112070",title:"Dr.",name:"Muhammad",surname:"Abubakar",slug:"muhammad-abubakar",fullName:"Muhammad Abubakar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5405",title:"Trends and Advances in Veterinary Genetics",subtitle:null,isOpenForSubmission:!1,hash:"b81ca0dfa8e83073171dd1b5c29b2232",slug:"trends-and-advances-in-veterinary-genetics",bookSignature:"Muhammad Abubakar",coverURL:"https://cdn.intechopen.com/books/images_new/5405.jpg",editedByType:"Edited by",editors:[{id:"112070",title:"Dr.",name:"Muhammad",surname:"Abubakar",slug:"muhammad-abubakar",fullName:"Muhammad Abubakar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6473",title:"Animal Welfare",subtitle:null,isOpenForSubmission:!1,hash:"0814e6a1deeca43ab829e3ec1abb7402",slug:"animal-welfare",bookSignature:"Muhammad Abubakar and Shumaila Manzoor",coverURL:"https://cdn.intechopen.com/books/images_new/6473.jpg",editedByType:"Edited by",editors:[{id:"112070",title:"Dr.",name:"Muhammad",surname:"Abubakar",slug:"muhammad-abubakar",fullName:"Muhammad Abubakar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6206",title:"Ruminants",subtitle:"The Husbandry, Economic and Health Aspects",isOpenForSubmission:!1,hash:"2f4344b633afc742eb0cfc50413c928b",slug:"ruminants-the-husbandry-economic-and-health-aspects",bookSignature:"Muhammad Abubakar",coverURL:"https://cdn.intechopen.com/books/images_new/6206.jpg",editedByType:"Edited by",editors:[{id:"112070",title:"Dr.",name:"Muhammad",surname:"Abubakar",slug:"muhammad-abubakar",fullName:"Muhammad Abubakar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8006",title:"Livestock Health and Farming",subtitle:null,isOpenForSubmission:!1,hash:"f5d1afd2e7d3ed2ff77988629de50355",slug:"livestock-health-and-farming",bookSignature:"Muhammad Abubakar",coverURL:"https://cdn.intechopen.com/books/images_new/8006.jpg",editedByType:"Edited by",editors:[{id:"112070",title:"Dr.",name:"Muhammad",surname:"Abubakar",slug:"muhammad-abubakar",fullName:"Muhammad Abubakar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6694",title:"New Trends in Ion Exchange Studies",subtitle:null,isOpenForSubmission:!1,hash:"3de8c8b090fd8faa7c11ec5b387c486a",slug:"new-trends-in-ion-exchange-studies",bookSignature:"Selcan Karakuş",coverURL:"https://cdn.intechopen.com/books/images_new/6694.jpg",editedByType:"Edited by",editors:[{id:"206110",title:"Dr.",name:"Selcan",surname:"Karakuş",slug:"selcan-karakus",fullName:"Selcan Karakuş"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"66281",title:"Nanocomposite-Based Graphene for Nanosensor Applications",doi:"10.5772/intechopen.85136",slug:"nanocomposite-based-graphene-for-nanosensor-applications",body:'Graphene, as an atom-thick sp2-hybridized carbon nanosheet, has been extensively studied since it was first separated and characterized by Andre Geim and Konstantin Novoselov in 2004 [1]. The graphene presents a unique property including large specific surface area, easy functionalization, unique optical properties, chemical stability, high electronic conductivity, and photonic and mechanical properties and provides a promising platform for the design and construction of useful nanomaterials. Recently, the field involving graphene nanomaterials is a rapidly developing area due to their potential applications in biomedical and clinical medicine field. One of the most valuable virtues of graphene is their applications in sensors, particularly in fluorescence sensors and electrochemical sensors [2].
Mainly graphene-based nanomaterials are graphene oxide (GO, 2-D), graphene quantum dots (GQDs, 0-D), and heteroatom (N, P, S atom)-doped graphene quantum dots (doped GQDs, 0-D). The structures of different materials are shown in Figure 1. GO is a layered stack of nanosheets, while GQDs are regarded as GO nanosheets cutting into nanodots in oxidation process showing excellent performance of graphene. Recently, the GQDs have greatly attracted attention of scientific workers due to the good biocompatibility, excellent water solubility, and stable photoluminescence (PL) and chemical inertness [3, 4]. The GQDs contain carboxyl group, hydroxyl group, and epoxy groups at the edge and show similar structure to graphene and can be easily functionalized by various biological and non-biological species. Meantime, heteroatom-doped GQDs showed enhanced chemical activity, higher fluorescence quantum yields, and effectively modulated performance of bandgap.
Structure of graphene oxide (GO) and nitrogen-doped graphene quantum dots (N-GQDs).
In this chapter, efforts have been made on summarizing the design, synthesis, and applications of nanocomposite-based graphene. We mainly focused on the recent development of graphene-based nanocomposites as fluorescence sensors and electrochemical sensors for the detection of biological species and non-biological species in human serum, respectively.
People are very interested in the detection of amino acids due to their multiple biological functions. Cheng and co-workers designed and synthesized a turn-on fluorescent nanosensor based on the alizarin red aluminum (III) complex covalently binding to graphene oxide (GO) for the detection of lysine with high sensitivity and high selectivity [5]. The nanosensor was prepared by GO, Al(III) ions, and alizarin red (GO-Al-AR) by coordination mode. The as-prepared GO-Al-AR nanosensor was depicted in Figure 2. It showed weak fluorescence due to photo-induced electron transfer (PET). However, the fluorescence intensity of GO-Al-AR obviously enhanced upon addition of lysine. The fluorescence response of GO-Al-AR nanosensor exhibited good linear relationship with the concentrations of lysine within 25 mg/L to 250 mg/L. The detection limit was 2.0 mg/L. The premium pH value was between 6.5 and 7.2, suggesting the as-synthesized sensor is suitable for detection of lysine in living cells.
A schematic illustration of a turn-off/turn-on fluorescence response of GO-Al-AR to lysine.
Another novel fluorescence sensing method was developed for the detection of tyramine based on CdSe/ZnS quantum dots-GO using imprinting technique [6]. The fluorescent sensor was synthesized by using CdSe/ZnS quantum dots, GO, 3-mercaptopropyltriethoxysilane (MPTES) (monomer), and tetraethyl orthosilicate (TEOS) (cross-linking agent) and targeted molecule tyramine for synthesizing molecularly imprinted polymers (MIPs), namely, Gra-QDs@MIPs. The as-synthesized sensor showed a high selectivity for the detection of tyramine. The fluorescence intensity of Gra-QDs@MIPs showed a good linear relationship with concentrations of tyramine between 0.07 and 12 mg/L. The Gra-QDs@MIPs can be used to detect tyramine in rice wine samples. A biosensor was constructed and reported based on reduced GO field-effect transistor (rGO-FET) modified by the cascading enzymes arginase and urease for the monitoring of l-arginine [7]. The rGO-FET was employed to immobilize arginase and urease through electrostatic interaction based on cationic polyethylenimine (PEI) building block. The functionalized transistors showed high sensitivity and high selectivity for the detection of l-arginine within 10–1000 μM. The detection limit was 10 μM. The sensor showed fast response and good stability.
Bao and co-workers designed RhBPy-graphene oxide (GO) complex as a fluorescent probe for the sensitive and selective detection of doxorubicin (DOX) in MeOH/H2O solution [8]. The fluorescence of RhBPy[2] rotaxane can be efficiently quenched by addition of graphene oxide (GO) due to fluorescence resonance energy transfer (FRET), while the fluorescence of RhBPy[2] rotaxane can be recovered due to different interaction forces between DOX and RhBPy[2] rotaxane toward GO. Li et al. developed a fluorescent probe for the monitoring and detection of antibiotic virginiamycin based on GO-supported carbon quantum dots (GO/C-dots) as the signal element and molecularly imprinted polymer (MIP) as the recognition template [9]. MIP with virginiamycin as the template molecule was constructed and designed using o-aminophenol as monomer on the surface of ITO electrode deposited by GO/C-dots. The specific sensor can be obtained by removing the virginiamycin from the MIP. The GO/C-dot complex displayed strong fluorescence signal, while its fluorescence intensity declined obviously upon adsorption of virginiamycin. The specific probe showed high selectivity and high sensitivity toward virginiamycin, and detection limit is 1.56 × 10−11 mol/L.
The novel doxorubicin (DOX) functionalized GO nanosensor was designed and synthesized for the detection of dopamine based on mechanism of fluorescence resonance energy transfer (FRET) [10]. The DOX showed strong property, but the fluorescence was quenched upon addition of GO (Figure 3). The GO-DOX complex as sensing platform showed a high selectivity toward dopamine based on different adsorption interactions between dopamine and DOX and GO. The fluorescence intensity of DOX-GO complex was partly recovered upon addition of dopamine based on competitive adsorption of DOX and dopamine on the surface of GO. The fluorescence response of DOX-GO exhibited a linear relationship with concentrations of dopamine between 8.3 × 10−7 M and 3.3 × 10−5 M in aqueous solution and 1.44 and 11.48 μmol/L in human serum, respectively. The DOX-GO can be an efficient nanosensor for sensing dopamine in human serum and living cells.
A schematic illustration of the fluorescence response of a DOX-GO complex to dopamine (a); Molecular structures of DOX (b) and dopamine (c).
The hexylenediamine-functionalized high fluorescent GO was constructed and prepared for the detection of hypochlorous acid (HOCl) in aqueous solution [11]. The fluorescence of functionalized GO was quenched upon addition of HOCl based on the mechanism of intramolecular charge transfer (ICT) between GO and chloramines forming by the oxidation of amino groups of functionalized GO using HOCl. The functionalized GO showed high selectivity and sensitivity for the determination of HOCl. The detection limit was 3.5 μM. The obtained sensor can be used to detect HOCl in tap water. The water-soluble and good biocompatible nanocomposite sensor was designed and prepared based on GO, Cu2+, and histidine-functionalized perylenediimide (PDI-HIS) for the determination of pyrophosphate (PPi) in biological conditions [12]. The as-synthesized sensor can be used as an efficient sensing platform in physiological conditions by fluorescence turn-on switch. The obtained sensor PDI-HIS-Cu-GO (PCG) displayed high selectivity and high sensitivity for the PPi detection with affinity constant 1.0 × 106 M−1. The detection limit was 0.6 × 10−7 M. Compared to the PDI-HIS+Cu2+ complex, the PDI-HIS-Cu-GO nanocomposites showed higher selectivity for PPi in intracellular detection.
Cheng et al. designed a dual-output nanosensor based on GO for the detection of Ag+ in aqueous solution with high sensitivity and high selectivity [13]. The nanosensor (Figure 4) was prepared by conjugation of GO with well-known fluorophore 1,8-diaminonaphthalene (DAN). The addition of Ag+ ions significantly quenched the fluorescence of resultant sensor based on the mechanism of PET, while the intensity of second-order scattering obviously enhanced. Furthermore, the intensity of as-prepared sensor showed a good linear relationship with the concentrations of Ag+ ranging from 6 to 12 mg/L. The fluorescent sensor showed no or weakly response to Na(I), K(I), Ca(II), Mg(II), Cr(III), Mn(II), Fe(II), Co(II), Ni(II), Cu(II), Zn(II), and Fe(III).
Synthetic pathway and AFM images of GAP and its fluorescence response to fivefold Ag+ in aqueous solutions with various pHs.
Gevaerd et al. designed and synthesized imidazole-functionalized graphene oxide (GO-IMZ) as non-enzymatic electrochemical sensor for the detection of progesterone [14]. Progesterone (P4) plays an important role in the stabilization and maintenance of gestation as most important progestogen of mammals. The GO-IMZ complex as an artificial enzymatic active site was reported using voltammetric determination of progesterone. The as-synthesized sensor displayed a synergistic effect of GO nanosheets and imidazole showing the obvious enhancement on the electrochemical response of P4. The electrochemical response signal showed a linear relationship with concentrations of P4 between 0.22 and 14.0 μmol/L. The detection limit was 68 nmol/L. The limit of quantification was 210 nmol/L. The higher sensitivity was presented compared to the unmodified electrode.
Tomita and co-workers designed and reported the construction of high accessible and high tunable multi-fluorescent sensing system, and this sensing system presented protein fluorescent signals from a single microplate well [15]. The principal mechanism of approach was based on three single-stranded DNAs (ssDNAs) functionalized-nano-graphene oxide (nGO). The single-stranded DNAs showed different sequences and functions, and fluorophores exhibited different optical properties. The fluorescence of three fluorophore-modified ssDNAs was quenched upon conjugation with nGO. The partial recovery of fluorescence intensity of individual ssDNAs was observed upon addition of analyte proteins.
Abdallah and Ibrahim designed and developed an imprinted potentiometric sensor for the detection of gabapentin that is an anticonvulsant agent [16]. The sensor was constructed using carbon paste electrode following three steps: (i) the GO was decorated by silver nanoparticles; (ii) silver nanoparticles modified with GO mixed physically with molecularly imprinted polymers nanoparticles with gabapentin as a template molecule and then leached the template molecule; and (iii) the abovementioned mixture deposited on carbon paste electrode. The sensor showed good selectivity and high sensitivity, and the detection limit is 4.8 × 10−11 mol/L. Yang and co-workers designed and prepared CdTe quantum dot (QD)-decorated poly(diallyldimethylammonium chloride) (PDDA)-functionalized graphene (CdTe-PDDA-Gr) nanocomposite based on the presence of PDDA and CdTe QDs using chemical reduction of exfoliated graphite oxides [17]. The CdTe-PDDA-Gr nanocomposite showed very fast electron transfer behavior and obvious absorption effect for puerarin due to high surface area and good conductivity. They exhibited very good electrocatalytic behavior toward the oxidation of puerarin. The oxidation peak current showed a good linear relationship with the concentrations of puerarin within 0.001–1.0 μM by differential pulse voltammetry (DPV). The limitation of detection was 0.6 nM (SNR of 3).
The nickel tetra-amined phthalocyanine-graphene oxide covalent compound was developed as a photoelectrochemical sensor for the detection of erythromycin with high sensitivity [18]. The graphene oxide was modified by tetra-amined phthalocyanine (NiTAPc) by covalent bonding getting the final product NiTAPc-Gr. The as-synthesized sensor exhibited a higher photoelectrochemical efficiency and showed a peak wavelength of 456 nm by irritation of visible light. Compared to that of GO/ITO, the photocurrent of NiTAPc-Gr/ITO was 50-fold at the same conditions. The photocurrent showed a good linear relationship with the concentrations of erythromycin between 0.40 and 120.00 μmol/L. The detection limit was 0.08 μmol/L. The constructed photoelectrochemical sensors have been successfully applied to detect erythromycin in human blood plasma.
A bimetallic electrochemical sensor was designed and constructed for the sensitive detection of uric acid (UA) with high selectivity [19] as shown in Figure 5. The bimetallic nanoparticles (NPs) were synthesized by electrodeposition on the glassy carbon electrode (GCE) using the HAuCl4 and AgNO3 as precursors by co-reduction through cyclic voltammetry scanning. Firstly, the GO-TH complex was formed by electrostatic interactions between GO and thionine (TH); then, the GO-TH complex was drop-coated on Au-Ag NPs to construct Au-Ag NPs/GO/TH@GCE. The redox current peak intensity showed regular increase with the increase of concentration of UA. The good linear relationship was exhibited between
Illustration of the preparation and applications of the Au-Ag NPs/GO/TH@GCE sensing platform.
A non-enzymatic sialic acid (SA) electrochemical sensor was designed and constructed based on indicator displacement assay (IDA) of dopamine with high sensitivity and high selectivity [20]. The mechanism of SA detection was based on reversible covalence with boronic acid-diol complex. In other words, the SA and DA all can covalently interact with 2-fluorophenylboronic acid (FPBA) by replacing of 1,2-diols. The electrode was constructed and synthesized based on tetra(4-carboxyphenyl) porphine-graphene oxide (TCPP-GO), DA, and FPBA on the surface of glassy carbon electrode (GCE), respectively. The TCPP-GO complex obviously enhanced the sensitivity of the electrochemical sensor. The recovered anodic current intensity of DA showed a good linear relationship with the concentration of SA within 0.1–7.5 mM. The detection limit was 28.5 μM. The sensor has been successfully applied to detect SA in human blood and urine samples.
The gold/silver/gold/chitosan-graphene oxide (Au/Ag/Au/CS-GO) sensor was designed and constructed for the detection of Pb2+ and Hg2+ ions with high sensitivity [21]. The higher affinity constant of Pb2+ binding with the CS-GO showed higher affinity than that of Hg2+ binding with the CS-GO. The maximum S/N was 1.53. The Au/Ag/Au/CS-GO surface plasmon resonance (SPR) sensor displayed good repeatability toward Pb2+ ions due to the coordination interaction. The adsorption behaviors of Pb2+ and Hg2+ ions onto the surface of CS-GO sensor fit to the Langmuir isotherm model. The affinity constant of Pb2+and Hg2+ to bind Au/Ag/Au/CS-GO sensor was 7 × 105 M−1 and 4 × 105 M−1, respectively. Priya et al. resigned and prepared a voltammetric sensor based on graphene oxide/κ-carrageenan/l-cysteine nanocomposite (GO/κ-Car/l-Cys) for the detection of Cd2+ and Pb2+ ions [22]. The GO/κ-Car/l-Cys composite modified with glassy carbon electrode (GCE) was successfully synthesized. The electrochemical response of GO/κ-Car/l-Cys composite showed a good linear relationship with the concentrations of Cd2+ and Pb2+ ions within 5–50 nM, and the detection limit was 0.58 and 1.08 nM for Cd2+ and Pb2+ ions, respectively. The sensitivity for Cd2+ and Pb2+ ions was 1.39 μA/nM and 1.32 μA/nM, respectively. The interference experiment results showed no affect even on the presence of other species.
The fluorescent graphene quantum dots-gold nanoparticles as nanosensor showed a high selectivity and high sensitivity for the detection of cysteine [23]. The AuNPs@r-GQDs nanocomposite was prepared by the following processes. First, nitrogen-doped graphene quantum dots (N-GQDs) were reduced to r-GQDs by NaBH4 as reductant and subsequently the r-GQDs converted HAuCl4 to Au nanoparticles (AuNPs) by reduction reaction and coated onto AuNPs forming core-shell-structured AuNPs@r-GQDs. The AuNPs@r-GQDs showed good dispersion behavior with an intensive surface plasma band at 525 nm. The AuNPs@r-GQDs exhibited aggregation behavior and led to their color change by using cysteine as cross-linking agent through adsorption of Ag ions onto their surface. The detection limit was 5.6 nM. Furthermore, the AuNPs@r-GQDs showed higher selectivity for cysteine than that of glutathione (GSH) even at the interfere condition of 1000-fold concentrations of GSH.
The GQD-MnO2 complex as a convenient fluorescence nanosensor has been constructed and prepared for the detection of glutathione (GSH) with high selectivity and high sensitivity [24]. The fluorescence intensity of GQDs was quenched upon addition of MnO2 nanosheet based on the mechanism of fluorescence resonance energy transfer (FRET). The fluorescent signal recovered upon GSH reducing MnO2 nanosheets into Mn2+ ions and releasing GQDs. The GQD-MnO2 complex as nanoprobe showed a sensitive response to GSH between 0.5 and 10 μmol/L. The fluorescence intensity showed a good linear relationship with the concentrations of GSH. The detection limit was 150 nmol/L. The GQD-MnO2 complex exhibited higher selectivity for the GSH than that of other metal ions and biomolecules and successfully applied to detect GSH in living cells.
Zhou et al. designed and developed a convenient fluorescent sensor based on the molecularly imprinted polymers (MIPs)-functionalized GQDs for the detection of tetracycline (TC) with high sensitivity and high selectivity [25]. The GQDs were prepared by one-pot method, and the amino-functionalized GQDs and carboxyl-functionalized GQDs were fabricated, respectively. The GQD-MIPs were synthesized by sol-gel method. The GQD-MIPs exhibited strong fluorescence property, and the fluorescence was quenched upon addition of TC. The fluorescence quench efficiency showed a linear relationship with concentrations of TC between 1.0 and 104 μg/L. The detection limit was 1 μg/L.
The sulfanilic acid and glutathione-functionalized GQDs was constructed and synthesized as fluorescent sensor for the detection of sulfide anions and ascorbic acid [26]. The sulfanilic acid and glutathione-functionalized GQDs were prepared through amide linkage using 1-(3-dimethylaminopropyl)-3-ethyl-carbodiimide hydrochloride (EDC) as catalyst, namely, SSGQDs. The SSGQDs showed strong fluorescence property. The fluorescence of SSGQDs was quenched upon addition of Cu2+ ions, forming SSGQD-Cu(II) complex. The S2− ions showed high coordination interaction with Cu2+ ions from SSGQD-Cu(II) complex and induced the fluorescence recovery of SSGQDs. The ascorbic acid (AA) as a reduction can reduce Cu2+ into Cu+ and induced the disaggregation of the SSGQDs, and fluorescence of SSGQDs was recovered again. The GQDs as a green sensor were synthesized for the detection of free chlorine with high selectivity and high sensitivity [27]. The GQDs showed strong fluorescence property, and fluorescence of GQDs was quenched upon addition of chlorine-based fluorescence resonance energy transfer. The fluorescence quenching efficiency exhibited a good linear relationship with concentrations of chlorine with a wide range from 0.05 to 10 μM. The sensing system has been applied to detect chlorine in drinking water.
The europium-functionalized GQDs (Eu-GQDs) were synthesized by treatment of Eu-decorated graphene (3D Eu-graphene) through a strong acid oxidation [28]. The amount of Eu was 2.54%. The Eu-GQDs complex showed higher electron density and surface chemical activities compared to that of GQDs. The as-synthesized Eu-GQDs exhibited a sensitive response for the detection of Cu2+ and l-cysteine with high selectivity and high sensitivity. The fluorescence of Eu-GQDs was quenched upon addition of Cu2+ due to the coordination interaction between Cu2+ and carboxyl groups of Eu-GQDs. The fluorescence of Eu-GQDs was recovered in the presence of l-cysteine due to strong affinity of Cu2+ and S of L-cysteine. The good linear relationship was shown within the range of 0.1–10 μM for Cu2+ and 0.5–50 μM for l-cysteine, respectively. The detection limit was 0.056 μM for Cu2+ and 0.31 μM for l-cysteine, respectively. The proposed nanosensor can be used to detect Cu2+ and l-cysteine in serum samples.
A fluorescence sensor based on gold nanoparticles-functionalized GQDs has been designed and synthesized for the detection of Pb2+ with high sensitivity and high selectivity [29]. The GQDs showed strong fluorescence property. The fluorescence of GQDs was quenched in the presence of Au nanoparticles due to the aggregation of GQDs. The fluorescence of GQDs was recovered upon addition of Pb2+ ions inducing de-aggregation of gold nanoparticles-GQD complex. The fluorescence intensity exhibited a good linear relationship with the concentrations of Pb2+ ions within 50 nM–4 μM. The detection limit was 16.7 nM. The dopamine-functionalized GQDs (DA-GQDs) was constructed and prepared for the detection of Fe3+ ions with high sensitivity and high selectivity [30]. The DA-GQDs showed bright blue fluorescence, and the fluorescence of DA-GQDs was quenched in the presence of Fe3+ ions. The fluorescence quenching efficiency exhibited a good linear relationship with the concentrations of Fe3+ ions between 20 nM and 2 μM. The detection limit was 7.6 nM. The DA-GQD sensing probe displayed excellent selectivity for the detection of Fe3+ ions in the presence of other biomolecules. The reaction mechanism of Fe3+ was based on coordination interaction and oxidation of dopamine. The as-synthesized nanosensor as sensing platform can be widely used for environmental monitoring and biomedical applications.
The folic acid-functionalized GQDs (FA-GQDs) were designed and synthesized by thermal pyrolysis of maleic acid (MA) and folic acid (FA) [31]. The FA-GQDs showed obvious fluorescence behavior, and fluorescence property depends on the different ratio of FA/MA used in thermal pyrolysis. The FA-GQDs as a turn-on fluorescent sensor showed a high sensitivity for the detection of folate receptor-positive cancer cells. The resulting FA-GQDs also exhibited a fluorescence response to Hg2+ ions. The fluorescence quenching efficiency showed a good linear relationship to the concentrations of Hg2+ ions within 2.0 × 10−6 to 5.0 × 10−12 M. The detection limit was 1.7 × 10−12 M (S/N = 3). The FA-GQD nanosensor displayed excellent selectivity for the detection of Hg2+ ions in the presence of other metals and biomolecules.
The fluorescence sensor lecithin/β-CD@NR@ GQD complex was constructed and synthesized by covalence Nile red (NR) onto GQDs using lecithin/β-cyclodextrin (lecithin/β-CD) complex as linker [32]. The GQDs connect with NR through lecithin/β-CD complex based on electrostatic interaction and hydrophobic interaction. The fluorescence of GQDs was quenched upon addition of lecithin/β-CD@NR based on Förster resonance energy transfer. Meantime, the fluorescence intensity of NR obviously enhanced. The lecithin/β-CD@NR@ GQD complex as nanosensor exhibited high sensitivity for the detection of acid phosphatase (ACP). The detection limit was 28 μU/mL. The proposed sensor has been successfully applied to monitor ACP in PC-3 M cells.
The graphene oxide quantum dots@silver (GQDs@Ag) nanocrystals with core-shell structure was designed and prepared as fluorescence sensing platform for the detection of prostate-specific antigen (PSA) [33]. The quantities of GQDs on GQDs@Ag decided the intensities of fluorescence signal. The incorporated GQDs can be released by removing of silver shell based on oxidative reaction without affecting their fluorescence performance. The anti-PSA antibody (Ab1) and antibody (Ab2) was immobilized onto magnetic beads (MBs) and GQDs@Ag, respectively. The GQDs@Ag showed a high sensitivity and high selectivity for the detection of PSA. The fluorescence intensity exhibited an excellent linear relationship with concentrations of PSA within 1 pg/mL to 20 ng/mL. The detection limit was 0.3 pg/mL. The as-synthesized immunosensor has been successfully applied to detect PSA in human serum. The antibody anti-cardiac troponin I (anti-cTnI) modified with amine-functionalized GQDs (afGQDs) was constructed and prepared by carbodiimide coupling reaction, namely, anti-cTnI/afGQDs [34]. The complex anti-cTnI/afGQDs exhibited sensitive response for detection of target antigen (cTnI) with high sensitivity and high selectivity. The as-synthesized complex as nanosensor showed strong fluorescence behavior, and the fluorescence of anti-cTnI/afGQDs was quenched in the presence of graphene (Gr). The fluorescence of anti-cTnI/afGQDs was recovered upon the addition of target antigen (cTnI) on anti-cTnI/afGQDs/Gr-inducing Gr apart from GQDs. The fluorescence intensity showed a good linear relationship with the concentrations of cTnI between 1.0 pg/mL and 1.0 ng/mL. The detection limit was 0.192 pg/mL.
The functionalized glassy carbon electrode (GCE) based on composites of GQDs and β-cyclodextrins (β-CDs) was designed and synthesized as an electrochemical sensor for the detection of tyrosine (Tyr) enantiomers [35]. The as-synthesized β-CDs-GQDs/GCE exhibited an ultrasensitive response signal for the monitoring of Tyr enantiomers using GQDs as substrate and β-CDs as recognition molecule. The β-CDs-GQDs/GCE showed obvious difference in the oxidation peak current between l-Tyr and d-Tyr. The quantities of l-Tyr of healthy people showed higher than that of depression patients. The detection limit was 6.07 × 10−9 M and 1.03 × 10−7 M for l-Tyr and d-Tyr, respectively.
The gold nanoparticles/proline-functionalized GQDs (GNs/Pro-GQDs) were constructed and prepared as ultrasensitive electrochemical sensor for the monitoring of p-acetamidophenol [36]. The proline-GQDs were synthesized using pyrolysis of citric acid and proline. The GNs/Pro-GQDs were formed by directly reacting HAuCl4 with proline-GQDs. The peak current (
The GQDs/riboflavin (RF) functionalized glassy carbon elec-trode (GC/GQDs/RF) was developed as a sensitive electrochemical sensor to detect persulfate (S2O82−) [37]. The modified electrode exhibited a stable redox peak between pH 1 and pH 10. The obtained GC/GQDs/RF showed a good electrochemical activity for the detection of S2O82−. The linear calibration range was from 1.0 μM to 1 mM. The detection limit and sensitivity were 0.2 μM and 4.7 nA/μM, respectively. One electrochemiluminescent (ECL) sensor was developed and synthesized to monitor Cr(VI) ions in water samples based on fluorescence signal changes of graphene quantum dots/peroxodisulfate (GQD/S2O82−) complex [38]. The fluorescence of GQD/S2O82− complex was quenched in the presence of Cr(VI) ions based on mechanism of fluorescence resonance energy transfer (FRET). The linear response range was 50 nM–60 μM. The detection limit was 20 nM (S/N = 3). The obtained sensor has been successfully applied to detect Cr(VI) in river water.
The hybrid GQDs/TiO2 NTs were constructed based on titanium dioxide nanotube arrays (TiO2 NTs) infilled with GQDs as an efficient ECL sensor for detection of PSA [39]. The fabricated GQDs/TiO2 NP composite electrode presented good stability and showed higher fluorescence intensity compared to that of pure TiO2 NT electrode. The TiO2 functionalized Fe3O4 magnetic nanoparticles (CdTe/MNPs) acted as quencher for the sensor. The GQDs/TiO2 NT sensing platform showed high sensitivity and high selectivity for the detection of PSA. The ECL quenching efficiency exhibited a good linear relationship with log of the concentration of the PSA within 1.0 fg/mL to 10 pg/mL. The detection limit was 1 fg/mL (S/N = 3). The obtained nanosensor has been successfully applied to detect PSA in clinical human serum samples. The label-free ECL immunosensor was designed and synthesized based on GQDs [40]. The Au/Ag-rGO complex was prepared and employed to immobilize GQDs. The aminated-GQDs and carboxyl-GQDs were loaded onto electrode. The antibody of PSA was conjugated with modified electrode by absorbing Au/Ag to target proteins. The ECL quenching efficiency showed a linear relationship with log of concentrations between 1 pg/mL to 10 ng/mL. The detection limit was 0.29 pg/mL.
The chitosan-functionalized GQDs (GQD-CS) were constructed and employed to mobilize methylene blue (MB) using glass carbon electrode (GCE) based on aminohydroxy reaction [41]. The non-enzymatic sensor showed high sensitivity and high selectivity for the detection of H2O2. The obtained GQD-CS/MB/GCE displayed an obviously catalytic behavior toward H2O2 reduction. Compared with bare GCE, GQDs/GCE, and GQD-CS/GCE, the hybrid GQD-CS/MB/GCE showed higher electrochemical activities based on synergistic effect between GQD-CS and MB. The sensitivity was 10.115 μA/mM and detection limit was 0.7 μM.
The GQDs coated on hollow nickel nanospheres (hNiNS) modified with glass carbon electrode (GCE) were designed and synthesized as a molecularly imprinted electrochemical sensor (MIECS) for the monitoring of bisphenol S (BPS) with high sensitivity and high selectivity [42]. The pyrrole serves as monomer and BPS as template to polymerized molecularly imprinted polymer (MIP) film. The response signal showed linear relationship with the concentration of BPS between 0.1 and 50 μM. The detection limit was 0.03 μM. The ultrasensitive electrochemical sensor based on modified glass carbon electrode (GCE) was constructed and prepared for the determination of metronidazole (MNZ) [43]. The GQDs coated with molecularly imprinted polymers (MIPs) were synthesized. The complex of graphene nanoplatelets (GNPs) and MIPs exhibited obviously enhanced electrocatalytic property for MNZ based on good synergistic effect of GNPs and MIPs. The proposed electrochemical sensor displayed two linear ranges within 0.005–0.75 μmol/L and 0.75–10.0 μmol/L. The detection limit was 0.52 nmol/L. The electrochemical sensor has been applied to inspection of human serum samples. The GQD self-assembled monolayer-modified electrode was constructed as highly selective electrochemical sensor for the detection of dopamine (DA) [44]. The GQD-NHCH2CH2NH2 functionalized GCE was prepared. The functionalized electrode showed excellent electrical conductivity and displayed sensitive response to DA. The modified GCE showed a good linear relationship with the concentrations within 1–150 μM. The detection limit was 0.115 μM (S/N = 3). The obtained GQD-NHCH2CH2NH2 functionalized GCE displayed good stability and excellent anti-interference capability.
The chemical doping is a common strategy and used for tailoring the properties of GQDs. The heteroatom-doped GQDs showed exceptional properties such as tunable emission, changeable spin density, and charge distribution of carbon atoms [45]. Dopants include N, sulfur (S), phosphorus (P), boron (B), fluorine (F), and chlorine (Cl).
The first successful synthesis of nitrogen-doped GQDs was reported by Li and co-workers in 2012 [46]. Liu et al. synthesized N-GQDs by hydrothermal method using citric acid as carbon sources and ammonia as nitrogen sources with N/C atomic ratio of ca. 4.3% emitting an obviously blue luminescence [47]. The fluorescence quantum yield of N-GQDs was 2.46% by calculation. The as-prepared N-GQDs can strongly adsorb 18 mer ssDNA (5′-ATACCAGCTTATTCAATT-3′) via π-π interaction force. The fluorescence of N-GQDs was quenched by photo-induced electron transfer mechanism between N-GQDs and ssDNA. The fluorescence of N-GQDs can be recovered upon addition of mixture of bleomycin and Fe(II) due to the noncovalent binding between bleomycin and ssDNA.
Fan and co-worker constructed N-GQD-Hg(II) complex system as a highly sensitive fluorescence sensor for cysteine detection [48]. The N-GQDs was prepared by one-pot method using citric acid as carbon source and urea as nitrogen sources. The N-GQD-Hg(II) complex as fluorescence sensor showed weak fluorescence. The fluorescence was recovered upon addition of cysteine to the complex system of N-GQD-Hg(II) due to the coordinate interaction between cysteine and Hg(II). The fluorescence intensity showed good linear relationship with the concentration of cysteine within a range of 0.05–30 μmol/L. The detection limit was 1 .3 nmol/L.
Zhao et al. prepared oxygen-rich nitrogen-doped GQDs by using one-pot synthesis strategy as pH-sensitive sensor for the detection of Hg(II) ion [49]. The oxygen-rich N-GQDs were synthesized by using citric acid (CA) and 3,4-dihydroxy-l-phenylalanine (l-DOPA) as the carbon source and the N source, respectively. The N-GQDs showed excitation-wavelength-independent fluorescent behavior, and the quantum yield was 18%. The N-GQDs as an efficient fluorescent sensor displayed the highly sensitivity and highly selectivity for the detection of Hg(II) based on the mechanism of nonradiative electron transfer. The detection limit was 8.6 nM. The fluorescence quenching efficiency showed good linear relationship with the concentration of Hg(II) within concentration from 0.04 to 6 μM. The competitive experiments showed that the N-GQDs showed high selectivity and sensitivity for the detection of Hg(II) even in the interference of other metal ions.
The strip-based fluorescence molecularly imprinted sensor was designed and constructed for monitoring thiacloprid [50]. The fluorescence molecularly imprinted sensor was synthesized based on polydopamine (PDA) polymer, thiacloprid, and N-GQDs. Firstly, the filter paper is dipped into N-GQD aqueous solution; secondly, the dopamine with thiacloprid self-polymerized on the surface of strip. The polydopamine molecularly imprinted polymer acted as an high efficient sensor for the detection of thiacloprid. The as-prepared fluorescence molecularly imprinted sensor showed a linear relationship between 0.1 and 10 mg/L, and detection limit was 0.03 mg/L.
The hydrogen peroxide (H2O2) holds an important role in the biological system and is closely related with many diseases such as cancer, Parkinson disease, and so on [51]. The Pd nanoparticles decorated with N-GQDs @N-carbon hollow nanospheres was designed and synthesized as a high electrochemical sensor for the hydrogen peroxide detection [52]. The proposed NGQD@NC@Pd HNSs sensor showed highly efficient electrocatalytic activity as non-enzymatic catalyst for the reduction of H2O2. The NGQD@NC@Pd/GCE exhibited excellent repeatability and reproducibility by detecting eight different NGQD@NC@Pd/GCE in fixed concentration H2O2 with relative standard deviation (RSD) 2.7 and 3.6%, respectively. The cytotoxicity of NGQD@NC@Pd/GCE was evaluated by using Cell Counting Kit-8 (CCK8) assay. The results of CCK-8 assay displayed over 95% viability incubating NGQD@NC@Pd/GCE using MDA-MB-231 and HBL-100 cells for 4 h, indicating good biocompatibility of the NGQD@NC@Pd/GCE.
Peng and co-workers designed and reported a strategy method to detect Hg(II) ions by accelerating reaction rate between porphyrin and Mn(II) based on synergistic effect of N-GQDs and Hg(II) [53]. The reaction mechanism is based on larger Hg(II) of porphyrin-Hg(II) complex, which was replaced by smaller Mn(II) ions forming porphyrin-Mn(II) complex in a relatively faster speed. Such course was accompanied by the absorption red-shift and fluorescence quenching of porphyrins; meantime, the fluorescence intensity of N-GQDs enhanced. The CCK-8 assay showed over 90% viability by incubating 5.0 μM TMPyP, 40 μM Mn(II), or 20 μg/L N-GQDs for 24 h using A549 cells, indicative of good biocompatibility.
Liu and co-workers prepared N,P-GQDs as fluorescence sensor for the detection of nitrite with high sensitivity and high selectivity [54]. The N,P-GQDs were synthesized by hydrothermal method using tetrakis(hydroxymethyl)phosphonium chloride and ethylenediamine endcapped polyethylenimine as phosphorus, carbon, and nitrogen source, respectively. The N,P-GQDs were prepared by using different temperatures (230° and 250°) and showed higher oxygen, nitrogen, and phosphorus levels at 230° compared to the those at 250°. The absolute quantum yield of N,P-GQDs was 9.4%. The N,P-GQDs showed a fast response to NO2− with high sensitivity and high selectivity. The fluorescence quenching efficiency exhibited a good linear relationship with concentration of NO2− within 5–30 nM. The detection limit was 2.5 nM. The results of MTT assays displayed over 90% cell viability by incubating N,P-GQDs with T24 cells for 24 h, suggesting good biocompatibility and imaging nitrite in live cell.
Ananthanarayanan et al. used carbonization strategy for the preparation of N,P-GQDs from biomolecule adenosine triphosphate (ATP) as nitrogen and phosphorus source [55]. Firstly, adenosine triphosphate (ATP) was carbonized for 1 h at 90° and got carbonized ATP; then the carbonized ATP was exfoliated in HNO3 for 24 h and got final product N,P-GQDs. The results of Raman spectrum characterization of carbonized ATP exhibited prominent D and G bands, indicative of the presence of sp3 carbon with graphitic nature. The N,P-GQDs have many advantages, such as excellent biocompatibility, good photostability, high fluorescence quantum yield (QY ∼ 27.5% by calculation and ∼53.0% after chemical reduction using NaBH4), and low molecular weight (∼1.4 kDa). The doping proportions of N and P are 6.2 (C/N = 7.0) and 6.9 (C/P = 6.3), respectively. The N,P-GQDs exhibited good two-photon upconversion properties. The strong upconverted photoluminescence phenomenon was showed with maximum emission at ∼560 nm upon excitation at 800 nm. The lifetime measurements of N,P-GQDs exhibited τ1 (
Mahyari and Gavgani designed and constructed cobalt porphyrin-supported N,P-GQDs/graphene (CoPP@N,P-GQDs/G) complex as noble metal-free photocatalysts [56]. Firstly, the N,P-GQDs were synthesized by carbonization of adenosine triphosphate as nitrogen source and phosphorous source; secondly, the N,P-GQDs were embedded on graphene oxide; and thirdly, the cobalt porphyrins with photoactive property were loaded through ionic interaction. The resultant product CoPP@N,P-GQDs/G showed good dispersion in the reaction medium (water). The CoPP@N,P-GQDs/G complex as recyclable photocatalysts showed high efficiency with the aerobic oxidation reaction of alcohols by using visible-light irradiation. Furthermore, CoPP@N,P-GQDs/G complex displayed the good selectivity for various alcohols by mild and green ways.
Mondal et al. designed and synthesized N,S-GQDs from the mixture of graphene oxide solution and thiourea by hydrothermal method [57]. The N,S-GQDs exhibited strong emission peak at 405 nm upon excitation at 320 nm. The N,S-GQDs showed a sensitive response to 2,4,6-trinitrophenol with highly selectivity, and the detection limit was 19.05 ppb. The fluorescence of N,S-GQDs significantly decreased upon addition of 2,4,6-trinitrophenol based on photo-induced electron transfer (PET) mechanism. The fluorescence quenching efficiency showed good linear relationship with concentration of 2,4,6-trinitrophenol. The N,S-GQDs showed higher quenching efficiency compared to these of N-GQDs, S-GQDs, and GQDs. Gavgani and co-workers constructed an ammonia (NH3) sensor based on N,S-GQDs/polyaniline (PANI) hybrid with high sensitivity and high selectivity [58]. The N,S-GQDs were synthesized by hydrothermal process using citric acid as carbon source and using thiourea as sulfur source, respectively. The N,S-GQDs/PANI hybrid was prepared by using in situ chemical oxidative polymerization. The increased proportion of N,S-GQDs in N,S-GQDs/PANI hybrid showed considerable improvement of NH3 response, such as around 42% at 100 ppm and 385% at 1000 ppm, respectively. The N,S-GQDs/PANI hybrid showed fivefold higher response compared to that of free PANI. The enhancement of sensing properties for the N,S-GQDs/PANI hybrid attributed to the synergistic effect between the N,S-GQDs and PANI.
Chen et al. synthesized N,S-GQDs by one-pot pyrolysis method with quantum yield of 67% using citric acid and cysteine as carbon source and nitrogen and sulfur source, respectively [59]. The N,S-GQDs showed an excitation-independent emission property. The fluorescence of N,S-GQDs was quenched upon addition of AgNPs, and the fluorescence of N,S-GQD-AgNPs was recovered in the presence of CN−. The N,S-GQDs have no effect on the adsorption spectrum of AgNPs; however, addition of CN− obviously decreased the absorbance of AgNPs. The detection limit was 0.52 μM for fluorescent sensors and 0.78 μM for colorimetric sensors. The as-synthesized N,S-GQD-AgNPs as nanosensor has been successfully applied to detect CN− in realized water samples.
The S-GQDs were prepared and reported by Bian and co-workers through one-pot hydrothermal method using compound 1,3,6-trinitropyrene as carbon source and 3-mercaptopropionic acid (MPA) as sulfur source [60]. The S-GQDs as fluorescent sensing probes showed highly sensitive response to the Ag+ ions with high selectivity within a wide linear range of 0.1–130.0 μM. The detection limit was 30 nM. The fluorescence intensity of S-GQDs was obviously decreased upon addition of Ag+ ions. The fluorescence quenching efficiency showed a good linear relationship with concentration of Ag+ ions based on photo-induced electron transfer (PET) mechanism. The feasibility of as-synthesized S-GQDs as fluorescent sensing probe in practical application was assessed by Ag+ detection in local lake. The detection results obtained from S-GQDs and ICP-MS were close.
Li et al. synthesized the S-GQDs by electrochemical approach using graphite electrode in sodium p-toluenesulfonate aqueous solution [61]. The S-GQDs obviously improved surface chemistry and electronic properties. The S-GQDs as fluorescent sensor showed a sensitive response to the Fe3+ ions with high selectivity and high sensitivity. The fluorescence intensity of S-GQDs obviously decreased upon addition of Fe3+ ions concentration between 0.01 and 0.70 μM. The fluorescence quenching efficiency showed good linear relationship with the concentration of Fe3+ ions. The detection limit was 4.2 nM. The S-GQDs as a fluorescent sensor can be reused over five times without signal lost. This fluorescence sensing probe can be successfully applied to detect Fe3+ ions in human serum. Dong et al. prepared S-GQDs by hydrothermal process using the mixture of 1,3,6-trinitropyrene, Na2S, and NaOH in aqueous solution [62]. The reported S-GQDs exhibited a stable yellow-green emission. It was found that fluorescence quenching was pH-dependent and showed best quenching efficiency at pH 7.0. The as-synthesized S-GQDs showed excitation-independent photoluminescence property. The S-GQDs as a newly fluorescent probe showed high selectivity and high sensitivity for the detection of Pb(II) ions. Compared to Pb(II) ions, ions such as Na(I), K(I), Cu(II), Ca(II), Mg(II), Fe(III), Ni(II), Co(II), and Cd(II) have no obvious effect on the fluorescence intensity of S-GQDs. The fluorescence intensity of S-GQDs significantly decreased upon addition of Pb(II) ions from 0.1 to 220.0 mM in aqueous solution. The fluorescence quenching efficiency showed good linear relationship with concentrations of Pb(II) from 0.1 to 140.0 μM. The detection limit was 0.03 μM.
In this chapter, we concluded recent development of modified graphene-based nanocomposites (including of GO, GQDs, doped GQDs) as novel and convenient fluorescence nanosensors and electrochemical sensors for the detection of amino acids, proteins, metal ions, inorganic anions, drug molecules, and small molecules, pH, respectively. The obtained functionalized fluorescence sensors and electrochemical sensors as sensing platforms displayed high sensitivity and high selectivity for the detection of biomolecules, respectively.
The graphene-based composites attracted the interest of scientific workers due to its nanosize, quantum confinement, edge effects, low toxicity, and good conductivity. We comprehensively summarized the preparation, dopant element, interaction mechanism, and practical applications. The relationship between response signals and analyte concentrations was discussed in detail. The functionalized graphene-based nanocomposites showed good biocompatibility and low toxicity. The as-synthesized fluorescence sensors and electrochemical sensors have been successfully applied for the monitoring of biomolecules in the human serum samples. The graphene-based nanocomposites showed great potential as sensing platforms for the biomedical applications and clinic research.
The authors thank peer workers for their contributions to the work cited. We are also thankful for financial support from the Medical and Health Science and Technology Project of Zhejiang Province (2015KYB254, 2017KY492), Wenzhou Bureau of Science and Technology (Y20170012), and Chinese National Nature Science Foundation (21405115).
The author(s) declare that they have no competing interests.
Liposuction is the most common cosmetic plastic surgery procedure in the world. The advent of tumescent microcannula suction-assisted lipoplasty (SAL) technique, Power-assisted lipoplasty (PAL), ultrasound-assisted lipoplasty (UAL or Vaser), water-assisted lipoplasty (WAL), laser-assisted lipoplasty (LAL, or SmartLipo) have all been energy assisted innovations to the liposuction technique that have contributed to making liposuction less traumatic, faster, optimize the extraction technique with stem cell preservation (UAL) or offer moderate dermal contraction (LAL) [1, 2, 3, 4, 5, 6]. Despite these advances in the basic liposuction technique, one of the major challenges facing liposuction surgeons is optimizing and ensuring soft tissue contraction and body contouring outcomes after removal of adipose tissue [7, 8, 9, 10, 11]. Worsening of skin laxity and suboptimal soft tissue contraction following adipose aspiration is common [1].
\nThe Introduction of BodyTite® Radiofrequency Assisted Liposuction 10 years ago and the evolution of the various RFAL applicators and technology since that time has led to an era of optimal control of soft tissue contraction and more consistency in quality body contouring results [12, 13, 14]. This chapter outlines the peer reviewed articles and basic science of BodyTite® and reviews the authors use of RFAL in over 1000 cases in his body contouring and facial rejuvenation practice.
\nThe BodyTite® device is comprised of a workstation, or platform, which houses the RF Generator, software and circuit boards of the system. Into this workstation attach the various clinic hand pieces (Figure 1). The hand pieces come in different sizes and configurations and are designed for specific clinical procedures and anatomical locations.
\nThe BodyTite® RFAL workstation. The various hand pieces in the BodyTite® RFAL family plug into the workstation.
Each BodyTite® hand piece is in a bipolar configuration, where the internal electrode is a silicon coated cannula that is RF emitting in its distal uncoated region and has a sophisticated bullet shaped tip to aid is soft tissue dissection and movement, while minimizing the risk of end dermal hits and thermal injury.
\nThe external electrode, which is attached to the same hand piece, slides along the surface of the skin in tandem with the internal electrode (Figure 2).
\nThe BodyTite® bipolar RFAL hand piece.
The internal electrode emits positively charged RF current, which flows back and forth from the positively charged internal electrode to the negatively charged external electrode. The RF is strongly ablative and coagulative within 1–2 cm of the internal electrode and dissipates at is flows and diffuses up to the external electrode. Soft tissue within 1–2 cm of the internal electrode will undergo a necrotic, ablative tissue thermal effect, while the dermis will experience a sub-necrotic, non- ablative dermal, thermal stimulation.
\nThe Radiofrequency energy within 1–2 cm of the internal electrode provides a coagulative, ablative issue on local tissue, adipose, vascular and the fibroseptal network (FSN). As RF flows up, ever more diffusely, to the external electrode moving in parallel and in tandem with the internal electrode, RF will be more diffuse and is flowing to a much broader, bigger surface area electrode and the thermal effect on the dermal structures will be non-ablative heating (Figure 3).
\nThe RF energy flows from the internal electrode, where it is ablative in nature, to the external electrode, where the RF has a gentle non-ablative thermal effect on the dermis.
The Soft tissue tightening concept of BodyTite® is to provide and 3-dimensional contraction of the soft tissue through internal RF stimulation and contraction of the Fibroseptal network, together with dermal enhancement through non-ablative thermal stimulation and neo-collagenases [15].
\nThe Following features have been built into the hardware and software of the BodyTite® to optimize soft tissue contraction and minimize the risk of a thermal injury.
\nThe proximal internal electrode is silicone coated along its length to minimize the risk of a thermal injury to the access port and soft tissue that is not in direct proximity to the tip. There is a small, distal section of the internal electrode that is not silicon coated and this portion emits the positive charged radiofrequency energy. The distal aspect of the internal electrode has a silastic, bullet shaped cap, which facilitates dissection through the adipose tissue and minimizes the risk of an end dermal hit, or thermal injury to the underside of the dermis or deeper, delicate soft tissue structures.
\nThe RF energy is high frequency electrical current that travels in a wave form and oscillates between the internal and external electrode at a frequency of 1 million cycles per second. The RF energy oscillates molecular structures in its path 1 million time per second, generating intermolecular kinetic energy and heat. The heat can be necrotic and ablative in nature (near the tip) or sub necrotic, non-ablative tissue heating (the external electrode). The RF flows from the small, internal electrode with a smaller, more focused tip and high power density to the larger, lower power density external electrode providing “thermal containment”, or heating energy between the two electrodes, with very little heating below the internal electrode, which is a safety feature when performing RFAL around delicate structures like the face and neck where there is a the Facial nerve that is under the investing fascia of the facial muscles and is sensitive to thermal stimulation if there were significant heat flowing below the internal electrode.
\nThere are a number of high-tech sensors built into the BodyTite® hand pieces that communicate with the software algorithm on the workstation (Figure 4). Contact
The GUI screen o the BodyTite® RFAL workstation. On the left hand side, he external (skin) electrode and internal electrode (adipose) cut off temperatures are set by the physician. Increments of 120 s of RF energy are dispended and when the 120 s are up, double clicking on the foot pedal gives another 120 s. On the right-hand side are the real time temperatures of the external skin and internal fat temperatures as measured by the external electrode and internal electrode thermistors. As the user gets within 2°C of the cut off temperature, the audible beep that is emitted when RF energy is on, increases in tempo and when the cut off temperature is reached, either internal or external, the and audible will sound that is characteristic for the external and one for the internal cut-off and the RF energy delivered is terminated to the hand piece and tissue heating stops. When the external and internal temperature is 0.1°C below the cut-off RF energy flow begins again. The automated feedback loop allows heating of the adipose and skin to occur together or independently and not exceed the pre-set amounts.
The treatment time and amount of energy delivered in seconds and KJ is measured.
\nThere are a number of well-designed studies that have confirmed significant soft tissue contraction following BodyTite® and RFAL. Kreindel and Mulholland were able to show the vertical, horizontal and oblique fibers of FSN (Figure 5) as the major vehicle for significant three-dimensional soft tissue contraction at the time of surgery [15]. Further, this paper showed that 69° was the optimal temperature for thermal contraction and shortening of the FSN network. Duncan and others [16], were able to confirm upwards of 25% soft tissue area contraction after BodyTite® and RFAL at 6 months, which increased to 34% at 12 months. There have been numerous clinical papers outlining the soft tissue contraction advantages of the RFAL applicators in the face, neck, arms, inner thighs and body [17, 18, 19, 20, 21, 22].
\nThe FSN are shown above connecting the anterior rectus sheet below to the overlying abdominal adipose tissue. The vertical, horizontal and oblique Fibroseptal bands will shorten and contract when the RFAL thermal temperature and stimulation reaches 69°C pulling the overlying soft tissue envelope in tighter association with the underlying muscle and delivering soft tissue contraction.
The basic RFAL approach of the author has been to deploy BodyTite® applicators just before aspiration to ensure optimal soft tissue contraction, liquefy the adipose tissue for more gentle aspiration forces and coagulate the small venules and arterioles to lessen post aspiration extravasation and ecchymosis. Some physicians choose to aspirate first and perform the RFAL after debulking and they have reported good results with this technique, but theoretically aspirating first may compromise and traumatize some of the FSN, perhaps limiting the amount of contraction that could occur and would injure the small vessels before thermal coagulation increasing the risk of bruising.
\nThe BodyTite® applicators come with a dial on the hand piece that can control the distance between the internal and external electrodes, facilitating delivering thermal coagulation and different depths and levels. In general, Level 6, 5, 4, 3, 2 and 1 correspond to 6, 5, 4, 3, 2 and 1 cm inter-electrode distance and, remember, the effective coagulation is within 1–2 cm of the tip of the internal electrode (Figure 6).
\nThe various BodyTite® applicators are bipolar RF electrodes, with the internal, positively charged electrode being inserted into the adipose tissue and the external, negatively charged electrode sliding along the surface of the skin in tandem with the internal. RF flows from the internal, uncoated electrode with the RF energy is ablative close to the electrode, up through the adipose to the dermis, skin and large diameter electrode where the RF is then more diffuse and non-ablative in nature. The physician can control the distance between the electrodes by setting the inter-electrode distance on the proximal end of the hand piece. Each setting, 1–6 on the dial corresponds approximately to the number of centimeters between the electrodes.
\n
Shorten the vertical, oblique and horizontal FSN for optimal contraction.
The stamping technique. Stay in each spot until the internal thermal cut-off of 69–70 is reached, then move to the next spot.
Other physicians will withdraw very, very slowly, allowing the temperate to rise to therapeutic cut off while withdrawing. GOAL of this step is to ensure as much of the FSN experiences 69°C for optimal contraction. This process is performed at each vertical levels determined by the “skin pinch” and 2 cm formula. Multiple, sequential vertical FSN thermal stimulation and contraction is then achieved, optimizing the 3D soft tissue skin and adipose contraction and body contouring results (Figure 8).
\nVertical sequential thermal stimulation to 69–70° cut-off is achieved, which is the temperature that optimizes the FSN contraction and remodeling, resulting in the 35% or greater skin and soft tissue contraction.
Zig zag the applicator through the adipose tissue to avoid coming the same peri-port location each time, which will help avoid a peri-port thermal injury.
Once I have stamped retrograde on the way back, or using a slow moving technique, I will keep my foot on the pedal and perform several back and forth passes, slow moving technique, at that depth to ensure optimal thermal coverage of the FSN, as well as more complete lipocoagulation and liquification (easier aspiration, perhaps less trauma to the FSN, edema and pain) and coagulation of small venules and arterioles prior to aspiration (less ecchymosis). Again, it is important to zigzag your back stroke to avoid a peri-port burn (Figure 9).
When you have covered the 8 × 15 cm zone at one depth, stamping and slow moving, withdraw the internal electrode/cannula from the port and set the dial, 2 cm more superficial and repeat the stamping or slow withdrawing technique at the next, more superficial level. In the BodyTite® devices in the USA, the internal temperature before you move up to the next most superficial level must be 69 or 70° to get optimal FSN contraction (internal cut offs will not go higher the 70°). International BodyTite® users will find the external temperature will rise 4–5°C at each successive, more superficial level and there is no internal thermal cut-off control.
The skin temperature will continue to rise at each successive more superficial level until you approach the end point of 38–40°C. Both International and USA BodyTite® users would set their external skin cut off temperatures to 38–40°.
Like any liposuction or Body Shaping procedure, RFAL patients need have realistic expectations, no uncontrolled medical conditions and appropriate skin tone and focal or multifocal lipodystrophy concerns. The BodyTite® family of applicators allow physicians to selection the right-hand piece for the job. International Physicians have a slightly different array of hand pieces and thermal controls than American physicians (FDA requirements) but both parameters are outlined below. In general, BodyTite® RFAL treatment can deliver up 35% area contraction over 12 months and, as such, does allow the physician to extend the indications for liposuction to patients with more skin laxity than they might have in the past. Those older patients, or those with larger BMI’s, weight loss and weight gain, multiple parity may be BodyTite® candidates. The optimal RFAL soft tissue contraction means that physicians may be able to offer more minimal excisions: mini tummy tucks, axillary arm-lift, anterior inner thigh lifts and mini facelift in combination with BodyTite® RFAL treatment.
\nOnce you have selected a good BodyTite® candidate, then the appropriate port is selected to access the targeted lipocoagulation areas. Both RFAL BodyTite® and final aspiration contouring will be performed through the same port. Generally, this author prefers a single, well concealed port. The authors most favored zonal access ports are outlined in Figure 10.
\nSome of the standard BodyTite RFAL and aspiration ports.
Vertical sequential multi-level thermal coagulation, both stamping and/or slow moving to the deep (USA) and skin (International and USA) end points. Aspiration generally follows the heating (Figure 8).
\nThe thermal endpoints are thermal, 69–70° internal (USA) and 38–40° external cut off (USA and International). The final contour endpoints remain the art of the physician and are the aspiration endpoints.
\nPostoperative BodyTite® care is similar to non-thermal liposuction and the author favors 6 weeks of compression garmenting. The first week is with silicone coated foam compression and the next 5 weeks the garment alone. For Abdominal RFAL BodyTite® cases, a small #7 JP drain is used, as seromas are much more common than with SAL, with an incidence approaching 8–10%. Presumably post RFAL seroma are more common resulting from temporary thermal damage of the lymphatics that takes some time to normalize. The drain is removed when there are three consecutive days with less than 20 cc of drainage each day. The first 3 weeks of garmenting are 22 h per day, which is reduced to 12 h a day (day or night time) for the next 3 weeks. Full ambulation is encouraged immediately, but return to low impact activities, such as an elliptical, stair climber, exercise bike at the end of 3 weeks and high impact exercise, running, spinning, etc. at the end of 6 weeks.
\nNoninvasive bulk heating devices, to achieve even better skin tightening can be deployed when the skin is less sensitive at 8–12 weeks. Shock wave devices can be used on any areas of lumps and areas of firmness.
\nBodyTite® leaves the skin very stiff, indurated and firmer for longer than non-thermal SAL/PAL or UAL and there is strong sense of tightness and contraction on the part of the patient for the first 6–9 months, which is the contraction process. At 3–6 months, for any areas of slight contour excess, noninvasive, localized fat destruction technologies, like SculpSure®, BodyFx®, EMSculpt®, CoolSculpting® and Ultrashape®, can be used to try to improve the contour non-surgically.
\nInternationally there are 3 BodyTite® hand piece options, a 3.7 mm diameter × 25 cm or 17 cm long and a 2.4 mm × 17 cm long, also called the NeckTite®. The BodyTite® USA workstation comes in 20 W and 40 W configurations, the 40 W being more powerful and faster to endpoints and is called the BodyTite PRO (Figure 11). Both versions of the USA BodyTite® workstations automatically give as much power in watts as the treatment and hand piece needs to achieve the thermal velocity during the treatment of 20°C/cm2/s and when this thermal velocity is exceeded (20–25°C/cm2/s) will adjust down the energy until it is under 20°C/cm3/s and if the rate of rise is >35°C/cm2/s will shut off the energy flow and the foot pedal must be tapped again to being. The only BodyTite® hand piece currently available in the USA is the 2.4 mm × 17 cm hand piece.
\nThe RFAL family of applicators, starting with the FaceTite® on the left, the BodyTite®/NeckTite® 2.4 mm, the CelluTite and the larger BodyTite® 3.7 mm × 25 cm (not all are available in the USA, but are internationally).
Following the protocols and parameters outlined above, excellent results using RFAL thermal coagulation can be achieved. The areas that may benefit from BodyTite® and RFAL are outline in Figures 12, 13.
\nCommon areas where RFAL BodyTite®, FaceTite® and AccuTite® treatments can be effective.
BodyTite® before and after result at 12 months. Top panel RFAL was performed on the inner and outer tight of a 45-year-old and the middle and bottom panel BodyTite® was performed on the abdomen and hips in 68-year-old patient.
The NeckTite® is available internationally and is 2.4 mm × 17 cm and was originally designed for large necks, but has become the smaller BodyTite hand piece for smaller adipose zones in the non USA markets, while the 3.7 mm diameter hand piece is used for the larger body zones. With the introduction of the FaceTite Internationally and in the USA, the FaceTite(R) has become the RFAL applicator used most commonly for jawline, necks and very small body zones.
\nFor International physicians, the external electrode of the 2.4 mm × 17 cm NeckTite® hand piece is much smaller in diameter than the BodyTite® 3.7 mm external electrode and, as such, has a much higher power density, is more efficient and heats tissue much more quickly and with less energy.
\nUsing the protocol and parameters outlined above, excellent small zone Body contouring results can be achieved with the 2.4 mm × 17 cm hand piece and is most commonly used on the inner thighs, bra line, arms and smaller abdominal convexities (Figure 12).
\nThe FaceTite® is a very small RFAL applicator, designed for the neck, jawline, face and very small body contouring areas and is great for small secondary liposuction enhancements where fibrofatty tissue, which is like cement, can be anticipated (Figures 14, 15).
\nAreas of the face and neck that can be treated with the FaceTite® and AccuTite®.
In both the USA and Internationally, the FaceTite® hand piece is 1.2 mm in diameter × 10 cm long and is a solid, non-aspirating electrode (even internationally). The distance between the internal and external electrode is controlled by pinching the electrodes together to create the desired interelectrode distance, rather than a fixed dial, prior to entering the subcutaneous fat. Again, super-wet tumescent fluid is infiltrated prior to treatment (Figure 15).
\nThe FaceTite® applicator.
Using the protocols and parameters listed below, excellent results can be achieved tightening along the jawline and neck and small body contouring areas. The treatment of the jawline, submentum and neck can be performed using a three port approach, with a single submental port accessing the submentum and neck for RFAL and aspiration. Two more lateral ports are used to thermocoagulate and tighten each jowls and jawline. These Jawline and jowl ports can be either at the inferior border of the mandible at the lateral aspects of the submental crease on either side, or, through a sub-lobular port (Figure 16).
\nThe FaceTite® RFAL approach to the submentum, neck and jawline.
When working over the jawline, the FaceTite® physician must ensure that the internal electrode is above the SMAS and platysma, in the subcutaneous space to minimize the risk to the facial nerve. Because the RF flow is from the internal electrode up to the external electrode, there is a “thermal containment” which is not present in other mono-probe systems, minimizing a thermal neuropraxia of the marginal mandibular branch of the facial nerve (Figure 17).
\nKeep the internal electrode of the FaceTite® above the SMAS and platysma, working in the very superficial fat, to protect injury to the marginal mandibular branch of the facial nerve.
When performing RFAL along the jawline, the FaceTite RFAL lipocoagulation is executed using a slow moving and/or stamping technique within the superficial fat, just under the dermis (Figure 18). Always leave 3–5 mm of fat between the internal electrode and the dermis. The thermal endpoints are 69° in the superficial fat (US systems), a popping sound (International) and a skin cut off temperature of 38–40°. The FaceTite® can be performed just under the skin of the jawline and jowl to create significant skin tightening and firming of the jawline with reduction of the Jowl. Minimal or even no suction may be used in this region.
\nFor skin tightening and contraction, the FaceTite is passed with the superficial fat just under the dermis. Always leave 3–6 mm of fat between the internal electrode and the dermis. Adipose coagulation and dermal remodeling lead to tightening of the skin. Aspiration may or may not be performed depending upon the area.
When using the FaceTite in the submentum and neck, the internal electrode is passed through the submental fat pad, coagulating the adipose and delivering soft tissue contraction with deep endpoints being 69° (USA) or popping (International) and the skin temperature is brought to 38–40° (Figure 19). In the submentum and neck, suction aspiration is performed after the heating if there is a fatty deposit.
\nThe FaceTite® can be used superficially to deliver skin tightening without aspiration (jawline) or within the jowl, submental and neck fat and modest aspiration performed after for contour.
The FaceTite® and the newer AccuTite® can provide the liposuction surgeon with a procedure that “bridges the gap” between non-invasive face and skin tightening and the more invasive excisional procedures like a facelift (Figures 20, 21).
\nThe FaceTite® and AccuTite® can fill the gap in therapeutic options between more aggressive excisional procedures, like a facelift and the completely noninvasive external energy-based device (EBD) treatments and injectables.
Top panel is FaceTite® of the jawline and jowl, with FaceTite® and Morpheus of the neck. Bottom panel is FaceTite® and liposuction of the submentum and neck.
The FaceTite ®can also be used for small, focal liposuction body zones with little fat, to ensure soft tissue contraction prior to aspiration. Zones such as the upper arms, inner thighs, upper abdomen, as well as the jawline and neck as easily treated with the FaceTite®.
\nThe CelluTite hand piece has a V-dissector shape plastic tip, rather than bullet shaped and is used to treat advanced, grade 3 nodulo-pitted cellulite of the buttock and thighs. The hand piece is 2.4 mm × 17 cm long (Figure 22).
\nThe CelluTite® has a V-shaped tip, making the CelluTite® a thermal V dissector. The V-tip, traps the vertical, shortened, fibroseptal band that pulls down the dermis causing the deep skin pits. The band undergoes a thermolysis, release the pit and smoothening the skin.
The CelluTite® is designed to treat the three anatomic pathologies of Cellulite
nodules,
pits, and
dermal thinning with adipose herniation.
Cellulite patients tend to have a more vertically oriented FSN anatomy and, over many years there is a contraction of many of the vertically oriented fibroseptal bands and edema of the superficial fat which leads to the pits and nodules characteristic of more advance cellulite (Figure 23).
\nThe anatomy of cellulite: the FSN tends to be more vertically oriented. The pits are caused by shortened fibroseptal bands. Nodules result from edematous, swelling of superficial fat from the microcirculatory compromise. The dermis is thin, leading to fat herniating into the reticular dermis.
The CelluTite® patient is marked out in the standing position and all deep pits are marked for release, while the nodules are marked using a different color and are targeted for stamping and popping to reduce the nodules. The thinned dermis, that allows superficial fat herniation is then heated, thickened and minimizes the ability of superficial fat to herniate into the dermis.
\nOnly superficial tumescent anesthesia is required (first 4–6 cm of soft tissue) and a tense tumescent infiltration is instilled. The entire treatment is performed at level 2 on the CelluTite® depth setting. The procedure is divided into releasing the pits, followed by coagulation and reduction of the nodules. To release the pits, CelluTite tip is advanced the slowly at several levels across each pit. The thermal V-dissector captures the contracted FSN which is causing the dimple at the apex of the V (Figure 24) and bends the FSN over the RF emitting internal electrode, result in a thermoseptolysis and release, which allows the pitted skin to “pop back up” and smoothen the pitted appearance to the skin.
\nThe thermal V dissector captures the shortened vertical fibroseptal band(s) in the apex of the V and bends the band over the thermal electrode causing a thermoseptolysis and band division. This slow back and forth release is repeated a several vertical depth, providing a thorough release. This allows the pitted skin to “pop’ back up smoothening the overlying skin.
Additional smoothening is then achieved by moving the internal electrode up under a pre-marked nodule and performing a stationary stamping technique under each nodule and heating until the cutoff of 69° is achieved (USA) or, for International physicians, for 2 s, until there is a “popping” sound, both of which coagulate the edematous herniated fat, flattening the area and smoothening the contour (Figure 25).
\nThe CelluTite® applicator is placed under a nodule and a stationary stamping technique is performed causing coagulation of the nodule (70° cut off in the USA BodyTite® platforms and popping after 2 s in international BodyTite® systems). This coagulates the edematous fat and flattens the nodular skin.
Once all the pits and nodules have been successful performed, slow back and forth passes are made under the soft tissue until there is no FSN resistance with each pass and the external skin temperature reaches the pre-set cut off of 38–40°C. This will provide additional dermal thickening, minimizing herniated dermal fat (Figure 26).
\nThe skin and dermis are then heated to 38–40°C superficially and the subdermal space to 69° (US systems), thickening the dermis and reducing fat herniating into the dermis.
Excellent long term CelluTite® results can be achieved with a single treatment, often 50–70% reduction (Figure 27) which can last for many years (22). Recurrent nodulo-pitted irregularity is prevented by the creation of more multi-directional FSN, than the vertically oriented anatomy that contributed to the deformity and this multi-directional, remodeled FSN is resistant to any single fibroseptal band to shortening and causing a deep pit (Figure 28).
\nLong term, 36 month results of CelluTite of the buttock.
With release of the pits, flattening of the nodules and thickening of the skin, the remodeling process leads to a more multi-directional FSN network, which is resistant to shortening of individual bands and nodular swelling of the fat.
CelluTite® can be performed at the same time as BodyTite® and aspiration liposuction. Generally, in combination cases, CelluTite® of the buttock, posteriorly and laterally is performed superficially first, follow immediately by BodyTite® RFAL liposuction of the outer and inner thighs second.
\nNon-invasive suction coupled RF devices such as the BodyFX®, Velashap. 3®, Venus Legacy® and others can be used after 6 weeks of garmenting to maintain the outcome and protect the patient’s improvement.
\nThe AccuTite® is the newest and smallest of the BodyTite® RFAL applicators and can be deployed on any of the BodyTite® workstations (the 20 W and the 40 W BodyTite® Pro as well as the new Embrace RF workstation). The AccuTite® has all the thermal, impedance and contact automated monitoring and feedback as the BodyTite®, FaceTite® and CelluTite® applicators, but it is very versatile by nature of its tiny size. The internal solid, silicone coated electrode is only 0.9 mm in diameter and is 8 cm long. The entire Bipolar RFAL applicator can fit easily into the palm of your hand (Figures 29, 30). The AccuTite® is smaller than most of the conventional microcannulas being used to inject soft tissue fillers in the deep subcutaneous and supra-periosteal space (Figures 29, 30). The AccuTite® appeals to virtually every physician, both the surgeon and non-surgeon users who are looking for safe, predictable, non-excisional methods of coagulating fat and tightening skin. Physician users can think of AccuTite® as
The AccuTite® is the smallest of the RFAL hand pieces. It is 0.9 mm in diameter and can fit into the palm of your hand. The internal electrode is inserted under the skin to remodel the deep reticular dermis to 70°, while the external electrode will move along the surface of the skin and heat to 40–42°. The AccuTite® is shown above, next to a commonly used 22 gauge microcannula and the internal AccuTite® electrode is actually smaller. A 21-gauge needle is used to create an insertion port for the AccuTite®, which is then inserted under the skin and RF is injected under the dermis, resulting in skin and soft tissue tightening, hence, the
The AccuTite ®is small and easy to control. Above it is being used to tighten the para-nasiolabial smile line tissue and, following that, Juvederm is being injected through the same plane at a deeper level. The AccuTite® can be used under local anesthesia together with your soft tissue fillers and at the same time, often using many of the same tactics and skill sets.
The small size of the AccuTite® allows the physician us use a small #21-gauge port creation needle anywhere on the face, neck and body where skin needs to be tightened, with or without lipoaspiration. Once under the skin, the stamping and moving techniques for thermal coagulation are deployed, with the cut off temperatures of 69° internal and 38–40° external being deployed. When used subdermally for skin tightening, no aspiration is required.
\nThe AccuTite® can be used to coagulate fat and tighten the FSN prior to liposuction and aspiration in very small zones. The #21-gauge port needle site need not be closed with a suture and the physician can simply “pop in and out” of lax skin zones all over the body, including the upper and lower lid and perioral, jawline and neck (Figure 31).
\nThe small, compact size of AccuTite® and the small size of the internal and external electrode, allows this versatile RFAL applicator to gain access to areas of loose skin all over the face, neck and body. Despite its small size, the sub-dermal space is heated quickly and effectively to the same thermal endpoints as are used by BodyTite ® and FaceTite®, with the thermal endpoint of the subdermal space being 70° and the skin cut-off of 40°C. Skin tightening is significant and the small port access means a suture is not even needed for an access port.
The Morpheus is an externally applied fractional radiofrequency assisted lipocoagulation (RFAL) device that has been developed to help tighten and contract soft tissue, and contour superficial fat and skin texture at the time of liposuction, or as a stand-alone procedure. For the liposuction surgeon, once the BodyTite®, FaceTite®, AccuTite® or CelluTite® device has been deployed and the aspiration of the fat completed, a final step of lipocoagulation can be performed using the Morpheus, from
The Morpheus is an external applied micro bipolar RFAL device, that emits a 24 pin, positively charged array into the adipose tissue under the skin. Each needle, like RFAL, is a positively charged electrode that penetrates the fat and then releases ablative RF energy that flows up to a negative electrode on top of the skin.
Like BodyTite®, the Morpheus emits RF energy is ablative and coagulative near the uncoated tip of the pin and then, the RF energy flows strongly up the coated pin to a triangular shaped negative electrode. The RF pulse creates a zone of ablation several hundred microns in diameter that coagulates the fat and tightens the FSN (Figures 33, 34). The RF current then flows up the pin to the negatively charged, triangular electrodes located at pin exit sites on the tip to provide a bipolar, non-ablative thermal stimulation effect on the reticular and papillary dermis (Figures 33, 34). RF also flows form the positively charged, mono polar pin tip to the widely space negatively charge rails on the sides of the tip for a gentle sub-necrotic heating and the entire zone (Figures 33, 34).
\nThe tiny, coated, positive charged electrodes are inserted into the superficial fat, and, when the RF energy is released, a zone of ablation and adipose coagulation is created with each pulse, leading to FSN contraction and soft tissue contouring and tightening. The RF flows up to the negatively charged triangular shaped electrodes which creates a strong, non-ablative dermal remodeling effect of the each of the.
The zone of ablation and adipose coagulation contracts the FSN and contracts the soft tissue. The flow of RF up to the negative electrodes creates a more gentler, sub-necrotic, non-ablative heating and tightening of the dermis.
Basically, each of the 24 needles acts like a mini-BodyTite® internal electrode. Because the needle is silicon coated, there is no thermal epidermal-dermal effect and the ablation occurs around the positively charted, uncoated tip and is within the superficial fat using the FSN as the main vehicle for soft tissue contouring and tightening (Figures 33, 34).
\nThe physician can set the pin penetration depth to periocular (approx. 2 mm), face (3 mm) and body (4 mm) and treat at multiple sequential depths to create a vertical and horizontal fractional thermal stimulation and optimal contraction. The Morpheus is an excellent final step in BodyTite®, FaceTite®, AccuTite® and CelluTite® treatment to obtain superficial liporeduction, lipocoagulation and soft tissue tightening.
\nLike with BodyTite®, multiple passes of the Morpheus will allow the physician to create a vertical thermal lipocoagulation with skin tightening and remodeling. This horizontal and vertical thermal lipocoagulation leads to excellent skin tightening and can be done in contraction (Figure 35, 36).
\nMultiple pass and variable depth Morpheus will lead to vertical sequential FSN contraction, contouring and skin tightening.
The Morpheus can be offered on the face, or body, and after a treatment with a BodyTite® liposuction procedure for enhanced contraction and skin tightening after liposuction (Figures 36, 37).
\nMultiple pass, sequential vertical and horizontal Morpheus RFAL will lead to 3D soft tissue contraction and tightening.
When Morpheus is used on the face, multiple pass, multiple depth approach is used. The deep pass is ablative and coagulative in the deep layer, often the frontalis, orbicularis, SMAS and platysmal. The next pass coagulated the subdermal fat and the final pass into the fat of the subdermal space (Figure 37).
\nThe Morpheus can afford the liposuction surgeon, an external mini RFAL device that delivers 24 tiny mini BodyTite RFAL thermal injury injuries and can result in significant skin contraction. This can provide a nonexcisional face and necklift like result.
The Morpheus can be combined with BodyTite RFAL liposuction to improve overall soft tissue contraction and skin tightening (Figure 38).
\nCelluTite® or BodyTite®, FaceTite® and AccuTite® can be combined with Morpheus to enhance the overall soft tissue contraction and skin tightening with an “inside out” and “outside in” thermal sandwich approach.
The ability to achieve significant BodyTite® RFAL contraction has opened a more minimal excisional opportunity for surgeons in achieving optimal contouring results with less invasive procedures. Mini intra-pubic skin pinch tummy tucks, removing infra-umbilical skin excess with BodyTite® RFAL upper and lower abdominal lipocoagulation and aspiration can achieve results of a full abdominoplasty, with less scarring when the rectus abdominus diastasis is not significant. Axillary mini-brachioplasty with BodyTite® lipocoagulation and aspiration of the arm, limited incision, inguinal Anterior thigh lifting with BodyTite® liposuction to the inner thigh and lateral post or periauricular lateral face and neck-lifting with anterior compartment FaceTite® RFAL and lipoaspiration are all examples of combining BodyTite® RFAL applicators in combination with more minimal excisional approaches to achieve excellent results in selected patients.
\nBy combining the contraction power of RFAL with more minimal limited excisional approach, a less invasive option between totally non excisional energy based device treatments and full excisional, more standard lifting is created that gives patients the option for a better outcome than an EBD without the excisional scars, or recovery of a typical open surgery. Often these BodyTite® assisted procedures can be performed as an outpatient, under oral and tumescent anesthesia and nitrous oxide inhalational, avoiding a full general anesthetic. This BodyTite® RFAL together with the mini-lift, give physician an
BodyTite® RFAL is an industry leading lipocoagulation skin tightening technology and technique, with documented 35% soft tissue and skin area contraction. The physician still needs to perform final aspiration and contouring. Small, microcannula SAL, PAL (MicroAire, Vaser PAL or Tickle Lipo) are the most common aspiration options. UAL, Ultrasound assisted may be deployed prior to BodyTite®, particularly if fat grafting is being performed, as UAL will facilitate fat cell decohesion, separation and then aspiration and collection of the adipose tissue, BUT these adipocytes and adipocyte derived stem cells
SmartLipo®, or laser assisted liposuction (LAL) is another viable thermocoagulation soft tissue tightening system, with documented 17% area contraction. LAL is not as efficient as RFAL with inferior published skin contraction data, but, is a very strong brand and can be easily marketed. Occasionally, the physicians with both SmartLipo® and BodyTite®, may use the laser lipolysis for a small, and often subdermal component of the procedure and then deploy the BodyTite® applicator for the majority of the thermal coagulation process. Propulsive water assisted liposuction (WAL), is gentle, with less bruising, but does not lead to enhanced soft tissue contraction, so is not a common technology in most regions of the world. Plasma assisted liposuction is relatively new and can deliver soft tissue contraction, but lacks internal thermal control, is relatively slow and plasma may be better suited and relegated to external skin resurfacing.
\nBodyTite® is usually the stand along soft tissue contraction system and can be performed before the final aspiration contouring or, after aspiration and contouring has been performed. There are no studies confirming which, RFAL before or after aspiration, delivers the best contraction and results. The author does prefer to perform BodyTite® RFAL first, not just to optimize the number of FSN architecture that can be shortened prior to aspiration, BUT, also to ensure, small venule and arterioles undergo a thermal coagulation and then, when aspiration is performed last, there is less injury and bleeding into the subcutaneous space with less patient ecchymosis. The coagulation and liquification of fat, means more gentle aspiration forces are required, which likely translates into less edema, swelling and pain.
\nThe use of body tight RFAL applicators has evolved into a very safe and efficacious tool. Over 10,000 procedures have been performed worldwide with a very low complication rate. However, like any surgical tool untoward outcomes can occur and the risk of complication is often proportionate to the therapeutic index of safety of the device and the experience of the surgeon. Fortunately, over the past 10 years of BodyTite® innovation in the thermal lipocoagulation, there has been a tremendous evolution in the onboard sensing of soft tissue thermal profiles and automated modulation of the radiofrequency output around those variables.
\nContact sensor, high and low impedance sensors, external and internal electrothermal cutoffs, audible warnings as temperature rises, automated cut off temperatures, and energy output linked to the rate of rise of temperature with temperature surge protection are all part of myriad of onboard thermal control systems. Despite these safety features there is a small risk of a thermal injury. Because the heating from the subcutaneous level up through the, any thermal excess, any thermal excess will result in a full thickness burn. The vast majority these thermal injuries are small and limited nature and heal by secondary intent and occasional required excision once the scar has softened and remodeled (Figure 39).
\nA small full thickness BodyTite® burn during abdominal RFAL treatment. Secondary intent healing and remodeling, with dilute triamcinolone (Kenalog 2) injections will result is a very cosmetically acceptable result.
This risk a thermal injury far less than 0.25% (1 in 400 cases) and diminishes with the experience of the physician. To minimize the risk of a burner thermal injury conservative settings and parameters as outlined in this chapter and advanced training environments and experience, together with an adequate amount of tumescent anesthesia, and avoid peri-port injuries will make out the risk of the thermal excess very uncommon. When a peri-port burn occurs in a esthetically sensitive region, like the face or neck, the author will perform an epidermal closure over the injury, rather allow secondary intent healing and perform fractional RF or CO2 treatment once this is healed or, perform a secondary scar revision if necessary (Figure 40).
\nA small peri-port FaceTite® burn at the entrance of the nasolabial port. Simple epidermal 6–0 nylon closure over the injury will allow subdermal secondary intent healing without an obvious scab. Subsequent fractional RF or laser treatments or, even delayed excision will minimize the risk of any deleterious visible scar.
In the past BodyTite® and its RFL applicators lacked the sophisticated internal thermal monitoring and overheating of the adipose tissue occurred that often led to fibrous lumps and deep subcutaneous scar tissue. These internal areas of firmness and hardening are now extremely uncommon with sophisticated internal and external thermal monitoring the parameters are adhered to.
\nThe risk of significant bruising following RFAL assisted liposuction bruising is lessened with RFAL mediated thermal coagulation of small venules and arterioles and the resulting hemosiderin induced PIH is hence far less than lipocontouring with more ecchymosis.
\nThe risk of a seroma is higher using RFAL thermal coagulation is higher, most probably due to a temporary, but reversible injury to the subcutaneous and sub- dermal lymphatic system and so, an internal close drain is used by the author on all abdominal BodyTite® and RFAL cases. BodyTite® and RFAL to other anatomic regions does not increase the risk of seroma, so closed drainage is not deployed.
\nSensory anesthesia and, to some extent, dysaesthesia is more common with thermal lipocoagulation that non thermal lipoplasty and the during of recovery is longer (more like flap elevation). The reason for the more significant anesthesia is the effect of thermal coagulation resulting in a demyelinating effect of the sensory nerves, but generally 95% of patients get 95% return of sensation.
\nA good working knowledge of the anatomy of the region treated with the BodyTite® applicators will minimize deep internal thermal coagulation of sensitive vascular or neural structures. The most common reported injuries following BodyTite® when looking the worldwide literature would be damage to the antebrachial nerve of the upper arm and typically there’s a normal return of sensation, but occasionally permanent anesthesia can occur. Damage to motor nerves should not occur if one performs the RFAL in the correct subcutaneous plane. After 10 years of FaceTite® and AccuTite® to the face and neck, the author does not have a single case of permanent weakness of the marginal mandibular branch of the facial nerve. Because of the thermal containment of the bipolar RFAL, there is little to no heat below the internal electrode, which, when passed above the SMAS, platysma, orbicularis oculi and other facial muscles, the facial nerve is safe. Temporary neuropraxia of the marginal mandibular branch can occur, but this is typically from traction following aspiration and not a thermal injury.
\nBodyTite® and the RFAL applicators do lead to a more significant soft tissue contraction than any other liposuction assisted device. However, the thermal stimulus stimulation can result in a prolonged thickness and brawny edema of the skin that may take many months to settle. It is been the authors experience that this is uncommon when the focus is deep subcutaneous FSN mediated stimulation, rather than excessive dermal heating. Conservative superficial temperature and end points of 38–40°C are deployed. Because most of the contraction in the body zones relies on the deep FSN and three-dimensional contraction of this FSN, the author generally does not heat closer to the reticular dermis that 1–2 cm. However, when treating in the neck, face and the upper arm, more focus on dermal stimulation is required to gain the contraction and combination with the Morpheus, or RFAL from the “outside in” is safer.
\nWith appropriate patient selection, the risk of excessive skin laxity should be minimal. Most RFAL patients will achieve up to 35% area contraction and reasonable patient selection should result in a significantly high proportion of happy patients that would not have otherwise been liposuction candidates. Perry port burns.
\nBodyTite® RFAL is a highly sophisticated thermal coagulation system with a multitude of onboard automated, thermally monitored safety systems. It is to a testament to the safety of the system that the tens of thousands of treatments over the past 10 years have resulted in very few serious complications and has made BodyTite® the most effective and safest thermal coagulation body contour tool and in the esthetic space.
\nThe BodyTite® workstation has become one of the world’s most commonly used thermal coagulation liposuction system. The advantages and opportunities afforded the BodyTite® RFAL physician include:
Optimal soft tissue contraction using both the FSN mediated 3D contraction and dermal remodeling.
Studies show upwards of 35% areas contraction after 12 months.
An elegant array of automated feedback thermal control features that minimize over heating of adipose tissue and thermal complications that can ensue.
The ability perform liposuction more effectively on patients with more skin laxity and larger BMI’s.
The ability to offer outpatient, local anesthesia procedures that combine RFAL and more mini lifts with excellent result, less scarring and downtime.
Dr. Mulholland teaches physician workshops on the RFAL technology and is a paid consultant of InMode® and a patent contributor.
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