High frequency proficuity in aesthetic and therapeutic treatments

REVIEW ARTICLE

BESSA, Vicente Alberto Lima ^[1]

BESSA, Vicente Alberto Lima. The proficuity of high frequency in aesthetic and therapeutic treatments. Revista Científica Multidisciplinar Núcleo do Conhecimento. 04 year, Ed. 06, Vol. 07, pp. 116-139. June 2019. ISSN: 2448-0959

SUMMARY

It was Ernst Werner von Siemens who created the first high frequency generator and today this equipment has been used in aesthetics and physiotherapy. It can be understood the importance of this electrotherapeutic resource from this study, which aimed to analyze the physiological phenomena that can occur in the human body by employing high frequency in aesthetic and therapeutic procedures. Therefore, a qualitative explanatory bibliographic study was carried out in a database of Europe PMC, Pubmed/Medline, Lilacs, Scielo and Google Scholar. The research allowed us to infer that high frequency therapy has the ability to accelerate healing, destroy viruses, bacteria and fungi on the skin surface, in addition to oxygenating and nourishing tissues, analgesia and acting as an anti-inflammatory and facilitator of permeation of actives. There are several application techniques that must be selected according to the needs of each client. The indications are diverse both in the scope of aesthetics and therapy, but there are care and reservations in their use, that is, there are cases in which the procedure is not recommended. Therefore, it is inferred that the high frequency generator is highly beneficial to humans for both aesthetic and therapeutic purposes if correctly prescribed and applied.

Keywords: high frequency, ozone therapy, high frequency +healing, high frequency+bactericidal.

INTRODUCTION

Electricity has been widely used as a treatment for various organic disorders over centuries. It represents a form of energy that can promote changes in the physiology of the human body during its application. These changes can generate several aesthetic and therapeutic benefits. (ROBINSON, 2000).

The use of electricity to treat diseases came to be known as electrotherapy and over time a multitude of devices emerged that began to be used in medical practice, physical education, physiotherapy and aesthetics. One of the electrical equipment that can be used in therapeutic and aesthetic scope is the high frequency generator. It is known that this equipment generates alternating current, whose frequency and voltage parameters vary according to the type of manufacturer. (BORGES, 2006).

The equipment also generates ozone that is indicated in the treatment of circulatory disorders, as it activates local peripheral circulation. Besides being recommended for disinfection of infected lesions, because it has bactericidal action and antiseptic property. (DAL GOBBO, 2010).

The high frequency has an electrosmotic action that can by osmosis facilitate the permeation of substances in tissues, that is, permeation of cosmetic actives. (HERNANDEZ; MERCIER-FRESNEL, 1999).

The application of high frequency contributes to healing, as it accelerates the action of fibroblasts in collagen production and thus promotes aesthetic healing in people with first intention lesion. (MARCOS, ELIAS; PINHEIRO, 2013).

It is necessary to highlight that high frequency equipment is commonly found in aesthetic establishments, due to its simple handling, low cost and efficacy observed in clinical practice. Thus, understanding the physiological phenomena and the benefits that the application of high frequency generates in the human body is essential for the professional to correctly prescribe this type of equipment.

Therefore, your job requires scientificity in order to avoid errors in its handling or prescription. Based on the above, the following problem situation arose: What are the physiological effects provided by high frequency therapy and its aesthetic and therapeutic benefits?

To develop the study, the general objective was outlined, which consisted of analyzing the physiological phenomena that can occur in the human body by employing high frequency in aesthetic and therapeutic procedures. In addition to the specific objectives that consisted of: explaining the aesthetic and therapeutic benefits provided by the treatment with high frequency based on physiological effects; describe the techniques of aesthetic application of high frequency; identify care, indications and contraindications when applying to high frequency.

The present study was justified in that the use of high frequency therapy is widely applied in the aesthetic area and can promote benefits in facial, body and capillary aesthetic treatments. However, there is still a need to investigate how physiologically these organic benefits occur, because by knowing these mechanisms it can be elected more safely for each specific treatment. In addition to avoiding adverse effects or unexpected complications.

This study was undoubtedly relevant for all who work with Dermatofunctional Physiotherapy, for beauticians or for people who want to know more, how high frequency promotes various chemical and physical reactions that imply infection prevention, healing acceleration, hemostasis, etc. Added to the fact that understanding the proper use of high frequency equipment will avoid injury to clients and physical risks in the professional.

It is necessary to highlight that recent studies have not been disseminated in digital media, either in Portuguese or English, and very little material dates from recent years. This fact contributes to demonstrate the relevance of developing new research on high frequency, especially in the field of aesthetics.

2. LITERATURE REVIEW

2.1 THE HIGH FREQUENCY GENERATOR

Ernst Werner von Siemens was born on December 13, 1816, Lenthe, Prussia – present-day Germany – and died on December 6, 1892, Charlottenburg, Berlin, Germany. He was a German electrical engineer who played an important role in the development of pointer telegraph, electric lift, selenium photometer, electric generator and alternating current electric dynamo. In addition, he was the builder of Europe's first telegraph lines and one of the founders of the Siemens Aktiengesellschaft conglomerate, or simply Siemens AG, which is a German industrial conglomerate, being the largest in Europe and one of the largest in the world. (The Editors of Encyclopaedia Britannica, 2018). Therefore, it was Siemens who created the first high frequency generator (HF) in 1957.

At a later time, Kleinmann researched the efficiency of the high frequency generator to inhibit bacterial flora through tests on animal and human mucosa. (BARROS; SANTOS; BORGES, 2007). Since then, several works have been done to verify the effects that this equipment can have in the medical, physiotherapeutic and aesthetic spheres.

It is known that the equipment has different types of glass electrodes filled with gas or rarefied air. When the electric current reaches the electrode, there will be ionization of the gas molecules forming the ozone on the electrode surface (MARTINS, A. et. al., 2012). Therefore, the high frequency generating equipment produces an alternating current of low intensity and high voltage that when passing through different types of glass electrodes generates ozone. (KARELO, 2013).

This equipment uses alternating currents, and argon, xenon or neon gases come into contact with oxygen from the air and transform it into ozone. The main physiological effects are: thermal, hyperemia and vasodilation, increased cellular oxygenation, bactericidal and antiseptic action and improvement of dermal trophism (OLIVEIRA; PEREZ, 2008).

Ozone because it is an unstable molecule is facially decomposed into molecular oxygen (_O2) and atomic oxygen (O). It is known that ozone has disinfectant action thanks to the effect of atomic oxygen released during decomposition. (BARROS; SANTOS; BORGES, 2007).

It is necessary to highlight that the high frequency current when passing through the electrode can acquire several shades according to the type of gas contained in the electrode. If the contents of the electrode are the vacuum to the current assumes a bluish luminescence, already in the presence of neon gas, the current assumes an orange tint. (SORIANO; PÉREZ; BAQUÉS, 2002).

It is known that the alternating current of the high frequency generator has a frequency that can range from 150 to 200 kHz and a voltage of 30,000 to 40,000 volts. This device generates an electric field that has the ability to determine physiological changes with immediate effects in clinical practice, possibly due to its bactericidal, antiseptic and anti-inflammatory action, which can benefit tissue repair. (OLIVEIRA, 2011).

The aesthetic and therapeutic benefits provided by the treatment with high frequency are vast, because the effects of electrotherapy are added to those of ozone therapy. Since it is known that ozone therapy may intervene in the balance of oxide-reduction, therefore it has been widely explored in the treatment of acute and chronic diseases. Ozone can be obtained through high frequency generating equipment, which has been widely used in the treatment of skin disorders, accelerating the healing process of skin wounds. (Pereira Sá, 2010).

2.2 THE AESTHETIC AND THERAPEUTIC BENEFITS PROVIDED BY HIGH FREQUENCY TREATMENT

Ozone therapy can be used in all skin types and its use as germicide or bactericide is widespread. Ozone gas is considered an unstable form of oxygen, having the same properties of this, however much more energetic. (PEREIRA, 2007).

A study on the application of ozone therapy in patients with pulmonary emphysema was conducted to evaluate the effects of rectal ozone therapy in patients with pulmonary emphysema. For this purpose, 64 patients between 40 and 69 years of age with pulmonary emphysema who underwent 20 daily sessions with rectal or untreated medicinal oxygen were randomly assigned. To evaluate the result, the volunteers were submitted at the beginning and at the end of the study to clinical evaluation and spirometry. Fifty volunteers completed the protocol, 20 received ozone therapy, 20 received rectal oxygen and 10 did not receive any therapy. They concluded that volunteers who received ozone therapy had significantly lower values of forced expiratory volume in the first second (fEV1) and fEV1 / forced vital capacity, so rectal ozone therapy may be useful in patients with pulmonary emphysema (Calunga, 2011). This fact proves that ozone therapy can stimulate antioxidant systems and protect against free radicals and improve lung ventilation.

Several studies have been done to verify the effects of HF equipment, among them its effect on the treatment of onychomycosis of three patients. In this study, subungueal material was collected for mycological analysis, that is, direct examination and culture. Then weekly HF applications were made on the nail lamina for 12 months, and new analyses were performed monthly. Before starting hf sessions, the three examined had a positive test for Trichophyton rubrum and one of them was also positive for Candida. Although the result remained positive throughout the treatment, there was an inhibition of fungal growth in culture. Regarding the clinical and aesthetic aspect of the nails, there was improvement in shape and staining and there were no side effects. (DA SILVA; FARIA, 2011).

Another research conducted to verify the antimicrobial action of hf use was a case study of a patient with common nail wart, in which hf was applied for 15 minutes for 3 times a day and for 3 months. For this, the sheaddress technique was used. The follow-up was performed by photometry at the beginning and at the end of the treatment. The result culminated in complete tissue regeneration at the site of the lesion, disappearing the yellowish of the nail lamina and leaving no sequelae of deformation (BARROS; SAINTS, SAINTS, SAINTS, SAINTS, BORGES, 2007).

In order to verify the bactericidal effect of the HF generator on staphylococcus aureus culture, an in vitro experimental analytical study was carried out. For this purpose, 36 Petri dishes were inoculated with Staphylococcus aureus and divided into 6 groups with 6 plates. Two groups were used as control and did not receive intervention. Of these, one group was used to control the treated groups 5 times a week; another for the treated 3 times a week. Four groups were treated, 2 groups treated 5 times a week for 10 and 15 minutes, respectively. Another 2 groups were treated 3 times a week for 10 and 15 minutes, respectively. All 4 groups received a total of 15 HF interventions. At the end, replication was performed in sterile Petri dishes and after 48 hours, they were photographed to check for bacterial proliferation. The study allowed us to infer that the frequency of 5 times weekly for 15 minutes had the best bacterial effect. (MARTINS et. al., 2012).

A similar study was carried out at the Microbiology Laboratory of the AngloAmerican College in Foz do Iguaçu, Paraná, brazil, using the high frequency generator in Staphylococcus aureus culture. The objective of this research was to verify the bactericidal effect of the high frequency generator on the culture of S. aureus. Therefore, 36 Petri dishes were inoculated with bacteria and were divided into 6 groups: 4 treated and 2 controls (CG3 and GC5). Two plates (G5-15 and G5-10) were treated 5 times a week for 15 and 10 minutes, respectively; two others (G3-15 and G3-10) were treated 3 times a week for 15 and 10 minutes, respectively. In the treatment, the high frequency apparatus was used by the standard electrode and intensity 10 shetation technique. The plates were observed and photographed in order to verify the occurrence of bacteria proliferation. The study allowed us to infer that the device had a bactericidal effect after 15 interventions, at a weekly frequency of 5 applications, with a daily exposure time of 15 minutes. (Marquetti; ruaro; fréz, 2012)

HF has also been used in studies to investigate its effect on pain and healing of pressure ulcers. A pilot clinical trial study was conducted in 8 patients with grades II and III of pressure ulcers who were hospitalized in the ICU. The volunteers were divided into 2 groups, 2 patients for control and 6 patients submitted to daily HF sessions for 10 days. The technique used was pheasing with 80% amplitude around the ulcer and its interior. A total of 10 sessions were applied daily at the maximum time according to the lesion dimensions (1 minute for each cm²), in a total of 2 weeks of intervention. Pain was evaluated by the visual analog scale for pain and healing by push (Pressure Ulcer Scale for Healing) tool, PSST (Pressure Sore Status Tool) and ulcer surface area by planimetry and imaging. The study found that there was a significant difference between the control groups and submitted to HF. Improvement in healing and pain was observed. (KARELO, 2013).

Another study conducted to treat pressure ulcers through HF aimed to demonstrate its benefit through a literature review. The authors concluded that HF can be used in the treatment of various types of skin lesions, including pressure ulcers. The technique was considered safe, easy to handle and low cost. (OLIVEIRA, L.M.N., 2011).

An experimental study was conducted in 24 Wistar rats, in which skin wounds of 8 mm in diameter were made. Then, the animals were separated into four groups: A, control; B, GaAlInP laser; C, high frequency generator, and D, GaAlInP laser + high frequency generator. The equipment was: the GaAlInP laser of 670nm, 6 J/cm² and 120 seconds and the high frequency generator with intensity of 80% and 120 seconds. The study aimed to evaluate the action of gaalinp laser and high frequency generator in the treatment of skin wounds. It can be concluded that the combined therapy (GaAlInP laser + high frequency generator) was the most effective for abbreviation of the cicatrical process. (Pereira Sá, 2010).

To investigate the effects in the treatment of pressure injury on the size and time of healing, with the use of the high frequency generator, in elderly people affected by neurological diseases. The study methodology was descriptive, exploratory, of the type of non-pharmacological intervention research, which was carried out in a Physical Rehabilitation Unit, in Ijuí, in the northwest of Rio Grande do Sul. Three sedentary elderly men with clinical diagnosis of pressure injury in stages II or III and under clinical treatment were intentionally selected. The evaluation of the lesions was performed based on the appearance of the wounds, the characteristics and the degree of classification, in accordance with the National Pressure Ulcer Advisory Panel, which covered three dimensions: type of tissue, amount of exulate and area of the lesion. Two volunteers were submitted to 16 sessions lasting 15 minutes and one volunteer was submitted to 13 sessions lasting 15 minutes, because healing occurred. At the end of the sessions, complete healing occurred in two users and, in the third, partially. The study allowed us to conclude that high frequency therapy is effective in the treatment of pressure injury. (ALMEIDA. et al., 2017).

A study on the application of high frequency, laser and microcurrent aimed to demonstrate the effects of the association of these three resources in the treatment of tissue repair in pressure injury. As a methodology, a case study was made of a 25-year-old spinal cord injured man who had stage 4 pressure injury, due to a long period of beding or seding in the wheelchair. The volunteer was treated at the FisioUnisc clinic of the University of Santa Cruz do Sul and underwent an evaluation to collect demographic and clinical data. For this, we used the Instrument for Assessing the State of pressure injury proposed by Barbara Bates-Jensen and the Classification of Pressure Injuries by Stages. In the volunteer, it was applied 10 minutes of high frequency with small mushroom electrode sweeping the entire surface of the lesion. Subsequently, the microcurrent was applied for 25 minutes, with a frequency of 600Hz with two channels distributed in cross form with 100Hz intensity in each one. In the following session, the application of the high frequency followed by the low-power laser in point mode with intensity of 12 Jcm² was repeated for the time determined by the equipment for each point, with continuous beam emission, 660nm wavelength. The procedure was maintained for 15 sessions, 3 times a week alternately. The final result obtained was a reduction of 81% in the size of the pressure injury, which showed satisfactory results. (SCHUH, 2017).

A study was conducted to verify the efficacy and clarify the underlying mechanisms of oxygen-ozone treatment in DFUs (diabetic foot ulcers). Fifty type 2 diabetic volunteers complicated with DFUs were divided into 2 groups: a control group treated only by standard therapy and group treated with standard ozone therapy plus oxygen-ozone treatment. The wound was measured and tissue biopsies were performed at the beginning and end. Immunohistochemical tests of expressions of vascular endothelial growth factor (VEGF), β growth transformation factor (TGF-β), and platelet-derived growth factor (PDGF) proteins in pathological specimens were determined. It can be concluded that ozone therapy promoted wound healing in THE sUs through the potential induction of VEGF, TGF-p and PDGF in the initial phase of treatment. (Zhang et al, 2014).

The use of high frequency has been used in the postoperative period of abdominoplasty and rhinoplasty due to the aid of tissue oxygenation and its bactericidal effect. In such cases, it is recommended to use a gauze on the skin during the application of high frequency to facilitate sliding and decrease the incidence of direct current on the skin. (MAUAD, 2003).

Due to its antimicrobial effect on viruses, fungi and bacteria, HF equipment has been widely used in the areas of physiotherapy and aesthetics. In addition to the antimicrobial effect, HF has improved tissue nutrition and oxygenation, analgesia, healing and anti-inflammatory effect and therefore has been recommended in hair, facial and podiatry aesthetic treatments. (BORGES, 2006).

The use of high frequency collaborates in skin cleansing, in hair therapy improving the circulation of the scalp, in the healing of lesions originated by acnes, benefits the process of skin repair, and facilitates the indirect ionization of substances, such as nutritious aqueous ampoules based on collagen. (SANTOS; GUIMARÃES, 2008).

HF has antimicrobial effects, accelerates healing, provides analgesia, improves oxygenation and nutrition of tissues thanks to thermal and vasodilator effects, besides being anti-inflammatory, so it has been used both for medical treatment and in dermatological and aesthetic physiotherapy procedures, among them: after podiatry procedures, post-epilation, post-extraction disinfection of comedones, in capillary therapy of alopecia and seborrhea , cauterization of skin post-extraction of pustules, facilitate the permeation of actives etc. (IBRAMED, 2012).

A study was conducted on the application of high frequency in the treatment of acne, whose objective was to evaluate the effectiveness of high frequency current in the treatment of grade I and II acne vulgaris in dermatofunctional physiotherapy. The methodology was clinicaltrial, uncontrolled, exploratory, in which 50 volunteers aged 18 to 25 years female, who were evaluated and submitted to 8 sessions of high frequency, 2 times a week, with 1 hour of care. The volunteers responded to the end of the treatment that increased their self-esteem and were very satisfied with the results of the treatment. The study states that high frequency causes disinfection after extraction of acneetic efflorescences. (Rodrigues, 2014).

A prospective, descriptive and experimental clinical trial was conducted that aimed to perform and evaluate the efficacy of a protocol for acneskin that was prepared by the Medicatriz associated with ozone vapor and the high frequency apparatus. Photographic monitoring and visual evaluation were performed. The high frequency was used before the application of the clay mask in all sessions of acneic skin treatment to obtain antibactericidal, antifungicide and antiseptic effect. The result of the protocol allowed us to conclude that there was a reduction in inflammatory lesions, texture and decreased skin oiliness. (SILVA; PEREIRA, 2018).

A research was carried out whose objective was to review the literature in relation to the causal factors and topical treatments used for acne. The methodology adopted was a literature review in the last ten years in databases such as SCIELO, LILLACS and PUBMED. The authors concluded on the importance of treatment through topical substances (retinoids, benzoyl peroxide, nicotinamide, azelaic acid, azeloglycine and topical antibiotics) in people with mild and moderate acne, as well as oral medication. And they reported that there is a vast arsenal of treatment of open comedones, papules and pustules ranging from chemical peeling, microdermabrasion, laser therapy to electrotherapy equipment, such as high frequency and low potency. It is necessary to emphasize that the authors stressed that it is essential to associate the high frequency generator in the extraction sessions of the comedones to prevent infections. (DEUSCHLE et al., 2015).

2.3 THE TECHNIQUES OF AESTHETIC APPLICATION OF HIGH FREQUENCY

To apply high frequency therapy it is necessary to know the equipment, including its components, as well as the application techniques. Thus, it is possible to choose the most appropriate approach, therefore it is necessary to describe the techniques of aesthetic application of high frequency therapy.

It is known that the high frequency apparatus has different types of electrodes consisting of a vacuum glass tube or containing special gas that attach to a coil, which allows adaptation to the different body regions in which they will be applied. (SORIANO; PÉREZ; BAQUÉS, 2002).

The time of use depends on the location and type of application, which is most often in approximately three to ten minutes. Since the intensity adopted should be sufficient to generate pheasing, but respecting the sensitivity of the client. Disinfection of electrodes after use should be done with a paper, or cloth cleaned with 70% alcohol. (OLIVEIRA; PEREZ, 2008).

The equipment depending on the manufacturer can be bivolt or has a switch switch 110/220 volts. The components of this type of appliance are very similar and can be found described in the instruction manuals provided by the manufacturer. In the IBRAMED manual (2012) you can find each component of the high frequency device, namely:

1. HF high frequency applicator pen;
2. Switch off and high frequency intensity control;
3. HF pen cable;
4. Power supply of the equipment;
5. HF pen cable output;
6. Switch switch 110/220 volts;
7. Power supply connection pins in the power outlet;
8. Protective fuse.

It is good to note that the numbering corresponds to each component presented in Figure 1.

Figure 1: Components of the HF apparatus

For the application of high frequency therapy a pen called hf pen is used and it is that glass electrodes are connected. There are different types of glass electrodes to adapt to the client's body surface and to meet facial, body, capillary and podiatry treatments. It is necessary to emphasize that all electrodes have the same function, and the distinct shape has merely an anatomical function. Electrodes should only be sanitized with a clean cloth or tissue paper according to the IBRAMED Equipment Manual (2012).

Figure 2: Glass electrode and HF pen

The most frequent types of electrodes used in high frequency therapy are: 1. fork-type electrode; 2. small standart (or smaller chives or spherical); 3. saturator type; 4. cauterizer type (or cautelizer); 5. large standart (cebolão or spherical major); 6. comb type. It is appropriate to emphasize that the numbering described obeys each component presented in Figure 3.

Figure 3: Most commonly used glass electrodes

There are less used electrodes, but with their peculiarities and equal therapeutic efficiency, they are: 1. roller-type electrode; 2. cachimbinho type; 3. medium pipe; 4. big pipe; 5. fishtail (or whale tail); 6. language type; 7. mushroom type; 8. shower type; conjugated electrode 3 in 1. However, it should be noted that the different electrode models serve to better adapt the client's body surface.

Figure 4: Other types of glass electrodes

Source: the author, 2019

The techniques of application of high frequency therapy can be basically divided into four types: fluxation, direct sheezing, fulguration and indirect pheaking (SORIANO; PÉREZ, PADS; BAQUÉS, 2002; HIDROSUX[201?]).

Fluxation or fluviation is a technique in which the electrode is passed slowly on the flat surface and in direct contact on the skin well dry for better ozone actuation. Before touching the electrode on the client, the professional should place his finger on the end of the electrode and remove it only after contact with the customer's skin. At the end of the treatment, the electrode is removed by placing the finger at the end of the electrode and removing it from contact with the client's skin (DAL GOBBO, 2010). The use of cosmetics, paper or gauze in this application technique is contraindicated. This technique is recommended in cases of facial and body post-epilation such as prophylaxis, capillary treatment with comb electrode (seborrhean skin), after facial skin cleansing (acne skin). The electrodes most used in this technique are small and large standarts and the fork type, the latter besides being used post-epilations in the body, is also used for cervical relaxation.

Direct sparks is a technique in which the electrode is slightly away from the customer's skin in order to cause sparks. In this case, there is the formation of ozone and there will be an effect of hyperemia and stimulation, with antiseptic action and therefore, it is a technique indicated post-epilation, after extraction of comedones and pustules and also for unborn and devitalized skins.

Fulguration is a variation of the direct sheeping technique and in this technique the formation of ozone is obtained that will facilitate healing and homeostatic effect (blood stagnation), after drainage of pustules, small post-epilation bleeding, nail wounds after cuticle removal. For its application, the cauterizer glass electrode is used, which is a short distance from the skin (millimeters), however without touching it at any time.

The last technique is indirect sphinctering which is a unique technique for electrode saturator. It has a toning action on the neuromuscular system, the client should hold the glass electrode in one hand and the coil (electrode holder) in the other hand, while the professional performs a gentle patter on the client's skin or massages in the region to be treated. It is the only one that can have cosmetic use, so it is recommended for permeation of cosmetic assets such as oils, nourishing creams, since this procedure also has the property of increasing skin vascularity. It is recommended that the application time of this technique is 3 minutes, but when the skin is very devitalized, a maximum of 5 minutes can be applied. (DAL GOBBO, 2010).

2.4 CAUTIONS, INDICATIONS AND CONTRAINDICATIONS WHEN APPLYING AT HIGH FREQUENCY

High frequency therapy can be used as a complement in tissue hydration and facial revitalization; antiseptic after surgical procedures; after skin cleansing (acne skin treatment); cauterization of pustors; disinfection of the scalp; peticulose; alopecia; seborrheic dermatitis; post-epilation; folliculitis; psoriasis; treatment of friezes and mycoses in podiatry; after extraction of eponychic in the manicure and pedicure; open wounds; infected pressure ulcer; can be used with care in rosacea-bearing people; and for permeation of ionizable assets.

The main contraindications are: cardiac pacemaker, sensitivity changes, skin with flammable products, neoplasms (cancer) and pregnant women (OLIVEIRA; PEREZ, 2008). There are also contraindications in clients with deep vein thrombosis, chain allergy, renal and cardiac insufficiencies, hypertensive and decompensated diabetics. If the customer wears hearing aids, they should take it off, as they may be damaged or deregulated by high frequency equipment. It is also not recommended for people with epileptics and with pins or metal plates at the site of application and cardiopathic.

The following is possible to present a table with the main indications and contraindication for the prescription of the use of high frequency.

Table 1: Indications and contraindication of HF

Source: the author, 2019.

Some care is needed, among them:

• high frequency generating devices should be removed about 6 meters from other galvanic current or tidal appliances, if used concomitantly, as there are cases of care by more than one professional in very close cabins. Remembering that the cables of other devices can act as antennas, capturing the electromagnetic waves produced by the high frequency devices and this may damage the device and / or generate some danger to the customer under treatment;
• it is recommended that the high frequency appliance be subjected to preventive inspection and maintenance at technical stations every 12 months of use. (IBRAMED, 2012);
• the connection between the electrode and the electrode holder should not touch the customer's skin, as it may feel a very strong electric shock. Nor should the professional ever touch that connection;
• treatment if the region is wet or wet.

3. METHODOLOGY

The study was based on explanatory and qualitative bibliographic research and can be characterized as follows:

Bibliographic research because it was elaborated from books, articles and material already published concerning the use of high frequency in aesthetics and therapy.

The bibliographic research is done from the survey of theoretical references already analyzed, and published by written and electronic means, such as books, scientific articles, web sites pages. Any scientific work begins with a bibliographical research, which allows the researcher to know what has already been studied on the subject. There is, however, scientific research that is based solely on bibliographic research, seeking theoretical references published in order to collect information or previous knowledge about the problem about which the answer is sought. (FONSECA, 2002, p. 32)

It was explanatory because it explained the physiological phenomena that result in organic benefits in a person undergoing treatment with high frequency equipment. Therefore, it was undoubtedly a question of seeking the reason why a phenomenon happened.

The explanatory research "… have as its central concern to identify the factors that determine or contribute to the occurrence of phenomena. This is the kind of research that most deepens the knowledge of reality, because it explains the reason, the why things are." (GIL, 2007, p. 42).

It was qualitative, because it did not require the use of statistical methods and techniques, so she was concerned with aspects of reality that cannot be quantified, focusing on understanding and explaining the dynamics of the observed phenomena.

Quantitative research, which has its roots in logical positivist thinking, tends to emphasize deductive reasoning, logic rules and measurable attributes of human experience. On the other hand, qualitative research tends to highlight the dynamic, holistic and individual aspects of human experience, in order to apprehend totality in the context of those who are experiencing the phenomenon. (POLIT; BECK; HUNGLER, 2004, p. 201).

The study on the subject was carried out through the systematic analysis of textbooks in the area of Dermatofunctional Physiotherapy and Aesthetics that covered the subject in question. The following keywords were searched in the health information databases: Europa PMC, Pubmed/Medline, Lilacs, Scielo and Google Acadêmico using as uniterms the following keywords: high frequency, ozone therapy, high frequency +healing, high frequency+bactericidal in the databases in Portuguese and high frequency, ozonotherapy, high frequency + cicatrization, high frequency + bactericide in the English databases.

4. FINAL CONSIDERATIONS

The high frequency generator is an easy-to-reach device for aesthetics and physiotherapy professionals, as well as being simple to handle and with wide applications in the world of aesthetics and therapy.

The high frequency allows unmatched benefits, such as: acceleration in the healing process of skin wounds; antimicrobial effect on viruses, fungi and bacteria; improvement of oxygenation and tissue nutrition thanks to its superficial vasodilator effect; anti-inflammatory and analgesic effect; facilitates the permeation of some cosmetic actives, such as collagen-based nutritious aqueous ampoules, elastin, urea, placental extracts cutaneously.

The application techniques are fluxation, fulguration and direct and indirect pheasing. All techniques are extremely easy to apply and without increasing financial costs. As for the indications of high frequency, they range from therapy, facial aesthetics, body aesthetics to capillary aesthetics. Contraindications include decompensated arterial or diabetic hypertensive, epileptics, people with cardiac pacemaker or local metallic implant, sensitivity disorders, skin with flammable cosmetics (alcohol and ether), people with cancer and pregnant women.

It is concluded that high frequency therapy can add value to aesthetic and physiotherapeutic procedures, although it is not the only procedure to be used but part of a set of therapeutic strategies. It was observed the lack of updated studies concerning the topic approached and it is recommended that new studies be implemented to verify other aplicabilities of this therapeutic and aesthetic resource.

5. BIBLIOGRAPHICAL REFERENCES

ALMEIDA, R. et al. Gerador de alta frequência no tratamento de lesão por pressão em idosos. Rev enferm UFPE on line., Recife, v.11, n.8, p.3136-42, ago., 2017.

BARROS, V.C.C; SANTOS, V.N.S; BORGES, F.S. Tratamento de verruga ungueal causada por HPV com o uso do gerador de alta frequência: relato de casos. Revista de Especialização em Fisioterapia. v. 1, n.2, out/Nov/dez. 2007.

BORGES, F.S. Alta frequência. In: Borges, F.S. Dermato-funcional: modalidades terapêuticas nas disfunções estéticas. São Paulo: Phortes, 2006.

Calunga, J.L.; et al. Terapia de ozônio retal em pacientes com enfisema pulmonar. Revista Médica de Chile. v.139, n.4, p. 439-447, 1 abr. 2011.

DA SILVA, J.L.M.; FARIA, D.P. Uso de ondas de alta frequência no tratamento de onicomicose comunicação prelimilar de três casos. An. Bras. Dermatol. Rio de Janeiro, v. 86, n.3 maio/Jun. 2011.

DAL GOBBO, P. Estética facial Essencial: orientações para profissional de estética. São Paulo: Atheneu, 2010.

DEUSCHLE, V. C. K. N. et al. Caracterização das lesões e tratamentos utilizados na acne. Revista Interdisciplinar de Ensino, Pesquisa e Extensão. v. 3 n. 1, 2015. Disponível em: http://revistaeletronica.unicruz.edu.br/index.php/eletronica/article/view/224-236/pdf_52. Acesso em: 1 dez. 2018.

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^[1] Master in Human Motricity Sciences; Specialization in Sports Training and Personal Trainner; Specialization in Medical Gymnastics; Specialization in Advanced Topics in Physiotherapy; Specialization in Dermato-functional Physiotherapy; Specialization in Poruguesa Language; Graduated in Physiotherapy; Technologist in Aesthetics and Cosmetics,; Bachelor and Bachelor's degree in Physical Education,; Graduated in Letters,; Graduated in Pedagogy.

Submitted: April, 2019.

Approved: June, 2019.