Transcript Monopolar and Bipolar

Radiofrequncy
Dr.F.Iraji
Radiofrequency ablation
• radiosurgery, high frequency
electrosurgery) is a dermatosurgical
procedure that aims at the surgical
management of benign and malignant skin
conditions by using various forms of
alternating current at ultra high frequency
(500-4000) kHz
Radiofrequency ablation
It is also popularly known as "poor man's
laser" or "cold cautery". The most common
form of radiofrequency ablation used in
dermatology involves the application of
high-voltage electromagnetic energy in the
form of a damped sine wave.
Radiofrequency ablation
• This form of current may be applied by
electrofulguration, electrodessication or
electrocoagulation. Radiofrequency
ablation (RFA) has gained importance in
the recent years as it is highly effective in
the cutting of the skin lesions with
adequate hemostasis at the same time
because of good coagulation..
Radiofrequency ablation
• Radiofrequency can be used for incisional
techniques that produce full-thickness
excision of nevi, shave techniques that
produce partial-thickness removal of
superficial lesions and removing vascular
lesions such as hemangiomas or pyogenic
granulomas
Radiofrequency
• works on the principle of increasing the
frequency and voltage while
simultaneously decreasing the amperage
of alternating current so as to generate
oscillating radiowaves. These radiowaves
are further modified to produce different
waveforms that are passed into the lesion.
Modern high-frequency radiosurgical
devices transfer electrical energy to
human tissue via a treatment electrode
that remains cool.
Radiofrequency
• The electrical resistance of human tissue
helps in converting this electrical energy
into molecular energy; this causes the
denaturation of intracellular and
extracellular proteins, thereby resulting in
coagulation or desiccation effects..
Radiofrequency
• Increasing the temperature of the
intracellular water above the boiling point
(400-600ºC) causes the cell membrane to
rupture, thereby producing a cutting effect.
The lateral spread of heat results in the
residual thermal damage by causing
dehydration and coagulation necrosis of
the tissue proteins and carbonization
Radiofrequency ablation
• The basic equipment comprises a radiosurgical
unit with a ground plate (dispersive electrode),
foot switch and hand piece. It is provided with
tungsten electrodes of various shapes and sizes
with bendable shafts that are fitted into hand
piece. A suction device for the evacuation of
smoke in extensive surgery is also attached to
the equipment. Radiofrequency uses various
waveforms with the following tissue effects.
Electrosection
• The fully filtered and rectified waveform applied to the
tissues in biterminal fashion provides a smooth cutting
current resulting in elecrosection. An electrode tip in the
shape of a fine needle, wire loop, diamond, ellipse or
triangle is advanced slowly through the tissue, causing a
steam envelope to advance around the tip and producing
a smooth cutting effect.
Electrosection
• The fully rectified current simultaneously
produces cutting and coagulation. This
waveform produces least amount of lateral
heat spread with minimum tissue
destruction.
electrocoagulation
• Deep tissue destruction): The partially
rectified waveform applied to the tissues in
a biterminal fashion causes
electrocoagulation. It gives instant
homeostasis and is used in the treatment
of the vascular lesions in which
coagulation is primarily required.
electrodessication and
electrofulguration):
Superficial tissue destruction This is achieved by the
application of markedly dampened current to tissues in
monoterminal or biterminal fashion. Fulguration causes
the greatest amount of lateral heat spread and has a
potential dehydrating effect. It causes the superficial
tissue destruction through dehydration and surface
carbonization. The electrode is held at a distance from
the skin lesion in fulguration, while the tissue is touched
with the electrode in desiccation.
Local anesthetic
• Local anesthetic, i.e., lignocaine is administered before
most radiosurgical techniques. The use of lignocaine
with epinephrine further reduces blood loss, but the use
of epinephrine at the tips of digits and the nose should
be avoided. Another alternative is to use a eutectic
mixture of local anesthetics (EMLA) cream that contains
2.5% lidocaine and 2.5% prilocaine. It is applied under
occlusion to skin at least 1 h before the procedure to
achieve topical anesthesia. Anesthesia may not be
necessary for the electrosurgery of small lesions such as
telangiectasias and small skin tags.
Intensity of the power setting
•
: The cutting of the tissue should be brisk and
with the smallest electrode and power setting
that is required to minimize the tissue damage
and bleeding. The correct output power can be
determined by starting at a low power and
increasing the power until the desired outcome
is attained (destruction, coagulation or cutting).
In general, coagulation requires higher power
settings than cutting, which requires higher
power settings than desiccation or fulguration.
The power settings for treating cutaneous
lesions are generally low (10-20W).
Intensity of the power setting
• Surface area of the electrode and contact
time : An electrode of a small size causes
less lateral heat spread and requires lower
power setting. The cutting current
procedures are best accomplished with a
fine needle or wire electrodes. Movement
of the electrode through the tissue should
be continuous and fast to avoid build-up of
lateral heat that causes tissue damage.
The type of current selected :
• The selection of the waveform depends upon whether
cutting or coagulation is the primary aim. This gives
precise results with minimal tissue damage.
• Presence of moisture : The presence of moisture on the
surface of the tissue prevents charring. Therefore, the
surface should be moistened with saline soaked gauze.
• Waiting period : A waiting period of 10s is ideal between
two passages of electrode used for cutting in the same
surgical field. It allows adequate cooling and prevents
cumulative heat damage.
•
RFA
• is a simple, safe procedure with wider applications. It
causes less lateral heat spread and tissue damage and
provides better control in comparison to electric cautery.
The cutting mode of radiofrequency is more effective and
versatile in comparison to the carbon dioxide laser. As
hemostasis occurs simultaneously, the time required for
the surgery is less. There are fewer side effects and
complications. RFA can be easily combined with other
surgical modalities such as cryotherapy and laser for
treatment.
Dermatological Indications of RFA
• a. Diagnostic: Skin biopsy, excision of
cysts and abscesses.
b. Infections: Verrucae, pyogenic
granuloma and molluscum contagiosum.
c. Metabolic: Xanthelasma, xanthomas
Dermatological Indications of RFA
• d. Benign skin conditions: Freckles, dermatitis papulosa
nigra, acne, skin tags, cherry angiomas, spider
angiomas, naevi, trichoepithelioma, syringomas,
apocrine hidrocystomas, stucco keratosis, papilloma,
neurofibromas, cutaneous horn, keratocanthoma,
rhinophyma, sebaceous hyperplasia and keloids.
e. Senile skin conditions: Actinic keratosis, sebborheic
keratosis and senile lentigenes.
Dermatological Indications of RFA
• f. Malignant skin tumors: Squamous cell carcinoma,
basal cell carcinoma, dermatofibroma sarcoma
protuberans and carcinoma in situ lesions of the skin and
orogenital mucosa.
g. Nail procedures: Nail matrixectomies, surgical
hemostasis of ingrown toenail and onychogryphosis.
h. Cosmetic indications: Mole removal, telangiectasia,
unwanted hair removal, scar revision, ear-lobe repair,
development of flaps, oculoplastic procedures and
blepharoplasties.
The ThermaCool™ system
• is a unique monopolar radiofrequency
(RF) device. The differentiating factor
between the ThermaCool system and
other RF devices is a capacitive coupling
electrode. Through capacitive coupling,
deep, uniform and volumetric heating is
deployed to tighten and contour both the
skin and underlying tissues; meanwhile,
cryogen cooling is concurrently applied to
protect the epidermis.
The ThermaCool TC
• has been introduced to induce the tightening of
skin via a uniform volumetric heating into the
deep dermis tightening, thereby resulting in a
"non-surgical facelift." It causes immediate
collagen contraction and also produces longterm collagen remodeling. It has been used to
improve the neck and cheek laxity and
periorbital rhytides and to elevate the eyebrows.
The ThermaCool TC
• ThermaCool TC RF system represents a promising
noninvasive method of obtaining moderate facial
rejuvenation in the appropriately selected patient.
RFA in Combination with Other Physical Modalities
a. RFA with cryotherapy: Liquid nitrogen spray followed
by light electrodesiccation treatment is helpful in the
management of flat warts, small skin tags, seborrheic
keratoses and cherry angiomas.
RFA with laser
• The combination of diode laser and RF energy is
reported to decrease the appearance of wrinkles and
improve the skin texture. Diode laser using a fluence of
30-50 J/cm 2 and RF energy of 80-100 J/cm 3 , has
been used for nonablative wrinkle treatment of the face
and neck. The combination of 900 nm diode laser light
and radiofrequency energy is also found to be effective
for the treatment of facial venous malformations. It
provides additional heating of the vessels without
increasing the laser intensity. The side effects are
minimal.
RFA and combined RF:
• light source technologies are safe and
effective for treatment of several
dermatological procedures, including skin
tightening, hair removal, acne scarring,
skin rejuvenation and wrinkle reduction.
RFA
• RFA should be avoided in unstable cardiac patients and
in the treatment of the lesions of the skin overlying a
pacemaker. Special care should be taken while
performing radiosurgery near eye. RFA should not be
done in presence of oxygen as there is risk of explosion.
It should be made sure that patient is in contact with the
ground plate during procedure. The operator should
consider wearing a surgical mask and eye protection
when working on lesions containing HPV.
Side Effects and Complications
• The common side effects that occur with
radiofrequency are pain, tissue edema,
bleeding, infection, post inflammatory
hypo/hyper or depigmentation, scarring and
keloid formation. The bacterial transference of
Staphylococcus aureus through electrode from
one patient to another is possible; however, it is
much more possible during electrodessication
than during electrocoagulation.
Mono and Bipolar Radiofrequency (Accent™) for
a non-surgical facelift
History of RF
 RF has been a well known technology for more than
70 years
 In the field of surgery it is generally known as
diathermia
 The RF energy is also used in cosmetic applications
(electrolysis) and approved by the FDA for
permanent hair reduction by aesthetician
 There are two types of diathermia – Monopolar and
Bipolar
RADIOFREQUENCY: Electromagnetic Radiation
Alternate current modified emitter of electromagnetic
radiations : *long wave and frequency
cms.
Diagram of an electromagnetic wave
SPACE
1,5
1
T=1/f
Vp
λ
0,5
VOLTIOS
1 sec
0
0
0
-0,5
-1
-1,5
f
SEC
Velocity = light 300.000 KM/SEC
sec
TIEMPO
Radiofrequency
Electromagnetic Radiation.
Parameters to take into account:
Impedance of the tissue (Ohms)
Power (Watts)
Exposition Time (Seconds)
Electrode configuration
PARIS-2005
Radiofrequency
 There are two types of diathermia – Monopolar and
Bipolar
 The Monopolar uses a return electrode with a much
larger surface than that of the treatment electrode,
placed outside the treatment whilst the bipolar
applies both electrodes in the treatment area and
the heat and electrical energy are localised in a
small area
 Bipolar energy is safer, although it penetrates less,
as it only effects the area between the electrodes.
PARIS-2005
Radiofrequency:
Action Mechanism
Produces heat by:
Rotational movement of the water
molecules = production of
electromagnetic waves
Resistance of the tissues to the currents
conduction
PARIS-2005
Action Mechanism
Polarisation
Dermis
+
-
Subcutaneous
tissue
Muscle
PARIS-2005
-
Differences between Monopolar –
Bipolar RF currents
PARIS-2005
RF Heating Technology
Bipolar
Earth
RF
RF
Earth
Skin
The electrical field is created between the
electrodes: Very superficial
PARIS-2005
RF Heating Technology
Mono-polar
RF
Tissue
Deep heating
Earth
PARIS-2005
Heating Technology with RF
Monopolar Radiant
RF Antenna
Tissue
Deep heating
PARIS-2005
RF Heating Technology
Monopolar
PARIS-2005
Bipolar
Action Mechanism
IMMEDIATE EFFECT
 Contraction of the
collagen fibres
increasing and
retracting the
cutaneous tissue
PARIS-2005
 Tensing the septum
fiber
Action Mechanism
PROGRESSIVE EFFECT
 The heat generated by RF in the dermis
progressively triggers an increase of new collagen ⇨
cutaneous remodelling and continuous stretching
PARIS-2005
Morphological cutaneous changes
IMMEDIATE
MO:
• No significant changes in the
epidermis, dermis and essential
substances
• G. Sebaceous: ↓ size. Normal
structure.
• C. Epithelial G. Sebaceous disperse
moderate changes
6 MONTHS
MO: Epidermis: without change
ME: Dermis:
• Disperse and diffuse changes in the fibril
architecture of the collagen = increase in
fibre size and loss in definition of the
borders with the joining areas of fusion of
fibres.
• The fibril alteration was observed in
disperse areas affecting up to 25 % of the
fibres present
• The maximum effect was seen at a depth of
2-3 mm.
• The changes were doses dependent and
decreased with time
A.MOLECULAR: increase of the RNAm type
I collagen, HSP-47(Heat Shock Protein).
PARIS-2005
Morphological changes in the collagen at M.O
and M.E
DENATURALIZATION
SHORTENING
HSP-47(Heat Shock Protein)
INCREASE RNAm
NEOCOLAGENESIS
Collagen partially denaturalised
depth 3-4 mm
PARIS-2005
Study by Brian Zelickson, MD and Karl Pope
Accent RF System
 Excellent design
 Transportable (30 Kg)
 Comfortable for the user
and the patient optimum
results
 2 hand pieces
(Monopolar and Bipolar)
RF Tissue Connection Technology
Radiant Connection
Benefits
 Doesn’t require contact gel.
 Doesn’t require return electrodes.
 Doesn’t need good contact (pressure)
 Can be used in movement
 Without changing fluency
 Without consumables
 Choice of Monopolar or Bipolar treatments
PARIS-2005
Benefits of the Accent vs. other RFs
Wider radiofrequency : 40.6MHz instead of
6MHz
Better contact technology: moving instead of
stationary
Contact terminal refrigerated at 4ºC
Less painful
Configuration with two heads
Without return electrodes
Without consumables
PARIS-2005
Accent hand pieces
Monopolar
Bipolar
One sole interrupter
Designed to carryout
efficient manipulations
Minimising the tiring of
the user
PARIS-2005
Effects of the Accent
Produces the heating of the fat and the skin
Stimulates the collagenesis of the dermis,
tensing the skin
Stimulating collagenesis in the septum fibres
Stimulates blood circulation at a cutaneous
level, improving the quality of the skin
Drains the lymphatic excess of the fat,
diminishing the orange peel look, diminishing
body mass
Effects of the Accent
Increasing Lymphatic Drainage it diminishes
the adiposities fluids and toxins and reduces
volume.
Increasing the circulation and blood flow it
improves the texture of the skin.
Increasing the collagenesis, (dermis and
septum fibre) increasing the firmness of the
skin
¿LIPOLITIC ACTION?
PARIS-2005
Effects of the Accent
Facial rejuvenation
treatment.
 Treatment for face and
neck
 Improving quality of
skin and flaccidity
 Improving superficial
wrinkles
 Use of Monopolar and
bipolar
 4 sessions every 15
days
PARIS-2005
Body remodelling
treatment. Cellulite
 Treatment to any area
of the body:
1.-Arms
2.-Legs
3.-Abdomen
 Improvement in
flaccidity and cellulite
 Decrease in perimeters
 Monopolar use
 4-8 sessions every 15
days
Theory of the Accent Radiofrequency
Radiation through the air
PARIS-2005
Accent
Monopolar
RF without cold vs. RF with protection for cold
WITHOUT COLD PROTECTION
SIN
PROTECCIÓN POR FRÍO
EPIDERMIS
EPIDERMIS
epidermolisis
completa
Complete epidermis
DERMIS
DERMIS
coagulación de vasos superficiales
Coagulation of superficial blood vessels
necrosis infundibular folículos
Infundibular follicular necrosis
necrosis
canales sudoríparos
Sudoriferous channel necrosis
efectos neg. dosis dependiente RF
COLD PROTECTION
CONWITH
PROTECCIÓN
POR FRÍO
capa
epidérmica
PRESERVACIÓN
COMPLETA
Epidermis
layer COMPLETE
PROTECTION
no evidencia de alteraciones vasculares
No evidence of vascular alterations
en dermis reticular y/o papilar
In dermis reticular and/or papilla
no alteraciones en
sustancia fundamental, ni
No alterations in essential substances,
nor papilla
glándulas
papilares
glands
dosis controladas de RF sin efectos negativos
Controlled doses of RF without negative effects
Negative effects depending on doses of RF
COLÁGENA
coagulación pobre de colágena dosis
dependiente
en rangos de dosis
COLLAGEN
terapéuticasmuy
dedoses
RF
Poor coagulation ofbajas
collagen
Depending on level of doses
OBSERVACIÓN: MO
Very low therapeutics RF
OBSERVATION: MO
COLÁGENA
contracción colágena fibra inmediata post RF
progresiva aparición de nueva colágena
Immediate contraction of collagen fibre after RF
Progressive appearance of new collagen
OBSERV:
MO-ME-ANÁLISIS MOLECULAR
OBSERVATION: MO-ME- MOLECULAR ANALYSIS
Radiofrequency with Accent
Rejuvenation of face and neck
RF Facial: Selection of patient
 Patients who want to improve the quality of skin and laxity or
flaccidity
 Not effective in pigmented lesions
 Note – tensing effect NOT LIFTING!. “More compact skin”
“Firmer skin”
 Increases luminosity and diminishes wrinkles
 Best results on thick and well hydrated skins rather than thin
and dehydrated
 Notable improvement in 90% of cases, 10% obtain no result
 The impedance of the skin will mean more or less resistance
to the increase in temperature on carrying out each treatment
PARIS-2005
Accent Method
 Prior to treatment:
 No makeup 24hours before
 No IPL nor peeling 7 days before antes
 No Botulinum toxin 15 days before
 Day of treatment:




Take off all metal items
Cleaning of area with isopropyl alcohol
Marking of the are with a dermografic pen
Application of oil to avoid friction
 After treatment:
 Remove remaining oil
 Apply calming cream and photo protector
 Don’t sunbath for 7 days
PARIS-2005
RF Face and Neck
Method used
 Use of Bipolar and
Monopolar
 Division by anatomic areas
 Application in zigzag and
circular movements
 Rapid non-stop movement
 Taking metabolism
temperature = 34-36º C
 Reaches 38.5-40º C
 3 passes per area
PARIS-2005
Bipolar
Monopolar
RF Face and Neck
Method used
 Use of Bipolar and
Monopolar
 Division by anatomic areas
 Application in zigzag and
circular movements
 Rapid non-stop movement
 Taking metabolism
temperature = 34-36º C
 Reaches 39-40º C
 3 passes per area
PARIS-2005
RF Face and Neck
Method used
 Use of Bipolar and
Monopolar
 Division by anatomic areas
 Application in zigzag and
circular movements
 Rapid non-stop movement
 Taking metabolism
temperature = 34-36º C
 Reaches 39-40º C
 3 passes per area
PARIS-2005
RF Face and Neck
Parameters
 Monopolar:
 140watts
 20sec
 3 passes
 40ºC
 Bipolar:
 60watts
 10sec
 3 passes 38.5ºC
PARIS-2005
Bipolar
Monopolar
RF Facial: Contraindications
Pregnancy
Latency
Pacemaker
Metal plaques or screws
Not to be applied against permanent fillings
Serious heart conditions
Illnesses to do with connective tissue and
muscles
PARIS-2005
RF Facial: Secondary Effects
Pain:
Very tolerable
doses depends
Inflammation:
 discrete edema-erythema discrete,
clearing up within hours
Ecchymosis and Purpura: Thin skins
1st and 2nd degree burns (1st case)
Later on: none
PARIS-2005
RF Images
PARIS-2005
RF Images
Get the photographic station
started
 Adjust the camera and angle of
the flashes for optimum results
Standardize the parameters
Adjust data, patient number and
session number
PARIS-2005
Why do we take photos?
To document the progress of the
patients
To motivate patients
To control their progress to achieve
results
To give new patients evidence that
you achieve results
PARIS-2005
RF Facial with Accent: Conclusions
 The choice treatment for flaccid neck and face.
 Improves quality of skin due to the production of
collagen.
 Improves crows feet.
 Possibility of using Monopolar and Bipolar RF.
 No consumables.
 Quick and comfortable treatment for users
 More comfortable for patients than other RFs.
 Very good results in 20% of cases, good in 70% of
cases and bad in 10%.
 Better results on faces with thick and greasy or
mixed skins than in faces with fine and dry skin.
PARIS-2005
Thermage™Radiofrequency Thermage
•
•
•
•
heating in dermis and subcutaneous fat
with radiofrequency
•results after one treatment in most cases
•effects focussed more in tightening, less
in wrinkles
• •anaesthesia necessary
• •sides effects: erythema, blisters, oedema
What is Scarlet RF?
• Scarlet is minimal invasive fractional bipolar Radio Frequency with micro-needle
electrodes. It provides direct heat with
both epidermis and dermis through precise
depth control from 0.5-3.5mm.
What is Scarlet RF?
• Its efficient fractional radio frequency
enables capability of achieving fractional
and continuous treatment patterns. It
expends your practice by offering
efficacious minimal risk of downtime and
pain regardless of skin type
Why 55°C~60°C?
• Can stimulate the regeneration of
collagen, but without the risk of altering the
cell structure
1. Early Stage: Fibrous tissue contraction
and shrink pores can be seen.
2. Later Stage: After 2-3 weeks, can
significantly see the regeneration of
collagen, and the restore of skin elasticity.
3. Protein and collagen within the skin
tissue did not altered or degenerated
Why 55°C~60°C?
• What areas can be treated by Scarlet
RF?
• Improve droopy eyelid and smoothen fine
lines around the eye area
• Smoothen fine lines and wrinkles
Face Lifting
• What are the advantages of Scarlet RF?
• Treatment areas can be used beyond hair
lines and ears, improve the appearance of
fine lines and wrinkles
Face Lifting
• Less Downtime, can back to normal
activities after 2 hours after treatment.
(Actual downtime may differs from
different body condition)
Face Lifting
• During the treatment, a temporary lift
might be visible due to the reaction by the
RF wave. After the regeneration of
collagen and elastic tissues under skin, a
more long lasting and compact lifting effect
can be seen
Is the procedure painful?
• There is minimal pain as it uses not spring
to move electrodes but micro robot motor,
a technology named Dynamic Linear
Motor Technology, for smooth movement
What is interval of treatment?
• It depends on patient but mostly with 2-3
session they can have the best result and
interval of treatment is one month
Is there complication?
• It secures safe RF energy field so it does
not have any kind of complication
• How to mix and match with other
treatments and Scarlet RF?
• Suggested interval of 2 weeks required
between different treatments.
Scarlet RF Features
• Volumetric Tightening
• Unique effect from direct heating RF,
with invasive micro electrodes
• True Fractional RF
• Focused on strong RF energy to
maximize RF effect
• Fractional Laser + Deep Dermal RF Effect
• Target both epidermis (Fractional Laser
target field) and deep dermis (RF target
field), control depth 0.5-3.5mm with 0.1mm
increment
How long is downtime?
• How long does the procedure take?
• Treatment time is about 30-50 minutes
• Scarlet treatment needs minimal
Downtime which is about 1 day with
normal skin type
No Side Effect
• Less Pain, Less Downtime, No Side Effect
• Sophisticated control by using Shock
Free Needle Technology to deliver
effective results with minimal downtime
• Scarlet RF – Recommended
treatements
• Once a month for three consecutive
months, thereafter once every six months
to maintain the collagen level and skin
elasticity
Neocollagenesis- Fractional
Microneedle Radiofrequency
• As we age our skin changes with time.
This is natural but is affecting both the
topmost and mid layers of the
skin. Noticeable changes not only on our
face and neck but also on various body
areas just think about the back of hands.
• The topmost layer of skin called the
epidermis develops sun damage and
pigmentation, enlarged pores, fine
wrinkles, and superficial thread veins as
the time goes.
• Under the epidermis, in the dermis
collagen fibers degrade, loosing elasticity
resulting in volume loss and sagging.
Sagging is obviously visible on the jaw
line, and under the jaw on the neck as we
age.
• Everybody wants to look and feel young.
Aging is an option. Is there a way to
restore youthful appearance without
invasive surgery?
• refreshed collagen structures, visible
wrinkle reduction, effective plumping and
lifting without surgery, volumetric
tightening and flawless skin! Even one
treatment can fix you up with true
rejuvenation and visible results.
• Rejuvenate your skin today and restore
that youthful complexion!
• Neocollagenesis fractional microneedle
RF therapy turns back the clock on aging
or damaged skin!
• Neocollagenesis fractional microneedle
radiofrequency helps to achieve your
esthetic goals without pain or
downtime!
A new esthetic treatment?
• What is the science behind the
Fractional Microneedle RF
Neocollagenesis ?
• Fractional RF microneedle treatment is an
innovative approach to ascending RF
technology.
Theory:
• warming up collagen fibers in a precise
and controlled manner, result in changes
in the collagen structures. The fibroblasts
producing collagen and elastin activate
and stimulate regeneration processes in
the skin. Thus the skin lifts and responds
in volumetric tightening. Different skin
blemishes are in different skin layers.
• What is revolutionary about this fractional
RF technology is that the esthetician
expert performing the treatment can so
precisely send the RF energy in the
appropriate skin layers as never before.
• As the handpiece directs the rejuvenating
RF energy targeting precisely selected
skin layers in order to stimulate the body’s
natural restoration processes and
collagen, elastin production it treats many
kinds of blemishes at once.
• How does Fractional Microneedle RF
Neocollagenesis treatment work?
• For every treatment new, sterile
handpieces are used! The sterile
handpiece tips contain an array of gold
plated insulated or non-insulated
microdiameter need
• shaped electrodes. These electrodes are
rapidly inserted in the skin (without
causing extensive damage to the
epidermis) to selected skin depth while
focused RF energy pulses create
controlled thermolysis. Thus resulting in
rapid contraction of the skin as denaturing
occurs.
• Collagen denaturation is followed by
neocollagenesis, collagen re-modelling.
Fibroblasts are stimulated and new
collagen and elastin fibers are produced
while growth factors are naturally released
as the skin heals, resulting in a new
refreshed appearance.
What is the Fractional RF
• Our special machine is installed with
various functions for face and off the
face applications. So it is able to treat the
face, neck, décolleté, back of hands, body
and even the sensitive eye area safely
providing outstanding results. Anti –
aging treatment invigorating the skin
• Non surgical facelift
Volumetric tightening of the
skin
• Eyelid tightening without surgery
• Treating facial wrinkles and skin laxity,
treats sagging skin
• Improving skin tone and texture
• Lifting and tightening jaw line and double
chin
• Plumping nasolabial fold
• Decreasing lip lines
Microneedling treatment good
for?
• Acne condition treatment
• Sebum control treatment for oily skin
• Acne scars, Surgical scars, Burn scars,
Chicken pox scars
• Large pores treatment
• Pigmentation treatment, Skin whitening
• Hyperhidrosis treatment (treatment for
excessive sweating NO Botox)
• Body tightening: such as belly, arm, thighs
etc. Hand rejuvenation
• Stretch marks, Striae treatment
• Keratosis pilaris Facial veins, rosacea,
nevus flammeus, flushing, fading up to a
level Hair removal of white hairs up to a
level
• What skin types can benefit from
Fractional Radiofrequency
Microneedling treatment? Fractional RF
Microneedle treatment since it is not light
based and not laser treatment is able to
effectively treat all skin colors, even darker
skin types and also safe treatment for
sensitive skin types.
Can I have this treatment in
the summer time?
• Sure! Since it is a radiofrequency and not
a laser treatment, the epidermal injury is
so minimal the treatment is safe all year
round!
How is this treatment unique?
• Visible results after the initial
treatment, Additional treatment results
add up (cumulative effect), Non surgical,
minimally invasive, gentle treatment, Short
procedure with minimal to no downtime,
Volumetric tightening of skin, Result a
natural complexion.
How long does a single
treatment take?
• A treatment usually takes 25-30 minutes. If
treating sensitive skin and there is need
for topical anesthesia, the numbing cream
requires 30 minutes to take effect prior to
treatment. Cooling and aftercare (serum,
mask) can take up to a good 30 minutes.
In order to boost treatment results we use
moisturizing and firming active
serums/masks.
• In order for these enriched serums and
masks to be beneficial, they need to be left
on the skin to react. Therefore each
session requires approximately 1-1,5
hours. How will my skin look after the
treatment is there any downtime
associated?
• After the treatment the skin develops
transient erythema and edema which can
last approximately 3-4 hours. Skin will
have tight and slightly warm feel and can
be pinkish.
• Depending on the treatment parameters
and microneedle types, in some cases
signs of microthermal zones, scab
formation and flaking can be noticed for 12 days, which is part of the healing
process. You can wear makeup the next
day (after 24 hours).
• How often should I have Fractional
Microneedle Radiofrequency treatment
for good results?
• Best is to have a treatment package of
3-5 sessions.
• During your initial consultation you will
receive a treatment plan custom tailored to
your needs. The waiting time between
treatments varies, depending on what
body area and indication is to be treated.
To keep long lasting results yearly
maintenance can be recommended
depending on skin
• To maintain treatment resultsit is
essential to use good quality skincare
products at home in between treatments,
use good sunscreen and follow the
aftercare instructions!
• Our staff is happy to introduce you to
home care cosmetic products which can
further help boost treatment results.
• Does it hurt? Generally, treating up to
1mm depth anesthesia is not needed (you
can barely feel anything).
• If treating sensitive skin or performing a
deeper treatment, topical anesthesia
cream can be applied prior for more
comfort so the treatment can be virtually
painless. Our state of the art machine is
complemented with strong built in cooling
to provide more comfortable treatment.
• Who are good candidates for Fractional
Microneedle Radiofrequency treatment?
Adults between the ages of 18 - 65 and in
good health are candidates for this
treatment.
pre treatment instructions?
• On your scheduled consultation a trained
professional will fully examine and
evaluate your skin. Please arrive to your
consultation not wearing makeup. Men are
advised to shave if the face to be treated.
Do not wear antiperspirant, perfume,
cosmetics, body lotions, self tanning
lotions on the area to be treated.
pre treatment instructions?
• Pre treatment you should not drink
alcoholic beverages, because alcohol can
draw water away from cells thus
elongating healing process. Regeneration
of cells can be enhanced by taking Vitamin
C (500mg) daily, and homeopathy
products may also help.
Can this treatment help with
acne condition skin?
• Yes! Excessive sebaceous glands can be
decreased with this treatment.
Can this treatment help with
stretch marks and striae?
• Yes! Neocollagenesis treatment is suitable
for stretch mark treatment. As a result the
lines begin to fade, and eventually be
more even to the surrounding skin,
becoming less visible.
help with excessive underarm
sweating?
• Yes! Fractional Radiofrequency
Microneedle treatment is suitable for
axillary hyperhydrosis treatment. As a
result sweat glands show decreased
activity.
Aftercare instructions:
• During your initial consultation you will
receive detailed information of pre care
and aftercare instructions. Make sure to
protect your skin with a sunscreen with at
least SPF 30 for a month to prevent sun
damage.
Aftercare instructions:
• The aftercare instructions will guide your
healing and help to minimize the
occurrence of side effects. Good to know
that upon irritation of treated site (any
harm to epidermis) germs bacteria can
enter the skin, therefore avoid mechanical
irritation! Avoid scratching rubbing and
picking the skin, since it can cause
permanent scarring. Also can higher the
risk of complications.
The microneedle
fractional RF
• Needles are inserted into the skin by a
specially designed electronically controlled
smooth motion motor minimizing patient
discomfort. When the needles reach the
pre defined insertion depth the RF is
emitted selectively heating the dermis
while sparing the epidermis. RF emission
delivered over the whole dermal
The microneedle
fractional RF
• handpiece used in our study (Intensif
handpiece ,is a novel handpieces that
uses a tip with 25 noninsulated gold plated
microneedle electrodes. (max diameter of
300 micron at their base gradually tapered
to an extra sharp edge)..
Methods
• The study included 23 patients treated for
atrophic acne scars or skin rejuvenation.
We used the EndyMed PRO
• platform system equipped with the
Intensif™ micro-needles handpiece. The
micro-needle treatments were performed
once a month, (3 to 4 sessions).
specific technology:
• •Handpiece with 25 micro-needles
•penetrate up to 3.5 mm •Needles:: High
quality, Super sharp, gold plated
• •Customized smooth insertion by
unique
• step motor for reduced discomfort
insertion Constant measurement of
impedance •enhanced volumetric
heating mode •hardware and software
allow constant energy delivery
independent of individual tissue
impedance full hemostasis in contrast
to other RF Micro-needle systems
Results
• 23 patients with moderate to deep skin
lesions were treated 1-2 sessions using
the Intensif handpiece
•
Before and after
• photos, were graded according to
standard evaluation methods. Dedicated
Questionnaires evaluated treatment
comfort, safety and effectiveness.
Analysis of the questionnaires showed
Improvement of > 70% . treatment
comfort, was very good in > 90%,.
Effectiveness very good in > 90%.
There were no side effects.
Conclusion
• demonstrate the safety and efficacy of the
novel RF microneedles skin remodeling
handpiece for Acne Scars improvement
and skin rejuvenation. This modality gives
clear advantages over traditional skin
resurfacing lasers such as lower level of
adverse effects downtime and downtime,
complete control of the depth of effect,
volumetric heating and the ability to treat
all skin types.