JUL-AUG 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Page 26 of 68

DETAILS | By Raminder Saluja, MD Laser and light-based technologies have played an import- ant role in periorbital rejuvenation over the past several decades due to their benefi cial effects on neocollagenesis and elastin stimulation—but many patients fi nd long down times unacceptable. For these patients, radiofre- quency (RF) heating of the dermal tissue may be a desir- able alternative. While ablative laser technologies are the gold standard in treating this area through selective skin vaporization and revitalization, they are associated with compensatory downtimes and carry a greater risk of post-infl ammatory hyperpigmentation in higher Fitzpatrick skin types, mini- mizing the population base that can be treated. Compared to standard ablative procedures, fractional technology minimizes downtime considerably and offers added safety and greater patient compliance, but even four to fi ve days for re-epithelialization is too long for patients who want zero downtime. RF can be used on any Fitzpatrick skin type because it exerts its mechanism of action through streaming elec- trons, which pass through the low-resistance epidermis and dermis and collide with the highly resistant hypoder- mis. Through this impedance, kinetic energy is converted into thermal energy that can heat the dermal layer to 55° to 65° C. At this temperature, skin tightening occurs through collagen denaturation, contraction and fi broblast stimulation. The remodeling process continues up to six months post treatment. 1,2,3 Several RF devices are on the market: monopolar, bipolar and microneedling RF, each with its own unique nomogram. Published studies indicate that RF treatments using multiple passes with low-to-moderate energy set- tings offer greater collagen fi bril contraction and recovery than single pass, high-energy procedures. 3 But the question remains, "How many passes are suf- fi cient?" Or more specifi cally, "How long must the dermal layer be heated to optimum temperature to maximize safe- ty and effi cacy while also being tolerable to the patient?" In my practice, we are utilizing a 4Mhz monopolar RF treatment (Pelleve, Cynosure) delivered in 12-minute, multi-pass treatments to rejuvenate the periorbital area. We fi nd this protocol offers signifi cant improvement in rhytides with minimal treatment pain and no downtime. To analyze the outcomes of this procedure, we performed a prospective case study of 11 subjects (10 female, 1 male) who fulfi lled eligibility criteria of mild to severe wrinkling. Patients were excluded if they received any treatment (including botulinum neuromodulator, fi llers and other laser procedures) other than topical skin care to the periocular region within six months of study entry or during the three months following the study period. The mean age of the subjects was 51 years. All patients were assigned a numerical Global Assessment Score for peri- ocular rhytides based on their severity: mild (1-3), moder- ate (4-6) or severe (7-9). The mean GAS was calculated at baseline and three months post the fi nal RF treatment. Digital photographs were taken at the same time inter- vals by a single individual with a 35mm Nikon Camera us- ing identical patient positioning and ambient room lighting at baseline and one and three months post-treatment. © GETTY IMAGES 24 JULY/AUGUST 2017 | Med Esthetics RF for Periorbital Rhytides Establishing an effective, no-downtime protocol for the treatment of periorbital rhytides.

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