SEP 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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CHIN TO CHEST SOLUTIONS 44 SEPTEMBER 2017 | MedEsthetics Tightening Tools Until quite recently, few safe noninvasive treatment op- tions existed for sagging jowls and loose, crepey neck skin. Fractional ablative lasers, which have proven most effective for rejuvenating facial tissues, are more risky when used on the thinner neck and décolletage skin. Thus, ultrasound and fractional radiofrequency (RF) devices have emerged as the go-to tools for treating skin laxity in these delicate off-the- face areas. The Ulthera System, originally FDA-cleared for brow lifts, received clearance for face and neck lifts in 2012. "For patients with loose skin only, Ultherapy alone is a good way to tighten," says Dr. Kirby. "We need to be careful not to overpromise, though, especially when patients have signifi - cant excess skin. Ultherapy will not provide the degree of tightening we get with a surgical procedure." Ultherapy is typically offered as a single-session pro- cedure in her practice, although she may perform two sessions for patients with signifi cant excess skin who don't want surgery. "The second session needs to be eight months to a year later," says Dr. Kirby. "The initial result we get with Ultherapy continues to improve over that time period. Results aren't fi nal for about a year." But Ultherapy may not be the best option for people who are very thin. "It tends to shrink the fat as well as the skin, which can make very thin people look older," says Dr. Kirby. "Microneedling with devices like the SkinPen (Bellus Medical) are a better choice for these patients." Dr. Kilmer prefers Thermage (Solta Medical) to Ulthe- rapy. "Done right, Thermage is pretty predictable as long as patients are educated as to what it can and can't do," she says. "Ultherapy, although similar in effi cacy, is more painful." RF energy, like that used in Thermage, has gained fans worldwide for two important reasons. First, it does not target chromophores and therefore can be used on all skin types with less complication risk than a laser. Second, the heat it generates can be more easily concentrated in the dermis, causing less epidermal damage. While early RF devices worked through bulk heating to tighten and shrink the dermis, newer devices feature fractional delivery technologies to create thermal injury columns. These include both noninvasive fractional devices and minimally invasive devices with microneedles that pen- etrate the skin to deliver energy directly to the dermis. "Fractional microneedle RF devices offer a whole new approach to treating skin laxity," says Dr. Gilbert. "They work especially well in the neck and décolletage area be- cause they rejuvenate without overheating tissues. We use the Intensif RF (EndyMed) and usually recommend three to fi ve treatments at three- to four-week intervals. Final results may not be visible until three months after the last treatment. The collagen building provided by 3DEEP RF Microneedling lasts for several years." The Intensif, which is part of the EndyMed Pro Sys- tem, uses 25 gold-plated, noninsulated needles 300µ in diameter that can be inserted at prescribed skin depths up to 3.5mm. Practitioners can also adjust fl uence level and pulse duration. Lutronic introduced the latest of these devices, the INFINI 1.2, in June 2016. Unlike the Intensif, the INFINI uses high-intensity focused bipolar RF delivered through insulated 200µ needles. "For lax skin, we see the best results using three monthly INFINI treatments," says Dr. Shelton. "Redness and swelling dissipate in a few days, and the results are good." A third option, ThermiTight (ThermiRF), positions itself as a bridge between noninvasive and surgical treatments. With this procedure, a small probe is inserted under the skin to heat tissue wherever tightening is desired. The probe moni- tors skin temperature and provides feedback to help reduce the risk of burning. "ThermiTight is safe when used properly, but there is This patient underwent combination treatment with Botox, fi llers and CO 2 laser resurfacing. BEFORE AFTER PHOTOS COURTESY OF SUZANNE L. KILMER, MD

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