MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
Issue link: https://medesthetics.epubxp.com/i/123304
DETAILS Before Treatment Protocols Getting a patient ready for treatment is fairly easy and our prepping is straightforward. Reaction is not an invasive procedure, so being overly sterile is not necessary. Of course, we keep the rooms and sheets very clean. The patient is robed and draped with a comfortable sheet with the target area loosely exposed. The area is cleansed with a mild cleanser and dried. After applying gel to the target area, we start the procedure. We follow the protocol exactly as recommended by Viora. For skin tightening: on the forehead we do a total of four passes on Mode III. On the lower face, chin, neck and body, we do a total of six passes, at different energy levels, depending upon the thickness of the skin. For contouring and cellulite reduction we pre-heat the area to clinical efficacy of 39˚C-42˚C, using an external infrared thermometer supplied by Viora. Then we address the adipose tissue for 10 minutes and stimulate the fibroblasts for another four minutes. We do not overlap the treatment spots with the probe as it can overheat the skin. We check for target temperature constantly as well as determining the patient's comfort level. The probe is moved along the skin following lymphatic drainage patterns. When treating the lower face, we start from the peri-oral region and move out towards the lateral face. For the forehead we start at the brow and move up toward the 18 MAY/JUNE 2013 | MedEsthetics RF skin tightening can help to reduce the appearance of cellulite, as seen in this patient. hairline. The procedure takes approximately 30 minutes per target area. Since we're heating up the skin, we want to pay particular attention to the RF and vacuum settings. If the skin is excessively heated, you can burn the patient. Bruising can also happen if the suction level is too high. We constantly monitor how the patient is feeling and if the patient is intolerant of our standard setting, we modify it to improve her comfort level. We do expect patients to experience a sense of heat deep within their skin. On a case-by-case basis, patients are advised to avoid anticoagulants or anti-inflammatory meds before, during or after the procedure. We also contraindicate the use of ice postprocedure due to the benefits of protracted heat accumulation for fibroblast proliferation. Patient Recovery One of the advantages of the Reaction is the minimal, if any downtime. This means that patients can resume daily activities immediately following treatment. We recommend patients increase their water intake, but keep it on the room temperature side during the time after the procedure, again to not cool down the body temperature. We find that between two and four treatments are necessary to achieve tightening, depending on baseline per patient laxity. Afterwards we follow up with maintenance treatments every three to six months. Most patients are extremely satisfied with the Reaction procedure, and they often choose to continue treatments on other body parts. This is an added bonus for us as it decreases our marketing costs and efforts. Reaction was easy to integrate into our clinic and the flexibility it gives us, due to the variety of applications we can offer our patients, has been another benefit. ME Francisco Flores, MD, is a board-certified dermatologist and the founder of South Florida Dermatology Clinics. He is a published researcher and frequent expert guest of medical programs for Telemundo and Univision. Contact him at 954.885.5551, sfderm.net. PHOTO COURTESY OF FRANCISCO FLORES, MD fat-reducing device, there are other technologies more apt for that specific need. However, I think that this technology complements those procedures quite well. Reaction's skin tightening results following liposuction or laser-lipolysis are very exciting and can be the final step to these procedures, without the need for any additional surgical intervention, general or local anesthesia. I do not do the procedure on patients with metal implants in the mouth. For all patients, the heat can be uncomfortable when you are working on the jaw and neck. As a rule however, there are no high levels of pain so there is no need for any type of anesthesia. I also wait to perform RF skin tightening on patients with active peeling of the face or with retinoid irritation. With a chemical peel we will wait at least two weeks. For patients who have undergone deeper peels or an ablative laser treatment we start treatments only after three to six months, due to the lengthy recovery time. Patients with extremely sensitive rosacea need adequate control before this procedure. There are additional contraindications recommended by Viora, which we follow. These include avoiding treating patients with a history of skin cancer or skin illness in the specific treatment area, and those with pacemakers or other electrical implants. After