Medesthetics

MAY-JUN 2016

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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MAKING WAVES 22 MAY/JUNE 2016 | Med Esthetics © GETTY IMAGES Treatment with microneedle RF devices creates new, restructured collagen in the deep dermis. BETTER RESULTS FOR SOME "We began using microneedle radiofrequency devices in the fall of 2013 and fi nd they are becoming increasingly important in our practice," says E. Victor Ross, MD, dermatologic surgeon at Scripps Clinic Carmel Valley in San Diego. "The fi rst factor in deciding whether to purchase one of these devices is to assess your practice demographics, especially the number of patients with acne scarring and stretch marks. "Patient satisfaction levels are highest among patients with acne scarring," Dr. Ross continues. "That is where we get our best results with microneedle RF devices. Skin tightening is more unpredictable, both in what we can achieve and in how patients see the results." Girish "Gilly" Munavalli, MD, medical director and founder of Dermatology, Laser & Vein Specialists of the Carolinas in Charlotte, North Carolina, considers fractional RF specifi cally for defects of the dermal skin layer, such as acne scars, striae, wrinkles and skin laxity. "Fractional RF devices—especially microneedle devices— can percutaneously, nonselectively heat the dermal layer in a direct fashion with minimal impact on the overlying epidermis," he says. "Advantages are direct thermal heating with a precise on and off mode, which allows for complete and rapid control of the heating process. Another advantage is that RF energy is 'colorblind' and can safely treat skin of all colors, regardless of the amount of pigment or water in the epidermis." The reduced risk of post-infl ammatory hyperpigmentation (PIH) in darker-skinned patients was a key selling point for Neil Sadick, MD, clinical professor of dermatology at Weill Cornell Medical College and founder of Sadick Dermatology in New York City. "Fractional microneedle RF is a better fi t for our practice because it can be used to treat all skin types I-VI for acne scars, fi ne to moderate lines and wrinkles, hyperpigmentation/melasma and skin laxity," he says. Due to the depth of penetration of the microneedles, "patients need some anesthesia or the procedure can be uncomfortable," says Joely Kaufman, MD, associate professor of dermatology at the University of Miami Miller School of Medicine and director of Skin Associates of South Florida. "We use a topical lidocaine mixture and patients do well." While topical lidocaine may be enough in most cases, patients undergoing deeper treatments or treatment on larger areas of the body may experience increased pain and bruising, cautions Dr. Ross. "A topical will work on small areas at minimal depths, but with larger areas we use regional blockers and even tumescent anesthesia," he says. "We also use a Zimmer air cooler and occasionally oral medications such as Valium." A GO-TO DEVICE FOR ACNE SCARS A review of nonablative and microneedle RF treatments for acne scars conducted in September 2014 (B.J. Simmons, et al, Clin Cosmet Investig Dermatol, 2014) concluded that fractional

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