APR 2018

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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"Typically patients require four sessions at two-week in- tervals for face and neck treatments," says Yael Halaas, MD, a facial plastic and reconstructive surgeon based in New York City. "Depending on their age and the health of their skin, some patients may need a few more treatments than others. If they expect more results at the end of the pack- age, then we can add a few more sessions. Setting client expectations is very important: Try not to over-promise, and show lots of before-and-after pictures so clients know what type of results to expect." Stanley Kovak, MD, of Kovac Cosmetic Centers in Oakbrook Terrace and Rockford, Illinois, uses the RF-based Thermi250 because it offers multiple applicators, includ- ing a small size specifi cally for the eye area. "My preferred protocol depends on the area to be treated," he says. "For the eye area, we treat each eye twice during the session. On average, we would do eight treatments, spaced 10 to 14 days apart. Each treatment session takes about 15 minutes, and there is no discomfort. Some patients return for maintenance treatments four to six times a year to keep the area looking smooth." For full-face treatments, Dr. Kovak often starts with the Thermi250. "With this device, you can treat the cheeks and neck without worrying about damaging the fat and creating skin surface irregularities," he notes. About eight Thermi250 treatments are required, but some patients may not be willing to come in for that many offi ce visits. "Patients tend to get impatient and not complete the recommended course of treatment," says Dr. Kovak. "But most who do complete the recommended number of sessions get 75 percent im- provement and are satisfi ed." For patients needing a more aggressive treatment, Dr. Kovak turns to Ultherapy. "Though more uncomfortable than RF, it requires only one treatment to tighten tissue over the course of a few months," he says. Ultherapy also allows practitioners to measure skin thickness for more custom- ized treatments. "You can treat either the bottom layer or the top layer," says Dr. Kovak. "Many times we treat near the bottom of the skin for a tightening effect and then again near the top for a little textural change. We start at the highest setting and lower the settings as necessary for comfort. We do multiple pulses so patients do need a topical anesthetic, and if they have someone to drive them home, we will give them something to relax them as well." Kristy Murrow, PA-C, of Mariposa Aesthetics & Laser Center in Oklahoma City, Oklahoma, also opts for either Ultherapy or Thermi250 for patients with mild-to-moderate skin laxity. "With the Thermi250 ThermiSmooth treatment, there is no pain. Some patients say the gradual buildup of heat feels a little like a hot-stone massage and can actually be relaxing," she says. Her ThermiSmooth clients typically undergo a series of four to six treatments, while Ultherapy is offered as a one-time treatment for mild laxity. With both treatments, complete results take approximately 90 days. Laxity With Photodamage Patients with more severe photodamage and/or skin laxity are poor candidates for noninvasive RF and ultrasound- based devices. But newer options, including microneedle RF, can penetrate below the epidermis for enhanced outcomes. "Patients who present with mild-to-moderate laxity and photoaging complaints are ideally positioned for micro- needling RF," says Dr. Sadick, who uses the EndyMed IntensifRF and Venus Viva nanofractional RF. "These devices not only stimulate the skin-tightening cascade but also im- prove tone and textural issues. Energy settings depend on PHOTOS COURTESY OF SOLTA MEDICAL/MICHAEL KAMINER, MD 38 APRIL 2018 | Med Esthetics THE HEAT IS ON Patient before and four months after treatment with the noninvasive Thermage RF device. BEFORE AFTER

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