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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the patient, but a typical protocol for the IntensifRF would be focal depths of 1.5mm to 2mm, power at 12 to 14 watts and 140 millisecond pulse lengths." Lily Talakoub, MD, of McLean Dermatology and Skincare Center in McLean, Virginia, uses the Fraxel Dual laser (Solta Medical) 1550nm setting at an approximate level of 10 at 50J to 55J to treat skin laxity. "Then I switch to the 1927nm settings for the actinic damage at level 8 at 5J to10J," she says. "Following treatment, the patient will experience 48 hours of erythema and swelling and about fi ve days of skin crusting." She prefers the Fraxel Dual because it requires only one session with a maintenance treatment one year later. "It is much more diffi cult to have a satisfi ed client who needs to come in for six to eight treatments, which is why the RF devices are not my fi rst choice," she says. "Also, when these clients have improved skin color and decreased discoloration including brown spots and freckles, they are even more satisfi ed with their results. With most RF tightening devices, clients need a second procedure to address the actinic dam- age and will experience more downtime as a result." For patients with signifi cant laxity, she opts for the ThermiTight, which uses a wand inserted under the skin to deliver RF energy. "This is a surgical procedure that requires tumescent anesthesia. Downtime is minimal, how- ever, with about two to four days of redness and swelling, and patients see results within three months with only one treatment," says Dr. Talakoub. Choosing a Device With dozens of devices marketed toward noninvasive or minimally invasive skin tightening, it is important to perform due diligence before purchasing a new system. In addition to considering the most common concerns patients present with in your practice, Dr. Sadick recommends working with a reputable company that provides technical support and training. "Also look for clinical studies supporting the device's effi cacy and word-of-mouth from the medical com- munity on its performance," he says. "Of course, painless and short treatments are important, both for the patients who usually want lunchtime treatments, and for the prac- tice, as more treatments can be booked." Energy output can vary signifi cantly. "When investigat- ing RF devices, consider the amount of power or energy output," says Dr. Halaas, "We also look for devices with multiple applicators so we can treat small and large areas." Pain and number of sessions required play an important role in patient satisfaction. "I like noninvasive skin-tightening devices that offer minimal pain and minimal downtime," says Dr. Talakoub. "If a patient is in signifi cant pain, she will never come back. In my practice, three to fi ve days of redness and swelling are the most a patient will tolerate." She also cites consumables as a major factor in her pur- chasing decisions. "As a general rule, the cost of consum- ables can be no more than one-quarter the price of the procedure," she says. Ultimately, though, results are what matter most to a patient, Murrow says. "If you are not delivering the results your patients expect, then you are on your way out of busi- ness," she says. "Yes, consumables, pain, cost and energy output are important, but at the end of the day, your device had better do what you are saying it will do." Linda W. Lewis is the contributing editor of MedEsthetics. 40 APRIL 2018 | Med Esthetics © GETTY IMAGES Microneedle RF devices and the Solta Dual laser offer the advantage of addressing both mild laxity and skin discoloration. THE HEAT IS ON

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