microneedling Archives | The Aesthetic Clinique

DERMAPEN – ADVANCED MICRONEEDLING FOR SKIN TIGHTENING, WRINKLES, ACNE SCARS, STRETCH MARKS, AND IMPROVING ELASTICITY OF SKIN.

The Dermapen is used in conjunction with PRP and PPP in the video above.

The Dermapen 3 is a motorized microneedling device that can produce over 1300 dermal penetrations per second. The micro-injuries that are created cause an inflammatory response that ultimately causes collagen production. The injury to the dermis is fractional, only a small percentage is affected, which has been shown to lead to faster healing and an improved risk profile when compared to treating the entire dermis. There is no heat produced, as a laser would, so the risks of pigmentation issues is very low. For maximal benefits, a series of about 6 are recommended.The advantage of a Dermapen over a dermal roller is:

The penetrations are perpendicular to the skin so there is no tearing of the skin.
The perpendicular penetrations are linear and more precise than the roller that creates a wedge defect in the skin.
Depth of penetration can be changed for the different areas of the face.
The microneedles are much thinner than the dermal roller
Many more penetrations are performed in a Dermapen treatment
Able to treat areas where rolling is difficult or not possible – around the nose and eyes

What conditions can a Dermapen treat?

Superficial skin laxity and wrinkles, especially around the eyes
Enlarged pores.
Scarring, particularly acne scars
Stretch marks
Thin skin related to sun damage or age
Etched in superficial lines

What should I expect on the day of the Dermapen treatment?

After pictures are taken, a dermaplane is performed – using a scalpel, the superficial layer of skin is removed including fine superficial hairs.
A topical numbing cream will be placed on the skin for about 20 minutes
The cream is wiped off and the face is cleaned thoroughly with hospital grade soap
A hyaluronic acid lotion is placed on the skin which allows for easier movement of the Dermapen over the skin.
IF THIS IS A “VAMPIRE FACIAL”, PRP (Platelet Rich Plasma) IS NOW PLACE ON THE SKIN INSTEAD OF THE HYALURONIC ACID.
The Dermapen is then placed on the skin and each area is treated in at least 3 directions to get a thorough coverage. The product or PRP placed on the skin is pushed into the deeper layers of the dermis by the Dermapen
When finished with the Dermapen treatment (about 20-30 minutes), topical growth factors or collagen stimulators are placed on the treated skin. Studies have shown that these topicals can penetrate 50x better immediately after the treatment.
Your face will remain red or pink for 24-48 hours. There is a skin care regime that will be tailor made for your skin, recommended by the aesthetician.

What are some other uses of the Dermapen?

Prior to Levulan treatment for precancerous lesions, areas of concern can be treated with the Dermapen to allow for much better penetration of the Levulan.
There might be some benefit when used in combination with the laser for tattoo removal.
Chemical Peels will have better penetration and become more aggressive if Dermapen precedes placement of the peel.
Stretch marks can be improved, particularly when topicals are used immediately afterwards.
Although still experimental, there might be some benefit in treating areas of melasma followed by intensive topical therapy with hydroquinones and retin A.

Website: http://www.theclinique.net YouTube: http://www.youtube.com/user/StevenFWeinerFacial Facebook: https://www.facebook.com/TheAestheticClinique

2019 UPDATE: State-of-the-Art Acne Scar Treatments

Acne scarring has significant debilitating effects on one’s overall self-worth and confidence. Millions in the US are affected. There have been improvements in techniques and energy devices in past few years which have led to better outcomes for acne scar treatments.

Subcision – This is process of breaking up deeply tethered scar bands associated mainly with atrophic/rolling scars. Subcision has be performed for acne scars for decades and just using this procedure alone has proven to lead to significant acne scar improvements. Recently there have been a couple publications suggesting that cannula subcision had better outcomes, less downtime, and less discomfort than the traditional method of using a Nokor needle. A cannula has a blunt tip so it is also safer – less chance for cutting a nerve or blood vessel than the knife-like edge of the Nokor needle. In the study, both patients and the performing doctor rated the results better when using the cannula. Subcision is particularly important, in Dr. Weiner’s opinion, to be performed prior to any energy device for tethered scars. This is based on the fact that RF and laser will preferentially travel through collagen – which is high is water content – than fat or most other tissue. Scars are predominantly collagen, so it makes sense to cut the connection of the scar to the deeper tissue. Through personal communication with Dr. Davin Lim, biopsies he performed have shown scar band that reach the deeper fat pads from tethered acne scars. Transmission of the energy through the scar can theoretical lead to collagen contraction and deepening of the tethered scar. Sometimes fillers are placed at the time of the subcision to improve the volume loss associated with the scarring. Some hypothesize that putting a “spacer of filler” might improve results as well. Dilute lidocaine during the initial passes allows for this procedure to be well tolerated.

TCA CROSS – TCA (Trichloroacetic Acid) is a chemical peel used to improved acne scarring by placing minute quantities in the scar using a toothpick. CROSS stands for Chemical Reconstruction of Skin Scars. The most common use of this procedure is for ice pick and small boxcar scars. The process of causing a controlled chemical burn, allows for the body to heal from the deepest part of the scar towards the skin surface. This makes the scar smaller in diameter and shallower. Usually a series of 3-6 treatments are needed, with 3-4 weeks between treatments. There will be some mild scabbing for a few days which needs to be kept moistened for best results. Risk include widening of the scar or post inflammatory hyperpigmentation (PIH).

Radiofrequency Microneedling – This technology (RFM) has been available in the US for about 6 years and has revolutionized acne scar treatment. Using needles which are insulated, energy is delivered into the scar tissue directly and bypassing the epidermis, for the most part. The insulation protects the skin surface from heating so darker skin type individuals are at much less risk of PIH (post inflammatory hyperpigmentation) vs a laser treatment. The needles allow for deeper penetration than lasers as well. Overall, downtime is less than ablative lasers in most individuals (when insulated needles, proper technique, and appropriate settings are used). With acne scarring affecting darker skin types disproportionately, this is an excellent alternative to lasers. The Genius has recently been FDA approved and is now the “best of bread” RF microneedling device. There is now impedance feedback from the needles which allows for improved and exact energy delivery. The resistance in the tissues being treated is measured and this is important because throughout one’s face, there are differences, as well as between different individuals. Also, as tissue are heated or subcised, the resistance changes. Prior to Genius, there was no idea of how much energy was being delivered. There is now an accurate total energy for each pulse and a cumulative total. Other improvements include needle design-sharper, stronger motor, and feedback regarding quality of each pulse fired.

There is a myth that needs to be busted. Deeper does not mean better for acne scars.

The needles must stay within the scar for best results. If the needles go beneath the dermis, there is a risk for heating the fat and fat loss. Let it be known that the actual depth of the needles in most RFM devices is less than the settings, and becomes less accurate, the deeper the settings are. There is inherent resistance of the skin to penetration and many needles aren’t sharp enough or motors aren’t strong enough to get to the desired levels in the time required. This has also been addressed with the Genius and it’s depths are very accurate after extensive testing.

In addition, higher energy levels on any device which doesn’t monitor impedance, can actually result in very little energy delivered. Once the tissue is heating beyond a critical level, the resistance becomes so high that energy output cuts off. However, when higher energy levels are desired when using the Genius, the energy is adjusted to the increasing impedance and it is successfully delivered.

Fillers – Fillers are a very integral part of improving acne scars. They are extremely useful for the atrophic scars and the lipoatrophy associated with these scars. The aging process leads to dermal thinning and fat atrophy, which makes the acne scars appear worse, even if active acne has long been controlled. Fillers need to be injected deeply for correcting large areas of volume loss and superficially in minute quantities for focal defects. A hyaluronic acid filler will give about 12 months of improvement vs Bellafill which can give near permanent improvements. Bellafill does require a skin test to see if one has a allergy to the bovine collagen (0.5% chance) which needs 3-4 weeks to determine. There is some who feel fillers in areas of subcision will prevent re-adhesion of the scars. Most failures from other treatments are related to not recognizing the need to fillers to improve the acne scars.

Lasers – Erbium/CO2 ablative lasers still are beneficial for acne scars but have more downtime and risks vs RFM. Deeper skin imperfections are not improved with lasers and require fillers. These devices are best reserved for more superficial scars, mainly boxcar scars. Non ablative lasers are less affective but safer and in the author’s opinion give very minor results.

Microneedling – Also know as “Collagen Induction Therapy” CIT, has become popular in recent years. There are rollers available for home use and then there are medical grade devices which go to depths of 2mm or deeper and create thousands of penetrations per second. Rollers should be not be used at home for 2 reasons – questionable sterility at home and they tear tissue more than the in-office devices. Often these treatments are combined with topicals and PRP. It is highly recommended to not use any products on the skin which would normal not be injected. There have been many cases of infection and granulomas from these practices. Even when done in the office with PRP or amniotic membrane products, the efficacy of this procedure is minimal, and should be reserved for only mild acne scarring.

PRP/Amniotic membrane products – There is some date to support that better results and faster recovery with less side effects if PRP or amniotic membrane products are used during acne scar treatments. There is a movement more towards amniotic/placental products and away from PRP because there are more growth factors/healing properties in these vs PRP.

LLLT – There is a plethora of studies to suggest that using low level laser light (LLLT) is beneficial to results and healing times. The most researched device is Healite, and this should be performed immediately following all acne scar procedures which use energy devices. It calms the skin and improves circulation.

Acne scarring procedures are continuing to improve as technology and techniques evolve. One must understand that results require months to fully appreciate and multiple treatments (3-5 or more) are often needed to optimize results. Expectations need to discussed with providers/patients so that all are on the same page as to what one can achieve with treatments.

Dr. Weiner is an Acne Scar Center of Excellence designated by Bellafill and is a specialist on acne scars. He is a lecturer and trainer for Bellafill. He has become one of the leading authorities on Radiofrequency Microneedling and travels the globe lecturing on this technology. He performed the FDA trails for the Genius. He recently authored a chapter on RF Microneedling which soon will be published in the Facial Plastic Clinics of North America. He also wrote a recent chapter on Radiofrequency Safety and Complications which will be part of a book titled “Complications in Minimally Invasive Facial Rejuvenation: Avoidance and Management” by Paul Carniol, MD

The Genius is Truly a Huge Step Forward for RF Microneedling

The initial studies of radiofrequency microneedling (RFM) were performed by Hantash et al. in 2009. What Hantash was able to demonstrate was that RFM produced a fractionated radiofrequency thermal zone (RTZ) with coagulated tissue surrounded by normal tissue. Overtime, multiple growth factors and inflammatory components led to complete replacement of the RTZ with neocollagenesis and neoelastogenesis over the following 10 weeks.

Delivery of the RFM energy varies according to the device used. Unfortunately, there has been a paucity of solid research behind the majority of the devices. There is confusion in the marketplace for both consumers and providers as to what constitutes the best delivery system for outcomes, safety, and comfort. Lutronic decided to breakdown all the components of RFM energy delivery and optimize them in their development of the Genius.

One of the selling points of many of the devices has been that they are comfortable and have minimal downtime. What this actually means is that there is minimal energy delivered to the dermis. Discomfort is directly related to the amount of energy delivered. Lutronic’s research has shown that needle depths and energy settings don’t necessarily correlate to the what really occurs in the tissues.

Needle Depths

Skin intrinsically resists puncture by outside forces. If is especially difficult for 49 needles to penetrate the skin in a small area (1x1cm2). The natural tendency is for the skin to buckle with the needles “bouncing off the surface” and several of the RFM devices tested have been documented to exhibit this phenomenon. Furthermore, needles have a harder time penetrating deeper into tissue than superficially, so deeper depths are even more challenging to accurately place than more shallow treatments. Unfortunately, setting needle depth on the device doesn’t always correlate to actual tissue depth. Requirements for accurate depths include:

Sharp needles – but not too thin as to bend or dull during hundreds of pulses
Powerful motor – underpowered motors prevent accurate penetration
Quick motor – slower motors will lead to pushing the skin rather than penetrate it

Energy Delivery

One of the fallacies of RFM devices is that higher treatment levels correspond to higher energy delivery. Best results will be related to turning the energy settings “all the way up” is ABSOLUTELY FALSE. Too much energy in too short a period will lead to rapid rises in tissue impedance (resistance) and cut off energy flow immediately. Performance by the operator can affect the energy delivered if handpiece pressure is light or not flush with the skin as well.

Tissue Impedance

Impedance in the dermis is highly variable between patients and even within different areas of the face and body. Variables affecting impedance are: hydration, solar damage, collagen and hyaluronic acid content, and scarring. Using settings based on clinical findings and desired outcomes is not enough precision for optimal energy delivery.

Coated vs Uncoated Needles

Coated (insulated) needles allow the microneedles to penetrate the skin and deliver energy to the dermis while bypassing the heating of the epidermis. Some devices will use uncoated needles which will increase the risk of post inflammatory hyperpigmentation (PIH), particularly in darker skin types. To minimize this risk, uncoated needles use low energies and therefore sacrifice results. There will also be more downtime/wound care with uncoated needles because the skin surface will be more affected than with the coated needles.

The Genius Advantage

Proprietary needle design – sharp and coated for minimal resistance to insertion
Improved motor insertion – high torque and quick needle insertion
Improved protocols – changes to energy and pulse durations to avoid sharp rises in impedance based on Lutronic proprietary research
Impedance Feedback – the needles monitor tissue impedance every 2 msec and give feedback to the device to optimize energy delivery and adjust flow as resistance changes. This is the “brains” of the Genius.
Energy delivered feedback – each pulse is monitored and amount of energy delivered is noted. If energy is not exactly as desired/set, both a visual and audible signal is sent to operator. Adjustments in settings or technique can be made to improve energy output.
Total Treatment Energy – a running total of energy given is kept. This allows the provider to base treatments on energy delivered. Cumulative energies delivered from multiple treatments will become the standard of care to achieve clinical outcomes for a given diagnosis.

With the advancements made with the Genius, suddenly, all other RFM devices are now obsolete. Genius delivers a precise, safe, and efficacious treatment for laxity, wrinkles, neck lines, acne scarring, and hyperhidrosis in all skin types.

Subcision of Acne Scars – Revisiting an Old Technique

Acne scarring is a significant psychologically debilitating disease affecting millions in the US, approximately 1% of the adult population in one study. Treatments for acne scars include:

Lasers
RF Microneedling
Fillers
TCA Cross
Subcision
Microneedling
PRP (Platelet Rich Plasma)
PDO Threads (?)

Most of these techniques are based on trying to make the disorganized collagen in the scar to be more organized and natural. Using carefully induced tissue trauma with heat or microneedles (mechanical), the body initiates a healing process to smooth the scars.

Acne scars will often affect tissues deeper than the dermis. Fibrosis/scarring can affect the subcutaneous tissues and fat and lead to tethering of scar to the deeper structures. Lipoatrophy (fat loss) can occur as the result of the inflammatory mediators released from the acneic process. When heating from lasers and RF is applied, it is preferentially conducted through the collagen because the water content of collagen is high. Heating collagen will lead to collagen remodeling but also collagen contraction. If the collagenous attachments to the deeper tissue are not cut (subcised), there is actually potential for worsening the appearance of the scars with these heating devices.

A recent paper suggested that using a cannula to subcise acne scars is better tolerated, with less adverse events, and judged to have better results by the patients. This is Dr. Weiner’s (and acne scar expert Dr. Davin Lim’s per personal communication) preferred method of subcision vs using a Nokor needle. By subcising, the energy flow to the deeper structures is severed and harm to fat is less as is the risk of pulling some scars deeper. Placement of filler (Restylane Defyne, Bellafill) is often done simultaneously with the subcision to help elevate the scars and prevent reattachment of the scars.

Subcision has been around for decades for acne scar treatment. It is now even more important when energy devices are used to maximize the benefits of these treatments. The use of cannulas for this procedure leads to more comfort, less risks, and better satisfaction.

The Aesthetic Clinique has been designated an Acne Scar Center of Excellence by Suneva (Bellafill) and is considered an acne scar expert.

**(Subcision is also useful for treating cellulite as there are fibrous attachments from the skin which cause the dimpling.)

Dermapen – Advanced Microneedling for Skin Tightening, Wrinkles, Acne Scars, Stretch Marks, and Improving Elasticity of Skin.

[youtube=http://youtu.be/a63rF6Gb8kY]

The Dermapen is used in conjunction with PRP and PPP in the video above.

[youtube=http://youtu.be/aaCTrLr2wB0]

The Dermapen 3 is a motorized microneedling device that can produce over 1300 dermal penetrations per second. The micro-injuries that are created cause an inflammatory response that ultimately causes collagen production. The injury to the dermis is fractional, only a small percentage is affected, which has been shown to lead to faster healing and an improved risk profile when compared to treating the entire dermis. There is no heat produced, as a laser would, so the risks of pigmentation issues is very low. For maximal benefits, a series of about 6 are recommended. The advantage of a Dermapen over a dermal roller is:

The penetrations are perpendicular to the skin so there is no tearing of the skin.
The perpendicular penetrations are linear and more precise than the roller that creates a wedge defect in the skin.
Depth of penetration can be changed for the different areas of the face.
The microneedles are much thinner than the dermal roller
Many more penetrations are performed in a Dermapen treatment
Able to treat areas where rolling is difficult or not possible – around the nose and eyes

What conditions can a Dermapen treat?

Superficial skin laxity and wrinkles, especially around the eyes
Enlarged pores.
Scarring, particularly acne scars
Stretch marks
Thin skin related to sun damage or age
Etched in superficial lines

What should I expect on the day of the Dermapen treatment?

After pictures are taken, a dermaplane is performed – using a scalpel, the superficial layer of skin is removed including fine superficial hairs.
A topical numbing cream will be placed on the skin for about 20 minutes
The cream is wiped off and the face is cleaned thoroughly with hospital grade soap
A hyaluronic acid lotion is placed on the skin which allows for easier movement of the Dermapen over the skin.
IF THIS IS A “VAMPIRE FACIAL”, PRP (Platelet Rich Plasma) IS NOW PLACE ON THE SKIN INSTEAD OF THE HYALURONIC ACID.
The Dermapen is then placed on the skin and each area is treated in at least 3 directions to get a thorough coverage. The product or PRP placed on the skin is pushed into the deeper layers of the dermis by the Dermapen
When finished with the Dermapen treatment (about 20-30 minutes), topical growth factors or collagen stimulators are placed on the treated skin. Studies have shown that these topicals can penetrate 50x better immediately after the treatment.
Your face will remain red or pink for 24-48 hours. There is a skin care regime that will be tailor made for your skin, recommended by the aesthetician.

What are some other uses of the Dermapen?

Prior to Levulan treatment for precancerous lesions, areas of concern can be treated with the Dermapen to allow for much better penetration of the Levulan.
There might be some benefit when used in combination with the laser for tattoo removal.
Chemical Peels will have better penetration and become more aggressive if Dermapen precedes placement of the peel.
Stretch marks can be improved, particularly when topicals are used immediately afterwards.
Although still experimental, there might be some benefit in treating areas of melasma followed by intensive topical therapy with hydroquinones and retin A.

Website: http://www.theclinique.net YouTube: http://www.youtube.com/user/StevenFWeinerFacial Facebook: https://www.facebook.com/TheAestheticClinique

Dr. Steve Weiner: “FINALLY…A Radiofrequency (RF) Skin Tightening Device that Makes Sense. Infini by Lutronic.” Includes an overview of the RF skin tightening industry.

Before and after one treatment with the Infini. After is 8 weeks after the treatment.

Infini treatment of forehead lines. After (right) is 8 weeks after one treatment.

Infini RF treatment of face and neck. After (right) is 6 weeks after 1 treatment. Show improvement in jowls, jawline, upper eyelids, and cheeks wrinkles.

Infini treatment for neck and lower face wrinkles.

15 hours after having the Infini Treatment, ready for work

3 hours after Infini Treatment, she had already gone to yoga

[youtube=http://youtu.be/yoNqal9Y54Y]

[youtube=http://youtu.be/8JGuWHG6n8I]

[youtube=http://youtu.be/pKKAZC4RqrQ]

Dr. Weiner’s White Paper on Infini (more medical terms and more detailed than blog)

Dr. Weiner explains why Coagulation is so important in tightening skin

Radiofrequency use in medical treatments has over a 70 year history. It has been used for multiple applications but the most exciting innovations recently have been in skin tightening. Thermage in 2002 was the first to market a device which was FDA approved to tighten skin and improve wrinkles. Since then, there have been a least a dozen devices come to market with similar technology including: Exilis, Venus Freeze, Pelleve, Viora Reaction, 3Deep RF, Accent XL, eMatrix, eTwo, TriPolar RF, ReFirme, Sublime, Fractora, Evolastin, and most recently Infini. The “knock” on most of these devices has been:

The results are variable – most patients get minimal or no results
Multiple treatments (6 or more) are often needed with touch ups with some of the devices

This blog will help the reader understand how RF devices tighten skin, the problem with most RF devices (why they mostly don’t work), and why the Infini by Lutronic is a game changer in this group. Research has shown that heating the dermis to a certain temperature will cause collagen stimulation and contraction. By heating to 40-45 degrees Celsius, enough heat is created to cause the body to try to repair the area by laying down new collagen. Higher temperatures, in the 65 degree range, will denature collagen and cause contraction. Obviously this requires more energy but this equates to more visible results. Here’s the problem with all cutaneous devices (Exilis, Venus Freeze, Pelleve, Viora Reaction, 3Deep RF, Accent XL, eMatrix, eTwo, TriPolar RF, ReFirme, Sublime): It is very difficult to heat the dermis to a temperature that is effective and still maintain safe temperatures for the skin surface. If the surface were to reach the 40-45 degree area, it would burn. So, these device’s solution has been to try to cool the surface while pumping in energy to the deeper layers. This becomes a very difficult and unpredictable task. The devices rely on the tissues to carry the energy to the right level. Differences in skin thickness, hydration and the composition of collagen and fat can lead to placement of the energy at unknown or variable depths. If the energy is placed too deep, you can get fat necrosis, as what was occurring with the early Thermage device, and if placed too superficial, the skin can burn or get hyperpigmentation. Also, if you don’t actually reach the critical temperatures, you will get no stimulation of collagen. Multiple treatments are the norm for several of these devices because getting collagen stimulation is very difficult with the one treatment. The bottom line is that

ALL CUTANEOUS RF DEVICES, NO MATTER WHAT THEY ARE CALLED, HAVE THE PROBLEM WITH UNPREDICTABLE HEATING OF THE DERMIS AND THEREFORE UNPREDICTABLE OR VERY LITTLE RESULTS.

Skin surface is cooled and RF energy is pumped through the skin surface to heat dermis is UNPREDICTABLE manner

During Thermage, the skin surface is cooled and then RF energy is pumped through the skin surface to heat the dermis in an UNPREDICTABLE manner

Infini vs Other RF Devices

Ever since Fraxel was approved in 2005, the concept of treating areas fractionally has been the desired treatment modality for most devices. By treating only a fraction of the tissue, you can have more safety, more comfort, yet still get fairly similar results than treating the entire area. This concept has been borne out mainly with lasers in the arena of fractional laser resurfacing. Now comes another “knock” for the majority of RF devices: Almost all of the devices use a bulk heating method and not a fractional heating, so the risk, downtime, and discomfort are high. By keeping surrounding tissues untreated (fractionally) as with the Infini, you get faster healing, less pain, and much less risk. So how can we get more predictability with RF? Penetrate the skin to the level you would like to heat with microneedles and bypass the superficial layer that must stay cool and untreated. You can heat the deeper tissues to a much higher level with this technique, leading to greater collagen remodeling, collagen contraction, and stimulation. As a secondary benefit, the actual penetration with microneedles has been shown to mechanically stimulate fibroblasts to produce collagen.

$Precise fractional controlled thermal injury of the Infini$

Precise fractional controlled thermal injury of the Infini, vs monopolar and bipolar RF, vs ablative laser

There currently are many popular treatments based solely on microneedling (Vampire Microneedling). By creating an opening in the skin with the needles, topical therapeutics can be applied at the conclusion of the treatment which will get to levels much deeper than when typically applied to the surface of the skin. These can include: growth factors (rejuvenation), Vitamin C (for collagen), hydroquinones (for pigment), Retin A (rejuvenation and acne). Going deeper into the skin allows for some treatment opportunities which haven’t been/or poorly been addressed in the past with RF devices: Acne treatment (attacking the sebaceous glands), acne or other scarring (particularly darker skin types), and sweating (attacking the sweat glands). There are 3 devices on the market which use this microneedling concept:

Evolastin
Fractora
Infini

Evolastin: Uses 32g needles in depths which are between 1-2mm. The needles enter the skin in a tangential manner, so the exact depth is hard to predict. The energy transmits between paired needles, so the heating in fractional and localized. The major problem is that the patient requires tumescent anesthesia (infiltrating lidocaine mixed with saline) into the area being treated. This adds additional time, discomfort, and risk. Another concern is that this solution actually changes the tissue characteristics, so the treatment becomes less predictable – maybe more or less effective in different areas or maybe safety concerns in certain areas.

Evolastin has tangential needle placement and large caliber needles

Fractora: Uses needles which have a fixed depth of 1mm. The energy is transmitted through the needles and circles back to the electrode sitting of the surface of the skin. The surface probe has a sensor to monitor the skin temperature so as to maintain it within safe parameters. This is truly NOT fractional because the energy is dispersed in the areas between the needle tips and the skin surface. Here we go again with unpredictable traveling of the energy through the tissues and bulk heating. Concerns for safety and discomfort come to mind.

$Fractora electrodes are not insulated and treatment is not fractional.$

Fractora electrodes are not insulated and treatment is not fractional.

Infini: Uses needles which are 200 microns (small). Has variable depth of penetration from 0.5mm to 3.5mm so in the same treatment, several different levels of the dermis can be treated PREDICTABLY. Also, some parts of the face have different thicknesses of dermis, so the variable depth allows for treatment of the entire face. A depth of 3.5mm is much deeper than the other 2 needle devices. The energy is transmitted between the needles which results in true fractional RF ablation in the dermal tissue. The energy only travels a very small distance so the discomfort is minimized. (The more distance the energy travels through tissue, the more pain is felt.) The surface tissue is safe because the needles are at a level that won’t transmit energy to the epidermis. The treatment time is fairly quick: full face treatments take about 30 minutes, as do the neck procedures. For optimal results, it can take 2-3 treatments and full results take the standard 4-6 months to fully achieve (when the collagen remodeling is complete.)

$Infini showing the microneedles causing a small precise fractional dermal injury at multiple levels$

Infini showing the microneedles causing a small precise fractional dermal injury at multiple levels

The wide spectrum of indications of the Infini are:

Improving superficial fine lines and wrinkles of the face, eyes, neck
Improving the elasticity of aged and solar damage “thin” skin
Treating scars of all types but particularly acne scars. It has a great advantage over laser for darker skin types. Infini might turn out to be the “go to” device for scars over the Fraxel Dual 1550 because of deeper treatment levels (3.5mm vs 1.8mm of the Fraxel) and without the pigmentation risks.
Tightening loose skin on all parts of the body including: arms, chest, knees, abdomen. There are no limitations as to where the skin can treated on the body.
Potentially a treatment for acne and hyperhidrosis
No exclusion of patients based on skin type with no risk of hyperpigmentation.
Downtime is limited to only about 2 days of sunburn like sensation and slight redness

When comparing to the Ulthera, the differences are:

Ulthera is more for lifting than for the superficial lines and wrinkles
Ulthera is only used on the face and neck at the present time
Ulthera is still being evaluated for acne scars
Ulthera can be used in conjunction with Infini for even greater tightening and lifting then just Infini or Ulthera alone
Ulthera results in 15,000 coagulation points with a treatment, Infini is over 50,000
Ulthera depths are below the dermis for the most part where tissue tightening is not very effective.

To summarize, RF skin tightening has over a 10 year history which has been fraught with several different technical hurdles: unpredictable results, discomfort, and safety concerns. Using microneedling RF, we can get the energy down to the level needed with more accuracy and more safety. Infini seems to have the right combination of the transmission of energy through their needle tips as well as having variable depths to be the ideal RF Skin Tightener at the present time. It also has a broad list of indications including acne scars, skin tightening on the body, and improving the fine lines and wrinkles of facial skin.

Dr. Steve Weiner is a Facial Plastic Surgeon who “laid down his scalpel” in 2005 and concentrates solely on non invasive and minimally invasive cosmetic procedures at The Aesthetic Clinique. He is one of the first 15 adopters of the Infini in the United States. His website is http://www.theclinique.net . Call for a consultation: 850.622.1214

This link is from a European round table discussion about Lutronic Infini and Spectra (both at The Aesthetic Clinique). Infini discussion starts on page 7. http://digital.miinews.com/publication/?i=174629

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

DERMAPEN – ADVANCED MICRONEEDLING FOR SKIN TIGHTENING, WRINKLES, ACNE SCARS, STRETCH MARKS, AND IMPROVING ELASTICITY OF SKIN.

2019 UPDATE: State-of-the-Art Acne Scar Treatments

The Genius is Truly a Huge Step Forward for RF Microneedling

Subcision of Acne Scars – Revisiting an Old Technique

Dermapen – Advanced Microneedling for Skin Tightening, Wrinkles, Acne Scars, Stretch Marks, and Improving Elasticity of Skin.

Dr. Steve Weiner: “FINALLY…A Radiofrequency (RF) Skin Tightening Device that Makes Sense. Infini by Lutronic.” Includes an overview of the RF skin tightening industry.

Location

Follow Us

Recent Posts