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Off Label Uses of the Infini – A Plethora of Potential Treatment Options – Scars, Sweat, Cellulite, Acne, Fat, Breast Lift, Knees, Tattoos

Dr. Weiner Infini Hyperhidrosis treatment

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The Infini is quickly being recognized by the aesthetic physicians as a very powerful tool to tighten facial and neck skin with very little downtime (less than 36 hours). It has also proven to have an extremely low risk profile, with very few long term side effects noted, even in tan or dark skinned individuals. For those unfamiliar with the Infini, please read this blog. In a nutshell, the Infini is a microneedling fraction radiofrequency (MFR) device that coagulates the dermis at various depths (o.25mm – 3.5mm) leading to tissue contraction, new collagen and elastin formation, and overall skin tightening and wrinkle improvement. Dr. Weiner has been using the Infini soon after it was FDA approved and has become the largest user of the device in the US. There have been several off label (non FDA approved) uses of the Infini that Dr. Weiner has been studying that will be discussed below.

Scar Improvement – The Infini causes disruption of the abnormal/pathologic collagen deposition and stimulates new and more organized collagen that more closely resembles the body’s normal collagen. Acne scars have been treated, even in darker skin individuals, with improvements noted. A physician in Korea has a large series of acne scarring patients who have been treated with the Infini showing dramatic improvements. Other scars being studied are stria (stretch marks) and surgical scars (such as tummy tuck and skin cancers).
Hyperhidrosis (Excessive sweating) – The sweat glands lay in the lower part of the dermis and just below it. By heating these areas up to a certain temperature, they can be destroyed permanently. This has been proven by the Miradry device, which uses microwaves to heat up the tissue. There is a very high long term satisfaction rate using this device after undergoing 2 treatments. It’s drawback has been discomfort (requiring blocks with injections) and cost ($3000 for 2 treatments). The Infini can be set to a depth that targets the area of the sweat glands and heat this area up to a point of coagulation (gland destruction). In preliminary studies in axillary (underarm) sweating, Dr. Weiner’s patients have seen improvements with the Infini with less discomfort, no downtime, and at a fraction of the cost. Dr. Weiner’s Press Release about using Infini for Hyperhidrosis.
Acne – Dr. Weiner had been noting that patients whom were undergoing Infini for skin tightening/wrinkles were also noting improvement with their acne. It was postulated that the sebaceous glands, the glands responsible for sebum production (the root cause of acne) were being injured with the Infini treatment. An acne flair is not uncommon after an Infini treatment, and this is caused by inflammation of the sebaceous gland temporarily. Over time, the glands will involute (becomes smaller with less secretions) and lead to the acne improvements noted. Eventually sebaceous glands can enlarge again (unlike sweat glands with don’t have the ability to regrow), so the treatment with Infini turns out to be a potential long term but not permanent solution for acne.
Body Skin Tightening – Areas such as knees and arms are a concern for many patients. Other than surgical correction, which leaves large undesirous scars, there hasn’t been a good solution. Perhaps the Infini can create similar skin contraction and thickening in these areas as it does on the face. Dr. Weiner is studying this on a few select patients.
Fat Reduction – The depth of 3.5 mm is below the dermis in most areas of the body. Using this depth with the Infini, it is possible to target fat, particularly in the submental (below the chin) area and along the jaw line. Many patients have seen improvements in these areas with their Infini treatments for wrinkles on the face and neck. Dr. Weiner purposely will go deep in these areas to coagulate and destroy fat and then go more superficial to tighten the dermis. Slimming the mid and lower face for patients with excessive fat tissue can be manage with the deep depth Infini treatment.
Cellulite Improvement – Using the same rationale as targeting fat, it seems logical that destroying the fat that is herniating would improve the appearance of cellulite. This is still an area of treatment that is more speculation and research is being conducted by Dr. Weiner on a few select patients.
Tattoo Removal – There is evidence that combining fractional ablative lasers with the Q-Switched laser has benefit in removing tattoos. If this is merely causing more of an inflammatory response to enhance the ink removal, then Infini can cause a similar tissue coagulation, but with less risk and downtime than the lasers do.
Breast Lifting – If the Infini can cause tissue contraction in the area of the breast, is it enough to see a noticeable improvement in the position of the breast? A no scar breast lift sounds extremely appealing. Studies will need to be done to see if the Infini can work for this and if so, how many treatments are needed, are touch ups required, and is it’s price justified.

Dr. Weiner is carefully studying the Infini for these off label uses and trying to develop standardized protocols for the medical community. It seems like the Infini’s potential is just starting to be recognized and its future is very promising.

VBeam (for Rosacea, Redness, Vessels) questions answered by Dr. Steve Weiner, Facial Plastic Surgeon

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Q: Is it safe to use V-Beam laser on the face if Juvederm has been injected into the cheek area?

A: VBeam will not affect Juvederm or other fillers

There have been numerous studies showing no affect of lasers on any of the dermal fillers. The VBeam is actually a fairly superficial laser as well.

Q: Will the vbeam be a good recommendation for me?

A: Redness after acne eruption, VBeam is a perfect solution

The VBeam is made to improve redness. State of the art. It is also good to improve acne. So in your case you will get a double benefit: acne and redness improvement. There is minimal downtime, just some redness for a few hours. You will need 2-3 treatments

Q: Is the Vbeam Perfecta Laser Good to Get Rid of Red Marks Left from Acne? (photo)

A: VBeam is the go to laser for redness after acne

The VBeam is tried and true for this particular problem. It takes about 3 sessions to get the improvement but everyone is different. It also helps with ongoing acne. Steve Weiner, MD, Destin, Panama City Beach, FL

Q: Has Anyone Used the V Beam to Treat Redness from a Chemical Peel? I’m 20 Weeks Post Peel (40% TCA Done by a Plastic Surgeon).

A: VBeam will work for post peel, post laser resurfacing redness

The VBeam is very well suited for treating your condition. Usually 2-3 are needed to decrease the redness. It’s about a 10 minute procedure with no downtime, no topical, and nearly painless.

Q: How Many V Beam Treatments Needed for Broken/dilated Capillaries?

A: Vessels and Redness need 2-3 treatments with the VBeam

In general, 2-3 treatments with the VBeam can improve enlarged vessels and redness. Over time, these can return. Some people this is a year, some a few years. There is no major side effects other than slight redness and maybe some swelling which lasts a couple hours, at most, overnight.

Q: Perfecta V Beam Okay for Asian Skin Type?

A: VBeam on Asian Skin is ok if skin is not too dark

There are studies treating Asians with the VBeam showing it’s safe and effective. It treats all vascular lesions such as hemangiomas, telangietasias, Portwine stains, rosacea, red scars, agiomas, and can treat acne.

Q: Will VBeam Treat White Stretch Marks?

A: VBeam for stretch marks works only in they are red

If the stretch marks are mature and white, the VBeam will not work. Stretch marks are tough to treat and you can only expect mild but real improvement with the Fraxel Dual. I don’t think using the CO2 laser on your skin type is a good idea but it is also used for stretch marks. I don’t think pigmentation should be a problem it you treat with hydroquinones before and after.

Q: Can I V-Beam my Ears?

A: VBeam can be used on ears to treat small vessels (telangiectasias)

Yes, the VBeam is excellent for treatment of vessels on the ears. The only place it doesn’t work well is on the legs because the pressure in these vessels is higher and the vessels are deeper.

Q: How Soon Can I Fly After Recieving a Vbeam Procedure?

A: Flying immediately after VBeam is perfectly ok

I have the VBeam Perfecta, the top of the line, latest version. It’s algorithms are set so there is very little chance of bruising. The most I see is usually only mild redness and occasional swelling. Flying afterwards will not affect your outcome at all.

Q: Can V-beam Perfecta Effect Hair Growth After Treatment Like Cause Hair Loss on the Body Where It is Used

A: VBeam should not affect hair growth in area treated.

A VBeam may temporarily remove hair in the area treated but there is no long term hair removal by the VBeam. It can vaporize the hair but not get deep enough to affect the hair follicle.

Q: V-beam Recovery, Is Delayed Pinkness Common?

A: Redness after VBeam is normal

After having a VBeam, it is not uncommon to have some redness which can last up to about a week. You can have some bruising as well. In general though, the redness is very mild, and the social downtime in minimal after having a VBeam.

Q: Will V Beam Help with Acne?

A: VBeam good for both acne and redness associated with it

The VBeam is a rather easily tolerated laser for treatment of redness associated with acne. It also helps improve the acne. It is usually done in a series of 3-4 treatments separated by about 3-4 weeks. Of course, topical medications are needed to treat acne as well.

Q: Can V Beam Help Diffused Redness if IPL Didnt Help?

A: VBeam is better than the IPL for redness

The VBeam was specifically designed to take care of redness. It’s actually safer than the IPL because it has DCD cooling which keeps the skin cooler than an IPL and because it is more specific for the redness than the IPL is. As far as discomfort, the VBeam is extremely comfortable too. It can take more than one treatment to get optimal results.

Q: Is V-Beam Good for Facial Erythema / Ruddy Complexion?

A: VBeam is great for Facial Erythema and Ruddy Complexion

The VBeam laser is the gold standard for treatment anything that is vascular or red. It is great for treating generalized redness, enlarged vessels (telangiectasias), rosacea, hemangiomas, vascular lakes, poikiloderma, and port wine stains, You must make sure that the ruddy complexion is not a cummulation of actinic keratosis, which would be best treat, in my opinion, with Levulan followed by activation with the VBeam.

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

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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

Did you know…..Interesting things to do at the Aesthetic Clinique

This blog entry is filled with random facts and procedures that many people don’t know are available at The Aesthetic Clinique.

Aging of the hands can be improved with filling the back of the hand with Radiesse and getting rid of the age spots with the VBeam or Fraxel Dual. Filler in this area is practically pain-free.
Chronic, recalcitrant acne can be treated with near Accutane results using Levulan. Two or three treatments are needed. The results can improve the acne 80% or more for a year or longer.
The temples are a common area of fat loss as we age and can be filled with filler in a few minutes with Sculptra, Radiesse, or Restylane.
Belotero is a new filler that can be injected more superficially than other fillers and is great for those fine lines around the mouth and cheek area.
Blunt cannulas for dermal fillers significantly decreases the discomfort and bruising that normal needles injections cause. We’ve been using cannulas since early 2011.
Those enlarged vessels around the nose and those small red spots on the body (cherry angiomas) can be treated quickly and with very little discomfort with our VBeam.
Ulthera, our non-invasive skin tightening device which uses ultrasound, has recently been approved for the entire neck. It has already been used by us for years on the face. Studies are ongoing for the chest as well as for reducing sweat in the underarms.
Sculptra is now being used to improve the loose, thin skin and wrinkles of the chest.
Facial slimming can be done with Botox for those people who have enlarged masseter muscles.
To improve healing in a surgical or traumatic scar, we are treating with the VBeam when the stitches are removed or the skin is healed.
Precancers on the face can be treated with the Fraxel Dual or Levulan without the need for surgery.
Sculptra not only improves the volume loss of the face, but also improves the skin quality by thickening it.
The duration of bruising after a procedure can be shortened to just a few days when treated with the VBeam a day or two later.
We have a chemical peel which can be done on the eyelids with very little downtime. We also have peels for the body.
With our new Coolcurve handpiece for Coolsculpting, we are now able to treat smaller areas, including inner thigh, male breast tissue (gynecomastia), banana rolls, or very small love handles.
We have a new freezing device from Europe that can take off benign skin lesions, tags, and warts almost painlessly.

For more information, please visit our website: www.theclinique.net

Off Label Uses of the Infini – A Plethora of Potential Treatment Options – Scars, Sweat, Cellulite, Acne, Fat, Breast Lift, Knees, Tattoos

VBeam (for Rosacea, Redness, Vessels) questions answered by Dr. Steve Weiner, Facial Plastic Surgeon

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.

Did you know…..Interesting things to do at the Aesthetic Clinique

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