venus-freeze Archives | The Aesthetic Clinique

Most Frequently Asked Questions about Infini, RF Skin Tightening from Lutronic

What makes Infini different than other RF devices? The long answer can be found at my blog post. The short answer is: fractional not bulk heating, needles are insulated, needle depths are variable, coagulation occurs for maximal collagen stimulation, and the epidermis is safely protected from the heat. This allows for a very safe treatment for all skin types, that is also very effective.
What long term complications have you (Dr. Weiner) seen? With over 1000 treatments, I have seen no long term complications. No skin atrophy, no unintended fat loss, no scarring, and no pigment changes.
How long does a treatment take? With an experienced provider, the face treatment takes about 45 minutes, and if the neck is included, add another 15 minutes.
How long is recovery? The initial redness subsides very rapidly in the first hour. It takes about 24-36 hours to resolve, as does the swelling. Rarely, patients report extend redness for a few more days.
What are the restrictions after the Infini? Skin care must be only the prescribed creams. No make up until the morning and care with touching the skin with unclean hands or towels. There are no activity or sun restrictions!
Is ice or steroids used after the treatment? It is not recommended to use either of these after Infini. Although there is no data, it is Dr. Weiner’s opinion that the results can be compromised if ice or steroids are used. The results are dependant on inflammation, and “heat shock proteins”, both of which are inhibited with ice and steroids.
How many treatments are needed? Good question. It is variable. To get maximum benefit, the general consensus is 3. Some people might be happy with only one, but that is uncommon. Younger patients wanting only preventative treatments can get one yearly. Acne scarring clients should consider at least 3, and might be more satisfied with 5 or 6.
How does Infini affect fillers? If the fillers are injected deeply below the skin (sub Q, or deeper), such as is done by Dr. Weiner using the blunt cannulas, the fillers should not be affected. Sculptra and Bellafill are not affected at any depth and are frequently done at the same time as the Infini by Dr. Weiner. If the filler is placed in the dermis, they are at risk of being degraded.
How long should I wait between treatments? Consecutive treatments can be done as close as 3 or 4 weeks. If this is not possible because of your schedule, don’t worry, the final results are not affected.
How painful is the Infini? Most patients will rate the majority of the procedure a 3 or 4/10. The areas which might be higher are over the bone, such as the forehead, cheeks, and jawline. We have recently implemented changes in technique to make all but the forehead more comfortable. The forehead can be excluded if desired. All patients report no discomfort when the procedure is complete.
Can the Infini be used on other parts of the body? We routinely treat the neck and chest in conjunction with the face treatment. Other areas we have treated are arm laxity, knee area, and scars from abdominal surgery. Stretch marks have been treated but results are variable. We have successfully treated hyperhidrosis with the Infini as well. Bottom line is that when appropriate depths and settings are used, the Infini can be used on all areas of the body.
How many passes are performed on each area? Each area is treated at least with 3 depths and 2 passes for each depth. Some areas area treated at 4 or 5 depths.
What patients would you exclude? Very few patients wouldn’t be candidates. Patients with pacemakers should not be treated. If there is metal in an area of the face, the skin overlying this area can not be treated. Patients on blood thinners can be treated but will get bruising. We try to hold all thinners if it is possible prior to treatment. Aspirin needs 12 days for it’s action to be completely reversed on the platelets. Patients with severely sun damaged skin will theoretically respond less than a person with healthy skin.
Why is Infini safe for darker skin patients? The Infini is protective of the epidermis, where the pigment cells are, because it’s needles are insulated. Also, the depth can be adjusted so the heat from the RF stays in the dermis, below the most superficial layer. Other devices are either not insulated, or try to push heat through the skin, potentially damaging the pigment cells.
How does the Infini compare to lasers for treating acne scars? The Infini is safer than a laser, with less downtime, and no risk to the eyes. As stated above, the darker skin patients can be treated more safely with the Infini when compared to a laser because a laser will heat the upper layer of skin, the epidermis. Lasers have the risk of pigment changes (darker or lighter). Results from Infini appear to be better than lasers for acne scars. It is postulated the the increased depths of the Infini (up to 3.5mm) vs lasers (maximum about 1.8mm) seems to the difference. Also, elastin is produced (elastinosis) in response to a RF treatment, and this is not the case in laser resurfacing.
How long do results last? This is a difficult question and will be different for each patient. The collagen created will last at least 7 years. However, the amount of collagen is variable, and depends on the overall skin health, patient’s health, smoking habits, age, tanning, sun exposure, and lifestyle. It is usually recommended to have a “touch up” performed every 12-18 months.
What is better, Infini or Ulthera? My new blog answers this in detail: Infini vs Ulthera

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

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

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Fractional Coagulation is in, Bulk Heating is out for Radiofrequency (RF) Skin Tightening

Ever since Rox Anderson suggested that treating a portion (fraction) of skin while leaving untreated healthy tissue behind as the basis for the Fraxel Skin resurfacing laser over 10 years ago, patients have been having less downtime, less risk, and less discomfort with their laser procedures. Healing is dramatically improved because the adjacent nontreated dermis is able to provide the needed blood supply, nutrients, and local immune response much faster than the traditional treatments and results have been shown to be very similar in efficacy.

Until recently, all RF devices have applied heat to the skin/dermis in a nonfractionated approach, called “Bulk Heating”. Whether the RF device is Bipolar or Monopolar, if the heating element does not penetrate the skin, the energy is pushed into the deeper layers using this method. The implication of bulk heating is that all precision is lost. Exact placement of the heat is impossible, with large opportunities for errors in depth of penetration and/or temperature control. When treating skin, heat from the RF device using bulk heating can be placed too superficial, leading to burns or pigmentation changes, or too deep, leading to fat loss. The dermis needs to be heated to 42 degrees C for 3 minutes to affect collagen stimulation. Only if skin temperature is measured can the operator be sure that the 42 degrees is reached with bulk heating, which is not the case for most bulk heating devices. One last temperature issue is that bulk heating devices are unable to obtain coagulation of the tissue, which occurs at about 67 degrees C, which is needed for maximal tissue contraction and collagen stimulation.

The Infini uses microneedles to deliver the radiofrequency energy IN A FRACTIONAL manner. Its unique array of needles allows the energy to flow between the needles, creating 49 coagulation points AT A SPECIFIED DEPTH in the dermis. Surrounding tissue is sparred, which makes for very little downtime. The superficial layer of skin is spared (because the needles are insulated), leading to no wound care, and markedly reduced risk of burns and pigmentation issues affecting the epidermis. The temperature created in the areas between the needle is enough to create coagulation, for maximal tissue contraction and collagen stimulation.

(Not all microneedling RF devices are fractional. Fractora uses microneedles, but because the energy is directed from the needles to the skin surface, the heating is in a fashion similar to bulk heating devices. Also, because more tissue is affected using this heating method, discomfort is much higher and local anesthetic needs to be injected in most cases.)

It has taken a long time for RF devices to catch on to the fractional technology revolution. The Infini has created much more precision in the delivery of RF energy to the dermis, allowing for higher degrees of skin tightening, while affording the safety and quick recovery time that fractional technology has created.

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.

Coagulation is Necessary For Maximum Skin Tightening; Science and Experience Prove This – INFINI is the Best Solution

It is fundamental that my patients understand the science behind their treatments. There is too much “quasi science” in the aesthetic industry that is fooling the general public. As a result, many patients are dissatisfied with their outcomes and have buyer’s remorse. Perhaps the most controversial area of the industry is with “skin tightening” procedures. After reading this and my previous blog on the Infini, hopefully you will recognize the reasons why most of the devices/procedures for skin tightening don’t work well and why the Infini stands out from the crowd.

To achieve skin tightening, the deeper layer of the skin, the dermis, needs to create new collagen. It has been found that heating this layer of skin can stimulate neocollagenesis (new collagen production). The threshold is 42 degrees centigrade to impart a stimulus to the dermis, because at this temperature collagen denaturing occurs (the bonds holding collagen together break down). The body senses the injury, and during the repair of this area, new, youthful collagen is produced. The response is very mild at these temperatures. At higher temperatures, 55-70 degrees centigrade, coagulation of the collagen and surrounding tissue occurs, with more coagulation seen in the higher range of those temperatures.

WHEN COAGULATION OCCURS, THE BODY’S RESPONSE TO THE INJURY IS MUCH MORE INTENSE. TO ACHIEVE MAXIMUM SKIN TIGHTENING AND COLLAGEN FORMATION, COAGULATION IS NEEDED IN THE DERMIS.

Digression: The long standing “gold standard” for wrinkle control and skin tightening (without surgery) has been considered the fully ablative CO2 laser. It has been determined that its efficacy is based primarily on its significant coagulation effect. The risks associated with complete removal of the upper layer of the dermis – prolonged healing, redness, scarring, infection, and hypo and hyperpigmentation – have significantly curtailed its use. Recent technology improvements that have made the CO2 laser fractional (treating only a fraction of the skin) has greatly reduced the risks, but they are still present. Erbium laser resurfacing, which traditional has very little coagulation, has not been shown to have the same results as the CO2 laser. Changes in the Erbium to give it more of a coagulation effect on the skin have lead to better results.

The ideal skin tightening device would cause tissue coagulation in the dermis, but have very little of the risks and downtime associated with the CO2 laser. Radiofrequency devices have been trying for over 10 years to do this without success. They try to heat the dermis, but not the epidermis (upper layer of the skin) to the 42 degrees needed to get a mild neocollagenesis. THE PROBLEM IS THAT ALL THE NON PENETRATING RF DEVICES CAN DO, AT THEIR VERY BEST, IS HEAT, BUT NOT COAGULATE, TISSUE IN THE DERMIS.

So what devices can coagulate tissue is the dermis aside from the CO2 laser: Microneedling RF devices (like Infini) and Ulthera (High Frequency Ultrasound). In this category, Infini wins hands down. All of the other microneedling devices currently on the market have one or more of the following downfalls:

The needles are not insulated so the epidermis is at risk for injury (pigmentation or indentation risks)
The needle depth is fixed and not variable. The facial skin has a huge variation in depth, from 0.38mm to 3mm. Ideally, the coagulation is placed at the deep dermal layer. If it is too deep, there will be minimal collagen response.
The themal injury is not fractional. Treating fractionally is the way to treat in 2014. This allows for accelerated healing, minimal risks, without compromising results.
Their temperatures don’t reach the level high enough for coagulation. Without coagulation, results won’t be as good.

THE INFINI USES INSULATED NEEDLES, HAS VARIABLE NEEDLE DEPTH (0.5mm-3.5mm), AND CAUSES A FRACTIONAL COAGULATION INJURY IN THE DERMIS.
Infini Coagulates the Dermis

Ulthera has been a great tool in our office for the past 5 years. When comparing the Infini to the Ulthera, the following deficiencies in skin tightening have come up:

Ulthera currently only has 3 depths – 1.5mm, 3mm and 4.5mm. For most of the face, only the 1.5 is at the level of the dermis. Ulthera reportedly tightens at the deeper muscular layer, the SMAS, but this has yet to be a proven mechanism by histological samples (looking under the microscope at biopsies). Much of the coagulation from Ulthera is in the subcutaneous fat or fat layer, an area that produces very little or no collagen. It does explain the improvement in the jawline and upper neck though, the areas where there are fatty deposits.
Ulthera lays down about 15,000 thermal coagulation points (TPC’s) during a treatment. The Infini will create 50,000 or more of these TPC’s during a treatment. More TPC’s probably mean more results because Ulthera has proven that going from 7500 TPC’s to 15,000 TPC’s gave them better results.
Ulthera is more expensive for the physician to use, so the costs get passed on to the patients.

To summarize, skin tightening requires a coagulation injury in the deeper dermis. The discussion above has tried to show that besides the Infini, all other RF devices fail to deliver a predictable, safe, thermal injury to the point of coagulation in the dermis. Without the coagulation in the dermis, results will be unsatisfactory. In essence, the Infini has made Thermage, Venus Freeze, Exilis, Pelleve, Tripolar, Titan – all OBSOLETE.

To get a better grasp of the RF skin tightening Industry, please read the blog: “FINALLY…A Radiofrequency (RF) Skin Tightening Device that Makes Sense. Infini by Lutronic.” Includes an overview of the RF skin tightening industry.

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

Ultherapy – Non Invasive skin tightening with no rivals

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Dr. Weiner answers questions about Ulthera

Ulthera (or Ultherapy) was introduced in 2010 in the US. It uses ultrasound (high frequency) to cause an extremely predictable controlled injury at a certain depth (1.5, 3, 4.5mm depending on the hand piece) and a certain tissue volume. On the face, the level treated corresponds to the tissue called the SMAS, which is the area tightened during a facelift. So in essence, the Ulthera is tightening the SMAS without any incisions. The treated area is tightened and lifted gradually over the next 3-6 months as collagen is laid down in response to the treatment. Clients will notice a firmer jawline, less turkey neck, elevated cheeks and eyebrows, and less fine lines around the eyes. The newest hand piece, 1.5mm, is designed for the superficial fine lines around the mouth and eye area.

Almost all the other technology available (Thermage, Affirm, Exilis) for non invasive skin tightening uses radio frequency (RF) to heat up the underlying tissue to cause a thermal injury. Although Thermage was the gold standard for years, it’s problem was unpredictable results. That is because RF needs to heat the tissue to about 41-45 degrees C. Any more than that, too much damage is caused, and any less, no improvement is seen. RF requires the treated tissue to conduct the energy through existing collagen fibers, and the conductivity of people’s skin is different, and not predictable. (As previously stated, Ulthera will lay down it’s thermal injury at the exact skin depth and energy level in ALL PATIENTS similarly.)

The future of Ulthera is exciting. As experience grows, treatments are becoming more aggressive. More treatment line, more levels of treatment, seem to be able to create better corrections. Off the face treatments are beginning on the chest, knees, and soon buttocks.

Keep in mind that Ulthera does nothing to improve the outermost skin (pigment, vessels, texture) and does not create much additional volume. That is where lasers and fillers are needed to complete the total package of facial rejuvenation.

(We are very fortunate to have recognized the value of Ulthera and were very early adopters. Sandy, our RN, is a major contributor in the Advance Providers Round Table discussions at the company headquarters.)

Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.Blog: http://stevenfweinermd.wordpress.com/YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

Coolsculpting – Reducing Fat permanently with cryolipolysis

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Dr. Weiner answers questions about Coolsculpting

Coolsmooth Handpiece

Coolcurve Handpiece

Does the idea of permanently removing fat in the love handles or abdominal area using a procedure that is completely noninvasive, only takes a couple of hours, and has no downtime appeal to you? If it does (and why wouldn’t it?), then CoolSculpting is something you need to look into.

The CoolSculpting device has been on the market since 2009 and proves to be a very safe and effective treatment for removing that stubborn fat that just doesn’t seem to go away, despite all the hours spent in the gym. Before the advent of CoolSculpting, liposuction had been the mainstay for treating problem areas, but there are several drawbacks to this procedure: downtime, a need for anesthesia, discomfort, and a potential for uneven results. The ability to walk in and walk out and go to the gym or to lunch is an extremely attractive factor of the CoolSculpting treatment. You don’t have to miss any work, wear tight, binding garments, or change any bandages. In fact, there are no restrictions on activity or diet, and there is no need for wound care. Some might argue that liposuction is more aggressive because larger amounts of fat can be removed. This is true, but there is nothing preventing a person from getting a second or even a third treatment with CoolSculpting to achieve the desired results. Keep in mind that CoolSculpting is indicated for people who are within 15 percent of their ideal body weight, so it’s not meant for the very obese client.

Coolsculpting was conceptualized by Dr. Rox Anderson and Dr. Dieter Manstein of the Wellman Center of Photomedicine which is associated with Harvard Medical School and The Mass General Hospital. The two knew of a phenomenon called “popsicle panniculitis” which is loss of fat in the cheek area after a child freezes it while sucking on a popsicle. They also found a case report of a women riding a horse naked in cold weather which resulted in fat lose of her inner thighs, after they became extremely cold. They postulated that cooling fat can lead to fat loss – “Cryo = cold, lipolysis = breaking up of fat.”

Back in the lab, the 2 physicians found that fat was more sensitive to cold than muscle, nerves, skin, and vessels. They were able to find an optimum temperature to maximize the destruction of fat, while leaving all of the other structures unharmed. The concept of cryolipolysis was created. After the fat was exposed to cold for certain amount of time, it was terminally injured, and would gradually die. Over time, the body would remove the dying cells, with no increase in lipid or cholesterol levels in the blood.

With further research, it was found that about 25% of the abdominal fat treated was reduced in one treatment. Further treatments have been shown to further reduce the fat by about the same amount.

Coolsculpting was FDA approved in 2009 and was used off label for fat reduction initially. It was incorporated into the Aesthetic Clinique’s practice in December 2009. We were the 2nd in Florida to treat with Coolscupting, and one of the first 20 in the country.

The areas which have been treated at our office, The Aesthetic Clinique:

Abdomen, upper and lower
Flanks (love handles)
Muffin top
Inner Thighs
Gynecomastia
Back Fat
Arm Fat

Treatments are based on cycles. Each cycle is 1 hour. How many cycles you will need depends on the amount of fat and the area treated. Sometimes on the abdomen, a larger handpiece can be used which is the size of 2 handpieces and can reduce the time of a treatment.

Side effects are minimal and there is no downtime. Some of these are:

Bruising
Numbness
Moderate pain (0.04% of patients, lasting for a couple weeks)
No visible results
Enlargement of the fat – 5 cases (0.001%)

These stats are based on 303,000 treatments

The procedure is relatively painless, and most people work on their computer or watch movies during their treatments.

(I must digress and explain a competing technology which has confused clients. At about the same time Coolsculpting came to market, Zerona did as well. Coolsculpting was initial called Zeltiq which made things even more confusing. Zerona uses about 5 lasers, similar in power to the red laser pointers you can find at Office Depot. The company claims that the laser will reduce inches from arms, waist, hips, and thighs by shining these lasers on your skin. It is controversial as to whether these lasers actually go deep enough to affect the fat cells. If you believe what the company is saying, the laser makes the fat “leaky” and smaller. There is NO destruction of fat cells using Zerona, thus you are left with the same amount of fat cells. All the studies with this laser only go to 2 weeks from the last treatment. There are no long term studies showing lasting improvements. They are also done while the patient simultaneously is on a modification of his diet so any reduction in inches is hard to attribute just to Zerona. The company now states that the results are only temporary. Zerona is not a weight loss laser and claims of weight loss are false and misleading. As of writing this blog, Zerona has a 42% was it worth it rating from Realself.com and Coolsculpting has a 72%. Looking at Ebay today, there are 5 Zerona lasers for sale, there are no Coolsculpting machines being sold.)

There is now a new technology for fighting fat called Liposonix. It uses high frequency ultrasound, similar to Ulthera, but deeper. The technology seems promising, but side effects, pain, and results are still being evaluated. It is too soon to tell whether Liposonix will gain any significant market share from Coolsculpting. It is being sold by the company that makes the Fraxel laser, Solta Medical.

Currently, Coolsculpting is almost 3 years old and has proven itself as being safe, comfortable and effective with solid research and highly regarded physicians on it’s board.

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

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

Website: http://www.theclinique.net

Steven F. Weiner, MD, Aesthetic Clinique; Making 30A, Destin, and Panama City Even More Beautiful

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Maybe a little late to blogging, but let’s give it a try. I’m Steven F. Weiner, MD, a Board Certified Facial Plastic Surgeon in the Panhandle of Florida, between Destin and Panama City. I devote my entire practice to non surgical approaches to cosmetic enhancements and have done so since 2005. My practice is called, “The Aesthetic Clinique”, and consists of 4 full time aestheticians, one of which, my wife Sandy, is also a RN.

I trained at the Johns Hopkins Hospital, in the Department of Otolaryngology, Head and Neck Surgery. The hospital and department have been rated by their peers as number one for at least 10 years according to US News and World report. I was on staff at The Johns Hopkins Hospital for 2 years, then moved on to private practice.

I have been using Botox since 1994 and lasers since 1988

Dr. Weiner is a lecturer and trainer for:

Galderma: Restylane, Restylane Silk, Restylane Lyft, Sculptra, and Dysport
Suneva: Bellafill
Lutronic: Infini

The services offered at my office include:

Coolsculpting (First in the panhandle to do this procedure in 12/2009)
Fraxel Dual (one of the first in the country to perform in 9/2009)
LightSheer Duet (laser hair removal which is fast and comfortable)
Exel V for redness, rosacea, telangiectasias, enlarged vessels
ThermiVa
Spectra Q Switched laser for tattoos, pigmentation, and Spectra Laser Peel
Sculptra, Bellafill
Botox, Dysport, Juvederm, Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, Restylane Defyne, Radiesse
Facials, Chemical Peels, Waxing
ZO Skin Health
Blunt Cannula technique for facial fillers since 2/2011 – less bruising, less swelling, less discomfort than customary needle technique

Website is: www.theclinique.com

Facebook: http://www.facebook.com/pages/The-Aesthetic-Clinique/178656455073

Twitter: http://twitter.com/#!/theclinique

Youtube: https://www.youtube.com/user/StevenFWeinerFacial