SYLFIRM X treatment for porcelain skin

Jinah Yoo, MD, shares her clinical experience using SYLFIRM X to treat acne, enlarged pores and rosacea

JINAH YOO, MD, Consultant Dermatologist and Director at Dr Jinah Yoo Dermatology, London, UK; Honorary Lecturer, University of Manchester, UK N OWADAYS, interest and efforts for porcelain skin are increasing all over the world. When it comes to porcelain skin, you can think of so-called flawless skin which refers to clear, smooth, and blemish-free skin regardless of skin color. In dermatologic and aesthetic fields, it is considered an approach to skin quality that can be analyzed from visual, topographical, and mechanical angles. There are various presentations that affect skin quality that are often encountered in clinics, such as pigmentation and skin texture, but

I would like to focus on acne, rosacea and enlarged pores and the treatments for these symptoms.

Various methods are used to treat the above symptoms, one of which is RF (radiofrequency) microneedling. It works by creating microdamages with needles in a controlled manner to deliver an RF thermal effect to induce a healing response and is non-chromophore dependent, which is safe for use on all Fitzpatrick skin types. I use

SYLFIRM X, which is a dual wave of

RF microneedling developed and manufactured by ViOL, Co., Ltd.

SYLFIRM X is an FDA and CE cleared device and has several unique technologies that differentiate it from other RF microneedling devices. It is equipped with a dual wave that can be used for both continuous wave (CW) and pulsed wave (PW),

Figure 1 Rosacea patient, (A) before and (B) after 3 sessions of SYLFIR M X

enabling to effectively treat various skin conditions with a single device, and each wave is subdivided into four modes according to pulse duration, so operators can use it intuitively. The needle depth can be adjusted by 4 mm and a unique needle length of 300µm can be used to target the papillary dermis where senescent fibroblasts, capillaries, and type III collagen are present.

Acne

Acne vulgaris is one of the most common dermatologic conditions we see in clinics, and nearly 85% of teenagers are affected by acne at some point. Acne is caused by follicular hyperkeratinization,

“SYLFIRM X is a FDA and CE cleared device and has several unique technologies that differentiate it from other RF microneedling devices.”

Cutibacterium acne colonization, sebum production, and inflammation that are often triggered by hormones and stress, and different treatment methods are used depending on the target causes.

Medications such as topical or oral antibiotics and retinoids are generally used according to AAD guidelines 2016 but usually require long-term use and can be associated with serious side effects.

Non-pharmacological treatments used for acne vulgaris are either alone or in combination with energy-based device treatments, including PDL (pulsed dye laser), 1450 nm diode laser, and IPL (intense pulsed light) using a photothermal effect.

Another way to use thermal damage to reduce sebum production and sebaceous gland activity is RF microneedling. In addition, it can induce wound healing by inducing the secretion of cell mediators and growth factors due to the thermal effect on the dermis. When treating acne with SYLFIRM X, I use the PW4 mode. I often combine SYLFIRM X treatment with other methods for quick and effective results in acne treatment. Antibiotics and benzoyl peroxide face wash are used with monthly SYLFIRM X treatment, or long pulsed Nd:YAG laser and SYLFIRM X are alternately used every 2 weeks. Furthermore, skin boosters, such as exosome-based boosters with antiinflammatory effects or NCTF Cytocare with moisturizing and brightening effects, are applied immediately after SYLFIRM X treatment so that they can be well absorbed through the microchannels created by microneedling in order to reduce downtime and maximize therapeutic effect.

Enlarged pores

Pores are tiny openings around hair follicles that are involved in the secretion of sebum and sweat. The main causes of enlarged pores are high sebum excretion in those with acne and oily skin, decreased elasticity around pores due to aging, and increased hair follicle volume. Treatments to address these causes typically include topical retinoids, Botox, lasers (ablative/ non-ablative lasers), or RF microneedling. When using SYLFIRM X for enlarged pores, I use the CW2 mode and needle depth of 1.0–1.5 mm to target sebaceous and sweat glands. As a combination therapy with SYLFIRM X for the treatment of enlarged pores, Botox, widely used for enlarged pores, can be applied topically after SYLFIRM X treatment. Additionally, the effect of improving enlarged pores can be maximized by using the thulium laser targeting the superficial skin layers with SYLFIRM X targeting the deeper skin layer.

When treating acne with SYLFIRM X, I use the PW4 mode. I often combine SYLFIRM X treatment with other methods for quick and effective results in acne treatment.

Rosacea

Rosacea is another common condition that can sometimes be difficult to diagnose in dark skin types. Although rosacea may have similar clinical presentations to acne, it has very a different pathogenesis. This is a disease in which the skin barrier is impaired, and the skin becomes sensitive, itchy, rough, scaling or swollen. It is primarily accompanied by persistent or intermittent diffuse facial erythema due to vasodilation, lymphatic dilatation and angiogenesis impacting the mid and upper dermis. As you know, there are 4 types of rosacea: erythematotelangiectactic, papulopustular, phymatous, and ocular. The management methods are different depending on the type of rosacea.

The papulopustular type is often managed with medical treatments such as topical brimonidine, oral propranolol, or clonidine, whereas the erythematotelangiectactic type is frequently treated with energy-based devices, but patients with dark skin type may not be able to be safely treated with IPL, KTP or PDL due to the cross proximity of melanin absorption curve to that of oxyhemoglobin. For these patients, treatment can be maintained with a long-pulsed Nd:YAG laser, but RF microneedling could be an alternative treatment which is not affected by chromophores. When treating rosacea with SYLFIRM X, different PW modes are used depending on the symptoms: use PW 2 mode to treat diffuse facial erythema to selectively disrupt the vessels with high electrical conductivity, and use PW4 mode to treat papulopustular rosacea to reduce inflammatory components.

Conclusion

In summary, SYLFIRM X is a dual-wave RF microneedling device with multiple but intuitive modes, making it a versatile, clinically ideal device to improve overall skin quality and treat a wide range of skin concerns. In particular, the PW mode is effective for treating skin conditions related to diffuse erythema and inflammation of all skin types, and is easy to treat in combination with SYLFIRM X and other methods, and can help treat challenging chronic skin conditions such as acne and rosacea.

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