14 minute read
Skin tightening of the lower face and neck area using radiofrequency microneedling
Drs Lynhda Nguyen and Katharina Herberger discuss the results they witnessed using Lutronic’s Genius® insulated radiofrequency microneedling system
LYNHDA NGUYEN, MD; KATHARINA HERBERGER MD, Laser Department, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
email l.nguyen@uke.de
KEYWORDS Radiofrequency microneedling, minimal invasive, skin tightening, jawline, neck ABSTRACT The ageing face is characterised by increasing wrinkles, skin laxity as well as undefined contours. Radiofrequency microneedling (RFMN) is one of the latest generations of fractional methods in aesthetic medicine. The patient case presented here is a representative excerpt of the treatment method analysed in our prospective clinical study currently published in Dermatologic Surgery and describes a successful treatment for skin tightening of the lower face and neck region. Case: A 67-year-old patient was treated in one session using an insulated RFMN system. Topical anaesthetic ointment prior to treatment and air cooling during treatment were applied to reduce pain. Follow-up visits three and six months after treatment revealed a distinct improvement in tightening and smoothening of the skin. Volume difference was 4.1 cm3 at the last follow-up visit compared to the baseline. Adverse events included temporary oedema and erythema. The patient was very satisfied with the clinical outcome. Discussion: In this case study, the RFMN proved to be an effective and safe method for rejuvenation of the lower face and neck region. To adequately assess the long-term effects and safety of RFMN, prospective side-by-side clinical studies are warranted.
PHOTOAGED SKIN OF THE FACE IS CHARACTERISED BY WRINKLES, fine lines, and undefined contours. One of the most effective interventions for rejuvenation of the face is surgical face lifts. However, due to the associated adverse events, downtime as well as financial implications, the current trend is toward minimally invasive procedures. Here, common methods include fractional ablative laser treatments, intense pulsed light, and chemical peels1,2 .
Radiofrequency microneedling (RFMN) is one of the latest generations of fractional techniques and has already been established to be a clinically applied method in aesthetic medicine. By applying high frequency and frequency-modulated energy into the dermis, wound healing and subsequent remodelling of the extracellular matrix is induced3. Currently, RFMN systems with insulated and non-insulated needles are available. Despite the promising effects, to date, only a few studies have been conducted on this treatment method.
The aim of the present case study is to evaluate the efficacy of RFMN for skin laxity and to discuss its use in light of the current literature.
Cases
We report on a 67-year-old female patient with Fitzpatrick skin type II who had noticed progressive skin laxity around her lower face over the past few years. Especially fine
lines and sagging of her submental region, which limited her quality of life. She did not wish for a surgical intervention due to the associated adverse events and downtime. The patient decided under informed medical consent for one RFMN treatment session using an insulated radiofrequency microneedling system (Genius®, Lutronic Medical Systems, Hamburg, Germany). Prior to treatment, the regions to be treated were cleansed and disinfected. An anaesthetic ointment (23% lidocaine, 3.5% tetracaine, 3.5% tetracaine-HCl) was applied 60 minutes before treatment. During treatment, air cooling (Cryo 6®, Zimmer Medizinsysteme, Neu-Ulm, Germany) was used. In total, three passes in alternating horizontal and vertical directions were applied with about 50% overlap. In this case, 1474 J/cm2 with 517 impulses were applied. The patient was instructed to have sufficient sun protection after treatment. Three and six months after the last treatment session, follow-up visits were scheduled.
Figure 1 indicates the patient before and six months after treatment. Significant skin tightening and a more defined jawline could be observed. Using a computeraided three-dimensional imaging analysis (VAM; Vectra H2, Canfield Scientific Inc, Parsippany, NJ, US), the volume difference of the submental region was 4.1 cm3 at the last follow-up visit compared to baseline. The patient tolerated the treatment well, with a pain intensity score of 2/10 on the Numeric Rating Scale (NRS). No additional analgesics were necessary. Mild oedema and erythema resolved spontaneously within a few days. Overall, the patient was very satisfied with the treatment outcome and would recommend the treatment.
Discussion
The present case study describes a patient who demonstrated a very good response to RFMN treatment. Overall, the treatment was well tolerated, with only mild and temporary erythema and swelling. This study sets an example of the current development and demand of patients who want to slow down ageing without undergoing surgical procedures. A number of minimally invasive rejuvenation methods have gained increasing popularity in aesthetic medicine, including fractional ablative lasers and peelings. These are proven methods but are limited by skin colour, as darker skin has a higher risk for post-inflammatory dyspigmentation. In our case, we used an RFMN system with insulated microneedles allowing penetration into the dermis while protecting the epidermal layer from thermal damage. By continuously measuring the impedance, the amount of energy delivered to the skin is controlled by the system. As melanin is not the target of RFMN, the treatment is not at odds with skin colour and thus is suited for darker skin types.
To date, only a few prospective clinical studies have been published on RFMN for skin rejuvenation, mostly using non-insulated needles4-6. Gawdat et al. applied RFMN with insulated needles on the neck and reported a significant increase in dermal thickness using an optical coherence tomography7. Our study represents the first prospective, intraindividual controlled clinical trial that evaluated the efficacy, tolerance, and patient satisfaction of insulated RFMN for skin tightening of the lower face, jawline, and neck region8. Here, patients were treated in one to three consecutive sessions at four to twelve weeks
intervals. A volume analysis revealed a mean difference of more than 4 cm3 6 months after the last treatment session. The authors assessed the pain intensity of patients during the treatment and reported a mean
A B C
D E F
score of around 5.6 / 10 NRS, indicating the need for sufficient pain management and a potential limitation of this treatment modality. In contrast to this study, the present case only had mild pain intensity. This might be to the fact that she reported having a high pain tolerance. The patient, physician, and a blinded independent investigator assessed the clinical results as significantly improved. Interestingly, evaluation scores were even
higher at 6 months, implicating the progression of collagen and elastin remodelling even months after treatment.
The present case study and current literature indicate that RFMN is an effective and safe method for the rejuvenation of photoaged skin. It may act as an alternative to surgical face lifts for patients who do not wish for surgical treatments. Sufficient pain management should be provided using adequate topical anaesthetic ointment, air-cooling devices during treatment and
Figure 1 Before (A, B, C) and six months after (D, E, F) one session of radiofrequency microneedling treatment. Significant skin tightening and more defined contours was achieved.
Key points
Radiofrequency microneedling (RFMN) is one of the latest generations of fractional methods in aesthetic medicine. The authors evaluate the efficacy of RFMN for skin laxity. In this case, 1474J/cm2 with 517 impulses were applied. The patient was instructed to have sufficient sun protection after treatment. Three and six months after the last treatment session, follow-up visits were scheduled. Significant skin tightening and a more defined jawline could be observed. The volume difference of the submental region was 4.1 cm3 at the last follow-up visit compared to baseline. analgesics if required. Patients should be educated about the time it takes to witness visible results to provide compliance and patient satisfaction.
Declaration of interest The radiofrequency microneedling system Genius® was provided by Lutronic Medical Systems. Katharina Herberger received lecture fees from Lutronic Medical Systems in the past four years. Lynhda Nguyen has none to be declared.
Figure 1 © Drs Lynhda Nguyen and Katharina Herberger
References
1. Gold MH. The Future of Non-Invasive Rejuvenation Technology: Devices. J Drugs Dermatol. 2017;16(6):s104-s7 2. Lee KC, Wambier CG, Soon SL, et al. Basic chemical peeling: Superficial and medium-depth peels. J Am Acad Dermatol. 2019;81(2):313-24 3. el-Domyati M, el-Ammawi TS, Medhat W, et al. Radiofrequency facial rejuvenation: evidence-based effect. J Am Acad Dermatol. 2011;64(3):524-35 4. Kauvar ANB, Gershonowitz A. Clinical and histologic evaluation of a fractional radiofrequency treatment of wrinkles and skin texture with novel 1-mm long ultra-thin electrode pins. Lasers Surg Med. 2022;54(1):54-61 5. Tanaka Y. Long-term threedimensional volumetric assessment of skin tightening using a sharply tapered non-insulated microneedle radiofrequency applicator with novel fractionated pulse mode in asians. Lasers Surg Med. 2015;47(8):626-33 6. Gold M, Taylor M, Rothaus K, et al. Non-insulated smooth motion, micro-needles RF fractional treatment for wrinkle reduction and lifting of the lower face: International study. Lasers Surg Med. 2016;48(8):727-33 7. Gawdat H, Allam R, Hegazy R, et al. Comparison of the efficacy of Fractional Radiofrequency Microneedling alone and in combination with platelet-rich plasma in neck rejuvenation: a clinical and optical coherence tomography study. J Cosmet Dermatol. 2022;21(5):2038-45 8. Nguyen L, Blessmann M, Schneider SW, et al. Radiofrequency Microneedling for Skin Tightening of the Lower Face, Jawline, and Neck Region. Dermatol Surg. 2022;48(12):1299-305
DermaVTM KTP laser generates more than 3000W (3x the previous “gold standard” 532nm device). 60% higher fl uence compared to the next highest 532nm at all spot sizes and pulse durations.
VARIABLE SEQUENTIAL PULSING (VSP) Various vascular lesions contain an array of vein sizes. With ease, DermaV can treat 30um (small) to 100um (medium) to 150+um (large) vessels, as well as the entire vein with longer single smooth pulses using both 532nm and 1064nm wavelengths. Three distinct pulse modes emulate a “gold standard” pulsed dye laser, a “gold standard” 532nm laser, and a “micro mode”, which is similar to the original pulsed dye laser, for fi ne vessels.
Fig. 1: VSP Graph
CRYOGEN COOLING
Fig. 2.: Thermal camera image.
DermaV’s 532nm and cryogen cooling combination is the fi rst of its kind. Even after high fl uence treatments, DermaV ICD cooling reduces skin temperature by 37 degrees Celsius, 10ms duration at 10Hz (“at speed” – no competitor comes close). DermaV’s pre and post ICD cooling is unprecedented for a vascular device (the leading pulse dye laser only o ers pre-cooling). Post cooling allows the physician to safely treat pigment while decreasing side e ects and complications that have been problematic other 532nm devices due to extreme heat absorption at the ED junction.
Fig. 2.: Thermal camera image. (A.R.T) IntelliTrakTTM& Temperature Sensing: Large, pigmented areas, such as décolleté, have traditionally been treated with IPL: when using a single pass technique, striping, and stamping outlines are a common side e ect. DermaV’s unique Accelerated Rejuvenation with Tracking (A.R.T) treatment removes the need for gel, signifi cantly decreases treatment time/ number of sessions, and eliminates striping using IntelliTrak technology. Real-time, computer-controlled overlap can maintain consistently precise shot placement “at speed” – up to 9.24 cm^2/second (twice as fast as the leading IPL). The user has the option to engage pre or post epidermal protection, while delivering sub-milli and sub-micro pulses with a 14mm spot at up to 6Hz.
Fig. 4: GUI image
Fig. 4: GUI image
NEW LUTRONIC DermaV replace the dye laser
Join LUTRONIC Symposium at IMCAS, Paris “The future is green – new generation of vascular laser treatments from rosacea to port wine stain”, PD Dr. Katharina Herberger & Dr. Cathy Dierckxsens January 26th, 2023 at 13:30 (Room 351 – Level 3)
PD Dr. Katharina Herberger, head of the laser department of dermatology at UKE Hamburg Hospital and Dr. Catherine Dierckxsens, owner of a private practice specialized in laser and cosmetic dermatology in Brussels, are working with Lutronic’s DermaVTM vascular laser, launched in December 2021. After 1 year, both skin experts give us an insight into the advantages of the new technology, the unique selling points and the range of indications it treats. The DermaVTM has been introduced to the European market 2021. When Lutronic approached you last year with the request to work with the DermaV. Ho did you react? Katharina: Lutronic approached me with the new DermaV-technology and with it gave me the opportunity to get to know and test the new laser system. We quickly decided to plan a study on port-wine stains with this system – especially since there have not been many innovations in the field of treating this stigmatizing skin change in recent years. Therefore, this treatment is extremely interesting. Cathy: I was very pleased to be able to work with this new laser that combines KTP & Nd:YAG lasers, especially for vascular indications. I already work with the Clarity II, which is a great device combining Alexandrite and Nd:YAG, but having a powerful KTP is an added value for vascular treatments, especially here in Brussels where we treat a lot of patients with light skin photo-types.
PD DR. KATHARINA HERBERGER (D.A.L.M)
SENIOR PHYSICIAN & HEAD OF LASER DEPARTMENT OF THE UNIVERSITY HOSPITAL HAMBURG EPPENDORF Port-wine stains are unfortunately the most common congenital vascular malformations and then persist into adulthood. A large psychosocial burden-grade even in children. What ages were allowed to participate in this study? Katharina: As the regulations for conducting studies including children are significantly more complex, we will treat adults only for now. However, it is expected that the treatment results will be transferable to children, as treating adults is often even more difficult due to the thickness of the lesions. Thus, if the therapy is successful and, of course, well tolerated, it will at least be effective on children.
The DermaVTM is a vascular laser that not only works with two wavelengths and is therefore able to emit ultra-short pulses, but is also the only KTP laser that offers cryocooling or a cryo-spray that can be individually adjusted before and after the laser shot . What is your experience of using this new technology? Cathy: We all know how much cooling of the skin is important to avoid side effects when treating vascular indications. I have been using a cryospray with a PDL laser in the past and I also have experience with contact cooling and pulsed cold air. Of all the options, I find the cryo-spray cooling very effective and easy to protect the epidermis when treating vascular indications.
In your opinion, what is most revolutionary at DermaVTM ? Katharina: The IntelliTrakTM Technology is especially interesting for larger areas, such as large port-wine stains, in order to avoid treatment gaps or overlaps. When using it for fractional rejuvenation it is possible to treat facial redness for example, evenly and homogeneously. It makes the treatment faster and more e cient.
What can the audience expect from the DermaVTM Symposium at the IMCAS on 26.01.23, 13:30? Cathy: Introduction of an innovative vascular KTP-Nd:YAG laser system: understanding the advances in technological development and clinical applications of this laser. I explain the Technology and show clinical cases of Rosacea. Katharina: Treatment results and therapy protocols with the latest generation vascular laser, the KTP laser, are shown. A special focus will be on
the treatment parameters, expected courses and tolerability of this new therapy system.
Portwine Stains
Before Before
Courtesy of: Dr.Jaehyuk Lee AfterAfter 1 Month , 1 Treatment
Meet us at LUTRONIC booth for further questions. Look for the LUTRONIC red on 2.nd Floor Booth N201.
DR. CATHY DIERCKXSENS
DERMATOLOGIST & LASERSPECIALIST, BRUSSEL,
LUTRONIC DINNER SYMPOSIUM AT PULLMANN EIFFEL TOWER
LUTRONIC invites you to the upcoming Dinner Symposium at IMCAS Paris 2023 on Thursday, 26.01.23 at 19:30. The symposium o ers participants a unique opportunity to learn, share and discuss topics in laser and cosmetic surgery in an exclusive location with amazing view at the Ei el Tower by night and a delicious 3-course dinner. Don’t miss the chance to meet internationally renowned speakers and exchange new ideas, discuss novel research results and discover latest technical solutions. This event takes place at the luxury Pullman Paris Tour Ei el. The seats are limited. Speakers: Dr. Cathy Dierckxsens, Baby-Face Treatment by Thulium Laser ULTRATM, Dr. Katharina Herberger, Portwine Stain Treatment by DermaVTM KTP Laser. Please register to the Dinner Symposium by scanning the QR code.
