Chapter 28: The FotoFacial RF Pro Galaxy TM

Transcription

1 Chapter 28: The FotoFacial RF Pro Galaxy TM Evolution of the FotoFacial RF Pro - e-max TM & Galaxy TM The FotoFacial RF Pro has become one of the most commonly performed optical-based skin rejuvenation procedures in the world. On any given day in the U.S., there are over 10,000 FotoFacial RF Pro procedures performed. The FotoFacial RF Pro procedure evolved from being a single pass, full face, intense pulsed light treatment using multiple IPL cutoff filter passes. The original IPL FotoFacial RF Pro is very good at removing melanin and hemoglobin-based chromophores. However, original IPL FotoFacial therapy alone was only modest at best at improving wrinkles, tightening skin and smoothening texture. The addition of Nd.YAG (1064nm, 1340nm or 1450nm) was the next advance of the FotoFacial RF Pro procedure and was called the FotoFacial Plus. The addition of multiple segmental passes of The Aurora TM long pulsed YAG treatments over areas of wrinkles and laxity, in combination with the full face and segmental IPL treatments, improved the degree of dermal enhancement, wrinkle and texture improvement that could be achieved with a series of FotoFacial RF Pro treatments. The recent introduction of conducted, bi-polar radio frequency energy into the aesthetic market place, has resulted in a significantly enhanced ability to tighten skin and improve fine to moderate wrinkles, as well as remove vascular and melanin-based chromophore targets with less inflammation and downtime. With the introduction of the Aurora TM (by Syneron Inc.) of IPL and RF in the same pulse profile, a concept called ELOS TM (electrical-optical synergy), the FotoFacial RF Pro procedure was born. The addition of 25 J/cm 3 of radio frequency energy pulsed synchronously with the IPL, has allowed us to achieve a much greater degree of skin tightening, texture enhancement and wrinkle 146

2 improvement than every before. The FotoFacial RF Pro Galaxy TM represents an evolution in the pulsed-optical-rf technique, and at the time of it s introduction, was the most advanced non-invasive skin enhancement ever introduced into the market. The FotoFacial RF Pro Galaxy TM produced by far the most impressive improvements in chromophore resolution, skin tightening, skin laxity, texture and wrinkles that we have ever been able to achieve with any other non-ablative technology. By combining the Aurora TM platform with Polaris TM operating systems into one device, the Galaxy TM physicians could now have, at their disposal, the most advanced IPL-RF and high fluence RF and Pulsed Optical Diode Laser energy to non-invasively rejuvenate the skin. The Galaxy TM Operating Platforms To perform the FotoFacial RF Pro Galaxy TM a physician user must be familiar with the various technology platforms that have been incorporated by Syneron Inc. The Galaxy TM series of devices incorporates the Aurora TM technology, whose treatment heads combine lower fluence bi-polar radio frequency energy and Intense Pulsed Light, in the same treatment profile. The Aurora TM heads include the SR/SRA (Skin Rejuvenation), DS (Hair Removal) and AC (Acne) head. The specification of which are outlined below: Aurora TM Treatments Heads Head Application Wavelength Fluence Pulse Profile 1. SR Head Skin Rejuvenation nm up to 45 J/cm 2 25ms Short 25 J/cm3 RF Double Long 2. SRA Head Skin Rejuvenation nm up to 45 J/cm 2 17ms Short Advanced 25 J/cm3 RF Triple Long 3. DS Head Hair Removal nm up to 30 J/cm 2 25ms Short 25 J/cm3 RF Triple Long 4. AC Head Acne Head nm up to 16 J/cm 2 10 Pulse train 20 J/cm3 RF 2ms on/30ms off 147

3 Polaris TM Treatment Heads Whereas the Aurora TM platform combines only intense pulsed light and radio frequency energy in the same treatment profile (and depending upon the exact configuration of your Aurora TM and the number of heads you purchase) you may have IPL-RF Skin Rejuvenation head, DS-Hair Removal head and/or and AC, Acne head. The Polaris TM does not employ intense pulsed light but incorporates pulsed diode laser energy combined with radio frequency energy in the same pulse profile to deliver therapy. This pulsed laser diode, RF ELOS TM technology, is configured in an LV (Leg Vein) Head, and a WR (Wrinkle Reduction). The Polaris The Polaris TM platform, like the Aurora TM, emits synchronous pulses of pulsed optical energy (a pulsed diode laser) and RF (radio frequency) in the same pulse profile. The diode array has its wavelength at 910nm, in the infared spectrum, and its prime chromophore is deoxygeneted hemoglobin and some interstitial water (nd:yag like effects). The head has two contact, conductive radio frequency electrodes on either side of an Optical Diode crystal. The handpiece is water cooled to 5 degrees celsius and employs an %ISM that will cut off the laser energy in the post-pulsed diode RF heating if the impedance drop (dermal temperature rise) exceeds the preset %ISL. The technique for the Polaris TM head is exactly like the contact technique with the Aurora TM in that the two diode electrodes stay in flat contact with the skin, and contact coupling medium of the treatment area and the pulsed optical head is slightly recessed to avoid direct contact. The dimensions of the Aurora TM head is 9mm wide (between the electrodes) and 26mm long. The Polaris TM WR bi-polar electrode system is larger with the WR electrodes being the WR is 14mm wide and 26mm long, while the LV head is more like the Aurora TM, measuring 8mm by 26mm. 148

4 CHAPTER 28 PolarisTM Treatment Head Head Application Wavelength Fluence Pulse Profile 1. LV Leg Veins 910nm J/cm2 Diode up to 300nms J/cm3 RF 2. WR Wrinkle Reduction 910nm J/cm2 Diode up to 200nms J/cm3 RF The PolarisTM WR (Wrinkle Reduction) Head The PolarisTM LV (Leg Vein) Head 149

5 The Galaxy TM The FotoFacial RF Pro Galaxy incorporates the Galaxy TM platform. The Galaxy TM platform is the newest of the Syneron Inc. ELOS TM based platforms to be FDA cleared and it combines the Aurora TM and Polaris TM platforms and heads into one system. On one side of the Galaxy TM is an Aurora TM port where the Aurora TM IPL-RF heads may be inserted, including the SR, DS or AC heads. On the other side of the Galaxy TM is the Polaris TM port, into which the Polaris TM heads may be inserted, including the Diode-RF heads, either the WR or the LV. The Polaris TM Physics: Dermal Matrix Heating The Galaxy TM 2 port, Aurora TM & Polaris TM System The physics, pulse profile, depth of penetration and level, and degree of dermal matrix heating is quite different from that of the Aurora TM and hence, so is the technique. The Polaris TM, like the Aurora TM, still relies on Syneron s patented ELOS TM technology, that is an electrical-optical synergy. The FotoFacial RF Pro Galaxy Procedure The are three basic steps to the FotoFacial RF Pro Galaxy TM. As with any FotoFacial RF Pro patient, the patient s medical health history must be taken, contraindications disclosed, and aesthetic skin concerns enumerated. A clear understanding of the patient s goals should be outlined, ensuring that the patient s expectations match the likely outcome of the FotoFacial RF Pro Galaxy TM program. 150

6 Polaris TM Selective RadioPhotothermolysis ELOS Physics Review The Polaris TM platform (along with the Aurora TM platform on the Galaxy TM, or the Polaris TM can be a stand alone system) comes with a WR (wrinkle reduction head) and LV (leg vein head). The WR head emits a 910 nm wavelength laser diode and synchronous radio frequency energy. (See Slide 1) Slide 1 Slide 2 The laser diode heats the microvasculature maximally to a dermal depth of approximately 2.5-3mm. The 910nm infrared diode warms the dermal tissue, lowers the impedance and results in augmented Radio Frequency current density (RF preferentially travels the path of least resistance or lowest impedance). Thus, similar to the Aurora TM, where IPL creates the optimal environment for a specific, localized RF heating, the Polaris TM 910nm diode focuses and concentrates the WR, RF energy for a specific and controlled dermal RF heating. It is at the intersection of the laser diode and RF that the dermal heating is maximal. The RF in the Polaris TM platform would be very diffuse and less effective wrinkle reduction and tissue tightening and lifting force, if the laser diode were not present to create a focused microenvironment of low impedance to focus and maximize the current density. Thus, the Polaris TM platforms exhibit classic ELOS TM physics, a true electric-optical synergy, whereby the laser or the RF energy unto themselves are less effective than the two energy sources combined (similar to the IPL-RF of the Aurora TM ). (see Slide 3) 151

7 These 3 dimensional graphics show the ELOS TM effect of the Polaris platform. In Slide 3, the 910 nm laser diode is depicted in red and the RF in green. The intersection of the two represents the area of the dermis where the 910nm laser diode has heated the dermis (2.5-3mm deep) and Slide 3 the RF current, which was initially diffuse, becomes concentrated in the laser heated dermal tissue with lowered impedance. The 910nm wavelength, like all infrared lasers, act optimally on deoxygenated hemoglobin. The pulse profile of the Polaris TM is quite different from the Aurora TM. With the Aurora TM, the relatively low level conducted bi-polar energy is present throughout the 200ms pulse duration (assuming the ISL is not reached) and the Pulsed Optical or IPL energy is only on for a brief period of time (25ms in short pulse and a double pulse of IPL in the Long pulse mode). The brief period of IPL heats the dermis and lowers the impedance enough for the relatively low level RF to act for 175ms. In the Polaris TM platform, the conducted bi-polar RF energy is very strong with energy levels up to 100 J/cm 3. Because of the high energy nature of the RF in the WR head, the pulse duration of the WR/RF is quite short. The entire pulse duration of the WR head is approximately 300ms. The RF energy is on as soon as the Polaris TM WR button is depressed. The first 10ms, the contact cooling, coupling adequacy and an average impedance calibration is performed. Then, for the next 70ms the high energy RF is released. However, in the absence of a 910nm laser infrared diode energy, the RF is quite diffuse and less effective. After approximately 10ms, the 910nm infrared laser diode is release concurrent with the high energy RF. As the 910nm laser begins to bind with the microvasculature and vessels (its prime target is deoxygenated and oxygenated hemoglobin in the deep dermis, 2.5mm-3.0mm deep) causing a selective photothermolytic heating of the vessels and the adjacent dermis. The dermal heating drops the impedance and the RF current density increases exponentially in the laser heated dermis. For 80ms the 910nm laser diode is focusing the high energy WR handpiece RF in 152

8 the narrow band of the dermis. By approximately 100ms, the high energy has acted for about 80ms in the selective environment created by the laser and, because of its very high energy nature, the RF must be turned off to avoid overheating the dermis and causing a thermal injury. The post-heating period in the Polaris TM is then delivered by the 910nm laser diode, that continues to heat the dermis for another 200ms. (see Slide 4) Slide 4 shows the RF (70ms) and 910nm laser diode are acting together for 70ms, during which the RF is concentrated to the narrow band of dermis heated preferentially by the diode. The post RF heating is augmented for another 200ms by the 910 nm diode. The unique long wavelength of the 910nm diode, large spot size and high energy, result in a deep dermal heating. Also, the wide distance between the bi-polar electrodes ensures a deep dermal RF delivery, where it can be concentrated by the diode impedance drop (Slides 1-2). The round edges of the WR electrodes avoid Slide 4 areas of excessive RF heating, minimizing risk of burns at the edges of the electrode, a significant risk of monopolar RF systems. The difference between the WR and LV heads is the size of the electrodes (the LV electrodes are closer together and not as long), as well as the relative fluencies for each of the modalities, where the WR Slide 5 head has up to 100 J/cm 3 of RF and 50 J/cm 2 of the 910nm diode, the LV has 50 J/cm 3 of RF and up to 140 J/cm 2 of the 910 nm diode. This is a feature that gives the LV head more reticular and larger spider vessels specificity. Slide 5 shows the depth of heating of the deep dermis with the WR head and the protection of the epidermis provided for by the dynamically cooled handpiece and the rounded configuration of the electrodes. 153

9 Indications: The indications for a FotoFacial RF Pro Galaxy TM treatment are an absence of absolute and relative contraindications (as in the FotoFacial RF Pro section), and skin concerns consisting of the typical skin rejuvenation vascular concerns such as diffuse telangiectasia, erythema, rosacea and melanin concerns of hyperpigmenation, lentigines, dyschromia and melasma. In addition, good FotoFacial RF Pro Galaxy TM candidates also complain of the fine to moderate periocular or perioral rhytides, skin texutural roughness, acne scarring and laxity. FotoFacial RF Pro Galaxy Indications 1. Vascular Chromophore Concerns Telangiectasia Erythema Rosacea Flushing and Blushing Lower lid dark circles of venous congestion origin 2. Pigmentation Melanin Chromophore Concerns Lentigines Hyperpigmenation Dyschromia Melasma, Cholasmo Poikilodermo 3. Fine and Moderate Wrinkles 4. Skin Textural Issues Acne Scars Depressed Scars 5. MacroPores 6. Mild to Moderate Skin Laxity Brow, Cheek, Orbital, Jowl and Neck laxity 154

10 Contraindications: Standard FotoFacial RF Pro contraindications. (see Chapter 11) 155