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    Fractional bipolar radiofrequency device achieves marked tightening, lifting

    Kissimmee, Fla. — A facial rejuvenation device that delivers fractional bipolar radiofrequency (RF) energy via microneedling directly into the dermis tightens skin and achieves measurable lifting and volume increase the likes of which have never been seen by any other devices on the market, said Lori Brightman, M.D., at the 2012 meeting of the American Society for Laser Medicine and Surgery.

    "The benefits of bipolar RF energy in facial skin rejuvenation are largely known, but until now, the deeper effects of RF and safety of technique were limited by its mode of delivery. Introducing bipolar RF energy directly into the dermis using a micro-needling device allows us to deposit the energy where it is needed most to catalyze the skin rejuvenation process," says Dr. Brightman, a board-certified dermatologist at the Laser & Skin Surgery Center of New York.

    Device details

    Syneron/Candela developed Evolastin, an aesthetic device approved by the Food and Drug Administration and designed to deliver controlled fractionated bipolar RF energy directly into the deep dermis via microneedling. The 32 gauge, 6 mm-long insulated micro-needles are arranged in five pairs and deposit RF energy at a depth ranging from 1 mm to 2 mm in the dermis, Dr. Brightman says. This results in the skin's natural production of collagen, elastin and hyaluronic acid.

    According to Dr. Brightman, the skin tightening, lifting and volumizing effects that the device can achieve can be appreciated after only a single treatment.

    In a recent study, Dr. Brightman performed Evolastin treatments in 10 consecutive patients with mild to moderate facial skin laxity, with each patient receiving only one treatment. Patients were followed up to nine months after the procedure, and changes in volume and lift were assessed with three-dimensional imaging. Patients also completed a subjective evaluation questionnaire to score their perceived facial changes/improvements.

    Nine of the 10 patients treated completed the satisfaction questionnaire to date, Dr. Brightman says. Results showed that 44.4 percent, 22.2 percent and 22.2 percent of patients evaluated their outcome as "very much improved," "much improved" and "improved," respectively, while 11 percent of patients scored a "no change," and no patient reported "worse change" in their evaluation.

    Going 3-D

    While Dr. Brightman says that histologic examinations expectedly revealed neocollagenesis and neoelastinogenesis in prior studies, the three-dimensional images in her study showed elevation changes, which were calculated by the device's computer program, in targeted areas.

    "You can only see and appreciate so much in two-dimensional images. Measuring the change achieved in the elevation of the targeted areas using three-dimensional images removes the human bias encountered when viewing two-dimensional photographs. These changes could not only be significantly appreciated in the 3-D images but by the patients themselves," she says.

    Talking technique

    In her technique, Dr. Brightman applies a topical anesthesia consisting of a mixture of 20 percent benzocaine, 6 percent lidocaine and 5 percent tetracaine for approximately one hour and follows up with nerve blocks in the targeted areas. She then performs tumescent anesthesia in the lateral face ranging from 10 cc to 30 cc of tumescence per side of the face.

    In a typical treatment, Dr. Brightman says, the number of insertions may range from 130 to 160 insertions per side of the face. Upon insertion of the micro-needles, the targeted tissue is heated between 67 and 70 degrees Celsius for a range of three to four seconds.

    Aesthetic devices such as Thermage (Solta Medical) and Ulthera (Ulthera) can achieve skin tightening, Dr. Brightman says, but neither these nor other devices have a proven efficacy in volumizing targeted skin.

    According to Dr. Brightman, the lifting and volumizing effects seen with Evolastin treatments are likely achieved due to the mode of bipolar RF delivery, which results in a more effective and enhanced production of collagen, elastin and hyaluronic acid.

    "Other devices involve placing the energy on the skin and penetrate from there. Evolastin's micro-needling approach bypasses the epidermis and delivers all the bipolar RF energy straight into the deep dermis," Dr. Brightman says.

    Disclosures: Dr. Brightman is a clinical investigator for Candela/Syneron, which loaned the Evolastin device for her study.

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