INTENSE PULSED LIGHT (IPL) AND RADIOFREQUENCY (RF)
- SUITABLE FOR FACIAL REJUVENATION AS NON-INVASIVE AND NON-ABLATIVE DEVICES
If one is going to consider persons for non-ablative facial rejuvenation and skin tightening then one must do some diagnostic tests, take a history; examine the face before recommendations can be made. But according to BOLANDCELL , microdermabrasion plus a peel, should be the starting point for facial rejuvenation, because the results are predictable and the costs acceptable. Simply because rejuvenation takes time ( subtle and gradual) and many treatment sessions are needed that are costly. Then the therapist has the options of botulinum, fillers, RF, microdermabrasion, IPL, mesotherapy, ACR ( see ACR-PRP) , peels and lasers to mention a few. Also the availability of ELOS technology and non-ablative photothermolysis needs to be discussed with the patient. Potential side-effects of IPL and lasers, such as post-inflammatory hyper pigmentation need discussion. Classification via the Fitzpatrick classification is needed before proceeding. Imaging ( CanfieldT or Skin VisioT) is also of value.
SKIN REJUVENATION GOALS
- Minimize wrinkles, improve depressed lines and scars, by plumping and smoothing of the skin to improve sagging
- Skin tightening (hopefully to prevent further sagging and jowls).
- Correcting dyspigmentation or dyschromia
- Enhancing complexion, restoring youthful appearance, restoring the full 3D appearance of the face, and skin " glow"
- Improving pore size
IPL UPDATE: NON-ABLATIVE PHOTO-REJUVENATION AND COLLAGEN REMODELLING
The aim is to rejuvenate the photodamaged skin, but needs multiple treatments. IPL is broadband light and photo rejuvenation technique that uses noncoherent pulsed light (515-1200 nm) at a low fluency over multiple treatments (weeks) to target hyper pigmentation, lentigenes and telangiectasis. The benefits of IPL in the treatment of rosacea, photo aging has been demonstrated before. The process is achieved by controlled dermal heating, damage, inflammation and new collagen synthesis by fibroblasts that are part of the reparative process. Fractional photothermolysis has the advantage over IPL, by producing thermal damage but at the same time leaving small intact epidermal bridges from which healing occurs. In the process of IPL degradation of the pigment occurs but only after many treatments. The outcome of IPL is theoretically: improvement of fine and course wrinkling, improvement of hyper pigmentation, improved skin smoothness and pore size. Treatment is needed in sessions every 3-4 weeks for 4-6 weeks. The down side is oedema and erythema which lasts for about 48 hours. Beauty salons often combine IPL with superficial glycolic acid peels. Results reported at IMCAS Asia 2007 indicate that IPL may help reduce the pigmentation in melasma in some patient's, but recurrence is not uncommon. Lentigines do respond to IPL.
The radiofrequency device of AccentT (Alma ) provides both uni-and bipolar radiofrequency technology in one apparatus. The Accent allows for controlled volumetric tissue heating to two distinct depths of tissue. The Bipolar RF allows for penetration between 2 and 6mm and provides structural and structural change. The unipolar capability penetrates up to 20mm and thereby reaches adipose tissue and cellulite. New innovations allow selective delivery of energy to the deep dermis and subdermal layers with the protection of the epidermis. This is where microscopic changes occur and collagen contraction, with eventual collagen remodelling over months. Feedback from the probe or handpiece to a Pentium based computer in the RF generator regulates the amount of energy applied to the tissue ( see. www.shorelaser.com) . Candidates for RF are persons with mild loose or lax skin. Patient's with a thin skin are thought to respond better than those with a thicker skin. FDA has approved the use for periocular and brow areas. Other areas include the cheeks, melolabial folds, jowls and neck. Results of treatment are variable and subtle rather dramatic. In some persons treated with RF, redness and selling can persist for a few hours. So at the present time do not expect miracles but rather mild improvement.
Consider alternatives such as 633nm LED red light ( OMNILUXT ) for photo rejuvenation of the face. This is achievable by new athermal technology that stimulates fibroblastS, keratinocytes and mast cells by biomodulation. Multiple treatments are also needed but the technology has an excellent safety profile. This approach can also be combined with peels and NEOSTRATA T. True photoantiaging with LED therapy is highly effective and the guru is Dr Glen Calderhead, from Japan .
ADVANTAGES OF THE ACCENTT BODY SHAPING THERAPY
- No down time
- Dual RF hand pieces
- Predictable results in a short period of time
- Well developed hand piece facilitating the function of the therapist
- Comfort and no pain ( contact cooling)
- Reliability and transportability
- Continuous contact cooling, providing patient comfort and epidermal protection
ACCENTTAPPLICATIONS IN A SALON OR SPA ( www.almalasers.com )
- Cellulite treatment
- Skin tightening
- Complete body contouring
- Volumetric dermal therapy
- Post liposuction smoothing
- Lipoma treatment
- Acne-type rosacea
PROPOSED MECHANISM OF ACTION OF ACCENT T
- Controlled heating of the tissues
- Improves local circulation
- Promotes fibrous tissue breakdown
- Improves oedematous regions, promotes reabsorpton of retained fluids
- May facilitate and enhance the break-up of adipose tissue, thereby mobilizing and eliminating fat deposits-non-invasively
- Results from IMCAS Asia 2007, show that RF is effective in achieving mild to moderate and gradual clinical improvement in the treatment of facial skin laxity.
BOLANDCELL ACADEMIC REFERENCES FOR FURTHER READING :
- Nestor MS et al. New perspectives on photo rejuvenation. Skin & Aging. 2003: 11; 68-74.
- Nestor MS et al: Photo rejuvenation: non-ablative skin rejuvenation using intense pulsed light. Skin & Aging. March, 2000.
- Goldberg DJ et al. Non-ablative treatment of rhytids with intense pulsed light. Lasers Surg Med 2000; 26 ( SUPPL 2): 196-200.