Enhanced full-face skin rejuvenation using synchronous intense pulsed optical and conducted bipolar radiofrequency energy : introducing selective radiophotothermolysis

Journal of Drugs in Dermatology, March-April, 2005 by Neil S. Sadick, Macrene Alexiades-Armenakas, Patrick Bitter, Jr., George Hruza, R. Stephen Mulholland

Abstract

Background: The authors previously reported their experience achieving non-ablative skin enhancement with serial, full-face, intense pulsed light treatments in a large series of patients. A new method for skin renewal electro-optical synergy (ELOS), which combines intense pulsed optical energy and conducted bipolar radiofrequency (RF) energy into a single pulse, has been recently introduced. Intense pulsed optical energy and bipolar RF energy have been used in dermatologic surgery for many years; however, this study represents the therapeutic impact of the combined energies.

Objective: The authors report their experience using an ELOS system (Aurora SR, Syneron, Yokneam, Israel) on 108 consecutive patients treated with a series of full-face procedures.

Methods: Patients received 5 full-face treatments every 3 weeks. Each treatment consisted of 1 to 8 full-face and segmental passes. The number of passes, specific wavelength of pulsed optical energy, and RF energy were determined by the patient's skin type, dyschromia, wrinkle pathology, and presence of a tan. A total of 540 treatments were performed on 108 subjects. All patients had pre- and post-procedural photographs. Results were assessed by double-blinded physician photographic evaluation and patient satisfaction scales.

Results: Overall skin improvement was rated at 75.3%. Overall average wrinkle improvement was 41.2%, with an average Class 1 wrinkle improvement of 64.7%, Class 2 wrinkle improvement of 38.6%, and Class 3 wrinkle improvement of 20.4%. Improvement in skin laxity was rated at 62.9%. Skin texture was reported to improve 74.1%. Improvement in the appearance of pore size was rated at 65.1%. Average improvement in erythema and telangiectasia was 68.4%. Average improvement in hyperpigmentation and dyschromia was 79.3%. Overall patient satisfaction was 92%. The overall minor complication rate, including blistering, crusting, and stripping was 8.3%, and the major complication rate was less than 1%. One small, depressed nasal scar was observed in one patient.

Conclusions: This study demonstrates the safety and efficacy of a new technology using combined optical and conducted bipolar RF energies for noninvasive skin rejuvenation. The results show improvement in wrinkle reduction and amelioration of erythema, telangiectasia, and hyperpigmentation comparable to that reported for other intense pulsed light technologies.

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Introduction

Patient demand for non-surgical, non-invasive, and no-downtime skin enhancement procedures has grown dramatically over the past decade as new treatments and technologies have been introduced. During this period there has been a substantial increase in the utilization of medical prescriptive skin care, (1,2) botulinum toxin injections for cosmetic purposes, (3,4) a variety of injectable filler substances, microdermabrasion, (5,6) and photon or radiofrequency-based non-ablative skin rejuvenation. The photon-based non-ablative skin rejuvenation market has expanded to include pulsed dye technology, (7,8) long and short-pulsed Nd: YAG technology, (9) and intense pulsed light therapies. (9-13)

According to patients' evaluations of photon-based systems on skin rejuvenation, the results vary from minimal to moderate improvement in wrinkle, laxity, texture and pore size, and significant improvement in erythema, telangiectases, and dyschromias while conducted radiofrequency (RF) energy has been reported to produce improvements in skin laxity and wrinkles. (14,15) The authors' combined experience of nearly 8,000 intense pulsed light treatments over the past 5 years reports 60% to 75% improvement in vascular and melanin irregularities, supporting the efficacy and safety of the original serial, full-face, intense pulsed light technique. (10) Despite these advances in treating erythematous and dyschromic skin, treatment options for wrinkles, laxity, and scarring with non-ablative treatments have remained limited with most series citing 10% to 30% improvement. (7-10,16)

The mechanism of optical energy on tissue is based on selective photothermolysis, in which a chromophore in the target tissue preferentially absorbs photons of a specific wavelength. The absorption is intended to heat the target chromophore to a critical temperature resulting in the selective elimination of the target while sparing collateral tissue. (17) In the case of broadband pulsed light, photons of multiple wavelengths are simultaneously absorbed by several target chromophores causing them to gradually resolve in the exposed tissue. When serial, sequential, intense pulsed light is used in a series of treatments, it produces a gradual and global improvement in the appearance of photo-aged skin.

In this article, the authors describe a procedure using a technology that combines pulsed visible light with conducted bipolar RF energy in the same pulse profile, generating electro-optical synergy (ELOS) for enhanced textural changes and skin rejuvenation. The term Selective radiophotothermolysis is introduced and discussed as a more accurate description of the mechanism of the two simultaneous, but different energy modalities' impact on tissue.