PEER-REVIEW | HAND REJUVENATION |
Therapy using simultaneous
infrared laser at 900 nm with
bipolar RF, as well as IPL at lower fluences with bipolar RF, has
been evaluated for the systematic reduction of
photodamage and rhytides.
is that the device delivers a uniform, volumetric
heating effect into the reticular dermis, generated by the tissue’s resistance to the current flow13
. Cooling occurs
through a digitally pulsed cryogen spray in the treatment tip, which helps prevent damage to the epidermis56 The original Thermage systems used a high-energy
.
output, which resulted in patients experiencing significant discomfort. Only approximately 70% of patients believed the treatment met their expectations. Since its development in 2002, there have been advances in tip geometry and energy delivered, which has resulted in more efficacious treatment in less time, as well as increased patient satisfaction. In one particular study, 94% of patients stated the treatment met their expectations57, 58
. Furthermore, a 2006 study
demonstrated that there was twice the amount of collagen denaturation after three passes were performed on lower energy settings, rather than one pass at a higher energy setting59, 60
. The major advantages of RF treatments for
photorejuvenation are the minimal side-effects and downtime. The most common side-effects are mild erythema and oedema lasting less than 24 hours61
. There
Figure 3 (A) Before and (B) after fat transfer to the hand
are, however, some contraindications for the use of RF therapy in patients with pacemakers, defibrillators, implantable cardioverter–defibrillators, and other implantable electronic devices62
Relative contraindications also include any conditions that would predispose a patient to poor wound healing, including smoking, autoimmune conditions and prior radiation therapy62
.
Combination device therapies The combination of electrical and optical energy has been implemented to enhance the non-ablative effects of either device alone, as well as allow for lower levels of each energy type, thereby potentially reducing the risk of associated side-effects63
. Combination treatments
typically do not require systemic analgesia and are well-tolerated with topical anaesthetic creams64
.
Therapy using simultaneous infrared laser at 900 nm with bipolar RF, as well as IPL at lower fluences with bipolar RF, has been evaluated for the systematic reduction of photodamage and rhytides. The combinations demonstrated tissue contraction as well as effects on laxity, rhytides and photodamage in general65–68
. The IPL combined with RF into a single pulse
has been termed an electro-optical synergy system (ELOS, or elōs; Syneron Medical, Inc., Yokneam, Israel). Using this system on 108 patients, Sadick et al demonstrated improvement in wrinkle reduction, erythema, telangiectasias, and hyperpigmentation, as well as a patient satisfaction rating of 92%65
. . This is an especially important consideration in the ageing population.
In addition to heat exposure, mechanical stress from the application of a vacuum has been reported to
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October 2013 |
prime-journal.com
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