Chapter 28: The FotoFacial RF Pro ® GalaxyTM

CHAPTER 28
Chapter 28:
The FotoFacial RF Pro® GalaxyTM
Evolution of the FotoFacial RF Pro® - e-Max & Galaxy
TM
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 AuroraTM
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/cm3 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
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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 PolarisTM 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 GalaxyTM 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:
AuroraTM Treatments Heads
Head
Application
Wavelength
Fluence
Pulse Profile
Skin Rejuvenation
580-980nm
up to 45 J/cm2
25 J/cm3 RF
25ms Short
Double Long
2. SRA Head Skin Rejuvenation
Advanced
470-980nm
up to 45 J/cm2
25 J/cm3 RF
17ms Short
Triple Long
3. DS Head
Hair Removal
680-980nm
up to 30 J/cm2
25 J/cm3 RF
25ms Short
Triple Long
4. AC Head
Acne Head
400-600nm
up to 16 J/cm2
20 J/cm3 RF
10 Pulse train
2ms on/30ms off
1. SR Head
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PolarisTM Treatment Heads
Whereas the AuroraTM platform combines only intense pulsed light
and radio frequency energy in the same treatment profile (and
depending upon the exact configuration of your AuroraTM 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 PolarisTM 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 PolarisTM 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 PolarisTM 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 PolarisTM 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.
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PolarisTM Treatment Head
Head
Application
Wavelength
Fluence
Pulse Profile
1. LV
Leg Veins
910nm
50-140 J/cm2 Diode up to 300nms
10-50 J/cm3 RF
2. WR
Wrinkle Reduction 910nm
10-50 J/cm2 Diode up to 200nms
10-100 J/cm3 RF
The PolarisTM WR (Wrinkle Reduction) Head
The PolarisTM LV (Leg Vein) Head
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The GalaxyTM
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 PolarisTM 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 PolarisTM port, into which
the PolarisTM heads may be inserted,
including the Diode-RF heads, either
the WR or the LV.
The PolarisTM Physics:
Dermal Matrix Heating
The GalaxyTM
The physics, pulse profile, depth of
penetration and level, and degree of
dermal matrix heating is quite different from that of the AuroraTM and
hence, so is the technique. The PolarisTM , like the AuroraTM , still relies on
Syneron’s patented ELOS TM technology,
that is an electrical-optical synergy.
2 port, Aurora TM & PolarisTM System
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.
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PolarisTM Selective RadioPhotothermolysis ELOS Physics Review
The PolarisTM platform (along with the AuroraTM platform on the
Galaxy TM , or the PolarisTM 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 PolarisTM 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 PolarisTM 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 PolarisTM 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)
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These 3 dimensional graphics show the ELOSTM 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 PolarisTM 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 PolarisTM platform,
the conducted bi-polar RF energy is very strong with energy levels up to 100 J/cm3. 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 PolarisTM 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
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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 PolarisTM
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
Slide 4
of the WR electrodes avoid
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/cm3 of
RF and 50 J/cm2 of the 910nm diode, the LV has 50 J/cm3 of RF and
up to 140 J/cm2 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.
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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
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Contraindications:
Standard FotoFacial RF Pro® contraindications. (see Chapter 11)
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