Chapter 10: FotoFacial RF Pro® Indications

CHAPTER 10
Chapter 10:
FotoFacial RF Pro® Indications
1.
2.
3.
4.
5.
6.
The “PINK”
The “BROWN”
The “DAMAGED”
The “WRINKLED AND LAX”
The “COMBO’S”
The “IRREGULAR”
(i)
Erythema (The “PINK”): Redness of the face, neck or chest
responds well to the full face FotoFacial RF Pro®. Significant
reduction of 50-75% in erythema is noted after 5-6
treatments and results can last for up to 1 year. It is the
panfacial approach and settings using the 470 nm or 580 nm
cut-off filters, and the RF and their optimized hemoglobin
absorption peaks and more shallow depth of penetration
and action (due to the shorter wavelengths), that results in
the majority of the superficial hemoglobin and melanin
chromophoric improvements.
(ii)
Flushing (The “PINK”): The associated warmth and burning
of the cheeks and facial skin that these individuals present
with can show improvements of up to 75% with the panfacial
FotoFacial RF Pro® treatments. Similar to the resolution of
telangiectasias, the settings, using the hemoglobin avid 470
nm filter and RF Selective RadioPhotothermolytic therapy,
account for the clinical improvements.
(iii) Rosacea (The “PINK”): Both stable and inflammatory acne
rosacea show significant improvement with the first step
FotoFacial RF Pro® therapy (Fig 6). Again, it is the IPL 470 nm
filter and RF settings, with their hemoglobin absorption peaks
and Selective RadioPhotothermolysis that account for the
clinical improvement.
43
CHAPTER 10
Fig 6: Rosacea and Erythema
a) Facial rosacea, erythema and
diffuse telangiectasia patient before
the FotoFacial RF Pro®
b) Facial rosacea, erythema and
diffuse telangiectasia patient after
the FotoFacial RF Pro®
Fig 7: Hyperpigmentation
c) Dyschromia, diffuse hyperpigmentation
and photoaging patient before
the FotoFacial RF Pro®
d) Dyschromia, diffuse hyperpigmentation
and photoaging patient after
the FotoFacial RF Pro®
Fig 8: What do we want to say here?
e) What do we want to say here?
44
f) What do we want to say here?
CHAPTER 10
(iv) Hyperpigmentation (The “BROWN”): These individuals
present predominantly with hyperpigmentation, either
lentigines, ephili, melasma or cholasma. The FotoFacial RF
Pro® parameters provide optimal resolution (Fig 7) and can
be followed by 2nd and 3rd pass laxity vector and
WrinkleLite® techniques during each FotoFacial RF Pro®
session, to tighten laxity and soften wrinkles.
(v)
Photoaging (The “DAMAGED”): Freckling, lentigines,
telangiectasia, fine wrinkles, solar elastosis,
hyperpigmentation and dyschromia from chronic
sundamageshow tremendous improvement with the
FotoFacial RF Pro® approach to skin rejuvenation (Fig 8).
The FotoFacial RF Pro® employs the full face 470 nm and/or
580 nm pulsed optical and RF energy, and settings for
Selective RadioPhotothermolysis with their hemoglobin and
melanin absorption peaks and activity. The wrinkled, lax and
sun-damaged, solar elastotic skin responds to the
FotoFacial RF Pro® parameters with resultant collagen and
ground substance formation.
(vi) The “WRINKLED AND LAX”: Class 1 (fine wrinkles
presenting at ages 20-30’s) and class 2 wrinkles (moderate
Wrinkles presenting at ages 30-40’s) can often be improved
by up to 65% with the FotoFacial RF Pro® procedure. These
enhancements occur in a non-ablative, no-recovery,
no-downtime fashion (Fig 9). The improvement relies on
non-ablative, subepidermal, dermal collagen and ground
substance production and the shortening of existing collagen
in response to the Selective RadioPhotothermolysis process.
The optimal wrinkle improvements, laxity enhancement and
skin tightening will occur with the FotoFacial RF Pro®
WrinkleLiteTM treatment, the WR head, the Laxity Vector
treatment and the ST head.
(vii) The “COMBO’S”: Many patients, if not the majority, present
with a combination of sun-damage, erythema or rosacea and
wrinkles. The standard FotoFacial RF Pro® full face therapy
most often provides excellent cutaneous skin rejuvenation.
45
CHAPTER 10
(viii) Macropores (The “IRREGULAR”): FotoFacial RF Pro®
treatments can improve the appearance of large pores (Fig 9).
It is my belief that the improvement occurs by a production of
collagen, ground substances and edema around the apocrine,
eccrine and pilosebaceous secretory ducts exiting the dermis
and epidermis onto the skin. The dermal substrate production
and its water retention effects compress the duct, which in
turn, minimizes the relative size of the orifice and pore. In
addition, the FotoFacial RF Pro® therapy does stimulate the
production of some elastin and collagen and shorten existing
fibrils, but, perhaps more importantly, it reduces the
vascularity around the secretory unit (sweat gland or
pilosebacious) resulting in a physical reduction in its size.
Most FotoFacial RF Pro® patients do claim that their skin is
“less oily” after completion of the entire 6 session program.
Fig 9: Wrinkles and Skin Laxity Improvement
a) Wrinkles and skin laxity patient before
the FotoFacial RF Pro® performed in
combination with a Pan G® lift
b) Wrinkles and skin laxity patient after
the FotoFacial RF Pro® performed in
combination with a Pan G® lift
* Bitter and Mulholland patient-based study
(ix) Acne Scars (The “IRREGULAR”): The FotoFacial RF Pro®
therapy can produce noticeable improvement in the soft,
reducible, wide-based “saucer-like” scars left by acne,
chicken pox and other inflammatory conditions (Fig 10).
This textural improvement also occurs through the nonablative, subepidermal production of collagen and ground
substances. The ground substances (proteoglycans and
glycosaminoglycans) hold dermal water, like “dermal
sponges,” improving texture, scars and wrinkles.
46
CHAPTER 10
Fig 10: Acne
BEFORE
AFTER
Nodulocystic patient treated with the FotoFacial RF Pro® AC Head and
protocol of 8 treatments over 4 weeks. Almost complete resolution of active
nodulocystic lesions. The now quiescent erythema and potential scars may
be aggressively treated with the standard FotoFacial RF Pro® program
(x)
Post Laser Resurfacing: FotoFacial RF Pro® therapy can
reduce by 50%, the time for the post resurfacing erythema
to dissipate (Fig 1). The mechanism for this effect is a rapid
reduction in the post-laser neovascularization and vessel
edema through the panfacial FotoFacial RF Pro® vascular
filters and RF settings. The treatments are generally initiated
2 weeks after resurfacing (or when re-epithelialization is
complete) and near complete resolution of the erythema is
often witnessed after 4 sessions, delivered every 3 weeks.
(xi) FotoFacial RF Pro® Combo Procedures: The FotoFacial RF
Pro® procedure can provide an excellent adjunctive, value
added oradditional procedural enhancement to standard
facelifts, resurfacing, blepharoplasty and other cosmetic
surgical procedures. Especially pleasing for these facial
cosmetic surgery clients is the FotoBody RF® treatment
of necks and hands. The treatment of these areas brings the
face and body into harmony and avoids the common plastic
surgical pitfall of “50 year old face and 70 year old hands”
on the same individual. There are many adjunctive
procedures that can enhance the outcomes and results of
FotoFacial RF Pro® procedure (see next page).
(xii) Harmonization Procedure “CUTANEOUS SALVAGE”:
The FotoFacial RF Pro® procedure can harmonize the
photo-damaged hands and chest with a facelift patient, that
47
CHAPTER 10
has, or is undergoing, a surgical or laser rejuvenation
procedure and thereby diminish the aforementioned “young
face but old hands and chest effect.” In addition, patients that
have undergone previous laser procedures, resurfacing,
Q-switched system or pulsed dye and were left with
demarcated areas of hypopigmentation or
hyperpigmentation, can benefit from the ability of the
FotoFacial RF Pro® procedure to blend and harmonize the
appearance of skin and the zone of demarcation.
Adjunctive Procedures: The following medical spa
procedures may be performed in conjunction with the
FotoFacial RF Pro® procedure to enhance your patient’s
outcome.
(xiii) Botox® Adjunct and Skin Care Adjunct: When clients begin to
notice wrinkles diminish, and the texture and pigment of their
skin improve after FotoFacial RF Pro® procedures, they often
want to protect this enhancement and rejuvenation with skin
care products and Botox®. Botox® and booster FotoFacial RF
Pro® sessions are often performed at the same time, with no
increased risk. It is recommended that the Botox® be injected
after the FotoFacial RF Pro® treatment, as the degree of
dermal and skin heating could, in theory, deactivate or
diminish the effects of the Botox® polypeptides.
(xiv) Injectable Fillers: Similar to Botox® and skin care, the
adjunctive use of injectable fillers, such as Collagen TM,
Hyaluronic acids (Restylane TM, Perlane TM ), CollagenTM,
FascionTM, CimetraTM, Radiance TM and ArtecollTM, can greatly
augment the wrinkle and textural enhancement achieved with
the FotoFacial RF Pro®. For sometime, I have been using the
FotoFacial RF Pro® or WrinkleLite® parameters in
simultaneous combination with ArtecollTM, or Perlane TM and
Restylane TM injectable into and along wrinkles, furrows and
depressions to augment the neocollagenesis of the ArtecollTM
methylmethacylate microspheres. It is important to hold off
injecting dermal fillers until after the 15 week FotoFacial
RF Pro® program or the dermal heating may change the
integrity and longevity of the filler substance.
48
CHAPTER 10
(xv) Non-Surgical Facelifting: The FotoFacial RF Pro® may be
combined with either the Pan GTM non-surgical facelift (using
resistive MyofacialsTM to elevate and contour soft-tissue/or
the ThermaliftTM (high energy mono-polar RF), or the multiple
pass WR head (high energy bi-polar RF and infrared), or ST
head to tighten skin and lift it as well.
(xvi) SonoPeelTM or Microdermabrasion: Removal of the dead
keratinocytes on the stratum corneum can be a valuable
adjunct to the FotoFacial RF Pro® treatments, as a thinner
stratum corneum can increase by up to 40% penetration of
ncident pulsed optical energy, thereby increasing FotoFacial
RF Pro® efficacy. In addition, a denuded stratum corneum
enhances skin care product penetration.
(xvii) Maintenance Therapy: FotoFacial RF Pro® therapy can, and
probably should, be advised or recommended a minimum of
one FotoFacial RF Pro® treatment every 3 months to maintain
the skin enhancement, or following surgical or laser
treatments, to maintain the beneficial effects.
(xviii) Darker Skin Types: The safety of FotoFacial RF Pro®
techniques, as taught in this book, can be applied and
judiciously used in up to skin type 5 patients. Some skin type
6 individuals, and some of the hyperpigmentation issues that
they present with, may also benefit from gentle FotoFacial
RF Pro® treatments. However, extreme caution should be
exercised and all skin types 4, 5, and 6 should be pre-heated
prior to performing FotoFacial RF Pro®. Skin type 6 FF
and the treatment is not formally supported in this book, nor
taught in the associated Advanced Training Course.
49