Very versatile tool for minor cosmetic procedures High frequency AC radiowaves generate cellular heat Cells vaporised Radiowaves pass through the

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1 Dr Hans Raetz, Queenstown. Dr Peter Chapman-Smith, Whangarei.

2 Very versatile tool for minor cosmetic procedures High frequency AC radiowaves generate cellular heat Cells vaporised Radiowaves pass through the body No painful muscle contraction or nerve stimulation Select different wavelengths to: incise, excise, ablate Electrodes remain cold Less post operative pain Less fibrous scarring

3 Mains power voltage altered for selected circuit functions Passing through oscillator increases current frequency Delivered to patient via a hand piece-electrode. Radiowave passes through tissue to a receiver plate Current converted to heat energy (impedance, resistance). Intracellular water boils causing cell membrane rupture (volatilisation)

4 Ellman Surgitron Transmits a pure frequency of cycles per sec

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6

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8 Tissue can either be delicately removed or totally ablated. Selecting waveform & current intensity, allows: excision, ablation, coagulation or fulguration.

9 Type 1 90/10 cut & coagulation. Cosmetic cutting. Minimal lateral heat to avoid carbonisation/ charring) Type 2 50/50 cut & coagulation. More collateral heat Type 3 10/90 cut & coagulation Haemostasis and coagulation Type 4 Fulguration Destruction of tissue by desiccation Type 5 Type 5 Bipolar Microsurgery and haemostasis in wet areas Combination of first 3 waveforms

10 Not grounded Recycles and less power output needed to cut. Current flows into the patient, increasing Pt voltage and lessens the gradient of flow to the Pt.

11 Removal of epidermal lesions: solar and actinic keratoses benign moles, sbcc ingrown toenails verruccae scar revision spider naevi / red veins rhinophyma Haemostasis during skin surgery Snore ops, hair removal

12 Pain free intra and postoperatively Require only topical or local anaesthetic Virtually scar free No suturing required Rapid healing Inexpensive technology, minimal consumables Quick to perform

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14 Rhinophyma

15 Giant Rhinophyma

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20 Plantar Warts

21 Well established treatment of snoring Dedicated electrode available 80% success Local anaesthetic only Minimal post op discomfort Outpatient procedure

22 Radiowave Palatoplasty Turbinates Hard palate Soft palate

23 Radiowave Palatoplasty RF burn approx 10 mm x 2 mm

24 Theoretically self cleaning but not recommended Disposable electrodes are available First remove charred tissue deposits Place in soaking solution (Clinadet etc) Dry and autoclave Steam cleaning damages rubber coated electrodes over time.

25 Dispersive electrode (hand piece electrode) acts as transmitter RF wave passes through patient Passive ground plate acts as receiver This completes a circuit that starts and finishes in the unit.

26 1. Finger switches 2. Foot pedals

27 Smoke plume has risk of viral infection to operators. Vaporisation of tissue is similar to CO2 laser surgery. Possible pulmonary damage from particulate fine matter Therefore masks and evacuators are recommended. Smoke evacuation with absorptive filters should be the norm in a safe working environment.

28 Scarring possible if deeper than epidermis or superficial dermis. Bruising & Infection Technique sensitive pressure too hard, accidental trigger of electrode current, poor choice of current and strength. Pacemakers!!! Fire. Electrical Shock.

29 Diagnose epidermal lesion Excise or punch biopsy prn Hx of abnormal scarring or hypopigmentation Advise: possible recurrence, limited histology Informed consent Histology even if macroscopically benign

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32 Surgitron Radiofrequency techniques can be readily learnt by any GP with a steady hand.

33 NZ agents : Intermed

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