Chapter 21: FotoFacial RF Pro Treatment of Specific Clinical Subtypes

Transcription

1 Chapter 21: FotoFacial RF Pro Treatment of Specific Clinical Subtypes 1. Erythema in Skin Types 1-3 (with or without Flushing, Laxity and Wrinkles) using the SR/SRA Head 116 The program usually takes 5-7 treatments, each separated by 3-4 weeks. In skin types 1-3, Step 1 FotoFacial RF Pro settings, the SR (580nm) or SRA (470nm) filter is used to capture the SR 577 nm specific absorption peak, and the shorter wavelength will target superficial hemoglobin and melanin. The RF pulse will concentrate to the preheated vascular and melanin targets. The first of the 5-6 treatment sessions is started with a good test spot to protect against excessive reactions. A test spot is used to assess skin reaction each visit and on each side of the face. Treatments are performed 3-4 weeks apart and no sooner. Each treatment may advance the fluence up 1-2 J/cm 2 / Rx. There is often less of a reaction as a patient proceeds with treatment as there will be less chromophore for the photons to react with. In individuals exhibiting isolated, large facial spider veins (1-1.5 mm) or resistant regional melanin based lesions, a second pass over these specific vessels and brown lesions may be required with the same or increased parameters, and/or spot welding, or the LV applicator for large vessels. For e-light TM, e-max TM, Galaxy TM, and Aurora TM users, Step 2 Laxity Vector treatment is delivered along the cheek, jowl, orbital and brow vector, and, if the neck is being treated, the Neck-lift Laxity vector. The long wavelength intense pulsed optical filter (680 nm) using the Vector Laxity parameters is employed, or the new ST applicator. Finally, for e-light TM, e-laser TM, e-max TM, Galaxy TM, Polaris TM and Aurora TM users, Step 3 wrinkle therapy using the WrinkleLite parameters is performed along localized areas of wrinkles.

2 For FotoFacial RF Pro Galaxy TM users, the e-light TM & Aurora TM SR/SRA stay the same, but the e-laser TM & Polaris TM WR head is used for WrinkleLite and laxity vector, while the Polaris TM LV head is used for resistant vessels. 2. Erythema and Flushing in Skin Type 4 using the SR/SRA Head (with or without Laxity, Wrinkles) In this situation, where, in the darker skin type, hyperpigmentation, hypopigmentation and epidermal reaction risk is higher, more conservative FotoFacial RF Pro FFI parameters are used with lower intense pulsed optical energies. Again, for the larger spider telangiectasia the second pass options of the FotoFacial RF Pro FFII parameters can be employed. The Step 2 Laxity Vector therapy and Step 3 WrinkleLite protocol for laxity of the facial envelope, wrinkles, acne and textural irregularities parameters for skin type 4 patients can be employed if required. 3. Rosacea Patients using the SR/SRA Head Those patients with intense facial rosacea (often both cheeks, chin and glabella) erythema, flushing, inflammation and acne have a more intense vascular component to their pathology. Hence, they are initially given a more conservative set of parameters. In these rosacea patients, the Step 1, full face FotoFacial RF Pro FFI protocol calls for a lower intense pulsed optical fluence in skin types 1-3 and much lower in skin types 4 and 5) due to the increased concentration of the hemoglobin chromophore in these patients. With subsequent treatments there will be a gradual resolution of chromophore and if there has been no purpura, blisters or diffuse swelling, then the intense pulsed optical fluence can be increased for both the FFI and, if necessary, FFII treatments. For second pass treatments over the larger spider veins (perinasal, chin, and occasionally the cheeks) and resistant rosaceaic erythema, conservative (lower fluence) FFII should be used. 117

3 The e-light TM, e-max TM, Aurora TM, and Galaxy TM Laxity Vector therapy and WrinkleLite protocol for laxity of the cutaneous envelope, wrinkles, textural depressions or scars, are the same settings and parameters as in all other skin types and pathologies. 4. Photoaging in Skin Types 1-3 using the SR/SRA Head For those skin type 1-3 patients with fine wrinkles, hyperpigmentation, lentigines, telangiectasia and solar elastosis from sun-damage, the Step 1 full face FFI FotoFacial RF Pro protocol calls for a full face treatment with incremental 1-2 J/cm 2 of optical energy increases through the 5-6 treatments. If there are larger spider complexes, a second pass over these with the same or increased parameters may be necessary. As with all second pass treatments, watch for any sign of epidermal reaction and discontinue therapy upon signs of skin reaction or persistent burning will occur. The Step 2 Laxity Vector and Step 3 WrinkleLite treatments along wrinkles, acne scars and depressed textural irregularities in these patients employs the skin type specific parameters set out earlier in the parameters section. 5. Hyperpigmentation or Photoaging in Skin Type 4 using the SR/SRA Head All skin type 4 patients should be treated with pigment suppression-based skin care products for 4 weeks prior to treatment. The darker skin type necessitates lower optical fluences, longer pulse durations of optical energy and a lower ISL level during Step 1 full face FFI FotoFacial RF Pro therapy to ensure less superficial melanin absorption. Second pass treatments using the skin type 4 FFII parameters can be used over any large, muscular vessels. The FotoFacial RF Pro session is completed with the standard Step 2 Laxity Vector and Step 3 WrinkleLite settings and therapy for skin type

4 6. Skin Type 5 (Asian & Hispanic) using the SR/SRA/DS Head All skin type 4 (and type 5) patients, as well as dark skin type 3 s, melasma and cholasma patients, MUST be protected with a melanocyte suppressive skin care regime (see below) for 4 weeks BEFORE starting a FotoFacial RF Pro program or the risk of adverse reaction increases. For these darker skin types it is recommended that a formal skin care preparation be undertaken with an Obaji or FotoFacial RF Pro brown type regime. The skin care program employs a retinoic acid, hydroquinone and/or Kojic acid for 4 full weeks prior to initiating the FotoFacial RF Pro procedures. This will blunt the usual melanosomic response to intense pulsed light treatments and lighten the skin prior to treatment. The pre-treatment protocol in these patients calls for SonoPeels TM in addition to the skin care products to lighten and blunt. The pre-treatment should lessen the risk of hyperpigmentation, blisters and scarring in this high risk group. Once the 4-week melanocyte suppressive skin care program is complete, then Step 1, full face FFI FotoFacial RF Pro treatment is begun using the 680 nm filter, long triple pulse (8ms on/50 ms off/8ms on/50ms on/12ms on), interpulse delay times of 50ms and initial fluences of 1 J/cm 2. Fluence is increased by 16 J/cm 2 for each of the 5-6 sessions. All FotoFacial RF Pro treatments are separated by at least 3-4 weeks. The Step 1, full face FotoFacial RF Pro FFI treatment is followed immediately by standard Step 2 Laxity Vector therapy using skin type 5 parameters. It is unusual for Asian skin to have a lot of fine wrinkles, but the skin type 5 WrinkleLite settings can also be used safely in these pre-treated individuals. 7. Skin Type 6 (Black Skin) using the DS Head Extreme Caution! Not for Beginners! Scarring and Pigmentation abnormalities can be very common For the darkest skin types, FotoFacial RF Pro treatment is generally a full face FFI treatment using the long wavelength 119

5 680 nm cut-off filter, long-triple pulse duration, low optical energy (9-10 J/cm 2 ) and a low ISL% (5-10%). In African- American skin types, the thick dermal layer often prevents the development of fine or moderate skin wrinkles. The real benefits from the FFI FotoFacial RF Pro treatments in skin type 6 are the improvements in pore size and the resolution in the facial hair and Pseudo-folliculitis Tinia Barbi (the inflammation around the pilosebaceous facial hair units) and the resulting hyperpigmented facial papules that develop. As in type 6 hair removal, the black skin types will retain heat more effectively and you will not witness much erythema. This FotoFacial RF Pro approach is very similar to some of the type 6 hair removal protocols. With this long wavelength cutoff filter, triple pulsing, RF, and lowered ISL%, there will be a minimum of superficial melanin absorption, and the deeper depth of penetration will debilitate the hair shaft, shrink the pilosebacious units and diminish the inflammation. In addition, the dermal heat production will stimulate collagen and ground substance production, shorten existing collagen fibrils and enhance pore appearance and any superficial wrinkles that might exist. Clearly, with skin type 6 patients, there is far more risk associated with FotoFacial RF Pro treatments and extreme caution should be exercised to avoid superficial epidermal-dermal blisters and thermal injury, and the disastrous hypopigmentation, hyperpigmentation and scars that can ensue. Performing skin type 6 FotoFacial RF Pro treatments is highly risky and not generally recommended except in the most expert of hands. 120