Clinical papers

Facial aging is a combination of intrinsic, hereditary and extrinsic forces. Extrinsic factors, including UV light exposure, smoking and diet, combined with the heretics and intrinsic aging factors results in facial deflation (loss of fat), descent (laxity) and deterioration (aging skin). Skin aging and deterioration is characterized by reduced and abnormal collagen, elastin and ground substances, together with discoloration, both in increased melanin based lesions and vascular proliferation. Anti-aging physicians have generally had to combine various lasers, intense pulsed light (IPL), infrared (IR) and radio-frequency (RF) energy systems to treat the combination of these aging dermal and epidermal elements. (Table 1). Fractional and non-fractional radio-frequency energy systems have become popular options in the treatment of skin laxity and wrinkles, but have not been generally effective in treating vascular and melanin based dyschromia of the aging skin. This paper reports on the comprehensive anti-aging effects of a novel new fractional radio-frequency device, the Fractora (Invasix, Yokneam, Israel).

An analysis of the technologies listed in Table 1 reveals the following therapeutic interventions are required for the wide array of aging effects we see in the skin:

• Pigmented malformation treatment requires superficial ablation or coagulation
• Vascular lesion treatment requires coagulation of blood vessels in papillary and reticular dermis
• Wrinkle treatment requires ablative and/or sub-necrotic heating of the reticular dermis
• Skin laxity improvement requires deeper heating of the reticular dermis and dermal-fat junction

The ideal situation for the aesthetic professional would be to have one technology with the tunable ability to address all the clinical manifestations of aging skin. The principal difference between the ablative and non-ablative RF in the novel device used in the current study, when compared with light based deep fractional ablation is that the action of RF is not limited by the ablation crater and adjacent tissue based upon a chromophore, but rather, RF current flows through the ablative lesion and the entire reticular dermis, creating the potential for additional anti-aging effects [10].

This current study describes the results of the clinical evaluation of a novel fractional radio-frequency ablative and semi-ablative treatment used to treat the multiple aging pathologies of the skin.

Acne vulgaris (AV) is a common disease that often results in disfiguring facial scarring that carries into adulthood. Here we report our experience with fractional radiofrequency (FRF) device in treatment of patients with acne and acne related scarring. Materials & Methods: We retrospectively reviewed the charts of all patients with acne scarring who completed a four treatment regimen in our clinic. Results: We identified eight patients who completed four treatments with median age of 20.5 years (range 17 – 41). All patients demonstrated significant improvement of acne lesions and acne scarring. Skin biopsies demonstrated reduction of scar depth and increased new collagen production, and repopulation of the scar tissue by elastic fibers and adnexal structures after the fourth treatment. Conclusion: FRF emerges as a safe and effective treatment modality for AV and acne related scars. Further randomized controlled studies are required to fully evaluate the magnitude of this positive effect and more basic science studies are needed in order to better characterize its mechanism of action on acne lesions.

Acne vulgaris and acne scarring are prevalent conditions that can have a negative effect on a patient’s quality of life. Fractional radiofrequency technologies have been shown to be clinically safe and effective in managing acne scars through dermal remodeling without causing direct damage to the epidermis. In a recently published study, we presented our clinical and histological results in the treatment of patients with active acne and acne related scarring using a Fractional RF (FRF) device. In the current article we demonstrate long term follow-up results, up to two years post last fractional treatment. Methods: Four out of the eight patients who completed a four treatment regimen were invited for long term follow-up visit to document treatment results. In some cases, touch-up treatments were conducted to optimize clinical results. Results: Patients demonstrated significant improvement of acne lesions, acne scarring, pores and skin texture. Long term photos demonstrated that clinical improvement progressed with time. Conclusion: The current study further supports the previous findings that FRF is a safe and effective treatment modality for active acne and acne related scars. Treatment protocol can be customized according to patient needs and clinical results last for long term.