Chapter 15: FotoFacial RF Pro Treatments

Transcription

1 Chapter 15: FotoFacial RF Pro Treatments The FotoFacial RF Pro procedure always involves a full face treatment using the FotoFacial RF Pro (FFI) parameters. All patients, whether being treated on a Galaxy TM or an Aurora TM will receive a full face (full anatomic part) FotoFacial RF Pro I pass. This first full face, or full chest, or full neck, or full hand (full anatomic part) pass is critical to the success of the FotoFacial RF Pro outcome as it provides the initial lightening of pink and brown chromophores in the areas where it is required. In addtion, because of the full face nature of the procedure, the FFI evens and blends all other regions of the face and, in so doing, avoids much of the unevenness, demarcation and irregularity that results when regional or spot treatments are attempted. In most patients, depending upon the clinical condition they presented with, a second regional pass for pigment (FotoFacial RF Pro II, or FFII, for resistant pink and brown discoloration) is required. If the patient is lax or wrinkled, a third regional pass or Vector Laxity treatment and, finally, a fourth pass over wrinkles called WrinkleLite is required. Each treatment is delivered sequentially, during the same single sitting. The total treatment time is approximately minutes for the FFI +/- FFII (spot welding), Laxity Vector and WrinkleLite. Similarly, the FotoFacial RF Pro Galaxy TM can be performed in minutes. The patients present for treatment, remove makeup, undergo treatment and, in the vast majority of cases, reapply make-up and return to normal activities immediately. 1. Pre-Treatment Instructions: Stop ASA products for 2 weeks prior to therapy to diminish the risk of bruising and discoloration. Patients should not be on Coumadin at the time of treatment and cannot be tanned. 2. Pre-Treatment Skin Care: All patients will have been started on skin are products prior to initiating their treatments (see skin care section). All retinoic acid products are discontinued for hours prior to therapy, and tetracycline (due to its photo-sensitizing effects) is also stopped. A gentle cleansing and hydrating regime is started days before. Three days after treatment they start back on their skin care treatment 73

2 74 program (see also skin care section). Patients may resume Retin A and all skin care regimes and antibiotics 48 hours after a FotoFacial RF Pro treatment. 3. Antivirals: We find when treating with RF around the lips and lip lines it is a safe approach to prescribe Valtrex (500mg, twice daily) for 1 day before, the day of and for one day after treatments, to minimize the risk of cold sores. The RF, IPL and laser energy can be potent stimuli for the activation of herpes simplex virus particles. 4. Preparation: All makeup is removed and Num-It is applied. The treatment plan is reviewed with the patient and the previous notes and treatment parameters are reviewed. The patient is asked again if there were any adverse reactions, medication changes or sun exposure since their last treatment. The settings and parameters are adjusted accordingly if, on the previous treatment, there were some adverse outcomes. 5. Positioning and Comfort: We recommend that the patient be supine or with the bed slightly raised. Quiet music in the background helps create a relaxing atmosphere. Ensure the room is warm. Topical anesthesia can help diminish the little pain and burning that ensues. ELA-MAX TM makes a topical 4% xylocaine gel (Num-It) that does not have the same vasoconstriction properties as EMLA TM. EMLA TM would diminish the effectiveness of the therapy as the resulting vasoconstriction will decrease the caliber of small cutaneous blood vessels, resulting in less oxygenated and deoxygenated hemoglobin available to act as a chromophore for the incoming photons. The SynerCool TM is a skin chiller that passes cold air (-30 degrees celcius) over the skin just prior to the FotoFacial RF Pro pulse. Together with the anesthetic cream, the SynerCool TM can make the procedure almost painless. 6. Safety: Like all laser, intense pulsed light and RF interventions, the treating individual must either be a trained physician, nurse, aesthetician or technician. This delegated medical act should follow all state and local laws for delegation of medical services in your locale. The physician s

3 Fig 11: Photo Rejuvenation Safety Stainless steel teflon coated eye-shields are always used during the FotoFacial RF Pro as the therapy can cause corneal injury when practiced by poorly trained practitioners. Training is mandatory before attempting any of these techniques. The teflon coated eye shields prevent RF conduction and skin burns. clinic should have a written delegable act protocol outlining the training and clinical endpoints and therpeutic decisions and algorithms. The room should be locked from the inside, so that no one may enter while treatments are underway. Appropriate door signage should be available that shows the wavelength of light. All reflective surfaces should be covered and the blinds closed. Appropriate safety goggles (I use the special silicone coated Aurora TM and Polaris RF TM safety goggles by Oculo Plastik - see Fig 14). 7. FotoFacial RF Pro Treatment Parameters: FotoFacial RF Pro therapy is a series of 5 treatments performed every 3 weeks. It is important not to sell individual FotoFacial RF Pro treatments or you will lose many patients after 1st, 2nd, or 3rd treatments who have had the full benefits of the series. You will never know how many people (these less than optimally treated patients) may have made negative comments to regarding your FotoFacial RF Pro treatments (1 happy patient = 4 word-of-mouth referrals, whereas 1 unhappy patient will tell people!) Thus, although you gain a few patients by not charging up front for the 15 week program, you will actually lose far more patients over time by negative word-of-mouth! Most patients undergo multiple passes each visit. The first step FotoFacial RF Pro I (FFI) is whole face (or hand or chin or full anatomic area) pulsed intense optical light and RF energy treatment. Then followed by Step 3 second pass Laxity Vector treatment and finally, Step 2, WrinkleLite treatment. The FotoFacial RF Pro Galaxy TM has its own new chapter and combines the IPL-RF 75

4 Aurora TM, FotoFacial RF Pro with Diode Laser-RF Polaris TM treatments. The prime therapeutic goals of the step one, whole face, FotoFacial RF Pro pass (FFI) is the resolution or improvement of vascular conditions (erythema, flushing, rosacea and spider telangiectasia), dychromias (solar lentigines, ephilli, hyperpigmentation), pigment basis of photo-aging, and, to some degree, texture and pore size. FII (FotoFacial II), if required, is a regional pass over stubborn vascular and melanin dense areas. The Laxity Vector therapy is designed to shorten existing collagen, produce new collagen and ground substances along the vectors of laxity, resulting in tightening of the facial-cervical envelope. The WR head is used for Laxity Vector therapy and incorporates longer wavelength IPL (680 nm to 980 nm), therefore more melanin chromophores located deeper in the dermis will be heated than with the SR head, lowering the impedance and streaming the RF towards these deeper dermal zones of lowered impedance. Finally, the last pass is the WrinkleLite treatment targeting improvement in the wrinkles, loose crepe lower lid skin, scars and textural irregularities of the face and body. For Galaxy TM users, the Aurora TM FFI and/or FFII passes are followed by Polaris TM WR head passes (see FotoFacial RF Pro Galaxy TM chapter). The parameters for these steps are determined by skin type and the actual settings have been selected for the optimal balance of resolution and diminished risk of adverse outcomes. The treatment parameters will include the selection of cut-off filters, fluence, number of pulses, the duration of each pulse, RF energy distribution, the degree of handpiece cooling and impedance safety level. Although, many parameters could achieve some degree of improvement, the following settings are based upon the combined experiences of the authors and thousands of patients and will give the user a starting point for efficacious and safe treatments. The parameters do not indicate the considerable degree of finesse in technique that is required for each step. 76

5 For those of you that own an SRA head and/or the ST Refirm TM head, the basic FotoFacial principles still apply, but the parameters, number of passes and therapeutic end points differ, so we have written separate chapters on The FotoFacial RF Pro SRA head (Chapter 22) and the FotoFirm TM ST head (Chapter 23). 77