Reducing Scars With RF
By Tania Meneghel, MD
One of my favorite procedures involves the use of Alma Lasers (almalasers.com) iPixelRF ablative fractional technology to treat scarring and stretch marks. The device uses radiofrequency energy to create micro-thermal zones, alternating areas of coagulation and ablation with areas of healthy skin for rapid recovery. Not only does the system deliver excellent results in the stimulation of collagen, but it also offers a quick, comfortable treatment and fast recovery times.
The system’s roller-style in-motion handpiece is easy to maneuver. It glides smoothly along the skin for precise treatment and takes only a fraction of the time required for a typical spot treatment performed with a stamp pattern handpiece. The iPixelRF has become my method of choice for treating atrophic stretch marks and atrophic scars that are not distensible. The procedure requires very little downtime—despite the fractional ablation of the epidermis—and it produces tangible results that are immediately visible. Within two sessions,
patients begin to see dramatic results. Patients with acne scars (distensible or not distensible) begin to see improvement after just a single treatment. Not distensible scarring requires additional sessions to achieve significant results.
Patient Selection
Treatment with the iPixelRF system is contraindicated for areas contaminated by bacteria or viruses (e.g. herpes simplex). Depending on the thickness or depth of the stretch marks or scars, one or more treatments may be required.
For ablative procedures on the face, I prescribe prophylactic valacyclovir or acyclovir for herpes simplex beginning the night before treatment. On the day of the procedure—after washing the area to be treated with soap and water—I apply a topical anesthetic (lidocaine 23% with tetracaine 7%) and leave this in place for at least one hour. Afterwards, I wash the area again with soap and water, and apply alcohol or acetone to remove oils on the skin.
The Procedure
For the treatment of stretch marks only, I use the in-motion roller with six to eight passes. The area will be swollen and very erythematous. After treatment, I cover the area with Vaseline and apply a plastic film.
When performing the procedure for wrinkles or acne scars, I work first with the stationary medium size tip at 50 watts energy level and a 0.2-second pulse duration. I do five pulse stacks over each wrinkle or scar, and then change to the roller in-motion handpiece at 50 watts with a 30 second pulse duration. I go over the treatment area an additional three to five times with the roller. Afterwards, I apply a silicone gel. In areas where the injuries are deeper, for example with chickenpox scars or deep perioral wrinkles, I may go over it several more times until I get to the bloody dew. The procedure is very fast, typically taking less than 20 minutes to treat the entire face.
We apply either topical petrolatum or silicone gel—that acts as a kind of plastic film—to minimize discomfort postprocedure. Most patients have no pain or burning when they leave the office. I recommend they do not wash the treated area for the next 12 hours to prevent the burning sensation that may result from exposure of nerve endings due to the ablation. After 12 hours, patients may wash the area with antiseptic soap and apply a moisturizing cream, such as Cetaphil Daily Advance, followed by sunscreen applied three to four times daily.
Most patients experience just three days of downtime. Typically, the first two days will bring edema and erythema. On the third day, the skin becomes dry and fine peeling (scaling) may occur. The use of a moisturizer minimizes the scaling and the sensation of dry skin.
Adverse effects are rare and most often involve hyperpigmentation in the treated area as a result of sun exposure. To prevent this, I prescribe the use of sun block and, should hyperpigmentation occur, a topical for depigmentation.
The procedure is extremely well-tolerated by most patients. When care is taken to apply a topical anesthesia, patient satisfaction is greater than 80%. Treatment with the iPixelRF presents consistent, near-immediate results that become apparent after just one week post-treatment. The ablation renders the scar superficial. As a result of the intense formation and restructuring of collagen, the results continue to improve over the next one to two months.
If repeat sessions are required, we deliver these no sooner than 30 days after the previous session. Histological findings are exactly the same as that of a fractional CO2 treatment at medium power, but with at least one-third of the downtime.
Note: The iPixel RF system is currently not approved for sale in the United States. Other iPixel modalities for fractional resurfacing include the iPixelEr and iPixelCO2. Both feature the roller-style in-motion handpiece.
Dermatologist Tania Meneghel, MD, is a leading expert in the field of cosmetic dermatology and dermatologic surgery in Brazil as well as the clinical director of the Renaissance Clinic. She is certified by the Brazilian Society of Dermatology, the Brazilian Society of Orthomolecular Medicine and the Brazilian Association of Nutrition. Contact her at taniameneghel.com.br.
Photo courtesy of Tania Meneghel, MD