Evolutions in radiofrequency and standard microneedling, as well as picosecond fractional and pulsed dye laser technologies, were hot topics yesterday when E. Victor Ross, M.D., presented on next-generation energy-based anti-aging skin treatments at The Aesthetic Show in Las Vegas.
Today’s focus on microneedling technology is on improving radiofrequency devices and clarifying differences in outcomes between microneedling with and without radiofrequency, according to Dr. Ross, a dermatologist with the Scripps Clinic, San Diego, Calif.
Increasing comfort is important for improving radiofrequency microneedling devices, he says.
“That’s tied into the needles’ penetrating more easily,” Dr. Ross says.
The principle is much like that of the man walking on a bed of nails, who doesn’t get hurt because he makes sure to distribute the pressure of the nails evenly on his feet. The challenge with radiofrequency microneedling is in trying to engage, or insert, 20, 30, 40 needles simultaneously into the skin, while distributing the pressure evenly and simultaneously to full depth. The problem is the needles tend to push away the skin.
“It’s one thing to take one needle and stick it into the patient for immunization or a blood draw, but to have 30, 40, 50, 60 needles go in at one time is a bigger challenge,” he says. “So, we’re working on smaller needles, as far as the diameter; sharper needles; smoother mechanisms to insert the needles; and different types of ways to force the needles in. Those are the types of things that are going to eventually improve radiofrequency microneedling.”
Another issue is the controversy about whether adding radiofrequency to microneedling translates to better outcomes. There are many reasons that’s an important question to answer, one of which is cost.
“The cost of a microneedling system could be $5,000 to $7,000, whereas, if you do radiofrequency microneedling, you’re talking about $30,000 to $50,000,” Dr. Ross says.
There are no definitive studies comparing the two, according to Dr. Ross. Early research, however, suggests that microneedling with radiofrequency creates more tightening than without radiofrequency, according to Dr. Ross.
“But microneedling alone does seem to have a role for some things. For example, acne scars and skin rejuvenation, particularly when applied with PRP. And that’s another controversy,” Dr. Ross says.
The question about whether adding PRP to microneedling also needs to be answered with definitive studies, according to Dr. Ross.
Fractional picosecond lasers are stirring interest in cosmetic medicine, according to Dr. Ross, who is among the researchers doing studies on the technology.
Early studies look promising, including one published November 2017 in Lasers in Surgery and Medicine, by Eric F. Bernstein, MD, MSE. He and colleagues report the 1,064 and 532 nm picosecond‐domain laser incorporating a 10 × 10 holographic beam‐splitting handpiece was safe, effective and well tolerated when used to treat facial acne scars.
“In general, you’re going to see more picosecond fractional laser discussions and studies coming out looking at how the technology improves tone, texture and pigment, and, maybe, melasma,” Dr. Ross says. “I think we’ll see more picosecond fractional and nonfractional laser systems in the next four to five years.”
The new pulsed dye laser on the block
Syneron-Candela is expected to release its new pulsed dye laser technology, called V-Beam Prima, later this summer, Dr. Ross says.
“That’s a pulsed dye laser similar to what they had before but it has more power, a longer dye life, the option for contact cooling as well as cryogen spray cooling, and bigger spot sizes,” he says. “It’s a hot new visible light technology.”
Dr. Ross and colleagues presented research on the new 595 nm pulsed dye laser in April 2018 at the American Society for Laser Medicine and Surgery annual conference in Dallas. The researchers examined the laser’s role in facial rejuvenation in 13 women and men, ages 51 to 74, with Fitzpatrick skin types I through III. They treated 16 facial lesions, including photodamage, diffuse redness and telangiectasia. Twelve patients had two treatment sessions, performed one month apart; one had three sessions.
They report that 100% of lesions had at least 50% clearance. More than three quarters of lesions cleared 50% to 75%, and 23% had 76% to 100% clearance. More than 90% of patients were satisfied and indicated they would recommend the procedure.
They found that while they had applied lidocaine cream before treatments, mean discomfort during treatment was 4.7, on a scale of zero to 10. Immediate responses post-treatment included mild to moderate erythema in all patients and mild edema in 89%. The researchers also noted mild cold sores and moderate crusting post treatment.
Disclosure: Dr. Ross reports receiving research support from Lutronic, Candela and Lumenis.