Fractional Ablative Radio-Frequency Resurfacing in Asian and Caucasian Skin: A Novel Method for Deep Radiofrequency Fractional Skin Rejuvenation.
This paper reports the clinical experience of a multi-center, multiple physician trial with a novel fractional radiofre-quency ablative skin resurfacing and rejuvenation device (Fractora, Invasix, Israel) deployed on both Caucasian skin types I – III and Asian skin type IV. Histological study demonstrated deep ablation and collagen restructuring in the papillary and reticular dermis. The Fractora device combines the more “cone shaped” ablation seen with CO2 and Er-bium lasers with a deep non-ablative heating pattern, seen with other bipolar RF fractional needle resurfacing devices. Ablation, coagulation zones and healing dynamics are analyzed for different energy settings. Two different treatment protocols are suggested: one for light skin and then one for darker skin with a higher risk of post-inflammatory hypper-pigmentation. Treatment results show improvement in skin texture, pores, wrinkles and skin dyschromia.
Skin Resurfacing; Skin Rejuvenation; Fractional Treatment
Since its inception in the 1990’s, carbon dioxide (CO2) laser resurfacing has enjoyed the distinction of being the gold standard in the treatment of rhytides, texture con-cerns, acne scars and photo-damage skin. Numerous peer reviewed articles documenting its excellent long-term skin resurfacing results have been reported [1-8]. One of the unique characteristics of the CO2 laser is that it cre-ates almost equal degrees of ablation, coagulation and re- sidual sub-necrotic thermal zones in the skin with vol- umes of 50 – 100 microns . Although full surface CO2 laser ablation provides some highly regarded results in the treatment of wrinkles, acne scars and photo-damage, it also presents some disadvantages. These problems in- clude a long recovery period, prolonged erythema, un-certain wound healing characteristics derived from the re-epithelialization process, post-inflammatory hyperpig- mentation in darker skin types, and long-term hypopig- mentation in the majority of patients [9-12].
In response to the disadvantages of ablative CO2 and Erbium YAG lasers, the era of non-ablative near-infrared wavelength lasers and radiofrequency devices arose for sub-necrotic tissue heating inducing collagen remodeling [13,14]. All of these non-ablative technologies worked
through targeting the relatively thick dermal layer of skin, sometimes in combination with external cooling, to pre-serve the epidermal skin surface from damage and create significant heating in the sub-dermal space. With the cor- rect parameters and wavelengths, the temperature in the dermis can be very close to necrotic levels, inducing col-lagen remodeling and delivering modest results for skin tightening and wrinkle reduction. With the “non-abla-tive” approach to skin enhancement, multiple treatments were usually required and results were generally less dramatic than ablative therapies. Clinical data suggests that RF based devices provide stronger tightening effect [15-18], through the ability to penetrate more deeply into the sub-dermal space, while laser penetration depth is limited by the dermis.
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