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Radio-Frequency Microneedling and Monopolar Radio-Frequency

Post 1 SylfirmX

From our "Just Laser It" Podcast that you can find on Spotify, Audible and Apple Podcast.

Dr. Minni Saluja: 0:57

Well, today we are going to focus on radio frequency and Kane, do you know what I love so much about radio frequency?

Kane Rogers: 1:04

Probably a lot of things, but what's, what are some of them?

Dr. Minni Saluja: 1:07

So I love the fact that radio frequency, because it's electrical energy and not a wavelength of light, you can use it on any skin type, mine included,  any time of the year. So even when a patient is tan, you can use RF.

Kane Rogers: 1:27

So when you talk about any skin type, give us a little more clarity into that.

Dr. Minni Saluja: 1:30

There are basically six skin types. They're called Fitzpatrick skin types.

  1. Type one is very pale skin coloration.
  2. Type 2 is more like you with blue eyes, lighter complexion. 
  3. Type 3 is my darker haired,  browner eyed patient, but still quite light skin.
  4. Type 4: darker skin (I am a Type 4 as I have Eastern Indian heritage).  Asian, Hispanic, Native Americans are typically type 4.  Certain lasers, because of the fact that they can really interact with melanin, cannot be utilized on darker skin types. So typically with skin type four, five, and six, we kind of have to watch what type of energy based device we utilize on our skin.
  5. Type 5: darker pigment
  6. Type 6: very dark colored skin.

Kane Rogers: 2:14

So when you talk about radio frequency and that being for all skin types, what comes to my mind is something like radio waves or something. What is radiofrequency? What are you even talking about?

Dr. Minni Saluja: 2:24

Radiofrequency is electrical energy and it oscillates at a very fast rate. So, for example, when we utilize RF for bulk heating and even for RF microneedling, we're at the one to six megahertz level, which means that it is oscillating the current back and forth about 6 million times per second. This energy going into the skin collides with tissue resistance and heat is created. Heat then causes collagen fibril contraction and produces additional elastin and collagen.

Kane Rogers: 3:01

So you're basically taking radiofrequency or electrical energy which then heats the skin and that stimulates the elastin collagen that would benefit you.

Dr. Minni Saluja: 3:13

That's a good way of looking at it. And there's two major types of radio frequency. There's monopolar radio frequency, and there's bipolar radio frequency.

With monopolar radio frequency a neutral pad or grounding pad is placed on prior to the treatment.  This type of radio frequency is more of bulk heating type of radio frequency. It's usually continuous motion. The one that we utilize in our practice is Tempsure which actually has a temperature sensing device, a thermister where it can read what temperature setting you're at. For example, around the eye area, I set it to 43 to 44 degrees Celsius, and the device alerts me as to when I have achieved that temperature and it won't supersede that temperature.

Kane Rogers: 4:04

So you mentioned the eye area and patients have come in for big areas like the legs or something like that. What device do you use and what areas can you treat?

Dr. Minni Saluja: 4:14

Really any area on the body can be treated with RF.

With RF monopolar, if the area is larger such the abdomen or leg area, I might choose a 60 millimeter spot size. You can think about the depth of the penetration as basically half the size of the handpiece being utilized (simplistically speaking).  Tempsure helps to improve the quality of the skin. It is not going to give you abdominalplasty type of results, but it helps improve the texture of the skin.  Sometimes I will combine this with smooth PDO threads, which we'll talk about in a different episode. When I'm around the eyes, there's a wonderful little 10-millimeter spot size that allows me to go around that periocular tissue. And when I say it is a zero downtime procedure, it truly is. You might be a little bit pinkish red for about 15 to 20 minutes and that's it.

Kane Rogers: 5:12

Okay. So a couple of things, you talked about energy and heat, which makes something come to my mind. Okay. That might hurt. Does it hurt?

Dr. Minni Saluja: 5:25

It really truly does not hurt. It feels like a hot stone massage. In fact, it even plays this little spa-like music to relax you as well. But it's very comfortable. It's just an easy procedure to do. So again, that’s monopolar radio frequency.

Now this differs from bipolar radio frequency and the early iterations of bipolar radio frequency had a  more superficial type delivery because it had both of the electrodes in the hand piece, so they're very, very close together, and the depth of penetration was basically half the distance between those two electrodes.

 

Then the way that they superseded this superficial delivery was to create RFMN (radio-frequency microneedling) which everybody's heard about, I'm sure.

Kane Rogers: 6:59  

So you often hear of just microneedling and then you've also heard of radiofrequency microneedling. What's the difference?

Dr. Minni Saluja: 7:09

I really wish they would have given it a different name because it gets so confusing. So microneedling, utilizes tiny needles and it's just microneedles alone. It's basically creates little mechanical fracture in the skin, which does stimulate some collagen. And it's also a great pathway for topical products to infuse into the dermis via these little pathways created. 

But it does NOT add radio frequency energy, so radio frequency microneedling utilizes microneedles, and these tiny electrodes go into the skin but more importantly, radio frequency energy is released, and  you can titrate the energy settings, which then creates the heat to 55 to 60 degrees Celsius that stimulates that elastin and collagen in the skin, which is so vital to really rejuvenate the skin.

Kane Rogers: 7:59

So really RF microneedling is able to transport the energy into the skin depth that you want.

Dr. Minni Saluja: 8:05

Yes, RFMN has the added benefit of heat in the form of energy. Whereas if it's microneedling alone, there is no energy that's being transported. It's just needles in and out. And again, I don't mean to poo poo that, but also your results will be less with microneedling alone as opposed to RF microneedling.

Kane Rogers: 8:20

Because again, that that heat that's being generated is stimulating elastin and collagen.

Dr. Minni Saluja: 8:25

Correct. And that's the key. And so what's so neat about electrical energy in the form of radio frequency is that it doesn't just stop at the dermis. Electrical energy has a way of even going down slightly below to the fibroseptal network, and it can contract that tissue so you get this little bit of a lifting effect that occurs. That is the wonderful thing again about radiofrequency. Now there are many, many devices out there.

Back in 2015 our first device (that we have since sold) was like a staple gun, stamping off the skin.

Kane Rogers: 9:01

What? This was your first device?

Dr. Minni Saluja: 9:02

Yes, our first RFMN device. And it was very bloody. It was with insulated needles so only the tip was a conductor. It was very uncomfortable and not smooth in delivery.

With our newer systems (Scarlet S and SylfirmX) , we still numb and certainly some areas can be a bit more sensitive, but it is much more comfortable than previous systems.  The entire needle of SylfirmX and Scarlet are conductors so there is more energy delivered per needle. There is also the “Na” effect which is named after the doctor that invented this, where you basically create a teardrop configuration in the dermis on the distal end of the tip and propagates upward, proximally into the papillary dermis.  This area of independent coagulation spares the epidermal layer.

Kane Rogers: 10:04

Okay. So you, you're, you're kind of losing me…

Dr. Minni Saluja: 10:06

Okay. Let's backtrack.

Kane Rogers: 10:08

Here is what I heard you say. Tell me if I'm correct or not. So basically, with the NA effect that you can insert the micro needles and, and the Na Effect it gives energy to a greater area.

Dr. Minni Saluja: 10:23

Correct. So with an insulated needle, you might have to do multiple passes to get at each depth whereas with the NA effect the teardrop configuration allows for a greater degree of tissue coverage so greater energy to the dermis, which correlates to more coagulation, et cetera. So that's what's really important.

Now, the reason why we have two devices, both the Scarlet and the SylfirmX is that the SylfirmX is the newer iteration, which has both a continuous wave, modality for skin tightening and an additional pulsed wave modality. And that pulse wave allows us to treat things such as melasma, I dare say melasma, because everybody knows that melasma is one of the hardest, hardest things to treat. And I tell patients, I always set the expectations that I could make this worse, not better with energy based devices. But the pulse wave does allow me to create controlled energy and I can treat it even with a Pico pulse laser and get some nice results with melasma.

Kane Rogers: 11:33

Okay. So do you have a typical patient that when you look at, you think you'd be great for a radio frequency microneedling?

Dr. Minni Saluja: 11:42

Anybody is that patient. But the ones that I always look at are the patients where they might have slightly darker skin typea. Those patients are great for RF microneedling.  Also patients desiring a little lift to their neck and jowl area.

Patients with a little fat herniation around the eye area, great for RF microneedling. There's also a microneedling device that's a monopolar device called Agnes that can sometimes get into those zones as well. So those are the type of patients, even acne scarred patients, really anybody can be.

Even upper leg knee laxity, abdominal laxity, arm laxity. There's multiple areas where you can utilize this modality.

Kane Rogers: 12:27

So if I am going to oversimplify it, this is really helping tighten skin and provide maybe a little bit of a lift.

Dr. Minni Saluja: 12:34

You got it. And because it creates tiny openings into the skin from the needles, which is different than ablative lasers which vaporizes the tissue, the healing is quicker and topical medications can be applied which allow for better penetration into the dermis.

Kane Rogers: 12:55

So, setting expectations. What would a patient expect from a pain threshold? From a downtime perspective? And how many treatments would be needed?

Dr. Minni Saluja: 13:03

Well, from a pain threshold, it, we recommend numbing for one hour prior with BLT cream, betacaine, lidocaine, tetracaine.  Around the eyes, it is a little pinchy  and over the forehead, but otherwise very, very tolerable.  The neck is probably the most comfortable area to treat.

Patients can expect a little bit of redness for maybe 24, perhaps 36 hours. There could be minimal swelling under the eyes that is typically noted the next day.  The skin will feel a bit “gritty” from the needle insertions for about 4-5 days.

Typically 3 treatments are needed for optimal results.  

Kane Rogers: 14:00

Okay, so you talk about another episode as well. So I do want to interject here. We do want to make this interactive with you guys. If you go to SalujalaserMD that's Dr. Saluja's Instagram account, you can DM her, ask her questions, give us show ideas. We'll try and incorporate all your feedback into the show because we want to make this your show just as much as ours.

Dr. Minni Saluja: 14:30

Now for our product spotlight category. The product that we are going to discuss today, and it's actually a category is sunscreen. It is so very important to find a sunscreen that you like so that it will be worn. While discussing the different procedures to help improve photodamage, we really want to highlight protecting our investment with sunscreen.

Always opt for a physical blocking sunscreen (zinc/titanium based.

 So my product spotlight. I really like Elta-MD Clear and Tinted.  I think it's a great sunscreen. The Elta-MD Clear is really good with rosacea and the tinted sunscreen for melasma patients

Over the counter alternatives would be La Roche Posay’s Anthelios Mineral Sunscreen. So any of those two are great. And again, anything that you utilize, sometimes patients will say, I use Supergoop, or I use this or that. Fine, that's perfect because I know you'll wear the sunscreen. So that's kind of my product

Dr. Minni Saluja: 15:56

So in summary:  There's monopolar radio frequency, there's bipolar radio frequency. In that bipolar category is RF microneedling. There are multiple companies that offer RFMN:

  1. Benev: Sylfirm X
  2. Cynosure: Potenza. There's
  3. InMode: Morpheus eight, there's
  4. Lutronic: Genius
  5. Cutera: Secret RF There's
  6. Cartessa: Virtue and Vybe RF
  7. ABM: Vivace
  8. AMPS: Scarlet

Kane Rogers: 17:04

So thank you for tuning in. Again, rate review and subscribe if you like the episode. And hopefully you'll be listening to us in the next episode.

You can find us on Apple Podcast, Audible and Spotify under “Just Laser It”

 

Author
Raminder Saluja, MD

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