Dr. MONICA ELMAN
Elman Aesthetics Clinic, Rishon Le Zion
Introduction
Signs of aging in facial appearance can be significantly ameliorated by a reduction of periorbital
rhytids and skin laxity. Use of broadband infra red (IR) light to induce skin tightening has been reported (1). This effect is achieved by utilizing tissue water as a chromophore for dermal heating, consequently enabling shrinkage and neocollagenesis. This report presents preliminary clinical results achieved with a new IR light device specifically developed for aesthetic skin tightening by Radiancy Inc.
Materials and methods
A single-site, open, clinical study was undertaken to assess the safety and efficacy of the new IR skin tightening handpiece for the treatment of skin textural changes primarily in the periorbital area. Eleven subjects were recruited to participate in the study. The participants were screened for inclusion and exclusion criteria and signed an informed consent form. Exclusion criteria included medications that could affect the characteristics of the skin, photosensitive edications, a sun tan in the treatment area, a history of keloid formation, pregnancy, epilepsy and
use of Accutane within the past 6 months. Treatment was performed with the new IR handpiece
attached to Radiancy’s Mistral light and heat energy (LHE™) system. The handpiece consists of a
780–1800-nm broadband, filtered, IR halogen light source which emits a maximum fluence of 25 J/cm2. Spot size adaptors enable a choice of different treatment areas ranging from 13 12 mm to 50 25 mm. IR light energy is emitted from the handpiece in a proprietary, multi-pulse algorithm of 30 seconds total duration, which provides optimal deep dermal heating while preventing epidermal over-heating. This broadband IR light allows a penetration depth of 1–3 mm, targeting the reticular dermis. The dermal temperature is raised to 50–60°C, while the temperature of the epidermis is maintained below 40–42°C to minimize pain and avoid any potential side effects.
A series of 10 biweekly treatments were administered and followed-up for a period of 3 months.
Photographs were taken with a VISIA Complexion Analysis system (Canfield, OH, USA) at
baseline, after five treatments, at the end of the treatment sessions and during each monthly follow-up visit. Photography was carefully standardized since it is known (2) that skin textural changes tend to be subtle and may go undetected. Treatments were administered with an average fluence of 17–18 J/cm 2. Treatment included two to four passes on the treatment area. An ArTek Spot Cooler (ThermoTek Inc., Flower Mound, TX, USA) was used to cool the epidermis before and after IR energy administration. The fluence applied was determined based on the patient’s feedback and immediate skin temperature measurement using a MiniTemp MT6 (Raytek Corp., Santa Cruz, CA, USA) non-contact thermometer. The maximum skin temperature allowed was 42ºC, which assures skin safety and patient comfort. No anaesthesia was necessary for the performance of this procedure. The result was evaluated clinically and by comparing the photographs obtained. Evaluation was scored according to the following scale: 1 no improvement; 2 slight improvement; 3 good improvement; 4 very good improvement. During treatment the patient was requested to grade the discomfort level on a four-point scale (1 no discomfort or pain; 2 slight warmth;3 discomfort; 4 intolerable heat or pain). This scale has been reported to be an effective methodto guide treatment (3). Histological analysis of the specimens was performed using H&E. Patient self-assessment of the clinical improvement was also recorded throughout the trial period using a similar visual analog scale (VAS) score. Patients were also asked to complete a patient questionnaire at the end of the treatment period. Finally, biopsy specimens were taken from two patients prior to treatment and at the 3-month followup visit for staining.
Results
Eleven volunteers were recruited for this study; all females aged 38–66 years with skin types II–V. All the participants completed the full treatment and follow-up regimen. An immediate heating and skin tightening effect was noted by all patients, though pain and discomfort were maintained at a low to moderate level (pain score 1–2). Visible changes could be observed as soon as the fifth treatment (week 3). Textural changes persisted throughout the treatment and follow-up periods. Changes consisted of a smoothing of periorbital wrinkles and a more radiant skin tone which produced an overall rejuvenated ‘new natural look’. At the end of treatments the average investigator VAS score was 3 ( ‘good improvement’) based on VISIA photographic evaluation, while patient self-assessment was rated to be ‘slight improvement’ by four patients (36.4%), ‘good improvement’ by six patients (54.5%) and ‘very good improvement’ by one patient (9.1%). At 3 months’ follow-up the average investigator VAS score was reduced to 2.7 (‘slight improvement’ in four patients, ‘good improvement’ in six patients and ‘very good improvement’ in one patient) while the patients’ average VAS score increased to 3 (‘slight improvement’ in three patients, ‘good improvement’ in five patients and ‘very good improvement’ in three
patients). Projected heat from the treated area was felt for a few minutes following treatment administration. Local erythema and slight edema persisted for up to 2 hours. No other side effects were recorded. There was no need for analgesia. Histological analysis of biopsies taken from two patients before treatment revealed in one patient (aged 53 years) mild to moderate solar elastosis with a focus of seborrheic keratosis at one lateral margin. In the second patient (aged 57 years), severe solar elastosis was found. Analysis of biopsies taken at the 2-month follow-up visit found, in both patients, dermal edema below the solar elastosis.
Elastosis in the sun-exposed skin of old persons or in those who have chronic actinic damage. elastosis [e″las-to´sis]. 1. degeneration of elastic tissue. Seborrheic keratosis (also known as "seborrheic verruca," and "senile wart" :767 :637) is a noncancerous benign skin growth that originates in keratinocytes.
Discussion
Non-ablative laser skin rejuvenation utilizing IR wavelengths such as 1064, 1320, 1440 and 1540 nm has been clinically applied for almost a decade (4) to circumvent complications and the prolonged convalescence often associated with ablative resurfacing techniques. Only recently, however, have broadband IR devices been introduced as an alternative to more costly laser systems.
Ruiz-Esparza (5) was first to report on the use of broadband IR (Titan; Cutera Inc.) to produce skin
contraction leading to lifting of the eyebrows and/or improvement of lower face and neck skin laxity using fluences below pain levels. A group of 25 patients were treated for eyebrow lifting, lower face tightening and neck skin laxity using fluences of 20–30 J/cm 2. Immediate skin contraction was obtained in 22 of 25 patients and was maintained for the whole followup
period, up to 12 months.
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