Sponsored by InMode
As more aesthetic patients receive hyaluronic acid (HA) fillers, it is important for providers to have solutions that can help reverse possible 
unwanted side effects, including post-hyaluronic acid recurrent eyelid edema (PHAREE). A proposed radiofrequency microneedling (RFMN) treatment protocol offers a new approach to treating this type of filler-related edema.
According to Erez Dayan, MD, plastic and reconstructive surgeon and medical director of Avance Plastic Surgery Institute (Reno, Nev.), PHAREE is the most common filler-related complication that may occur after injections around the eyes, and RFMN has been shown to be the most effective treatment for PHAREE symptoms in this anatomical area.
“[Incidence of] this condition continues to grow and RFMN devices, such as Morpheus8 from InMode (Irvine, Calif.), have shown promising results in improving appearance,” Dr. Dayan reported. “Research shows that radiofrequency contracts tissue to resolve PHAREE symptoms; the target treatment area looked better, and lymphatic function was improved.”1
Morpheus8 is an advanced bipolar RFMN device capable of penetrating deep into the epidermis, dermis and subdermal adipose tissues for fractional coagulation of subcutaneous tissue. It is considered an ideal treatment for tissue tightening with its ability to penetrate up to 4 mm on the face and 8 mm on the body.
Clinical studies have shown Morpheus8 and complimentary modalities not only address and resolve PHAREE symptoms, but also restore aesthetic periorbital anatomy, ostensibly due to the RF-mediated tissue contraction and improvement of lymphatic function.1
“Classically, hyaluronidase is used to ‘melt’ filler. However, we found issues with this as there remained volume loss and skin laxity,” Dr. Dayan explained. “We found that bipolar radiofrequency treatments like Mor
pheus8 manage the soft tissue and provide skin tightening effects. Additional benefits of RF include upregulation of growth factors that stimulate lymphatic regeneration and collagen/ elastin reorganization.”
Dr. Dayan recently co-authored a paper1 with plastic surgeon Kami Parsa, MD (Beverly Hills, Calif.), using Morpheus8 fractionated RFMN with serial hyaluronidase as a treatment protocol to treat PHAREE and found it may provide advantages over using hyaluronidase alone.
“We have found that some HA-type fillers can cause tissue expansion and lymphatic blockage,” Dr. Parsa stated. “Our PHAREE protocol slowly dissolves the filler with Hylenex in combination with fractional radiofrequency such as Morpheus8 to help induce tissue tightening.”
With the rise in popularity of fillers in aesthetics, the ability to manage the challenging side effects can improve provider confidence. Using Morpheus8 treatments to address volume and skin laxity associated with those side effects results in high levels of patient satisfaction.
Taking their technology even further, InMode will be introducing Morpheus8 Burst and Morpheus8 Burst Deep products, equipped with the proprietary SCALE modality. SCALE will allow greater energy to be deposited in deeper layers of the skin, and intelligently “scale” back energy for more superficial layers. The company expects the new SCALE innovation to be widely released in the second half of 2024.
Reference:
1. Karlin J, Vranis N, Dayan E, Parsa K. Post-Hyaluronic Acid Recurrent Eyelid Edema: Pathophysiologic Mechanisms and a Proposed Treatment Protocol. Aesthet Surg J Open Forum. 2023;5:ojad102. Published 2023 Dec 3. doi:10.1093/ asjof/ojad102
