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Patients, operators favor 'fast' treatment tip to reduce procedure time for skin tightening

Dallas — Self-rated intraoperative patient discomfort and skin tightening outcomes are similar when radiofrequency (ThermaCool TC, Thermage™) rejuvenation is performed using the new monopolar "fast" treatment tip compared with the slower cycling original tip. However, with an advantage of reducing procedural time, the fast tip is preferred by both patients and operators, reports Gilly Munavalli, M.D., M.H.S., who spoke at the annual meeting of the American Society for Laser Medicine and Surgery.

Dr. Munavalli presented the results of a split-face patient preference study comparing the two tips with respect to a variety of outcome measures. Eighteen patients, ages 39 to 68 years old, were treated on the right side of the face using the original "standard" tip and on the left side with the fast tip. Most of the procedures were performed after use of a topical anesthetic (lidocaine 4 percent; LMX 4, Ferndale), but no other premedication was provided to minimize discomfort.

Less procedure time Ratings made immediately after surgery showed total procedure time was 24 percent less using the fast tip compared with the standard tip, and the operator rated the fast tip as equal to or easier to use than the standard tip in 16 (89 percent) cases.

Based on the investigator's clinical impression, treatment with the fast tip seemed to be somewhat better tolerated by patients. In addition, patients indicated the fast tip felt hotter, but the discomfort seemed of shorter duration. However, when asked to rate the discomfort of the procedure immediately post-treatment using a scale of 0 to 5 (where 5 represents the worst score), the average score for both sides of the face was 4.5. Even so, 15 (85 percent) patients indicated they preferred treatment with the fast tip.

Early follow-up of some of the participants after one or two months suggested that from the investigator's perspective, there was an advantage for the fast tip in producing more rapid improvement. However, when patients were asked after six months to rate the improvement achieved on both sides, the mean scores using a 0 to 5 scale showed a slight numeric advantage for the fast tip versus the slow tip, 3.5 vs. 3.0, respectively, but the difference was not statistically significant.

"Based on experience using both tips, our preference is for the new fast tip. Interestingly, the manufacturer is now introducing a fast tip able to deliver 350 pulses instead of just 150, and that coincides with an effort to change the technique algorithm to routinely involve more than one pass," says Dr. Munavalli, who is a clinical instructor in dermatology, University of Maryland, Baltimore.

The study was conducted at the Maryland Laser, Skin & Vein Institute, Hunt Valley, Md., where Dr. Munavalli is completing a laser surgery fellowship under the direction of Robert Weiss, M.D. Their center was one of 13 sites participating in a multicenter trial comparing the fast and standard treatment tips.

Normal protocols followed At each investigational site, physicians were directed to follow their normal radiofrequency treatment protocol. The 18 patients in Dr. Munavalli's series represented a range of skin types and skin thicknesses. At their discretion, the investigators performed a double pass with the fast tip when treating some areas of thicker skin. All 150 pulses of each tip were used.

"The fast tip delivers the energy in a more rapid fashion, but it is not delivered as deeply. Therefore, we assumed as we entered into this study that the treatment effect achieved on areas of thicker or more sebaceous skin would be less after a single pass using the fast tip compared with the standard tip, and our experience confirmed that prediction," Dr. Munavilli says.

Other study results were consistent with the overall high patient satisfaction typically associated with radiofrequency treatment.

Patient satisfaction a big victory Although the study protocol allowed any patient to receive a full-face retreatment with the tip of their choice if they were unhappy with the outcome, none requested a second procedure. In addition, 75 percent of patients said they would absolutely recommend the treatment to a friend, 80 percent said they would like to be treated again, and the average overall satisfaction rating was 4.0.

"We feel those are some of the most telling results from this study because they clearly illustrate the high levels of patient satisfaction with this noninvasive skin tightening treatment," Dr. Munavalli says.


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