It’s the holy grail of skin tightening — to bypass and spare the skin’s top layer and deliver heat that causes controlled wounds deeper down. The result? A nonsurgical, relatively painless skin tightening procedure that requires little if no downtime, according to E. Victor Ross, M.D., dermatologist, at Scripps Clinic Carmel Valley, San Diego, Calif.
Radio frequency (RF) needles are getting closer to our goal, says Dr. Ross, who presented on the technology for skin tightening at yesterday’s American Society for Laser Medicine & Surgery 2015 annual conference in Kissimmee, Fla.
Technologies designed to deliver energy deep into the skin and spare the epidermis have, for the most part, fallen short, he says. Light and fractional devices don’t completely bypass the epidermis.
“The other way to get energy down deep and spare the epidermis is to use an insulated needle. In other words, you have a needle but only the tip of the needle is exposed to the skin,” he explains. “That way, you bypass the top layer of skin and can deliver the energy at any depth you want.”
RF needle devices used different mechanisms to push pins through the skin deliver and control energy, from springs (Infini, Lutronic) to a motor (Intensif, Endymed) to pushing needles with your own hand (Factora, Inmode).
But does RF needling work?
RF needles are an ideal technology for skin tightening with one caveat, according to Dr. Ross.
“This is a non-laser way to deliver the energy deeper than other fractional technologies because most technologies can only go about a millimeter or 1.5 mm down,” he says. “What we don’t know is what the perfect settings are. We don’t know how hard to push this needle technology. I think, if anything, we’ve been too conservative. I think we’ve set the pin pitch maybe a little too high and have set the energies possibly a little too low and performed too few passes. But I think as we continue to use these devices, people are starting to realize that they have great potential to deliver very ‘titratable’ wounds to the skin. With the Infini device — the one we have the most experience with — we are seeing very nice results on the cheek for acne scars and skin tightening.”
The critical piece of information is to determine how best to heat deep in the skin, according to Dr. Ross.
“With lasers that’s very difficult to go deep because the light is impeded by the skin. The pins bypass that and go right into the skin, so we put energy where we want it,” he says. “These devices offer a heck of a lot of control for the provider. And, so far, [RF needle] devices have been proven to be relatively safe. With proper technique, it’s not easy to hurt somebody with these.”