"We were looking for a way to do tissue tightening and collagen remodeling without pain," says Michael H. Gold, M.D., medical director at Gold Skin Care Center and at the Tennessee Clinical Research Center, Nashville, Tenn., and a lead author of the study.
By using a device that combines a vacuum apparatus with bipolar RF energy (Aluma Skin Renewal System, Lumenis), he says, "We showed conclusively that we were able to improve skin texture, tighten the skin and reduce wrinkles by a score of at least two elastotic units in the majority of patients we treated (M.H. Gold, MD, unpublished data)." The study included 46 patients (42 female, four male) treated for perioral and periorbital rhytids for a total of eight weeks, with follow-up visits at one, three and six months after the final treatment.Bipolar benefits
While monopolar RF therapies provide effective deep tissue heating, bipolar RF provides targeted tissue heating to the desired treatment area, Dr. Gold says.
"In other words," he explains, "when one uses monopolar RF, in order to treat at the corner of the neck or the jowls, one must deliver so much energy that it can be painful. If one uses too much energy, it can cause tissue damage that results in certain types of atrophic areas appearing."
Conversely, he says, one can perform Aluma treatments without anesthesia or causing any kind of discomfort to the patient.
"The process works by delivering heat into the dermis, which immediately causes collagen contracture. Then, over a period of time, the collagen renews and regenerates, producing tightening and new collagen," Dr. Gold explains. Aluma with Functional Aspiration Controlled Electrothermal Stimulation (FACES) technology is the only machine on the market that uses bipolar RF plus a vacuum to provide skin tightening, he adds.
"It's one of many new devices that have been developed over the last several years for skin tightening. The differences between it and the RF devices currently available on the market are that, unlike any other device, it's totally painless. And it's much faster," Dr. Gold says. For such reasons, he adds, "This is one of the better new devices I've been associated with in quite some time."
A full-face monopolar RF skin tightening treatment requires one to two hours, he notes. With near-infrared intense pulsed light (IPL), such a treatment takes one to 1.5 hours because each pulse of light requires a seven-second cycle time, Dr. Gold adds. In contrast, he says, "An Aluma treatment takes about 10 minutes if one is moving slowly. The other part of the equation that one must understand is that monopolar and near-infrared IPL technologies may deliver results a little more quickly. After two treatments with monopolar RF spaced six weeks apart, patients are usually done."
Bipolar RF, on the other hand, requires a total of four to five treatments performed weekly or every other week to achieve the same degree of improvement, Dr. Gold says. Nevertheless, he says patients easily accept this number of treatments because the procedure is painless, yet it usually produces visible benefits after a single treatment. "They want to see what they'll look like after the next treatment," he says.
Since the device won Food and Drug Administration approval late last year, Dr. Gold and his colleagues have begun studying treatment protocols and related issues.
He says, "We're looking at the question of 'Do we need to do it every week? Every other week? Do we need four treatments, or six?' I believe what we will find is that every other week is sufficient, and anywhere from four to six treatments will suffice, based on the patient's needs."