Microneedle Fractional RF Skin Care Treatment

Monopolar and bipolar RF devices which use electromagnetic waves in RF range have evolved over a period of time to treat the signs of ageing, skin tightening and body contouring. Microneedling skincare treatment causes volumetric heating of the dermal and subdermal tissue, which them results in the reduction of skin laxity and wrinkles.

INSTRUMENT:

The MRF handpiece tip (cartridge) contains an array of microneedles through which the RF energy is delivered in a fractionated manner. The microneedles are 200um in diameter, insulated all along the length except the tips. The RF energy is emitted only at the uninsulated and tapered active needle tip which is 300um in length. While the heat is generated in the dermis, the epidermis remains comparatively protected. The microneedle length is about 3.5 mm. The needles penetrate into the skin smoothly due to their small ultra- sharp point and smaller cross section, which minimizes the pain, skin depression and bounce back effect (over bony areas). MFR is invasive RF device, which effectively acts on the dermis (superficial to deep) and is used to treat scars, wrinkles, large pores, etc.

MECHANISM OF ACTION:

There are three mechanisms used in microneedling skin care treatment, which help in achieving optimum results through wound healing responses:

1. Thermal injury induced by RF energy at microneedle tips.
2. Mechanical injury caused by the movement of microneedles through the skin (normal and scarred).
3. Platelets released during bleeding (induced by microneedles) provide various cytokines, growth factors etc. which help in healing the wound.

INDICATIONS:

1. Facial rejuvenation - Skin tightening, photo-ageing (fine to moderate wrinkles, mild laxity)
2. Skin rejuvenation of upper eyelids, neck and arms
3. Acne scars (atrophic)- Macular, rolling, linear, valley type and boxcar (after subcision which acts as a panacea for improving all types of scars)
4. Other atrophic scars - Surgical, traumatic, post burn (parchment like with hypo/hyper or depigmentation), stretch marks etc.
5. Open pores
6. Drug delivery - Mesotherapy products, platelet-rich plasma (PRP) etc.

CONTRAINDICATION:

1. Keloidal tendency patient
2. Cardiac pacemaker or with an implanted defibrillator
3. Active acne
4. Secondary infection (bacterial, viral-herpes labialis, warts etc.)
5. Koebnerization (active psoriasis, vitiligo, and lichen planus)
6. Pregnancy
7. Patients with metallic implants (mental pins, prosthetic joints) need to be informed that they may feel tingling sensation around these areas.

PREOPERATIVE WORK:

1. Counselling – The steps of the procedure, its outcome, side effects, cost of microneedling skin care treatment in Chandigarh and the complications (if any) are explained in detail to the patient.
2. Photographs

PROCEDURE:

1. Preoperative medications: Oral antibiotic to be started a day prior to the procedure and continued for 5-6 days post the procedure. Prophylactic use of antiviral drugs in patients with a history of herpes labialis.
2. Topical anesthesia: Not completely effective. Local anesthesia is recommended and applied under occlusion for 1 hour prior to the procedure.
3. Preparation (spirit and povidone iodine) and isolation.
4. MFR microneedle cartridge is attached to the head of the MFR handpiece.
5. Technique (stamping method): Place the MFR cartridge perpendicular to the skin surface. Go linearly row wise from the centre of the face to periphery, stamping the MFR needle cartridge and simultaneously firing the shots of RF energy with a foot switch. The microneedles get automatically withdrawn leaving behind multiple bleeding points.
6. Hemostasis is achieved with saline soaked moist gauze pieces.
7. Dressing is done with a very thin layer of antibiotic cream.

POSTOPERATIVE CARE:

1. Medication: Antibiotic cover for 7 days with minimal use of analgesics and anti- inflammatory drugs.
2. Topical: Regular washes with soap and water 3-4 times for the first 2 days (during oozing, if any) followed by application of a thin layer of antibiotic cream.
3. Sun restriction and sun protection for 7-10 days.

SCHEDULE:

Once in 4-8 weeks (4-6 sessions)
Total treatment time 6-8 months in case of atrophic acne scarring, facial rejuvenation etc.

SEQUELAE:

Pain, bleeding (immediate), nil or minimal serous oozing erythema, burning sensation, edema.

RESULTS:

1. Immediate postoperative edema masks the scars and wrinkles making them less visible for the first 5-10 days (prior information of this must be provided to the patient).
2. Results of neocollagenesis appear to show in 4 weeks time and are fully noticeable after 3 months.
3. The parched, crinkled atrophic epidermal surface becomes thicker and fills out with improved textural appearance.
4. The atrophic acne scars get lifted up with visible improvement in their depth and size with overall reduction in the severity of their levels.
5. The wrinkles also start to flatten and improve with time and there is visible tightening of the skin that can be experienced.