Full title

Multisource phased controlled radiofrequency (3DEEP) for the treatment of face and neck wrinkles and lax skin, using an enhanced treatment protocol

The decrease in quantity and quality of collagen fibres with age and sun exposure is one of the main causes of wrinkles and lax skin. Non-ablative dermal heating to 55–65°C has been shown to trigger the production of new and more effective collagen. A number of studies have also shown that radiofrequency (RF) energy has the ability to volumetrically heat the dermis in a more effective and safe way compared with laser and intense pulsed light (IPL) devices. In this study, a new facial tightening protocol was tested using a novel multisource, phase controlled RF system (EndyMed Pro, EndyMed Medical, Caesarea, Israel) that delivers RF energy to the depth of the dermis and hypodermis, with significantly decreased risk to the epidermis. According to this new treatment protocol, the face and neck complex was divided into two main, relatively large areas (left and right), rather than the five traditional areas treated using the standard protocol, with high parameters being used in order to compensate for the large treatment area. Thirty patients completed the course of treatment (except for two patients: one who had only five sessions, and one who had eight sessions). The Fitzpatrick wrinkle score decreased from an average of 5.43 at baseline to 4.57 after six treatments, and to 4.28 3 months after the end of treatment. All patients reported a visible improvement after the treatment course, with 54% reporting a cosmetic change greater than 50%, and an additional 32% reporting a cosmetic change of 26–50%. No unexpected adverse events were detected or reported.

One of the main causes of skin laxity is the decrease in the quantity and functionality of dermal and sub-dermal collagen. This physiologic deterioration leads to skin laxity and wrinkles1.

Radiofrequency (RF) energy affects the skin by emitting high-frequency radio waves that interact with the tissue to produce a thermal change. It is well established that heating the dermis for a period of time to 55–65 °C triggers a process of collagen remodelling that results in the destruction of ineffective, damaged collagen, and the production of new collagen2, 3.

RF systems have continually gained in popularity for the treatment of wrinkles and skin laxity over the last decade. This is in part owing to the ability of RF energy to penetrate deep into the tissue without the limitation of skin colour, as seen with optical-based energies. Within the skin, RF energy triggers a significant thermal effect at a particular depth based on different parameters, such as the technology used and electrode configuration. The use of monopolar RF (first generation) systems that use one RF electrode require a higher level of user expertise owing to the higher energy density on the electrode4, 5. The use of this type of system is frequently associated with pain and requires intense active cooling to protect the epidermis. Furthermore, much of the energy is being wasted, as the energy flows uncontrolled throughout the body6, 7. The use of bipolar (second generation RF) or multipolar RF (third generation RF) has been limited because of the superficial nature of energy flow between the two or more bipolar electrodes connected to a single RF generator8. Despite high expectations, the improvements offered by first, second, and third generation RF systems are usually limited, owing to the small volume of dermal heat produced9.

A new generation of RF technology (fourth generation) uses multiple RF generators for optimal control of the thermal effect. A multisource RF therapy system (EndyMed Pro, EndyMed Medical, Caesarea, Israel) allows a volumetric, homogeneous, targeted, and controlled dermal heating for non-ablative RF treatments. The Food and Drug Administration (FDA)-cleared EndyMed Pro, powered by 3DEEP technology, has six RF generators that enable full control of the phase of the current flowing between each pair of electrodes. The multiple electrical fields created repel/attract each other, providing the ideal combination of energy directed to a deeper skin layer with minimal surface heating. The repelling forces between adjacent electromagnetic fields drive energy vertically into the target tissue, reducing the amount of energy flowing through the skin surface. In addition, the multiple generators enable better distribution of the energy on the electrodes, reducing the energy density on each electrode, which in turn makes the treatment more comfortable and safe for the patient. The comparison between the different RF modalities is schematically.

In the current study, the author tested a new treatment protocol for full-face non-ablative skin tightening. The treatment was performed using the EndyMed Pro multisource RF system. The system forces the energy to penetrate into the deep dermis, causing a non-ablative deep dermal heating effect that results in painless skin tightening.