Episode 2- RF (Radiofrequency)

Radiofrequency (electrical energy) is a wonderful energy based modality that can be used on any skin type from light to dark.  

RF energy can be monopolar energy (where a grounding pad is worn) or Bipolar energy.  In the Bipolar category is RFMN (radio-frequency microneedling) which has become very popular in aesthetic clinics.

This episode describes the different types and what a patient can expect with these type of treatments.
It also clearly describes the difference between microneedling and radio-frequency micro-needling (RFMN).

Enjoy!

Thank you for your listenership!

Transcript

Dr. Minni Saluja: 0:38

Hi everyone. Thank you for joining us for the second episode of Just Laser at All Things Cosmetic. My name is Dr. Minni Salujaand I'm here with Kane Rogers. Hello Kane. Hello

Kane Rogers: 0:49

and I'm here with Link again, our office dog. Everybody's coming to the office knows Link and he's here with us again. He'll probably always be

Dr. Minni Saluja: 0:57

Probably so. Well, today we're gonna focus on radio frequency and Kane. Do you know what I love so much about radio frequency?

Kane Rogers: 1:04

Probably a lot of things, but what's, what are some of'em?

Dr. Minni Saluja: 1:07

So I love the fact that radio frequency, because it's electrical energy and not a wavelength of light, you can use it on any skin type, mine included, which I always love devices that I can use on myself, and you can use it. Any time of the year. So even when a patient is tan, you can use rf.

Kane Rogers: 1:27

So when you talk about any skin type, give us a little more clarity into that.

Dr. Minni Saluja: 1:30

So there are basically six skin types. They're called Fitzpatrick skin types, and type one is essentially an albino. Type two is more like you blue eyes, lighter complexion. that skin type is a type two. Type three is my darker hair, maybe browner eyes, but still quite light skin. I'm a type four. I've got Eastern Indian heritage, and so my skin type is a type four, and then there's five and six, which are darker skin types. Now, certain lasers, because of the fact that they can really interact with melanin, cannot be utilized on darker skin types. So typically with skin type four, five, and six, we kind of have to watch what type of energy based device we utilize on our skin.

Kane Rogers: 2:14

So when you talk about radio frequency and that being for all skin types, what comes to my mind is something like radio waves or something. What is radiofrequency? What are you even talking about?

Dr. Minni Saluja: 2:24

So radiofrequency is electrical energy and it oscillates at a very, very, very fast rate. So, for example, when we utilize the ones we utilize for bulk heating and even for RF microneedling, we're at the one to six megahertz level, which means that it is oscillating the current back and forth about 6 million times per second. And so this energy, these streaming electrons are going into the skin and when they act on an area of tissue resistance, they create heat. And that heat is what transfers into stimulating elastin and collagen in the skin.

Kane Rogers: 3:01

So you're basically taking radiofrequency and some electrical energy, electrical energy. So that turns into energy, which then heats the skin and that stimulates the elastin collagen that would, benefit you.

Dr. Minni Saluja: 3:13

That's a good way of looking at it. And there's two major types of radio frequency. There's monopolar radio frequency, and there's bipolar radio frequency, so monopolar radio frequency, that's the type of radio frequency that you might have a neutral pad placed on your back. That's basically the grounding pad. And so this type of radio frequency is more of bulk heating type of radio frequency. It's usually continuous motion The one that we utilize in our practice is Tempsure which actually has a temperature sensing device, a thermister where it can read what temperature setting you're at. So for example, on the route, Around the eye area. I set it to 43 to 44 degrees Celsius, and it lets me know when I've achieved that temperature and it won't supersede that temperature. So it's very safe on the skin.

Kane Rogers: 4:04

So you mentioned the eye area and I've, you know, I've, I know other people have come in for big areas like the legs or something like that. So there's small areas, there's big areas. What what's the.

Dr. Minni Saluja: 4:14

Difference or why I use, So it's basically with RF monopolar. If it's a larger spot size, so for example, when we're doing the abdomen or leg area, I might choose a 60 millimeter spot size. And this is simplistic, but you can think about the depth of the penetration as basically half the size. Of the spot size, so you're getting pretty deep there so you can achieve some nice results on the abdominal tissue and also on the leg tissue. Now again, this is not gonna give you abdominalplasty type of results. This is just helping to improve the texture of the skin, and sometimes I will also utilize smooth PDO threads, which we'll talk about in a different episode. When I'm around the eyes, there's a wonderful little 10 millimeter spot size that allows me to go around that periocular tissue. And when I say it is a zero downtime procedure, it truly is. You might be a little bit pinkish red for about 15 to 20 minutes and that's it.

Kane Rogers: 5:12

Okay. So a couple of things. So you talked about energy and heat, which makes comes to my mind. Okay. That might hurt. And then you also talked about a grounding pad. So is it dangerous? So could you address those two things?

Dr. Minni Saluja: 5:25

Sure. So the radio frequency again, is at the one to six. Megahertz. In this case, we use a four megahertz system. It is very safe that grounding pad has to be placed securely on the back, but it's a very safe device. It's very similar to electrical surgical devices that are used in surgery. Same thing with a grounding pad. In fact, William Bovie was the one that brought electrical surgical devices to our attention. Back in the early 1920s at Harvard when he used it to basically debulk a tissue mass on on a patient's head. But it's very, very safe and in regard to does it hurt or not? It really truly does not hurt. It feels like a hot stone massage that's occurring. In fact, it even plays this little spa-like music to relax you as well. But it's very, very comfortable. It's just an easy procedure to do. So again, Monopolar radio frequency. Now this differs from bipolar radio frequency and the early iterations of bipolar radio frequency were really more superficial type of treatments because it had both of the electrodes in the hand piece, so they're very, very close together, and the depth of penetration was basically half the distance between those two electrodes. And so it'd be very, very superficial, but. Then the way that they superseded that to get to a bipolar device that allows us to go deeper was with the advent of radio frequency microneedling, which everybody's heard about, I'm sure.

Kane Rogers: 6:59

sure. Yeah, so that's a good point. So you often hear of just microneedling and then you've also heard of radiofrequency microneedling. What's the difference?

Dr. Minni Saluja: 7:09

Correct. So I really wish they would've given it a different name because it gets so confusing. So microneedling, it utilizes tiny needles and it's just microneedles alone. It's basically creating little mechanical fracture in the skin, which does stimulate some collagen. And it's also a great way to to place on topical products as well, because it creates these little pathways. But it does NOT add radio frequency energy, so radio frequency microneedling utilizes microneedles, so these little tiny electrodes that go into the skin. But importantly, it releases radio frequency energy, and again, you can titrate the energy settings that you place in there, which then creates the heat, this 55 to 60 degrees Celsius heat that stimulates that elastin and collagen in the skin, which is so vital to really rejuvenate the skin.

Kane Rogers: 7:59

So really the microneedling is just transporting the energy into the skin depth that you want. Is that, is that a

Dr. Minni Saluja: 8:05

with the radiofrequency microneedling. Whereas if it's microneedling alone, there's no energy that's being transported. It's just needles in and out. And again, I don't mean to poo poo that, but also your results will be a lot lot less with microneedling alone as opposed to RF microneedling

Kane Rogers: 8:20

because again, that that heat that's being generated is stimulating elastin and collagen.

Dr. Minni Saluja: 8:25

Correct. And that's the key. And so what's so neat about electrical energy in the form of radio frequency is that it doesn't just stop at the dermis. Electrical energy has a way of even going down slightly below that To the fibro septal element, and it can contract that tissue so you get this little bit of a lifting effect that occurs. So that's the wonderful thing again about radiofrequency. Now there are many, many devices out there. Back in 2015 when we got our first device. That device basically was stamping off the skin and it was almost like a staple gun.

Kane Rogers: 9:01

What? This was your first

Dr. Minni Saluja: 9:02

first, our first device back in 2015. And it was very bloody. It was with insulated needles. So only the tip was a conductor. And it just, it wasn't that comfortable. And, and RF microneedling we stole Numb for, And there's certain areas that can be a little bit pinchy. But now the devices have, the one that we've selected has a motor that's very, very smooth, and it also has non insulated needles, which the entire needle is a conductor. But the type of device that we have, both Scarlet and SylfirmX in our practice, allows for this NA effect and NA effect to occur. And that's named after the doctor that invented this, where you basically, A teardrop configuration that's created in the dermis and rides up in, into the upper papillary dermis. So you're basically creating an. Independent coagulation that starts at the end and starts to travel up, but it spares the top part. So your epidermal layer is, is spared, which is important.

Kane Rogers: 10:04

Okay. So you, you're, you're kind of losing me

Dr. Minni Saluja: 10:06

Okay. Okay. Let's backtrack.

Kane Rogers: 10:08

let me, here's what I heard you say. Tell me if I'm correct or not. So basically, with the NA effect that you can insert the micro needles and, and the na effect it gives energy to a greater area.

Dr. Minni Saluja: 10:23

To a greater area, Correct. So with, with a insulated needle needle, you might have to do multiple, multiple passes to get at the three millimeter, the two millimeter, the 1.5, the NA effect creates a teardrop configuration that's a little bit elongated. That allows you to, with one pass, get more. Now we do do multiple passes, but it allows you to just give greater energy to the dermis. Okay, so which correlates to more coagulation, et cetera. So that's what's really important. Now, the reason why we have two devices, both the Scarlet and the SylfirmX the Sylfirm is the newer iteration, which has a continuous wave, which is what. All the microneedling RF microneedling devices have for tissue tightening, but it also has a pulsed wave. And that pulse wave allows us to treat things such as melasma, I dare say melasma, because everybody knows that melasma is one of the hardest, hardest things to treat. And I tell patients, I always set the expectations that I could make this worse, not better with energy based devices. But the pulse wave does allow me to create some energy and I can treat it even with a Pico pulse laser and get some nice results with melasma.

Kane Rogers: 11:33

Okay. So is, do you have a typical patient that when you look at, you think you'd be great for a radio frequency micro?

Dr. Minni Saluja: 11:42

so anybody is that patient. But the ones that I always look at are the patients where they might have dark, slightly darker skin type. Those are great for RF microneedling patients who wanna have a little bit of lift to their neck and jowl area. Great for microneedling patients, radio frequency, micro needling. Again, I'm gonna qualify that. And then around the eye area, sometimes we get a little bit of fat herniation around the eye. Area great for RF microneedling. There's also a microneedling device that's a monopolar device called Agnes that can sometimes get into those zones as well. So those are the type of patients, acne scarred patients, really anybody can be. Even upper leg knee laxity, abdominal laity, arm laxity. There's multiple areas where you can

Kane Rogers: 12:27

So this is really, if I'm gonna oversimplify it, this is really helping tighten skin and provide maybe a little bit of a lift.

Dr. Minni Saluja: 12:34

You got it. You got it. And then also because it has these tiny openings from the, the needles, again, different than ablative, ablative vaporizes removes tissue. This is just creating insertions to deliver the heat, but it still allows a small portal of entry where you can put topicals on top. So we use a lot of exosomes in our practice, which has the growth factors in it. So that's a great place to put the topical on

Kane Rogers: 12:55

then again, it, it's, you know, setting expectations. What would a patient expect from a pain threshold? From a downtime perspective?

Dr. Minni Saluja: 13:03

Sure. And how many type of treatments? Well, from a pain threshold, it, we recommend numbing for one hour prior with BLT cream, betacaine, lidocaine, tetracaine and around the eyes, a little pinchy around the periocular area and around the forehead. Upper forehead, over bone could be a little bit pinchy, but otherwise very, very tolerable. The neck is very, very tolerable as well. They can expect a little bit of redness for maybe 24, perhaps 36 hours. There'll be some, a little bit of swelling around the eye area, but it's a very fast recovery because again, it's not ablative lasers, it is rf, which the injury is occurring down deep in the dermis and the top layer is still intact. Other, other than these little channels that are created. And so it's a really quick recovery. Now we. We do use it a lot with combination therapy, which again will be another episode as well on how we combine to maximize treatments.

Kane Rogers: 14:00

Okay, so you talk about another episode as well. So I do want to interject here. We do want to make this interactive with you guys. And so if you go to SalujalaserMD that's Dr. Saluja's DM her, ask her questions, give us show ideas. We'll try and incorporate all your feedback into the show because we want to make this your show just as much as ours. And so again, SalujalaserMD, that's her Instagram Wait a minute, what was that?

Dr. Minni Saluja: 14:27

so that

Kane Rogers: 14:27

like I'm on a game show and I just got called down the

Dr. Minni Saluja: 14:30

you kind of are. So this is our product spotlight category. And so the product that we're gonna discuss today, and it's actually a category. Is sunscreen, sunscreen, sunscreen. So, so very important. We're talking about all these different things that we wanna do to, to help improve our skin, but we need to, we need to protect our investment and we really need to do that with sun protection. So the main important thing about sunscreen is whatever sunscreen you like, I'm gonna like, because that means you're gonna wear it. That's, that's really the, the first thing. But the second thing is there are some nice things to recommend, and one thing is always try to opt for a mineral sunscreen, a physical blocking agent, like a zinc and titanium based sunscreen. Because what that's gonna do is it's gonna take the UV light and it's gonna bounce off of the skin, rather than absorbing the energy as chemical sunblocks do. So my product spotlight. I really like Elta-MD. I think it's a great sunscreen. The Elta-MD Clear is really good with rosacea. Patients over the counter you can get, I really like LaRoche Posay and I really like their mineral sunscreens as well. So any of those two are great. And again, anything that you utilize, sometimes patients will say, I use Supergoop, or I use this or that. Fine, that's perfect because I know you'll wear the sunscreen. So that's kind of my product

Kane Rogers: 15:52

So is the product spotlight, is this gonna be an ongoing thing every

Dr. Minni Saluja: 15:56

I think so I think I'll try to do something like that, but I'll try to recommend something that is more medical grade and I'll try to recommend something that we also like at the drugstore. So again, this is what we've talked about today is radio frequency. There's monopolar radio frequency, there's bipolar radio frequency. In that bipolar category is RF microneedling. There's multiple different companies that create that. There's Cynosure that has Potenza. There's InMode that has the Morpheus eight, there's Lutronic that has their genius. Cutera has secret. There's Cartessa that has Virtue, and I think they're coming out with a new one as well. And so there's, there's multiple different ones, but we've selected the Sylfirm in our practice as well as the Scarlet to give you the type of results that we, we want to see you have. So thank you so much for listening. The next. Episode what we're gonna highlight is I P L. We talked about wearing sunscreen to protect your skin. Now we wanna talk about how to get rid of those reds and browns. And I P L, which stands for intense pulse light will be our next episode.

Kane Rogers: 17:04

So thank you for tuning in. Again, rate review and subscribe if you like the episode. And hopefully you'll be listening to us in the next episode

Dr. Minni Saluja: 17:11

because remember, aging is inevitable, but how we age, totally our choice. Thanks so much. Thank