Episode # 18: Denza

Denza RF combines both monopolar and bipolar RF for greater tissue tightening than either one alone.

Listen to Dr. Minni Saluja and Kane Rogers as they discuss the newest RF device.

Thank you for your listenership!

Transcript

Dr. Minni Saluja 0:12

Hi everyone. Welcome to another episode of Just Laser and all things cosmetic. I'm again here with Kane.

Kane Rogers 0:18

Kane. Hello everybody. Happy New

Dr. Minni Saluja 0:20

Happy New Year to you. I can't believe this is the end of the year.

Kane Rogers 0:23

It's gone by fast.

Dr. Minni Saluja 0:24

It has gone by fast.

Kane Rogers 0:26

is upon us.

Dr. Minni Saluja 0:27

knocking on our door. Well, we, this has been a great year. We've, we've had a couple of new technologies coming to the practice with AgeJet, AdvoTX, and DENSA. And that's going to be the focus of today's discussion, Cain.

Kane Rogers 0:40

DENZA is. And for those of you that are interested, there are other episodes on AgeJet and AdvaTX on those newer technologies that we have already posted. So listen to those as well.

Dr. Minni Saluja 0:50

Yes. So, I'm going to first talk a little bit about what DENSA is and I'll actually go back into history and talk about radiofrequency. And radiofrequency has been around for a long time. We've used it initially with surgical procedures it was used more to excise tissue, to coagulate tissue, and then it went into a continuous motion type of radiofrequency with monopolar radiofrequency. A pulsed version of radiofrequency, and a lot of folks might have known the original version, which was Thermage. Thermage was one of the first monopolar stamped radiofrequency procedures, and since that time it iterated and one of the biggest iteration was then it started to go into bipolar radiofrequency. Now Kane, there's a difference between monopolar and bipolar. Do you know the difference between these two?

Kane Rogers 1:39

One is more superficial on the skin and one is deeper.

Dr. Minni Saluja 1:42

Correct, So Monopolar radio. You got it right. So monopolar radiofrequency, that's the one where you wear the neutral pad on the back and what it, the energy then flows to that pad. So it's a deeper type of energy that's delivered into, into the skin and even into the subcutaneous tissue. Whereas bipolar radiofrequency, you can kind of think about the energy is halfway. between the distance of the two electrodes, so it's more superficial. But the way that was bypassed with radiofrequency microneedling was to deliver it with needles, to have little needles that insert into the skin to control the depth of the penetration. And so that's where RF microneedling became such a big boon in the past decade, was to be able to go deeper. But now there's something a little bit better in that stenza.

Kane Rogers 2:30

Well, let's back up one second on when you talk about the radio frequency, micro needling radio frequency. So just in 30 seconds, like, can you just explain what that is? Like the needles go in and the, the radio frequency is between the needles. Is that how it

Dr. Minni Saluja 2:46

So the needles go in and the energy is actually delivered around the needle so the depth of penetration Can either be more at the tip or the full distance of the needle,, it creates A smaller type of coagulation in the skin from the rf.

Kane Rogers 2:59

Okay, and that's using the, is that the monopolar? No, That's the, that's bipolar,

Dr. Minni Saluja 3:03

bipolar now, without RF microneedling, it would just be delivered between the two anodes, so it'd be very, very superficial. The needles allowed it to penetrate a little deeper.

Kane Rogers 3:12

little deeper. Okay.

Dr. Minni Saluja 3:13

But it's still just giving the energy where the needles are delivered. And usually there's 25, 36, 49 needles on an RF microneedling tip. So you still are kind of giving, in essence, a fractional type of delivery to the skin, if that makes sense.

Kane Rogers 3:29

Yeah, it does. So there might be some little gaps.

Dr. Minni Saluja 3:31

Correct. And so where we wanted to have a little more of a benefit was with Denso, which actually is the first device that combines both monopolar, and bipolar in one tip that does not use needles. So what it does is the entire tip that covers over the skin, that entire area receives the energy. It's not just in the needle format.

Kane Rogers 3:57

So it's basically the full, like a full Stamp. When you stamp it on the skin, that full area is being treated.

Dr. Minni Saluja 4:06

Correct. So when we talk about ablative and fractional and full field, you know, we, we, we say that in reference to lasers. In essence, this is a full field radiofrequency energy that's delivering both monopolar to go in deep. And remember, it also gets down to the fibroceptal network that's in the subcutaneous tissue that's just below the dermis. And then it goes all the way. Into the dermal layers, reticular, then up, up to the superficial papillary, where also your bipolar is delivering some energy. So you can think about the full thickness is being treated with this.

Kane Rogers 4:39

so let me just kind of back up and summarize what I'm hearing you say. So Denza is really a first of its kind device where in the past Thermage was delivering monopolar

Dr. Minni Saluja 4:53

Monopolar only correct. And he used to hurt a lot, you know, and certainly they've iterated as well, but it's still hurt a lot. And it was only monopolar, whereas RF microneedling is only. bipolar. This is a combination of both without the need for needles. And the other nice thing about it too, Kane, is I was telling you that some of the previous iterations hurt a lot. This also has cooling on the tip of the of the hand piece. So when you deliver the energy, all you're really feeling is the coolness. You really don't feel a lot of discomfort. Now I do have patients numb for it, which we'll talk about the procedure itself, but it really is a very comfortable procedure.

Kane Rogers 5:33

so I just want to make sure I understand Denza. So you're getting the benefit of monopolar, which is, is that the more. Deeper,

Dr. Minni Saluja 5:41

Correct.

Kane Rogers 5:41

and then you're also getting the benefit of the bipolar, which is more superficial. And you're doing so without the need of needles. And and what the benefit of that is, is you're getting a full area treated by the tip of Densa and you're not relying on a bunch of small

Dr. Minni Saluja 6:02

Correct. So you're getting more energy into the skin per pulse, in essence.

Kane Rogers 6:06

both the deeper and more superficial perspective.

Dr. Minni Saluja 6:08

You got it.

Kane Rogers 6:09

that is a pretty cool, innovative device.

Dr. Minni Saluja 6:12

with more tissue treated. And you know what's fascinating is when I first got the device, of course we're always playing around with it initially and what was fascinating is the first several patients that I did, I could notice on the table a tissue contraction. And in fact, I posted a lot of those on our Instagram page at Saluja Laser MD, where you can see some initial popping of the eyes, initial lifting of the jowl area. Great because of that collagen conformational change that occurs while they're sitting on the table now granted We see more of that even at six weeks and certainly we will be evaluating our three month photographs at the end of January

Kane Rogers 6:49

so that's really key. So you may you may see some initial immediate Improvement right away, but the real benefit is going to take weeks and even several months to where you really start to generate that collagen and elastin again

Dr. Minni Saluja 7:03

I think the real benefit is at three to six months. And so, while the company says this could be, very well, could be as little as one treatment, I often tell patients it's one to two treatments. I mean, some patients might be happy with one, but I just tell them it's one to two treatments for

Kane Rogers 7:18

it's important to understand everybody is going to respond a little bit differently. So if somebody may have a remarkable improvement immediately, and somebody else may not have quite as much, but it's really having your headlights out, you know, three months or so before you really start to see those improvements.

Dr. Minni Saluja 7:34

And we're all different biological beings. And certainly there are some factors where I think are constitute a better patient for this, which we'll talk about as well. So in fact, let's, let's talk about that. So who is my perfect patient? Well, certainly, whenever we ask about smoking, it's It's because smoking, I do think non smokers certainly do better with lasers and RF, anything that you're going to build collagen, you certainly want to be a non smoker because smoking can impact the building of the collagen. But some of my, the patients that I think do the best with radiofrequency devices and certainly in this case, DENSA, would be patients with hydrated skin. So not really dry skin because of course, electrical energy conducts better in, in hydrated, in hydration and in water.

Kane Rogers 8:19

What would, sorry to cut you off, but like, what would constitute hydrated skin? How would I know if I have hydrated skin or not?

Dr. Minni Saluja 8:26

patients have a more dewier type of skin. And it's not to say that they're not 60 years old, but they can still have hydrated skin. They've had some care to it, they've used moisturizers, certainly they've got a good skin barrier as well. Someone with very dry or leathery skin that might have deeper wrinkles, they might do better with ablative type of procedures, whether that's with plasma devices at a higher level, whether that's with CO2 devices, that might be a better option for those type of patients.

Kane Rogers 8:55

makes sense.

Dr. Minni Saluja 8:56

And so, and I also think that patients who have, it's not necessarily only this, but patients, if you look at the photographs that we're posting, some of the patients who have a little extra submental fat or maybe some jowling at the lower part of the face, I can really see a nice difference there because as it tightens up that fibroceptal network that's in that fatty layer, you can see a lifting of that tissue. So you see more of a dramatic result that's there.

Kane Rogers 9:24

you can see that on your Instagram page where the you have photos of that.

Dr. Minni Saluja 9:27

I do, I do. And remember everyone, this is still a newer device in our, in our practice. I, love it, but we will have our three month photographs at the end of January. So we'll, we'll be posting some of those as well. The other place where I see nice benefits. are for lifting of the eyes. So patients who might have a little bit more hooding of the eyes, that's a nice treatment to do. And you could even couple it with plasma if you wish to. But the nice thing about Denza is because it has the monopolar and the more superficial bipolar, you don't necessarily need to couple it with a, with another Resurfacing type of device. So now, how do we go about this? So the way that we do DENSA is that patients numb for one hour. And, you know, I often thought about doing a split face where I can see the patient's comfort level on a scale of one to five with not numbing one side of the face and numbing the other side. But I just haven't done that yet. I just think that might as well just numb everyone. But there is again, cooling that you'll feel. And what I do is I start the procedure off. I take the numbing off. I start the procedure and I start around 2. 5, just throwing out some energy settings in case there's practitioners listening, but I start at 2. 5 and then I'll ask the patient, do you feel anything? And oftentimes they'll say. No, I don't really feel much at all. And so I'll increase it until they feel just a little something. Not where they're in pain, but just a little something. And oftentimes my settings fall between two to four usually two to 3. 5 in the cheek area. A little less on the forehead, a little less on the neck area.

Kane Rogers 11:02

you're modulating that based on the response of the patient.

Dr. Minni Saluja 11:05

The response of the patient and the tissue that I'm seeing in front of me. So if I'm starting to see a little erythema, a little bit of redness to the skin, I know that I have my settings there. And then there's There's three different tips that DENSA offers. One is a face tip that and one is an eye tip that's smaller and then finally a body tip. So what I typically start with, I start with the cheek area and I'll deliver my passes on the right cheek and I might put four to six passes on each cheek. Go to the other cheek, then I'll go up to the forehead, the chin area, and then I'll end with the neck and then I'll Click off that tip, and then I'll place an eye tip in.

Kane Rogers 11:42

Okay, so if I'm a patient coming in for this procedure, what should I expect from a downtime social downtime? Can I go out later that day? Am I going to look, how am I going to look? You know, all that kind of

Dr. Minni Saluja 11:54

So again, I posted some of the immediate posts on Instagram, but you'll notice patients will say they'll have maybe between a half an hour to maybe a couple of hours of some minor redness more on the neck area, more on the thinner tissue. They might be subtly swollen for that evening, subtly around the eye area. I'd say maybe 10 percent might. might report a little swelling, but there really isn't a lot of downtime with this procedure at all. I do ask for patients to not put any makeup on until the next day. I just like for the skin to breathe a little bit. I do not have them use any cool compresses. I do not have them use any anti inflammatories because I, it's so subtle, any inflammation that's, that's there and I don't want them to blunt that.

Kane Rogers 12:36

So other than numbing beforehand, is there anything somebody should consider doing before they get the

Dr. Minni Saluja 12:41

Well, we always say stop any retinol based products and that has more to do with the fact that we don't want them to be irritated from the numbing in this case because remember radiofrequency is non chromophore dependent. It's not dependent on whether the skin is tan, whether the skin is has any redness to it. It, it, it's not chromophore dependent. It's electrical energy. So it's not going to impact anything if there is redness present, but I just say stop your retinol so you're not irritated from the, numbing

Kane Rogers 13:08

But that's an important point. This is because it's radio frequency. You can do this any time of year.

Dr. Minni Saluja 13:13

anytime a year on any skin type,

Kane Rogers 13:15

Well, that's so it has flexibility as well.

Dr. Minni Saluja 13:18

it sure does. And so, you know, patients will say almost hear this every single time. They'll say, wow, I expected that to hurt more. And the, and the thing is it does not because I think they're used to RF microneedling, which I will say does pinch a little bit. So there's many devices out there. There's some that really pinch a lot. And so this does not, it is a. comfortable procedure and the cooling really makes a difference.

Kane Rogers 13:41

I know there's a lot of buzz about DENSA and this technology just in the marketplace. I know there's a lot of buzz in our practice because it is such a novel, new to deliver both monopolar and bipolar radiofrequency, which just hasn't been the case in the past. So there's really the benefit of hitting both the superficial and the deeper part of the skin all with one device, which we haven't had that in the

Dr. Minni Saluja 14:05

You got it. And so I've been so excited because I always feel the places where I want to deliver more to patients are that neck lifting, jowl lifting area, and the eye lifting area. Now I will say in the new year, we will be working more and more with the body tip. We did not work with it as much in the past couple of months. So I will start to work with that body tip more and I'll have more information on that as well.

Kane Rogers 14:29

And again, your Instagram

Dr. Minni Saluja 14:32

Saluja Laser MD, and you'll find before and after photos certainly there, and

Kane Rogers 14:36

and they're pretty remarkable. I mean, there, you see a noticeable

Dr. Minni Saluja 14:40

you really do and so in some, the initial ones are the immediately post, but now you're starting to see six week photos, and again, at the end of January, we'll have more of the three month photographs as

Kane Rogers 14:50

it. And

Dr. Minni Saluja 14:52

So that's it, and so, you know, Cain, that is it for 2023, and I often think that the end of the year, I get a little reflective, and It's interesting because I know that we're in the field of, of cosmetic procedures and beauty, but you know what I think true beauty is?

Kane Rogers 15:09

let you tell me. Well, I think about I

Dr. Minni Saluja 15:12

Well, I think about it and I think about it just with the wonderful patients that come into our practice. And I really think certainly good health is always there, right? You can see that in the face, but I really think it is. kindness. I think it's joy and I think it's a sense of gratitude. And when I see that in friends, family, patients, I walk away saying that is a beautiful person.

Kane Rogers 15:35

No, I agree and that attitude of gratitude makes life really good

Dr. Minni Saluja 15:40

Yeah. Yeah. So that's my new year's resolution or, or what do you want to call it? Insight, thoughts, you know, reflection for the, for the new year. And I sure wish everyone a wonderfully happy new year.

Kane Rogers 15:55

Yes, and thank you for listening again. We have other episodes to hit on some of the other newer technologies we have with AdvoTX and Denza now and Agejet. There's just a lot of buzz with this, these new technologies and people have been really happy with them. So please listen to them as well.

Dr. Minni Saluja 16:11

so much. Bye bye.