Advanced Laser Education Content - Part 7 Coolsculpting and Radio Frequency

This page contains treatments advanced education content about laser and treatments. 


Radio-frequency

RF energy is increasingly popular for medical applications involving tissue heating I the fields of surgery, cardiology, neurology, orthopedics and dermatology. Traditional RF electro-surgery is rarely used in skin resurfacing due to excessive heat generation. A relative low heat process (COBLATION) has been adapted for relative skin resurfacing. However, the more recent non-ablative use of RF hold promise for dermal remodeling, skin tightening and non invasive treatment of wrinkles and fine lines


RF Basics

  • RF current is formed when charged particles flow through a closed circuit
  • As energy meets resistance in tissue, heat is produced
  • The amount of heat depends on the amount of current, the resistance level in the tissue and the characteristics of the electrodes
  • Human tissues, including skin are rich in electrolytes and an array of compounds that allow current conductance with varying degrees of resistance and resulting heat formation
  • The amount of RF applied can be configured to target specific tissues
  • Water content of skin varies between area of the body, time of day, environmental humidity, internal hydrationa nd the use of topical moisturizing agents
  • Flow of RF through the skin depends on multiple factors and may not be consistent across treatments

Two configurations

Monopolar

  • One electrode is active and the other larger on is placed far from the first to serve as a grounding pad
  • Main advantage: concentration of high power density on the electrodes’ surface and the relatively deep penetration of the emitted power.

Bipolar

  • Current flows between two identical electrodes that are set at a small fixed distance apart – no grounding pad
  • Distribution of the current in the tissue is more controlled in this setting
  • Main advantage: electrodes are placed flush on the skin so depth of penetration is limited to approximately half the distance between the electrodes. This means lerss energy of sufficient density reaches the deeper structures, rendering a more superficial effect regardless of the emitted energy level

RF Current Types

Radiative - mobile phones, radio, unipolar systems
Conductive - used in medicine

RF on Tissue

  • Networks of collagen and elastin fingers provide scaffolding for the skin and determines its degree of firmness and elasticity
  • Overtime, this network loosens and unravels altering the appearance and function of skin
  • Adult skin loses approx. 1% of its dermal collagen content per year
  • When collagen fibers are heated some of the cross links are broken, causing the triple helix structure to unwind
  • Depending on a combination of temperature and exposure time, collagen fibers lose their structure
  • But, if cross links are maintained at least partially collagen shrinkage and thickening is achieved
  • Based on this, RF treatments are designed to cause shrinkage of the dermal collagen using heat generated by the RF current
  • Treatment promotes formation of enw collagen vis the skin’s natural wound healing response and a direct effect of the dermal cellular matrix
  • The extent of collagen shrinkage, fibroblast activation, fibroplasias and overall collagenesis based on complex multivariate mechanisms depending on temperature distribution and timing

 BTL Exilis

  • Effective for wrinkle reduction and fat reduction
  • Two handpieces: small with no cold tip for face and neck, and large with a cold tip that draws energy deeper into the dermis
  • Temperature of 41 to 43 degrees celsium must be maintained for 10-15 minutes for treatment to be effective
  • Patient must be well hydrated for conduction of RF

 Contraindications

  •  Pacemaker or internal defibrillator
  • Superficial metal implants in the teeth (possible to space away)
  • Metal implants in bones (usually deep enough)
  • Current or history of skin cancer, or current condition of any other type of cancer or pre-malignant moles
  • History of any kind of cancer*
  • Severe concurrent conditions, such as cardiac disorders
  • Pregnancy and nursing

 CoolSculpting

  • Developed by scientists at Wellman Center for Photomedicine at Mass General, a teaching affiliate of Harvard Medical School
  • FDA approved
  • Cryolipolysis – controlled cooling to target and crystalize fat cells
  • Crystalized fat cells gradually die off, then are naturally eliminated from body
  • Remaining fat cells condense, reducing fat layer
  • Usually one to three treatments are needed
  • After each treatment, patient will see 40% to 50% of fat cells eliminated
  • Works best on clearly defined bulges
  • Photos and weight measurements are essential; people forget how they previously looked

Contraindication

  • hernia or repaired hernia Sterilization and Disinfection

Sterilization

  • The destruction of all forms of microbial life (e.g., spores, fungi and viruses)

Disinfection

  • The process that eliminated many pathogenic microorganizms from objects

Methods of Sterilization and Disinfection

  • CaviWipes
    • Disinfecting towelettes pre-saturated with CaviCide
    • The wipes are intended for use in the medical setrtings and are effective against the following micro-organisms:
    • Mycobacterium tuberculosis
    • Staphyloccoccus
    • Hepatitis B Virus
    • Herpes Simplex Virus 1 and 2
    • HIV

Regulations

  • Liquid disinfectants and sterilants are regulated by the EPA and th FDA
  • According to OSHA, each employer is required to ensure that the workplace is sanitary to protect against bloodborne pathogens
  • Bloodborne pathogen: present in human blood and can infect or cause disease in persons who are exposed to blood containing these viruses (e.g., hepatitis B, HIV)