During pre-treatment consultation, I pull back the preauricular skin by about 1 cm to show the expected treatment outcome. If the patient still has unrealistic expectations, he/she fails to see any change after treatment. The distance from the center of the chin to the periauricular area is a little over 10cm. Contraction of this stretch of the skin contracts by 1 cm is a drastic change. However, some Japanese patients expect a 2-3 cm contraction around the nasolabial lines and believe that Thermage CPT can bring this outcome. In such cases, I take time giving thorough explanations and recommend surgery, injection or thread lift. On the other hand, patients who clearly understand the pre-treatment consultation tend to be satisfied with the outcome and come back yearly for repeated procedures.
HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)
Most Japanese patients do not want changes drastic enough for those around them to notice and give comments, even if they are positive. Thermage CPT, however, is the preferred choice in Japan as it brings natural improvement. It is very important for Japanese patients to have subtle changes that go unnoticed by those around them.
Taking a closer look at the treatment tip, tips with a 900 pulse count are more common in the US but those with a 400 pulse count are the norm in Japan (I heard that these tips are manufactured specially for Japanese market demand but it has not been verified). I set the parameters of Thermage CPT a little aggressively so that the effects can be seen with a smaller number of shots. The key technique here is to rapidly irradiate the next target before the heat from the previous irradiation dissipates (avoid immediate overlapping of irradiation). The 900 pulse tip may bring better results but the 400 pulse tip is more suitable in Japanese patients as they want subtle changes and lower treatment cost (lower equipment cost).
Thermage CPT has excellent efficacy with little downtime but if the patient wants a more noticeable effect, I recommend combination with HIFU. Several Japanese institutions currently perform this combination with high patient satisfaction. To avoid excessive thermal damage, use Thermage CPT on the skin surface and HIFU on the deeper layers. I do not use the 3mm transducer of HIFU in the cheek and neck areas.
Other than Thermage CPT, which can bring long-term effect with a single treatment, short-term RF treatments that can be performed monthly are also popular.
In particular, I use Accent XL extensively in my practice. It applies radiative heat in the deep layers of the skin, similar to microwave radiation, causes little pain and is affordable. Many Accent XL devices were sold in Korea and it has been established as a major aesthetic treatment in Japan, although it is not the newest model (Recently, a new device that can control the RF phases to vary the treatment depth has been introduced and is expected to improve RF therapy).
Some Japanese patients want new devices but many still prefer devices with extensive clinical data. I have a patient who has been visiting every month for over 100 treatments so far. The treatment goal in this patient is merely anti-aging skin care and the patient also understands this. The outcome is not visually noticeable but the patient feels that her skin is healthier and appears less tired in the evening. This patient is highly satisfied with the treatment as her friends compliment on her clearer and younger looking skin. IPL can also bring similar results. However, IPL treatments performed monthly at high output weakens the skin and the thermal damage from IPL gives the skin unnatural sheen and texture. This can be interpreted in different ways but IPL’s aesthetic effect can be said to be inferior in this regard.
-To be continued-
