Devices that irradiate radio frequency (RF) to induce collagenesis in deeper layers of the skin have been introduced and are used in various conditions. Each of these devices has unique advantages and disadvantages. Besides collagen synthesis, they can also be used to induce damage in certain areas. ‘Explore’ is one of these devices. It uses bipolar radio frequency and inserts a total of 49 needles into the skin 2.5mm apart. The top part of the needle is insulated and the RF energy is transmitted through the bottom 0.3mm of the needle. This minimizes epidermal damage and limits damage to the dermis or deeper tissues. This is the key advantage of Explore. The electric mode of needle insertion is slower than the previous hydrodynamic mode, causing less pain and lower incidence of bleeding during procedure or post-treatment petechiae. Make-up can be applied during the 2-3 days of recovery time to easily cover up traces of treatment. Explore is particularly beneficial for people who need to return to work quickly or who want to receive treatment without others noticing.
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The depth of the needles can be adjusted by 0.1mm from 0.1mm to 4mm. The depth of the needles can be changed depending on the patient, treatment goal and area. However, it is important to remember that strict application of numerical depth can be dangerous. In an animal study using porcine tissues, the insertion depth changed according to the characteristics of the treated area and surrounding tissues as well as the mere length of the needles. In the face, the insertion depth of needles is always shallow in the forehead or cheekbone areas as needles are pushed back out even with forceful insertion. This drawback of microneedle RF is more pronounced in the subcutaneous junctions. For example, application of microneedle RF to SMAS, a topic of much interest, may be theoretically possible, however, is not feasible in practice. A major concern with using needle RF is the risk of prolonged traces of needle penetration and epidermal damage from using excessive energy. However, an animal study with porcine tissues showed that the area of damage increased with higher energy, but after a certain level, stayed stagnant. In other words, the risk of scarring is low up to a certain level of energy. Considering this, we can think of two ways to treat patients with microneedle RF. First, as the extent of damage stays about the same, the energy can be raised up to Level 50. This allows irradiation of target areas with relatively little pain. Second, as collagenesis is enhanced with higher energy (increased HSP47 expression), high energy should be used in patients without contraindications for anesthesia such as sedation anesthesia, etc. and with tolerance for edema and erythema.
Explore has a wide range of indications but the most drastic improvement can seen in severe inflammatory acne with large areas of indented scars. Explore therapy is particularly satisfactory in these patients as it improves both acne and scars. On the other hand, patients without acne should be advised prior to treatment of the possibility of post-treatment acne. As epidermal damage is minimized, microneedle RF may not be as effective as fractional laser in pores or indented scar. To compensate for this disadvantage, fractional laser had been combined with RF. Recently, the needle depth is adjusted to deliver different energy levels to the dermis, epidermis and the papillary dermis. Auto MTS can be used to bring better outcome for pores. Microneedle RF can is generally performed once a month. However, it can be performed every two weeks with lower energy in patients sensitive to pain. Microneedle RF devices can be applied to various conditions. As for hyperhidrosis, it may be a better treatment option than liposuction or ultrasound as they have limited efficacy in this condition. Explore irradiates RF energy into 3-4mm below the skin surface. Irradiation at Level 120 brought favorable clinical outcomes. From my recent experience with Explore, 2-3 monthly treatments often brought satisfactory outcomes. In hyperhidrosis, liposuction immediately after RF therapy brought better outcome than liposuction alone.
Article/ Kim Heejung(Director, CU Cleanup Clinic Samsung Seoul, Korea)
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