What we didn’t know about RF microneedling and SYLFIRM X

Klaus Fritz discusses his experience using the SYLFIRM X to treat a variety of skin concerns

KLAUS FRITZ, MD, Director of Center for Dermatology, Laser and Aesthetic Medicine, Landau, Germany A NUMBER OF PEOPLE have a variety of skin concerns as well as lesions and visit the clinic to have them treated. In the clinic, various energy-based devices (EBDs) with different treatment mechanisms are being used depending on the indication. Laser is generally believed to be a representative and widely used group of the EBDs, but in addition to this, radiofrequency (RF) microneedling has been widely and steadily used for a long time as well.

Most people think that RF microneedling is used only for skin rejuvenation and scar treatment, but the scope of RF microneedling is wider than expected. Based on my experience using SYLFIRM X, the world’s first and only dual-wave of RF microneedling system with CE and FDA approval, I would like to talk about the aspects of RF microneedling that we do not know very well.

Radiofrequency (RF)

As mentioned above, EBDs of various treatment mechanisms are used to treat the skin, and each with different characteristics. Typically, lasers are mainly used for the purpose of damaging or removing the lesion by the absorption coefficient of the skin chromophore. For this reason, there is a limit to the penetration depth depending on the wavelength, and some wavelengths have a limit in treating dark skin types.

On the other hand, RF induces

Figure 1 (A) Before and (B) after four treatments with SYLFIRM X. Photos courtesy of Dr. Klaus Fritz

natural healing and tissue regeneration by flowing radiofrequency current to the skin to generate frictional heat of molecules in the skin. Furthermore, unlike laser, it is little affected by skin chromophores, so it has the advantage of being able to treat all skin types.

Lesions

Instead, one might question whether RF can selectively target lesions like lasers. Many people think that RF acts non-selectively on the skin tissue. However, the answer may vary depending on how RF is transmitted.

Two different types of RF waveforms are available with SYLFIRM X. One is to non-selectively denature or coagulate the skin tissue with relatively strong heat by irradiating radiofrequency in the form of a single long pulse (continuous wave; CW), thus, it is mainly used to treat lesions, such as skin laxity, wrinkles, pores, scarring, which are familiar with the application of RF microneedling.

The other is to selectively stimulate tissues with high conductivity or causes protein structural changes by irradiating radiofrequency in the form of multiple short pulses (pulsed wave; PW), so it can be applied to treat lesions like rosacea or melasma.

In the case of rosacea, the conductivity with blood is high, so treatment with PW is effective in improving facial redness. In particular, in the case of melasma, it is not a simple problem of hyperpigmentation but a lesion that should be treated in consideration of complex factors that affect melanocyte activity, such as disrupted basement membrane, increased vascularity, senescent fibroblasts, and others. PW stimulates and improves these factors.

“SYLFIRM X is the world’s first and only dual-wave of RF microneedling system that can improve various indications, from skin rejuvenation and scar treatment, to vascular and pigmented lesions, such as melasma.”

Needle depth

As with RF waveforms, needle depth adjustment is important as well for selective treatment of indications.

The biggest advantage of RF microneedling is that it can precisely deliver thermal energy to the desired skin layer by controlling the needle depth. With SYLFIRM X, needle depth is adjustable from 0.3-4.0mm. Usually 0.8-1.0mm is used for the face, but depending on the indication, treatment site or each patient’s skin thickness, it can be used more deeply or shallowly for more effective treatment. In addition, since a needle depth can be used up to 4.0mm, so it can target the very deep dermis or fat layer, so it is possible to contour not only the face but also the body.

SYLFIRM X’s 0.3mm is very unique and different from other RF microneedling devices. First of all, there are no such devices that can precisely penetrate the skin depth of 0.3mm, and there are also no protocols that use 0.3mm.

A needle depth of 0.3mm targets the papillary dermis just below the basement membrane of the skin. There are many influencing factors related to the redness and pigmentation mentioned above here. Therefore, despite the very shallow depth, it shows excellent effects on the treatment of redness and pigmentation, and has added advantage of little pain and less down time.

Microneedles

Speaking of needles, there are insulated microneedles which are coated on the needle column so that thermal energy is generated only from the tip of the needle, and non-insulated microneedles, which are not coated so that current can flow through the entire needle and generate heat. Although each has pros and cons, there is a popular opinion that insulated microneedles are preferred because of concerns about thermal damage to the skin surface with non-insulated microneedles. Insulated microneedles have a relatively small thermal effect, which causes bleeding issues, and requires increased power or multiple passes to increase the therapeutic effect.

Non-insulated microneedles, in contrast, can compensate for these shortcomings, and the concern about epidermal damage depends on the pulse duration. The pre-clinical study conducted by Dr. Na1 in 2015 proved that when bipolar RF was delivered using uninsulated microneedles, because of the different conductivity of the skin tissue, a teardrop-shape of thermal effect that minimizes the dermal damage of the epidermis and maximizes the thermal effect of the dermis, occurred up to an RF conduction time of 300ms. In other words, with an appropriate pulse duration, uninsulated microneedles can be both effective and safe in skin treatment.

SYLFIRM X

SYLFIRM X is the world’s first and only dual-wave of RF microneedling system that can improve various indications, from skin rejuvenation and scar treatment, to vascular and pigmented lesions, such as melasma2 . Also, each waveform is divided into 4 modes according to the pulse duration of each pulse. Therefore, various indications can be more delicately and effectively by considering the treatment area and skin conditions.

In addition, through numerous clinical practices, more delicate protocols have been developed and used according to the symptoms, even for the same indication. For example, in the past, all kinds of scars and stretch marks were treated with the strong heat of CW, but now the PW mode is used for early and red scars where blood vessels are working.

Figure 2 (A) Before and (B) after three treatments with SYLFIRM X. Photos courtesy of Dr. Klaus Fritz

Conclusion

In conclusion, SYLFIRM X is a versatile device that can treat many indications, and despite being an RF microneedling device, pain and downtime are small, and the therapeutic effect is high, so both doctors and patients are satisfied.

For more information, visit www.violmedical.com

References

1. Na, J.J., et al. (2015). Electromagnetic Initiation and Propagation of Bipolar Radiofrequency Tissue Reactions via Invasive Non-Insulated Microneedle Electrode. Scientific Reports, 5, 16735. 2. Kim, M.S., et al. (2019). Senescent fibroblasts in melasma pathophysiology. Experimental Dermatology, 28(6), 719-722.