My clinical experience using SYLFIRM X

Dr. Ayaka Nishikawa shares her clinical experience using SYLFIRM X to treat melasma and rosacea

AYAKA NISHIKAWA , MD, Director of Dermatology Department of Shonan Beauty Clinic Group, Japan IN GENERAL, THE radiofrequency (RF) needling device is widely used, in that it can treat various skin concerns and problems, such as large pores, wrinkles, sagging skin, acne scars and others, and is a great help in running a clinic.

However, it is unfortunate that it cannot be applied to patients with melasma and facial redness. In that sense, SYLFIRM X developed and manufactured by ViOL, South

Korea, is a revolutionary device because it can be applied to treat melasma and redness as well as other skin conditions.

Our clinic used other brands of RF needling devices in the past. In conventional RF microneedling, RF is delivered through the needles to cause thermal coagulation with strong heat to induce collagen and elastin production and a healing response. Therefore, it improves overall skin firmness and elasticity, and is effective for skin rejuvenation and as a treatment for scarring. I also achieved good results in treating large pores, fine lines, and acne scars.

However, I could not use them for patients with melasma, facial redness or pigmented or vascular conditions as the symptoms often worsen.

In 2021, SYLFIRM, the previous version of SYLFIRM X, was first introduced to our clinic. What was very interesting about SYLFIRM was that it is equipped with a method that delivers multiple short pulses of radiofrequency to the skin (pulsed wave, PW), unlike other RF microneedling devices that deliver a single long pulse of radiofrequency to

Figure 1 Rosacea patient, (A) before and (B) 1 month after 5 treatments

the skin (continuous wave, CW). PW mode stimulates the skin tissues that affect melasma or/and facial redness, ultimately improving the lesion and I along with my patients with melasma or redness and all the other doctors I work with, were satisfied with the SYLFIRM treatment. In particular, procedural pain and downtime were very little and short, and in the case of facial redness, a noticeable outcome was seen even after 2–3 treatments. Since then, SYLFIRM X, the latest version of RF microneedling equipped with both PW and CW, was released, and so far, a total of 25 branches of our group, including our clinic, have purchased SYLFIRM X and are using it on a daily basis.

Melasma

Melasma is a pigmented lesion that appears mainly in women in their 30s to 50s and appears symmetrically primarily on the cheekbones. It has many similarities to senile lentigo, such as appearance or the effects of ultraviolet exposure, so it is often misclassified or misdiagnosed. However, melasma is caused by more diverse and more complex causes and factors, including hormonal imbalance. Controlling the activity of melanocytes is very important in melasma treatment, and conservative therapy is commonly used. That is, by oral or topical administration of tranexamic acid, hydroquinone or other substances, leading to cytokines inhibited or melanocyte activity suppressed. However, it cannot be used for patients with some medical diseases and there are concerns about side effects like depigmentation due to long-term use.

That is why lasers are used to treat melasma or in conjunction with conservative therapy. Laser toning (low fluence of a Q-switched Nd:YAG laser or a picosecond laser) is usually used, but even this can cause

“Since SYLFIRM X is dual wave, it has the great advantage of being able to treat multiple indications and symptoms at once by applying different modes for each indication and each symptom.”

hyperfunction of melanocytes that worsen pigmentation or damage melanocytes that create mottled hypopigmentation. Among the numerous indications, what makes melasma really difficult to treat is not only that melasma is a recalcitrant lesion, but also that there is a big gap between what the patient wants and what the doctor can actually do. This is because patients with melasma want to see fast and dramatic results with intensive and frequent treatment using any methods, including energy-based devices (EBDs), and doctors need to take safe and careful treatment methods to treat melasma that easily recur or worsen due to various stimuli and there are not many options to choose from.

SYLFIRM X’s PW mode is very helpful in this situation. This is because an additional treatment option is given to melasma patients who want an EBD treatment, but for whom conservative therapy is the only option considering their skin and melasma condition. The PW mode selectively stimulates the highly conductive skin tissue. It is suitable for treating melasma as it improves by stimulation, rather than damaging the skin like a laser. Several clinical papers have confirmed that PW stimulates and improves melasma-related skin tissues and components, such as the basement membrane, which is the foundation of the epidermis, vascular endothelial growth factor (VEGF) and senescent fibroblasts that are associated with pigmentation production.

Rosacea

PW is also effective in the treatment of facial redness and rosacea due to its stimulation of capillaries and VEGF. For this reason, in patients with melasma accompanied by redness, both pigmented and vascular conditions are improved and satisfaction is doubled. My experience of treating numerous patients with melasma or/and redness in the clinic has shown noticeable results are seen after 3–5 treatments without any complications. In addition, PW mode of SYLFIRM X is not an aggressive treatment due to the abovementioned features, so it can be used concurrently with conservative therapy or/and other EBD treatment. This is a suitable treatment approach for patients with melasma who need to treat various factors or for patients who want to see fast and dramatic outcomes.

SYLFIRM X

Our clinic is visited not only by patients with melasma or redness, but also by patients with acne vulgaris or acne scars. For acne and acne scars, CO2 fractional laser or conventional RF microneedling is usually used, but it is not appropriate for use when the lesion is accompanied by post-inflammatory hyperpigmentation (PIH) or postinflammatory erythema (PIE) since excessive heat worsens the lesion as well as the accompanying symptoms.

In other words, while the above devices can be applied only to lesions without PIH or PIE, SYLFIRM X with dual RF waveform can safely and effectively treat the indications with or without the symptoms.

Furthermore, patients rarely visit the clinic with only one lesion, they usually have multiple skin concerns and problems that they want to treat.

Since SYLFIRM X is dual wave, it has the great advantage of being able to treat multiple indications and symptoms at once by applying different modes for each indication and each symptom.

Therefore, patients with melasma who are worried about enlarged pores or wrinkles can be treated simultaneously with a single device, SYLFIRM X, which ultimately improves the overall skin and appearance desired by patients.

In summary, SYLFIRM X can treat various skin concerns and indications, and doctors as well as patients show high satisfaction in terms of procedural pain, downtime, and clinical outcomes.

Figure 2 Melasma patient, (A) before and (B) 3 months after 4 treatments

For more information, visit www.violmedical.com

References

1. Cho, S. B., et al. (2018). In vivo skin reaction from pulsed-type, bipolar, alternating current radiofrequency treatment using invasive noninsulated electrodes. Skin Research and Technology, 24(2), 318-325. 2. Kim, Misun, et al. (2019). Senescent fibroblasts in melasma pathophysiology. Experimental Dermatology, 28(6), 719-722.