HIRONC

In the JUNE issue of D&PS, Korea's most recognizable aesthetic magazine, our KOL of V-RO LIFTING (export name: new doublo) spoke about the clinical effect of New Doublo.

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Review: 2023 KALDAT (Korean Association of Laser, Dermatology and Trichology) Advanced Beauty Medical Device Expo and Spring International Academic Forum

Synergistic Effect for Facial Lifting of MFU and RF Combined Technology

Lecture / GeeBum Kim (Finance Director, KALDAT)

On April 23rd, the 2023 KALDAT (Korean Association of Laser, Dermatology and Trichology) Advanced Beauty Medical Device Expo and Spring International Academic Forum were held at COEX Hall C. This event was planned as a place where various people involved in aesthetic medicine could naturally harmonize, and at the same time, it was prepared as a venue for communication in aesthetic medicine by inviting the Seoul Metropolitan Government Deputy Mayor and members of the National Assembly to examine current issues related to medical policy. In addition, through the slogan of ‘Leaders’, the executives and members of KALDAT made it clear that they were leading Korea’s aesthetic medicine with effective and safe techniques in the clinical field. In this issue, we introduce GeeBum Kim, KALDAT (Korean Association of Laser, Dermatology and Trichology)

 

Dr. GeeBum Kim from Korean Association of Laser, Dermatology and Trichology, emphasized that the development of cosmetic medicine has been achieved in a way that reduces downtime and pain while showing satisfactory effects, and that this should be taken into consideration in setting up protocols.

Less Adverse Event, More Dramatic Result

Among the areas of cosmetic medicine, skin rejuvenation · lifting · tightening can be explained in a similar category. Representative mechanisms that encompass this are RF and HIFU. This lecture will focus on Hironic's V-RO LIFTING (Export name: New Doublo). V-RO LIFTING (Export name: New Doublo) is a little unique device. It implements RF and HIFU almost simultaneously. In the past, RF and HIFU were treated with different devices, but V-RO LIFTING (Export name: New Doublo) can achieve various treatment effects at once without a time difference. As far as I know, it is the only device that shows RF and HIFU at the same time.

Just as there was a time when peeling procedures were mainly performed, aesthetic medicine developed dramatically with the appearance of Fractional Laser, RF, and HIFU. The key to this development is the reduction of downtime and pain. Most of the new mechanisms were painless, and it was possible to return to daily life immediately after the procedure. Recently, a lot of research on appropriate thermal energy and appropriate thermal temperature has been conducted, and parameters for each mechanism are being improved and established.

In other words, the demand for ‘less adverse event, more dramatic result’ is increasing in ‘high-risk, high-return’. Even plastic surgeons are increasing the proportion of minimally invasive procedures such as fillers and botulinum toxin. Of course, thread lifting is a bit more aggressive than that. Like this, what is needed for ‘less adverse event, more dramatic result’ is combination therapy. I think that one of the main combinations in this combination therapy is RF and HIFU. In actual clinical settings, lasers are added here, and if cold rejuvenation is to be emphasized more, drugs such as skin boosters are injected in parallel.

(Figure 1) is an image often mentioned when explaining the classical laser theory. In the past, we have focused on the area of protein coagulation. It is said that even with HIFU, the temperature can be raised by more than 60℃. I don't know if that actually happens. Of course, I don't know if I can do stacking hard on the spot, but I don't know if it will have any effect other than the fat melting procedure. So, recently, I am focusing on targeting a slightly lower temperature for treatment. Rather than protein degradation, we care about the region where reversible change takes place, and we are even more interested in the photoactivation region. The photoactivation area is not limited to laser treatment, but I think that you can get an idea from photo-activation when setting the parameters of all EBD (Energy Based Device).​ 

(Figure 1). Range of typical bioreactions associated with a surgical laser and their approximate temperature range. Source: Is Light-Emitting Diode Phototherapy (Led-Lllt) Really Effective?.,Wonseok Kim etc., Laser Ther. 2011; 20(3): 205–215., doi: 10.5978/ islsm.20.205.

Considerations for HIFU procedure

As is widely known, ultrasound uses waves of a certain frequency or higher or physical properties. Largely, it shows effects such as mechanical effect, cavitational effect, and thermal effect. Although there are differences in the degree of these three effects, it can be considered that they occur simultaneously in terms of time. Unusually, you can also find research related to pigment treatment through HIFU, which emphasizes the cavitation effect more. Even in ultrasound, there is talk of impedance. Ultimately, the speed varies depending on the medium, and biological reactions appear at the interface of the medium. B The percentage of reflection between one fat (49%) and soft tissue-air (99%) is high. If the density and propagation speed of the two tissues in vivo are the same, there is no ultrasonic reflection at the interface, but the density and propagation speed are different. This is because reflection occurs at the interface between tissues with different impedances. These are the points where side effects occur most frequently during treatment in actual clinical practice. HIFU is formed in different forms of energy according to the diameter and curvature of ceramics for each device. The thesis participated by several executives of the evacuation cap informs that the form of energy was different when the energy was investigated for each HIFU. It can be seen that there are more suitable types for each purpose of the procedure. It would be a little more useful if you know that the ceramic shape shows the characteristics of each device, just like a human fingerprint.

The advantage of HIFU is that it does not react to chromophores. Therefore, compared to other mechanisms such as lasers, it can be usefully used by Asians as well. There is almost no downtime, and the clinical effect is immediate. Poor contact between the tip and skin, excessive staking, or narrow spacing may cause side effects such as burns, ball pits, and nerve damage. V-RO LIFTING (Export name: New Doublo) has a special sensor attached to the tip, and it is set so that the shot itself is not irradiated if the grounding is not correct. The device stops if it determines the amount of illumination in the tip and determines that the environment is not suitable. If you are familiar with HIFU procedures, it may not be very necessary, but personally, I still turn on this sensor and perform the procedure. I think it is one way to maintain the consistency of the procedure.

When performing HIFU treatment, it is difficult to decide which layer to target. On which floor and at what temperature will the procedure be performed? How to treat patients with reduced volume or patients with sagging? How to do patient selection? However, most patients do not visit the hospital only with one specific concern. In the end, problems come in a mixed form, so you need to think about which mechanism to use in parallel. Several studies that have analyzed concurrent treatments show that the last procedure has a better effect. For example, if you want to reduce the volume, it means that you should do RF first and then HIFU.​

 

Then, what would be the result of the procedure with almost no time difference? Hironic recently analyzed the synergistic effect of RF and HIFU combined treatment compared to HIFU alone at the Human Skin Clinical Trial Center. It is effective for various indications, but interestingly, it is said that the effect of improving pores is very large. The hospital also makes and operates a separate pore program using a 1.5mm tip, and the satisfaction of patients is very good. Existing pore programs had many parts in the form of ablation, but since it can increase the effect non-ablatively, it might be worth considering. If you apply ultrasound gel during the procedure, the skin's outer moisture will naturally improve, but V-RO LIFTING (Export name: New Doublo) is also effective in improving the inner skin's moisture. The skin texture improvement effect is also positive. V-RO LIFTING (Export name: New Doublo) is used a lot in pigment treatment. The cavitation effect described above has an effect, and it seems to be helpful to restore the skin barrier and make the dermis healthy. In fact, it is convincing in light of the fact that the moisture inside the skin has improved. It can be said to be an attractive device that can be used in a variety of ways, from skin rejuvenation, lifting, and tightening to pigment treatment.

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