What are the Newest Technologies in Skin Rejuvenation? (Laser and RF Combinations)

Skin aging is associated with a series of structural and biochemical changes such as tissue loss, decrease in sweat and oil glands, and pigmentation changes in the epidermis and dermis due to both internal (intrinsic) and external (extrinsic) factors. As we age, symptoms such as dryness, fine and deep wrinkles, and sagging may occur in the skin.

Radiofrequency (RF) treatments, which are among the minimally invasive cosmetic applications, stimulate the contraction and shortening of collagen fibers in the dermis, and then stimulate the production of new collagen. As a result of this process, a significant tightening of the skin is achieved.

While bipolar RF works by generating heat in the reticular dermis, microneedle RF allows the subdermal fat tissue to reshape. Thus, an optimal rejuvenation effect is achieved with energy distribution in both deep and superficial tissues.

RF Combined Energy Systems: ELOS Technology

RF systems were combined with intense pulsed light (IPL), diode laser and infrared light systems to create electro-optic synergy (ELOS) systems. ELOS technology is used effectively especially in rejuvenation and photoaging treatments.

In a study conducted by El-Domyati and colleagues, a reduction in wrinkles was achieved on the entire face, including the periorbital region, with the combination of bipolar RF and IPL,

An increase in epidermis thickness and an increase in elastin production in dermal fibroblasts were observed after the treatment.
It has been shown that repeated thermal damage triggers new collagen production in fibroblasts and skin remodeling.
In the study by Sadick and colleagues, with ELOS treatment:

A 41% improvement was achieved in facial wrinkles,
A 62% improvement was achieved in sagging.
Bipolar RF and Infrared Light Combinations

Bipolar RF and infrared light (700–2000 nm) combinations have been found to be particularly effective on:

Periorbital wrinkles,
Facial sagging
.
A significant reduction in facial sagging was achieved with a three-session treatment protocol applied at three-week intervals.

In a multicenter study conducted by Gold et al. with 56 patients:

Bipolar RF and infrared light combination,
Then treatment was applied using a fractional bipolar RF device.
In the application performed at three sessions at 4–6 weeks intervals, tightening of the entire face and reduction in wrinkles were observed in 88% of the patients,
and it was reported that the treatment results were maintained for 6 months in 85%.
It was stated that the risk of epidermal damage in dark skin types was reduced thanks to the use of bipolar RF and infrared light energy in the same applicator.

Bipolar RF and Diode Laser Combination

In a study by Doshi et al. on 24 people:

A combination of 900 nm diode laser and bipolar RF was used in the treatment of deep wrinkles and photoaging.
After three sessions at 3-week intervals, a significant improvement was observed in most patients, especially in the periorbital region.
In another study:

The effectiveness of the combination of bipolar RF and diode laser and the combination of bipolar RF and infrared light were compared.
According to the results, the combination of bipolar RF + diode laser was found to be more effective than the infrared combination in reducing facial sagging and periorbital wrinkles.

Fractional RF and Thulium Laser Combination

The combination of fractional RF and non-ablative 1927 nm fractional Thulium laser is also used in rejuvenation treatments.

Thulium laser targets the epidermis and papillary dermis, providing successful results in cases such as photoaging, wrinkles and sagging.
In the study conducted by Park et al.:

Only fractional microneedle RF was applied to one half of the face of 25 patients,

The other half was treated with a combination of fractional microneedle RF and Thulium laser.

After three sessions performed at four-week intervals, the combination treatment was found to be more effective on forehead, crow's feet and neck lines.

Microneedle RF and Combination Treatments

Microneedle RF has also been tried in the treatment of under-eye bags.

After lower eyelid blepharoplasty:

In a patient who received a combination of microneedle RF and 15% trichloroacetic acid (TCA),
Tightening of the under-eye skin and a decrease in bruising were observed.

In neck rejuvenation studies:

A combination of fractional microneedle RF and platelet rich plasma (PRP) was used,
A significant increase in dermis thickness was recorded with optical coherence tomography in patients who received the combination treatment.
Combinations of Fillers with Laser and RF

The combination of filler applications with laser or RF treatments can be done safely. However:

In order for energy devices not to damage the fillers, it is generally recommended to apply energy before the filler injection.

A review conducted in 2015:

It was shown that RF, IPL or laser treatments applied after filler injections did not cause a histological change in the filler materials.