Treatment of Wrinkles and Acne Scars Using the TriFractional, a Novel Fractional Radiofrequency
Technology—Clinical and Histological Results
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and the resultant molecular motion generates heat. This
source of heat has been extensively used in surgery for
hemostasis and tissue ablation (electro-surgery). In the
past decade RF has been widely applied in the field of
aesthetics for various indications based on skin tight-
ening generated by deep RF dermal heating with resul-
tant collagen remodeling [6-8].
In the past several years, several fractional RF systems
have been introduced that allow controlled fractional skin
resurfacing, similar to the results achieved with various
laser systems. In addition to the epidermal effect, frac-
tional RF systems allow enhancement of the dermal layer
thus contributing to a combined effect leading to an ef-
fective micro-ablative skin resurfacing and improved ap-
pearance of wrinkles, fine lines and acne scars.
The novel TriFractional approach using the new Tri-
Fractional applicator from Pollogen® is designed to en-
able fractional skin resurfacing and treatment of wrinkles
via controlled epidermal micro-ablation and concomitant
dermal remodeling with a long established, highly reli-
able, and cost-effective technology. Treatment with the
new TriFractional applicator can be also done as part of a
combination procedure, the TriLipo MED™ procedure,
custom tailored to the patient, using additional technolo-
gies, TriLipo RF and TriLipo DMA, incorporated in the
same device, the multi-application Maximus™ system.
The current research was intended to evaluate the safe-
ty and effectiveness of the novel TriFractional technol-
ogy and applicator for skin resurfacing and treatment of
wrinkles.
2. Methods
2.1. TriFractional Technology
The TriFractional applicator is indicated for skin resur-
facing and the treatment of wrinkles by means of mi-
cro-ablation and coagulation. The TriFractional applica-
tor is one of the modules on the Maximus system. A dis-
posable treatment tip, containing a matrix of bi-polar elec-
trode pins, is attached to the distal end of the applicator
and is placed on the skin for treatment. TriFractional RF
energy is delivered to the skin in a fractional manner via
an array of multi-electrode pins.
Radiofrequency current is delivered sequentially be-
tween each of the pin electrodes and the large electrode
which surrounds the pin matrix. Due to this design, rela-
tively high RF current densities are formed in the tissue
under each pin electrode, resulting in localized fractional
treatment micro-wounds in the epidermis which are in
direct contact with the electrodes while heat is delivered
deeper into the dermis. This fractional manner of energy
delivery leaves intact zones in between the targeted areas
which serve as a reservoir of healthy cells to promote
faster, more effective wound healing.
The TriFractional technology emits a “train” of three
fractional sub-pulses spaced by very short pauses of
Thermal Relaxation Time (TRT), in one treatment pulse.
This modality enables to achieve an enhanced effect of
deeper penetration and optimized efficacy, with less dis-
comfort to the patient and a deeper gradual thermal ef-
fect.
Shortly after treatment there is moderate skin erythema
and edema in the treated zone, which resolves within 1 -
3 days.
During the healing phase, small pin-point epidermal
crusts appear at each micro-ablated spot. These crusts
exfoliate naturally after a few days leading to mild epi-
dermal resurfacing. In the dermis, treatment induces re-
modeling of dermal collagen (neocollagenesis) and of
other matrix molecules, leading to dermal renewal.
2.2. Clinical Methods
A clinical evaluation was conducted treating healthy vol-
unteers in order to assess the safety and efficacy of the
TriFractional technology. The subjects were treated for
various aesthetic reasons such as treatment of wrinkles,
acne scars and un-even skin complexion.
The protocol included 2 or more (according to treated
skin condition) treatments with the TriFractional appli-
cator at four weeks interval.
In addition, selected subjects were treated using the
TriLipo Med™ procedure which includes:
• Week 1: TriFractional
• Week 3: TriLipo focused RF + DMA
• Week 5: TriFractional
• Week 7: TriLipo focused RF + DMA
The addition of the TriLipo technology which com-
bines TriLipo focused RF and DMA resulted in enhanced
improvement of skin texture, toning and tightening. The
TriLipo RF thermal effect stimulates collagen production
while DMA is essential in improving lymphatic drainage
and reducing edema.
Prior to treatment a medical history was taken to ex-
clude any contraindication such as pregnancy, any im-
plantable electronic device that could be disrupted by RF
energy and any active dermatological or collagen-vascu-
lar disorder. Patients signed an informed consent form.
Topical anesthesia (Emla, AstraZeneca) was used on
some of the subjects prior to the treatment according to
the manufacturer instructions. The decision whether or
not to use an anesthetic on treatment area was made by
the physician based on size or sensitivity of the treatment
area, treatment parameters and the subject’s reported
general tolerance.
The face was thoroughly cleaned and the treatment
was performed only after the skin was completely dry.
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