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On Your Marks



Sublative skin rejuvenation, acne scar treatment.



By Nancy Jeffries, Contributing Editor



Published June 13, 2013
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On Your Marks

Skin imperfections surely  have an impact on self confidence, but a variety of issues often keep consumers from seeking treatment. Individuals considering invasive treatment are often inhibited by a number of factors including, cost, anticipated downtime, discomfort and side effects.

Now, say industry experts, there’s more options for wary consumers. Dr. Shimon Eckhouse, co-founder, Syneron, and co-developer of the proprietary Elos technology on which Syneron’s aesthetic medical devices are based, discussed the newest approach to skin rejuvenation and acne scar treatment, Sublative, describing both the mechanics of the process, as well as the reasons why individuals need not be inhibited by cost, pain or downtime.
 
At a press event in New York City last month, Dr. Eckhouse explained that Sublative is neither laser- nor light-based. Instead, the technology uses fractionated bi-polar radio frequency (RF), precisely directed to the skin in the form of a matrix. Healthy skin around the matrix dots accelerates the healing process, ultimately enabling the skin to return to a smooth, healthy state. Syneron, which develops, sells and supports energy-based devices that treat everything from leg veins and cellulite, to acne and hair removal, has zeroed in on the specifics of rejuvenation and acne scar repair with its latest product.
 
“When we talk about sublative rejuvenation, we are treating aging skin, skin laxity, visible lines and wrinkles, and overall deterioration in skin tone and texture,” explained Eckhouse. “The goal is to achieve a more compact, younger dermal matrix, a homogenous epidermis, and overall smooth surface.”
 
Sublative technology creates a minor injury on the surface of the skin, which ultimately enables the skin to come back to a healthy, smooth state. This is essentially a wound healing response. Very small electrode points are applied to the skin, utlizing a small amount of energy, and creating a slight injury to the surface of the skin, and it then conducts the thermal energy below the skin. It is a small disruption of the outer surface, with a stronger heating below the surface, which effectively targets the skin’s imperfections.
 
According to Dr. Eckhouse, sublative technology offers several advantages, including affordable cost to patients and doctors, treatment of skin laxity, wrinkles, and improved texture, and added brightness and luminosity for the skin. He adds that for acne, one can have laser resurfacing done, but that this technology, Sublative, is different, as it requires less downtime, reduces acne scars, and improves tone and texture. It is also claimed to reduce orbital wrinkles and lines, is long-lasting, and with the suggested regimen of three treatments, 4-6 weeks apart, patients are said to see a marked difference in the skin, including new collagen and healthy skin cell production, and a smoother, more elastic skin texture.
 
The Concept of Skinhibition
 
Skinhibition, said Dr. Eckhouse, is the name given to the sublative effect of the procedure, as it is intended to assure the patient that they can get rid of their skin inhibitions and reticence about going for a procedure.
 
 “The challenge today is finding the sweet spot for ridding yourself of lines and wrinkles,” said Dr. Thomas E. Rohrer, a board-certified dermatologist at Skincare Physicians of Chestnut Hill, MA, and a clinical associate professor of dermatology at Boston University School of Medicine, who joined Eckhouse in the presentation. “With every advance of technology, we get closer and closer to this, and we now can make changes and get dramatic results without all the downtime and with minimal epidermal disruption.”
 
He noted that, with age, collagen breaks down and loses contact with the fibroblasts, causing skin to lose elasticity and tone. This technology is designed to address this situation in the skin.
 
Dr. Rohrer provided a brief history of skin rejuvenating procedures, beginning with the ablative resurfacing lasers used in the 90s. These removed the epidermis and superficial dermis, and healing occurred in the epithelial layers. The procedure also required considerable downtime, and there were occasional scarring issues. Later, fractional resurfacing and non-ablative fractional resurfacing proved to be an improvement over the ablative procedure. This was followed by fractional CO2 technology; and now, the sublative technique, with its direct contact radio frequency.
 
“This makes a little mark in the surface of the skin and creates a maximized result in the dermis,” said Dr. Rohrer, who noted that the pins used are really contact points, enabling negative charge to flow back to the contact area. A typical procedure lasts 15-25 minutes, with most patients opting for 3-5 treatments, 4-6 weeks apart.
 
Some patients report a warm sensation as energy enters the skin, and following treatment there may be pink or red flush resembling minor sunburn. Topical anesthetic ointments and cooling gels may be used to reduce discomfort during treatment; unlike light-based corrective treatments, Sublative is said to work on all skin types.
 
Clinical results include skin tightening, improvements in texture and pigment, and a reduction of wrinkles, acne scarring and stretch marks. According to Rohrer, there is minimal dermal impact with maximal epidermal disruption. One of the unique advantages, said Rohrer, is that by creating a narrow corridor or conduit of application, the procedure has the ability to do things to impact the skin without irritating the melanocytes. This potentially eliminates darkening in the areas that have been treated. There is also no ionizing radiation, removing any chance of skin cancer.
 
“The beauty of this is making the skin heal itself,” said Dr. Eckhouse, adding, “We’re asking the skin to do a better job of keeping itself healthy, which is quite unique.”
 
A Psychological View
 
Jennifer R. Wolkin, PhD, a licensed psychologist and clinical neuropsychologist, reiterated the emotional component that is often overlooked, but may be the most important aspect when it comes to procedures.
 
“It’s an emotional journey. While many women have a desire to look younger and stay youthful for their career and themselves, many expressed anxiety about treatments,” she observed. “Can they afford it? Will they see improvement? What will the downtime be?”
 
Dr. Wolkin suggested that there are trigger moments when women notice changes in their appearance and want to look more like themselves again. While many women seem to linger or never get past the doubtful phase, there is a hopeful phase; and this is when women are able to get over their anxieties and do something hopeful for their appearance. This concept ties into the creation of the term, skinhibition, when the desire to have more youthful looking skin is hampered by anxiety regarding side effects, cost, and outcome.
 
Dr. Eric S. Schweiger, board-certified dermatologist at Schweiger Dermatology in New York City, and director of the Clear Clinic, a dedicated treatment center with the sole focus of treating acne and acne scars, demonstrated the procedure to attendees. According to Dr. Schweiger, treatments are customized for the particular scarring conditions for which patients seek treatment. He noted the classification of scars resulting from acne, including Rolling Scars and Hypertrophic Keloid scars, adding that the Sublative technology has been useful in reducing moderate to severe acne scars for all skin types, and does not cause demarcation marks. The Sublative RF applicator delivers RF energy to the skin in a fractional manner, via an array of multi-electrode pins, which deliver bipolar RF energy to the skin. Microscopic zones of epidermis and dermis are thermally ablated in a grid over the skin surface, where non-ablated zones serve as a reservoir of cells that promote rapid healing.
 
“The technology can also be used off the face as well,” noted Dr. Rohrer, “including for the treatment of back acne, and it will also enable the improvement of any surgical scar. We are finding that early treatment of scars is much better,” he said, adding that the technology is multi-functional. “We may be seeing these sublative techniques in use in the future for actual drug delivery,” he said.
 
Additional information about Sublative may be found at: www.syneron-candela.com.
 


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