Polaris WR Clinical Review and Technique

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Polaris WRClinical Review and Technique

• Michael Kreindel, Ph.D.
• Thomas Goslau

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Part IMechanism of Collagen Remodeling
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WR Mechanism of Collagen Remodeling Before

• Collagen has high density with small
  intrafibrilar spacing that prevents growth of new
  fibers and limits the blood supply.

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WR Mechanism of Collagen Remodeling Immediately
After

• Deep edema, intrafibrilar spacing is increased
  due to release of liquids from lymphatic and
  vascular systems.
• Fibers are separated and oriented chaotically.
• Edema and erythema appear.

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WR Mechanism of Collagen Remodeling 3-weeks After

• After edema decreases the collagen maintains
  enlarged intrafibrilar spacing which is filled
  with new collagen.

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Before
Side by Side Comparison
3-weeks After
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Collagen fiber has more chaotic orientation at a
depth of 0.5-2mm.
Remodeling Depth
Before
-0.0
-0.5
-1.0
-1.5
mm
3-weeks after
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What is the end point?

• Erythema is responsible for superficial
  improvements fine lines, skin texture
• Edema is required for deep wrinkle improvement
  and change of shape

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Part IITreatment Tips and Parameters
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Treatment Targets - Polaris WR

• Skin Tightening (face and body)
• Laugh Line (nasalabial fold)
• Enlarged Pores
• Acne Scars
• Peri-orbital Wrinkles
• Eyebrow Position
• Skin Tone (lighter color)

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Facial Treatment Zones

1. Forehead and Cheek Bone - over bone area,
   sensitive to RF energy.
2. Cheeks, Nasalabial Folds - soft part of face,
   easy coupling, tolerates well to higher energy
   levels.
3. Lower Eye Area - can be treated when tissue is
   pulled down over cheek bone.
4. Upper Lips sensitive to pain.
5. Chin semi-soft area with high curvature
   careful placement of electrodes.
6. Nose RF sensitivity and curvature careful
   placement of electrodes.

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3
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2
4
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Parameters (1)Starting Points

• 1 Over-bone sensitive area
• RF 45-55 / Laser 24-28
• 2 Soft part of face
• RF 75-85 / Laser 28-34
• 3 Under eye area
• RF 60-70 / Light 24-26
• Pulled down to over-bone area, single pulsing
• 4 5 Semi-soft area
• RF 60-70 / Laser 26-30
• 6 Difficult contact area
• RF 45-55 / Laser 22-26
• strong pressing, single pulsing
• Neck
• RF 70-80 / Laser 20
• Body (soft area)
• RF 80-90 / Laser 28-34

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Parameters (2)Adjustments

• If EMLA is used then parameters should be 5-10
  higher because of vasospasms created by lidocain.
• Energy can be increased by 5 during 2nd and 3rd
  treatments.
• Lower laser energy for neck should be used to
  avoid any damage of superficial arteries.

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Anchor Points

• Anchor points contribute to better skin
  tightening and face shaping.
• Anchor points should be treated with more passes
  to reach stronger edema.

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Treatment Procedure (1)

• Remove make-up from patient.
• (If needed) Apply topical anesthetic
  approximately 1 hour prior to treatment.
• Put on patient protective eyewear.
• Apply thick layer of gel (2-3mm).
• Set treatment parameters for most sensitive area
  (low settings).
• Treat first over sensitive and difficult to
  access areas.
• Repeat passes until erythema appears on treated
  area.

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Treatment Procedure (2)

• Set parameters for soft tissue (higher settings)
  areas.
• Repeat passes until erythema and edema appear in
  treatment area.
• Do more passes on anchor points
• Repeat procedure every 2-3 weeks. Recommend at
  least 3 treatment sessions, maximum 5 sessions.

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Treatment Tips (1)

• To be safe ALWAYS use lower energy over bone
  areas (e.g. forehead, temple, and cheek bone).
• Use single pulsing for face treatments and
  automatic pulse mode for body treatments.
• Press firmly on skin surface with applicator,
  ensuring good electrode contact to skin.
• If full contact of electrodes cannot be achieved,
  reduce RF energy by 40 (e.g. nose).

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Treatment Tips (2)

• Dont treat in the orbital area pull
  peri-orbital tissue over bone for treatment
  (careful to keep eye shields in place).
• Stacking of pulses is dangerous and may burn.
• Delay at least 30 sec between passes when
  treating the same area.
• Pigmentation does not effect settings and
  results.
• Some patients and areas require only single pass
  to achieve proper skin response, while some cases
  require up to 5 passes.

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Post-treatment Care

• Apply sun-protective cream after treatment.
• Recommend patient to protect skin from direct
  sunlight for up to one week after the treatment.
• Recommend alcohol-free skin care products
  (alcohol dries the skin).
• Recommend use of skin moisturizer.

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Part III Management of Patient Expectations
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Patient Expectations (1)

• BUILD REALISTIC PATIENT EXPECTATIONS.
• Wrinkle reduction (not disappearance).
• Skin tightening.
• Skin texture improvement (reduction of pores /
  smoother and brighter skin).
• AVOID OVER-PROMISSING.
• Results appear gradually.
• Sometimes more than 3 treatments are required.
• Wrinkles will not disappear, but will be shorter
  and more shallow.
• Not a surgical face lift.

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Patient Expectations (2)

• The best responding patients are women from 30-45
  years old with normal skin thickness (2-3 session
  is enough for good results).
• Thin skin patients usually require up to 5
  treatments with more passes (typically with
  settings 10 lower).
• Customer satisfaction according to Japan user
  survey
• 57 very satisfied
• 30 satisfied
• 10 see results but expected more
• 3 see some results but not satisfied
• 1 of patients had transient adverse effects
  during first 2 weeks that decreased to zero with
  improvement of treatment technique

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Patient Expectations (3)

• Clinical indications according to treatment
  efficiency
• Nasalabial folds
• Skin tone
• Pore size
• Acne scars
• Neck
• Peri-orbital and peri-oral wrinkles
• Eyebrow positions

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Combination Treatments

• Treat 2-weeks after and/or before injections of
  Botox, Retinol, etc.
• Users of both Aurora and Polaris have reported
  that satisfaction of customers from combined
  treatment is much higher than from one system
  only.

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Treatment Economics

• 90 of doctors using Polaris in Asia-Pacific
  region sell a package of 5 treatments for average
  price of US 2,500.
• Selling a package of treatments (3-5) improves
  management of customer expectations.

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Dr. A. Del Giglio, Italy Neck Treatment
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Dr. A. Del Giglio, Italy Peri-orbital Lines
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Dr. M. Kulick, CA, USA, Face Treatment
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Dr. M. Kulick, CA, USA Face Treatment
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Dr. M. Kulik, CA, USA Peri-oral Wrinkles
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Dr. Hidemi Akai, Japan Face Tightening
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Dr. H. Akai, Japan Skin Tightening (Hip Lift)
After 1st treatment
Before
After 3rd treatment
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Dr. E. Mihara, Japan, Face Treatment
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Dr. E. Mihara, Japan Acne Scars Pores
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Dr. E. Mihara, Japan Acne Scars Pores
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Dr. E. Mihara, Japan Skin Tightening (Hip
Lift)