Bipolar radiofrequency plus laser/light skin tightening and wrinkle reduction (Refirme, Polaris)

Generic name: Bipolar radiofrequency plus laser or intense-pulsed light (IPL) combination treatment

Brand(s): Refirme, Polaris via ELOS^TM (electro-optical synergy) technology

Maker / Website: Syneron, Inc (www.refirme.com, www.syneron.com)

Cost: Depending on the area treated, a single treatment usually costs from $250 to $1500. However, more than one treatment is usually needed. Some providers reduce the cost per treatment, depending on the total number administered.

Function / Purpose:
Bipolar radiofrequency is used primarily for skin tightening / reduction of sag (most commonly of the face and neck but sometimes elsewhere). However, it is often combined with another source of energy, typically a laser or intense pulsed light, which enhances subsequent tissue remodeling, including the synthesis of new collagen and elastin. Hence, in addition to skin tightening, such treatments are also used to improve wrinkles and fine lines.

Details:
Bipolar radiofrequency is one of the modes in which radiofrequency (RF) can be used in medicine and cosmetics. (See our overview of radiofrequency treatments). Bipolar delivery of radiofrequency for cosmetic rejuvenation is based on applying a two closely positioned electrodes to the treated area. The electric current that goes between the electrodes is relatively small and shallow. As a result, the tissue in the treated area is heated less deeply (usually up to 2-4 mm) and less intensely (compared to monopolar RF devices). As a result, bipolar RF procedures tend to be safer and gentler than the monopolar ones. In particular, since bipolar RF effects are relatively shallow, there is less risk of the overheating and subsequent loss of facial fat, a side-effect sometimes seen after monopolar treatments. Conversely, bipolar RF is less useful for indications when relatively deep tissue heating may be desirable, such as cellulite treatment and body sculpting.

Typically, a single bipolar RF treatment would produce less noticeable results than a monopolar one. In fact, bipolar RF procedures are often done in a series of several treatments whose benefits are believed to be cumulative.

In commercial rejuvenation systems, bipolar RF is usually combined with other energy sources, particularly lasers or intense pulsed light, which are believed to act synergistically with RF and help achieve better subsequent dermal remodeling. Hence, in addition to skin tightening, such treatments can also used to improve wrinkles and fine lines. In particular, the so-called ELOS (electro-optical synergy) technology developed by Drs. Shimon Eckhouse and Michael Kreindel at Syneron has been commercialized in Refirme and Polaris systems for skin tightening and wrinkle reduction.

Refirme is the commercial incarnation of the ELOS technology and combines bipolar RF and intense pulsed light (IPL). Notably, the IPL in Refirme is used at lower energy settings than is common for IPL-only treatments. Since it synergistically combines lower energy version of both RF and IPL, Refirme has (as one would expect) a good safety / side-effect profile and requires little recovery time after the treatment. Transient post-treatment redness is common (typically several hours duration); occasionally there may be transient swelling and, rarely, some blistering, which usually heals without scarring unless rubbed or picket. On the flip side, when treating skin/tissue sag, the effect of a single Refirme treatment is likely to be less noticeable than that of monopolar RF procedure such as Thermage. Thus Refirme is often repeated several times until the desired results are achieved.

Polaris system is another application of ELOS technology. It combines bipolar RF with 900 nm diode laser. The effectiveness and side effects of Polaris appear to be similar to those of Refirme. Similarly, Polaris treatments are often performed several times until the desired results are achieved. Additionally, Polaris is also promoted as a treatment for spider veins. However, the wavelength of light best absorbed by red blood cells (i.e. the one optimal to treat vascular lesions) is around 500-600 nm rather than 900 nm used in Polaris. It is conceivable that simultaneous application of RF makes 900-nm light may be sufficient to produce a clinically useful improvement in spider veins. But this requires an independent investigation. Unfortunately, very few independent studies into the effects of bipolar RF + laser/light and ELOS technology in particular have been conducted as of the time of this writing.

In a study conducted at the Weill Medical College of Cornell University (pub. Journal of Drugs in Dermatology, 2005), Dr. Sadick and co-workers treated 108 patient using bipolar RF plus IPL version of ELOS technology [Refirme]. Each patient received five full-face treatments spread 3 weeks apart; each treatment consisted of 1 to 8 full-face and segmental passes. The researchers reported the following results:

"Overall skin improvement was rated at 75.3%. Overall average wrinkle improvement was 41.2%, with an average Class 1 wrinkle improvement of 64.7%, Class 2 wrinkle improvement of 38.6%, and Class 3 wrinkle improvement of 20.4%. Improvement in skin laxity was rated at 62.9%. Skin texture was reported to improve 74.1%. Improvement in the appearance of pore size was rated at 65.1%. Average improvement in erythema and telangiectasia was 68.4%. Average improvement in hyperpigmentation and dyschromia was 79.3%. Overall patient satisfaction was 92%. The overall minor complication rate, including blistering, crusting, and stripping was 8.3%, and the major complication rate was less than 1%. One small, depressed nasal scar was observed in one patient."