Dr. Patrick Treacy discusses the 'Combination of Conducted RF and Optical Energies in Aesthetic Medical Procedures A new highly efficacious treatment' Original lecture made for Syneron Workshop circa 2006

1. Combination of
Conducted RF and Optical
Energies in Aesthetic
Medical Procedures
A new highly efficacious
treatment
Dr. P. Tracy

2. ELOSTM
Technology in Aesthetics
The ELOS advantage
• Synergy -
–electrical (Radio- Frequency) and
–optical (Light) energy
• Two different energy sources -
–selective mechanisms of action
–optimal treatment synergy
• Active epidermal cooling
• Active dermal monitoring TM

3. Syneron ELOS Technology
• Reduced optical energy
– to a safe level for all skin types
• Electrical RF energy
– Compensates for the reduction of optical
energy
– RF that is not sensitive to skin or target colour
ELOS technology replaces up to 60% of the
optical energy by the synergistic use of RF
bi-polar current, maximising efficiency and
minimising unwanted effects.

4. RF energy properties
• Well known in medicine
• No effect on melanin
• All RF parameters (Voltage, Current, Impedence)
can be measured and controlled with high time
resolution
• Skin impedence depends on temperature and can
be used for skin temperature monitoring where
impedance drop is about 2% per °C

5. How does it work?
Pre- Pulse
Test
Light Pulse
Target is
Pre-heated
Impedence of
target is
decreased
RF Pulse
Higher current
in zone with low
impedence
Target is heated
More effectively
than skin
Contact test
Cooling test
Tissue pre-
Heating with
RF

6. Pre-Pulse Test
If cooling temperature is too high → COOLING UP
Message appears in the display and the pulse is not
enabled.
If contact is not good → BAD COUPLING Message
appears in the display and the pulse is not enabled.
Pre- Pulse
Test
Light Pulse
Target is
Pre-heated
Impedance of
target is
decreased
RF Pulse
Higher current
in zone with low
impedance
Target is heated
More effectively
than skin
Contact test
Cooling test
Tissue pre-
Heating with
RF

7. Light Pulse
• Light pulse pre-heats target (vascular or pigmented) lesion
• Temperature of the target is higher than the temperature of the
surrounding tissue.
• Impedance of the target is lower than the impedance of the
surrounding tissue
• Cooling increases the impedance of the epidermis making it
resistant to RF heating.
Pre- Pulse
Test
Light Pulse
Target is
Pre-heated
Impedance of
target is
decreased
RF Pulse
Higher current
in zone with low
impedance
Target is heated
More effectively
than skin
Contact test
Cooling test
Tissue pre-
Heating with
RF

8. RF Pulse
RF current distribution depends on the impedance distribution
within tissue. Tissue with low impedance conducts higher RF
current while zones with high impedance conduct lower RF
current.
Cooled epidermis conducts low current and is heated less.
Pre-heated target conducts higher current and is heated more
effectively by the RF current.
Pre- Pulse
Test
Light Pulse
Target is
Pre-heated
Impedance of
target is
decreased
RF Pulse
Higher current
in zone with low
impedance
Target is heated
More effectively
than skin
Contact test
Cooling test
Tissue pre-
Heating with
RF

9. Aurora pulse sequence
RF energy
Light
Testing pre-pulse
to ensure
coupling and skin
calibration for RF
monitoring
Intense
pulse
Fine heat
adjustment
RF energy

10. p u r e s y n e r g y
wavelength [nm]
Absorptionskoeffizient[1/cm]Optical Parameters
Hämoglobin
Melanin
DiodeAlex
Aurora
DYE DIODE-Laser
for water
absorption

11. RF Current Distribution
Cold epidermal layerCold epidermal layer
DermisDermis
Pre-heated targetPre-heated target

12. Spotsize and Penetration
Spotsize small large
Penetration Depth small deep
p u r e s y n e r g y
RF
Energy

13. p u r e s y n e r g y
RF – cond.Current
Optical
Energy
Energy
Temperature
Impedance
Pre-Measuring
5 ms – 30 ms
Optical Pulse
7 - 12 ms
RF – Current post-heating
150 ms-
200 ms
Pulse + Safety
STOP
Impedance all 3 ms

14. Multi-target Effect in skin Renewal

15. Photo-facial RF
• Number Sessions: 4 - 6
• Session Interval : 2 - 3 weeks
• Skin improvement continues for 3
months post last treatment.
• Maintenance : 2-3 treatments per year.

16. Results – timescale
• Pigmented lesions : 3-5 days.
• Telangiectasia : 3-4 weeks.
• Haemangiomas : 10 mins.
• Skin quality : 2 treatment sessions.

17. p u r e s y n e r g yDevelopment of Laser and Light
SystemsEnergy
Skin
Damage
History Present Future
Successful
treatment of
the target

18. Hair Removal
Efficacy/Risk Algorithm
-----------------
Light skin
Dark hair
Dark skin
Dark hair
Light skin
Light hair
Dark skin
Light hair
Efficacy High High Low Low
Risk
(Adverse Effects)
Low High Low High

19. Light induced temperature distribution
• Light selectively heats
hair shaft.
• Bulb and follicle are
damaged by heat
transfer from hair shaft
Shaft
Follicle

20. RF selectivity - mechanism
Electrodes
• Current density in the
follicle is twice that of
the surrounding tissues
• Heat generation is
proportional to square
of current density

21. RF induced temperature distribution
• RF creates heat in the
30 microns layer
around the hair shaft
• Heated layer includes
hair follicle and bulb

22. RF + Light induced temperature distribution
• Combination of two
energy sources.
• Uniform heating of
the shaft, follicle and
bulb.

23. • Safety:
–less optical energy used.
–Lower incidence of side effects.
• Selective energy delivery to target.
• Multiple skin/hair types effectively treated:
–Dark skin - treated without compromising
efficacy or safety.
–Lighter hairs – treated effectively
ELOSTM
major advantages

24. Light brown hair (Aurora DS treatment)
Optical pulse at 20J/cm2
with no additional RF
energy.
Optical pulse at 20J/cm2
and RF energy of
20J/cm3
.

25. AfterBefore
White hair (Aurora DS Treatment)

26. Skin Renewal
Aurora SR
treatment

27. Before 2weeks after
Aurora SR treatment

28. Aurora SR Treatment
Lentigines
Before
After

29. Aurora Photo-rejuvenation Treatment
Before
After

30. Aurora Photo-rejuvenation Treatment
Before
After

31. Aurora Photo-rejuvenation Treatment
Before After

32. Aurora Photo-rejuvenation Treatment
Before After

33. Before
22weeks afterweeks after
Aurora SR treatmentAurora SR treatment
Age spots and fineAge spots and fine
lineslines

34. p u r e s y n e r g y
Temperature
Distribution
Effect of conducted RF
• Conducted RF heats the tissue between the two
electrodes only and directs the thermal effect on the
target ( Bipolar System )
• No Radiance (No Microwave).
• The penetration depth is depending on the distance of
the electrodes.
• Controlled heating of the target structure.
• Painless and no side effects.

35. p u r e s y n e r g y
Single
Energy
Single
Wavelength
Laser
IPL + long-pulsed +Multi-
Wavelength Laser
Single
Energy
Multiple
Wavelength
Multiple
Wavelength
Multiple
Energy
ELOS
Technology - Positioning
1980-2000
1990-2000
2000-2010