Polaris WRPolaris WRClinical Review and TechniqueClinical Review and Technique

Michael Kreindel, Ph.D.

Thomas Goslau

Part IPart I

Mechanism of Collagen RemodelingMechanism of Collagen Remodeling

WR Mechanism of Collagen RemodelingWR Mechanism of Collagen Remodeling BeforeBefore

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

WR Mechanism of Collagen RemodelingWR Mechanism of Collagen Remodeling Immediately AfterImmediately 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.

WR Mechanism of Collagen RemodelingWR Mechanism of Collagen Remodeling 3-weeks After3-weeks After

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

Before

3-weeks After

Side by SideComparison

Before

3-weeks after

Collagen fiber has more chaotic orientation at a depth of 0.5-2mm.

-0.5

-0.0

-1.0

-1.5

mm

Remodeling Depth

What is the end pointWhat 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

Part IIPart II

Treatment Tips and ParametersTreatment Tips and Parameters

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)

Facial TreatmentFacial Treatment ZonesZones

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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2

3

4

5

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Parameters (1)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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5

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Parameters (2)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.

Anchor PointsAnchor Points

Anchor points contribute to better skin tightening and face shaping.

Anchor points should be treated with more passes to reach stronger edema.

Treatment Procedure (1)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.

Treatment Procedure (2)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.

Treatment Tips (1)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).

Treatment Tips (2)Treatment Tips (2)

Don’t 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.

Post-treatment CarePost-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.

Part IIIPart III

Management of Patient ExpectationsManagement of Patient Expectations

Patient Expectations (1)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.

Patient Expectations (2)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

Patient Expectations (3)Patient Expectations (3)

Clinical indications according to treatment efficiency:

1. Nasalabial folds 2. Skin tone3. Pore size4. Acne scars5. Neck6. Peri-orbital and peri-oral wrinkles7. Eyebrow positions

Combination TreatmentsCombination 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.

Treatment EconomicsTreatment 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.

Dr. A. Del Giglio, Italy – Neck Treatment

Dr. A. Del Giglio, Italy – Peri-orbital Lines

Dr. M. Kulick, CA, USA, Face Treatment

Dr. M. Kulick, CA, USA – Face Treatment

Dr. M. Kulik, CA, USA – Peri-oral Wrinkles

Dr. Hidemi Akai, Japan – Face Tightening

Dr. H. Akai, Japan – Skin Tightening (“Hip Lift”)

After 3rd treatmentAfter 1st treatmentBefore

Dr. E. Mihara, Japan, Face Treatment

Dr. E. Mihara, Japan – Acne Scars & Pores

Dr. E. Mihara, Japan – Acne Scars & Pores

Dr. E. Mihara, Japan – Skin Tightening (Hip “Lift”)