A new rejuvenation procedure based on bipolar radiofrequency energy, evolastin (with e-Prime, Syneron/Candela) is the first minimally invasive energy-based treatment shown to provide an increase in volume, in addition to tissue tightening and lifting. In about an hour in the physician's office, the procedure, which is painless under local anesthetic, utilizes radiofrequency to produce thermal heating that encourages neocollagenesis and the synthesis of new elastin. Patients have shown good tolerability for the procedure and its short period recovery, and satisfaction has been high. Ahead, Amy Forman Taub, MD discusses her experience with the new procedure and patient reaction thus far.

What is evolastin?

The e-Prime system employs a handpiece with detachable cartridges featuring three sets of needles. The needles penetrate the skin at a 25-degree angle, using 32-gauge needles, to create thermal injuries located 1-2mm underneath the skin surface.

There, the radiofrequency energy is released, achieving a temperature of 70oC for four seconds, Dr. Taub explains. The procedure, while considered minimally invasive, is not bloodless. “Light bleeding typically develops at the needle insertion points, although it quickly resolves when treatment is complete,” Dr. Taub observes. Additionally, treatment requires anesthesia, and there is some degree of downtime.

Treatment is applied from the cheek to just below the mandibular line (a few centimeters). “The face is cleansed prior to the procedure using regular cleansers followed by alcohol and an antimicrobial, such as Hibiclens,” Dr. Taub says. “The handpiece is then applied to the treatment zones of the face in a serial procedure according to an established protocol.”

Treatment is administered under local anesthesia, which renders the procedure painless. There is no post-procedure pain. After treatment, the face is cleansed to remove any minor bleeding. Some swelling may be appreciated immediately after the procedure, much of it a result of local anesthetic, Dr. Taub reports. Swelling typically subsides in three to seven days. Pinpoint redness may be seen. Some bruising may develop in the first few days after the procedure, and occasionally raised flesh-colored welts of 2-3mm in diameter form in some treated areas. Make-up can be used to conceal bruising.

The treatment does not produce any epidermal damage, per se, however, “patients may notice tiny pin-prick holes in the skin where the needles entered. Small edematous papules can also form. There is no weeping or oozing that may be associated with fractional or full CO2 resurfacing,” Dr. Taub says.

What are the effects of the procedure?

A key difference between the evolastin protocol and other device-based rejuvenating procedures is the visible lifting that occurs after treatment, Dr. Taub says. Whereas several systems currently on the market are able to provide a tightening effect, evolastin with e-Prime is the only one that provides a visible lifting effect, “on the order of 2-3mm,” she says. In fact, Dr. Taub characterizes the effects of treatment as achieving three goals: tightening, lifting, and volumizing.

Results are evident by about three months post-procedure, sometimes sooner, although optimal at six months. Results are anticipated to last about two years, although as experience continues to grow, clinicians may be better able to predict the duration of response based on baseline patient characteristics (such as age and degree of existing damage), Dr. Taub suggests. Given that treatment is shown to induce the creation of new collagen and elastin, there is good reason to expect that cosmetic response may be quite durable.

Perhaps due to the multi-effect nature of treatment, results do not always translate well to standard, two-dimensional photography, according to Dr. Taub. “Patients in my experience have been very pleased with results, even when side-by-side photo comparisons do not seem to reflect the level of improvement they see in vivo,” she adds.

The total treatment time is about one hour, including the time needed to provide local anesthetic and perform the evolastin protocol. Dr. Taub does not find the use of topical anesthetic prior to injection of local anesthetic particularly helpful. However, “I do use a ‘trailing' method of anesthesia injection whereby I feather out the injections from an area already injected,” she says. Working “downstream” of previous injections increases the comfort of subsequent injections.

What has patient response been?

Early patient perceptions of the evolastin procedure are good, with many patients noticing some effects within a few weeks and all patients seeing substantial benefits within a few months, Dr. Taub says. The key differentiating point for this procedure is that it creates volume, which no other device-based procedure has been shown to do, along with tightening and lifting, she suggests. Because volume of the lower face around the mouth and inferior cheeks is effected, patients with loss of volume in this area are the best candidates.

Treatment is minimally invasive but associated with certain short-term side effects, notably swelling and bruising, that will prevent some patients from returning to work or certain events. Other patients may be satisfied to cover bruising with make-up. Because of pain associated with the administration of treatment, local anesthetic is provided, and no pain is felt in the post-procedural stage. “Patients in my experience have achieved high levels of satisfaction and are happy with the procedure,” Dr. Taub says.

Dr. Taub has received speaking honoraria, research funding in the past, and equipment discounts from Syneron.

Amy Forman Taub, MD, is founder of Advanced Dermatology  and Skinfo® Specialty Skincare Boutique in Lincolnshire, IL , a suburb of Chicago. Skinfo and skinfo.com, a professional skincare website, offer physician-dispensed and cosmeceutical- grade skincare products and product information to the public. Dr. Taub is an Assistant Clinical Professor at Northwestern University Medical School.