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A new treatment algorithm for the ThermaCool radiofrequency energy device is producing improved cosmetic results with a reduction in pain and adverse events, Michael Kaminer, M.D., said at a symposium on cutaneous laser surgery sponsored by SkinCare Physicians of Chestnut Hill.
"A year ago we were doing most treatments with one single pass over the face and trying to use as high an energy setting on the machine as our patients could tolerate. The concept was, since we're only going to go over the face once, we should give it as much heat as we could. But it hurt the patients a lot, and it wasn't working that well, so out of necessity we had to rethink this strategy."
Dr. Kaminer, a dermatologist with SkinCare Physicians of Chestnut Hill, Mass., said that he and some of his colleagues discovered the value of performing multiple passes with lower fluences when using ThermaCool (Thermage Inc.). He explained that in the past, roughly 70% of patients had marginal and variable results or did not respond to treatment at all, but the numbers have reversed with the new treatment algorithm; 70% now show good results.
"I call it the Thermage treatment triad—which includes controlling the pain, increasing the number of passes, and lowering the setting on the machine," he said.
With adequate pain control, including a topical anesthetic (LMX 5% lidocaine cream), oral lorazepam (Ativan) 1 mg about an hour beforehand, and then an injection of meperidine (Demerol) about 15 minutes prior to the procedure, Dr. Kaminer said patients can tolerate multiple passes over the face, at a lower setting.
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