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Radiofrequency (RF) is a mainstay in medical aesthetics thanks to its thermic effect on skin. RF-based treatments lead to the improvement of the appearance of aging skin with collagen stimulation and elastin production deep in the dermal layers for ongoing results. Popularity of RF is only increasing due to its effectiveness as well as the lack of downtime that today’s busy patients demand. Persistent efforts from aesthetic physicians to provide greater treatment results with fewer complications and little to no downtime have contributed to the overall rise of energy-based devices.
According to the latest market research, RF-based aesthetic devices are a leading category, with a market size that is expected to grow at an estimated compound annual growth rate (CAGR) of 12.11% between 2023 – 3031, to reach over $3.7 million by 2031.1 Today, RF microneedling devices are a staple in many cosmetic offices thanks to their versatility and ability to rejuvenate the appearance of aging skin.
Sylfirm X RF Microneedling System
Rising to meet consumer demand, the proprietary Sylfirm X device by BENEV (Mission Viejo, Calif.) is an FDA-registered pulse wave (PW) and continuous wave (CW) RF device that targets skin laxity and pigmentation for ultimate skin rejuvenation. With over 25 clinical studies, the Sylfirm X has adopted a system using bipolar, non-insulated microneedle electrodes to target the dermal layers with a uniform electric field to maximize treatment results. According to Suneel Chilukuri, MD, dermatologist and director of cosmetic surgery at Refresh Dermatology, there are 20 different RF microneedling devices in the U.S. that are approved by the FDA. All of them are slightly different, but Sylfirm X is the only RF device with two very unique features. “It allows for a penetration of 300 microns, which is ideal for treating pigment issues or erythema, and penetration that reaches up to 4 mm to promote color correction and collagen remodeling,” he explained. “Most RF microneedling devices offer continuous waves rather than a pulsed wave, but Sylfirm X offers both.”
With these exclusive features, physicians can treat more patient concerns on a wider range of skin types. But the Sylfirm X offers even more. “Each needle tip has a polarity to it, allowing it to go between positive and negative energy,” Dr. Chilukuri continued. “The effect is that we can lift the skin and reset it. With the Sylfirm X, I can lift where the cheek sits, lift the skin of the neck and even lift the fascia of the frontalis to provide an appearance similar to an eyebrow lift.”
TJ Tsay, MD, medical director and owner of Ageless MD (Tustin, Calif.) pointed out that Sylfirm X uses non-insulated tapered needles that deliver efficient energy to each individual needle, creating a teardrop coagulation zone around the needle. “This offers the best skin tightening and collagen stimulation possible,” he said.
The ‘Na Effect’
Sylfirm X was the result of research by leading Korean dermatologist Jongiu Na, MD, who found that tapered needles deliver more energy to the needle tip, while limiting the energy to the skin’s surface.
As Dr. Tsay explained, “The ‘Na Effect’ is the result of focused, independent tissue coagulation around each microneedle electrode. While other RF systems produce a widespread area of coagulation – leading to an ineffective treatment – the ‘Na Effect’ of Sylfirm X allows for more efficient RF energy to be utilized to its full potential.”
Gretchen Frieling, MD, owner of GFace MD (Wellesley, Mass.) described the importance of the ‘Na Effect’ for dermatologists and their patients. “The ‘Na Effect’ identified by Dr. Na describes the independent electrothermal coagulation around each electrode of bipolar RF,” she explained. “With the non-insulated microneedles, you have complete coagulation in the dermal layer, immediate contraction of old collagen fibers and long term neocollagenesis. There is no thermal damage in the epidermis, no bleeding and no downtime. And because of its ability to penetrate 300 microns deep, SylfirmX is the only device that can treat the epidermis, basement membrane and papillary dermis at the same time.”
Science and Technology of Sylfirm X
According to H. William Song, MD, founder and medical director of Omni Aesthetics (Oakland, N.J.), there are several features that allow Sylfirm X to achieve targeted results with little risk and little to no downtime. “The energy delivered by this device is very precise, so the risk of complications is much lower than with the competition,” he clarified. “The non-insulated needles, coupled with the precise distribution of energy, deliver lower heat through the length of the needle instead of just the tip. This allows for linear vectoring, which is not possible with insulated needles that deliver a lot of energy.” Dr. Song also mentioned that the needles stay sharp and are thinner and stronger, allowing smooth insertion and a treatment that is less painful than the staple-like stamping movement of some devices.
Sylfirm X is equipped with four CW modes and four PW modes, each supported by numerous clinical studies that show the efficacy and safety of the device.2 CW modes result in a greater delivery of stable RF energy for wide, independent coagulation around each electrode, from the deeper dermis to the upper dermis. The result is optimal skin revitalization for firmer, more youthful looking skin. PW modes target fibroblasts to strengthen the base membrane and reduce abnormal blood vessels with no noticeable effect on surrounding tissue. Physicians are also noticing the technology of the device. “The actual physical platform of the device is aesthetically pleasing, and the screen is very user friendly,” Dr. Tsay began. Whether you want to deliver a CW with a shorter pulse width, or address more vascular lesions, or inflammatory acne with the CW mode, the parameters can be easily adjusted.
“I also like that there is not a shot count limit for each tip as in other RF microneedling devices I have used in the past,” Dr. Tsay continued. “So I can deliver as many shots as I want for each patient without worrying about reaching a limit, which then forces you to purchase another tip by a certain number of shot counts.”
Sylfirm X Treatment Protocols
Dr. Tsay shared that the Sylfirm X is a staple treatment in his office because it benefits patients of all age groups and skin types. “I can treat the 20-year-old patient with acne scars or inflammatory acne, 30-year-old patients with rosacea and large pores on their T-zone and 40-year-old patients with mild to moderate laxity,” he explained. “The 50- to 60-year-old patients that have deeper static rhytides can also see improvement with minimal downtime.”
Renato Saltz, MD, a board-certified plastic surgeon, and Michelle Young, a licensed master aesthetician at Saltz Spa Vitoria (Salt Lake City, Utah) use the Sylfirm X because of its versatility in treating a wide variety of patient concerns. They also appreciate that the device is comfortable and easy to use. “This device allows us to treat eyelids, which can be difficult, and has given us a scar treatment option,” Dr. Saltz shared. “We also have protocols and treatment plans that combine Sylfirm X and exosomes for my facelift patients. It improves my surgical outcomes and adds longevity to my results. Overall, this is a great addition in modern facial rejuvenation surgery.”
“We recommend one to three treatments per year for a deep, firming treatment,” Ms. Young noted. “Patients will see the effects of firmer skin with clearer skin tone and reduced redness in two weeks following the treatment. Scars will be softer, smaller and lighter in color. In addition, we use BENEV exosomes to shorten healing time, reduce inflammation and for a greater tissue build response due to the growth factor in the product. I put them in the refrigerator, so they are cold when applying, which feels nice, as well. I use half the bottle and send the other half home with them.”
Dr. Frieling shared that she has several specific protocols using Sylfirm X. “I recommend it with exosomes one week after poly-l-lactic acid (PLLA) treatments,” she mentioned. “For patients under 45, we recommend a threeweek interval between treatments. Over the age of 45, we recommend a minimum of four weeks, specifically to allow the fibroblasts to receive the signals to appropriately respond to the treatment. We apply exosomes after every treatment. BENEV exosomes are paramount in scar remodeling, skin rejuvenation, pigmentation regulation and hair growth. We also recommend intense hydration and repair serums after the treatment.”
“I often use Sylfirm X for patients with skin type V with icepick scars,” said Dr. Tsay. “In a typical treatment protocol, we would recommend four to six sessions using the CW mode with three passes spaced four to six weeks apart. We automatically bundle BENEV’s Exosome Regenerative Complex + (ERC+) exosomes as part of their treatment because it significantly reduces recovery time and calms down the skin’s inflammation after the treatment is done.”
Exosome Regenerative Complex and Exosome Regenerative Complex +
Exosomes are vesicles, rich in proteins and bioactive molecules that are responsible for cell-to-cell communication and facilitating the exchange of important proteins like ribonucleic acid (RNA) between cells. They have been studied in a wide range of skin conditions, including skin remodeling and wound healing, contributing to their advancement in medical aesthetic applications.
Exosome Regenerative Complex (ERC) and (ERC+) are unique in that the exosomes are powered by Exo-SCRT™ technology to separate and refine pure exosomes from stem cells. The result is a topical treatment that can be safely used to improve post-treatment healing or as a standalone and powerful regenerative treatment. These clinically proven, dual action complexes are post-care cosmetic solutions for topical use to promote a more youthful appearance.
Containing isolated and purified exosomes, both ERC and ERC+ are reportedly the only cosmetic exosomes that have been accepted by the Personal Care Products Council (PCPC), and International Cosmetic Ingredient Nomenclature Committee (INC). Also, the name ‘Human Adipose Stromal Cell Exosomes’ was given and published in the International Cosmetic Ingredient Dictionary and Handbook (INCI book). With a shelf life of two years, these highly absorbable exosomes contain the necessary vital components such as growth factors, peptides and amino acids to improve the quality of skin cells.
According to the company, BENEV exosome products promote skin cell proliferation by up to 80% in a dose-dependent manner. ERC+ can be used to hydrate skin and promote a more radiant complexion but is also effective for hair regeneration as it noticeably reduces hair shedding while promoting a healthy hair growth cycle.
As Dr. Frieling mentioned above, she uses ERC after every treatment. “We apply them in quadrants after the area has been treated,” she said. “We prefer to use a SteriTip® to apply them, which allows even distribution in a clean manner.”
Dr. Chilukuri incorporates both Sylfirm X and ERC+ into his hair regeneration treatments. “BENEV exosomes are the only exosome technology that we have seen with shortterm and long-term healing effects. I utilize the exosomes for hair regrowth,” he reported. “Platelet-rich plasma (PRP) is an effective treatment for hair restoration. In the past, I relied on PRP, but the problem is that some patients may not be ideal candidates. For example, if somebody previously used an anti-inflammatory, if they recently used aspirin or anything else that is going to affect platelet activity, they may not get as spectacular results if we use it immediately after a Sylfirm X treatment. But the ERC+ exosomes are consistent.”
“In my hair regeneration protocol, I apply the Sylfirm X at low energy settings into the scalp,” Dr. Chilukuri continued. “I then apply the ERC or ERC+ and with that we are getting incredible hair growth within a very short period of time; within about two, sometimes three treatments. This protocol has shown spectacular results for our patients.”
Patient Results
Sylfirm X standalone treatment results and patient reactions are truly impressive. “With treatments we are seeing the entire skin looks like it has been lifted up. It looks healthier with an improvement in skin luminosity,” said Dr. Chilukuri. “These treatments are very versatile, and I can effectively treat fine lines, even for patients with very fair skin types. We are also seeing an improvement in acne scars as well as lifting and improvement of the skin of the neck, so it does not look saggy. We see some change right after the first treatment, but the results do improve over time, especially about a month after the first treatment.”
Dr. Song has also noticed his patients’ reactions to Syfirm X treatment results. “Patients notice improvement in texture, pigment and pore size as well as tightening and lifting. It is important to let the patient know before the treatment that the full results take time and will continue to improve with each subsequent treatment. We also let them know that maintenance is required to keep up with the results,” he noted. “Results get better over time but sometimes patients can see lifting and tightening immediately after the treatment. For the first treatment, it is helpful to do one side of the face first and then have them sit up and see the difference between the treated and untreated sides.”
In Dr. Song’s opinion, patients should consider maintenance treatments in accordance with their lifestyle and rate of aging. “A younger patient who takes good care of their skin may want to do one treatment every year to maintain results, whereas the older patient who does not really do anything else may want to get a maintenance treatment every three months,” he added.
“We are seeing phenomenal results from resurfacing, tightening and dermal rebuilding aspects. We see brightening of melasma and lentigines,” reported Dr. Frieling. “By treating the entire thickness of the skin, you fortify the skin structure and integrity while also inducing neocollagenesis and dermal remodeling. With the addition of exosomes, we believe this is the strongest and most impactful anti-aging treatment available in the U.S. We also see significant improvement in scars, dermatitis and wound healing. Patients love this treatment! They are thrilled that it is not painful and that there is essentially zero downtime.”
Conclusion
Incorporating Sylfirm X into an aesthetic practice improves the patient experience and can extend benefits to an aesthetic business. According to Dr. Song, it provides his practice with an extra source of revenue which does not require the physician’s time. “Sylfirm X has been the best way for me to scale my practice using physician extenders,” he clarified.
Dr. Frieling concurs and added her take on the benefits. “It has allowed us to maximize the skin health of our patients, and as a dermatopathologist, this is of utmost importance to me and my team. It has demonstrated a powerful anti-aging technology that has improved our patient results and satisfaction.”
With the versatility of Sylfirm X, along with ERC and ERC+ topicals, BENEV continues to demonstrate its commitment to delivering technologies that exceed expectations and empower aesthetic physicians to offer patients the best in skin rejuvenation. With BENEV the future of aesthetics is happening now.
References:
1. Research, S. (n.d.). Radiofrequency-Based Aesthetic Devices Market Size, Share and Forecast to 2031. Straits Research. https://straitsresearch.com/report/radiofrequency-basedaesthetic-devices-market#:~:text=How%20big%20is%20 the%20radiofrequency,period%20(2023%E2%80%932031).
2. Data on file at benev.com
