The Use of a Fractional Ablative Micro-Plasma Radiofrequency Device in Treatment of Striae
November 2015 | Volume 14 | Issue 11 | Original Article | 1205 | Copyright © November 2015
Vineet Mishra MD,a Lee Miller MD,b Salman M. S. Alsaad MD,c and E. Victor Ross MDb
cUniversity of Texas Health Science Center - San Antonio, San Antonio, TX
bSCRIPPS Clinic, San Diego, CA
cKing Saud University, Riyadh, Saudi Arabia
OBJECTIVE: To evaluate the efficacy of a fractional ablative micro-plasma radiofrequency (RF) device in the reduction of the appearance of abdominal striae.
METHODS: Five female patients (age range, 30-60) with abdomen striae alba (n=4) and striae rubra (n=1) were enrolled in the study. Skin type distribution among the 5 patients was two type II, one type III, and two type IVs. The device (Accent XL, Alma Lasers Inc.) is a radiofrequency fractional platform (40.68 MhZ) that deploys multiple conical pin electrodes on a moving handheld 6 cogs roller. Four treatments were performed every two weeks with settings based on test spots performed two weeks prior to a full treatment session. Assessment of striae was based on clinical severity of the lesions on a 1-4 scale, with “4” being the most severe. A questionnaire was administered to patients with possible subjective responses ranging from 0-4, with 0 being no improvement and quartiles from 1-4 (1= mild improvement, 2= fair improvement, 3= moderate improvement, and 4= marked improvement, respectively).
RESULTS: Three months after 4 treatments, a mean improvement of 20% was achieved (mean severity score changed from 2.9 to 2.5). Micro-wounds were approximately 200 μm wide on the surface, initially presenting as small gray “dots” and evolving into black dots lasting about 2 weeks. Mean pain was 2/10. Erythema and edema persisted for about one day. No pigmentation abnormalities were observed at the final evaluation. The results from the patient questionnaire revealed a mean score of 2.4/4, thus falling in the range of good to very good.
CONCLUSION: A fractional ablative micro-plasma RF roller device can improve improvement in the appearance of abdomen striae. J Drugs Dermatol
Ablative fractionated laser resurfacing has become popular due to the potential adverse effects associated with traditional ablative resurfacing.1 Instead of producing
confluent thermal damage, fractionated devices create columnar microthermal treatment zones (MTZs) that leave up to 95% of the cutaneous surface intact, providing an endogenous
reservoir for rapid healing and barrier to infection.2
Ablative fractionated microplasma radiofrequency (RF) devices use unipolar RF technology, a variant of monopolar RF, to create minimally ablative cutaneous microperforations. The discharge of high-frequency electromagnetic radiation that characterizes unipolar RF leads to the ionization of nitrogen atoms in the space between the skin surface and roof of electrodes, forming a gas-like state known as plasma. These microplasmas create superficial cutaneous microperforations between 100-150 μm in depth and 80-120 μm in diameter.3
Striae distensae is a common, therapeutically challenging cutaneous
disorder with significant cosmetic and psychological implications. Progressive or continuous mechanical stretching forces, such as those encountered in pregnancy, corticosteroid
therapy, or obesity, have commonly been implicated.4 Early inflammatory
processes, including macrophage activation and release of elastases from mast cells, characterize striae rubra, with an evolution toward superficial and mid-dermal elastolysis, disordered collagen, flattening of the dermal-epidermal junction,
and epidermal atrophy in striae alba.4,5 Pulsed-dye lasers, microneedling, ablative and nonablative fractionated lasers, and monopolar, multipolar, and bipolar RF devices, including fractionated microneedle RF technology, have been reported to improve striae distensae with limited adverse events.6-11 Treatment
with microplasma RF devices may lead to improvement in striae distensae via epidermal and dermal thickening, with increased density and organization of collagen fibers.12
The prospective study was approved by the Scripps Clinic institutional
review board. Study participants were recruited from a laser and cosmetic dermatology practice. Inclusion criteria
for participation in the study included: exhibiting clinically documented stretch marks limited to the abdomen of either gender with an age range of 21-75. Exclusion criteria included: active bacterial or viral infection, impaired immune system,