Will RF microneedling reduce my Voluma on my cheek?

Question

9 months ago I got Voluma in my cheek area that was poorly placed. I didn't seek to have it dissolved right away because of embarrassment/denial. Recently, I had to go to my derm for my yearly and she was horrified. She doesn't like using the stuff that dissolves it and recommended RF microneedling. She said it won't take it totally away but should shrink it. But I cannot find anything that says it will shrink Voluma after 9 months and does the stuff that dissolves Voluma hurt your skin?

Gregory DeLange, MD · Answer

With poorly placed filler, if microneedling RF is used, it could reduce the appearance as advised by your dermatologist but with an experienced injector, I would consider using hylenex to dissolve filler as voluma is a more difficult filler to remove in general due to the new vycross technology which causes the filler to be more resilient to all these treatments. As always, consultation with a board certified plastic surgeon is always recommended as every patient is unique. kh

Jason Emer, MD · Answer

The only thing that decreases fillers is Hyaluronidase.  Morpheus and deep Microneedling RF help to tighten the skin softening the appearance of fillers.
For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

First, let me say that I am sorry that you are going through this. Hyaluronidase, a natural enzyme, is the recommended treatment for treatment adverse reactions to injectable hyaluronic acid-based fillers and injectable volumizers. Although tissue shrinkage can occur with the use of radiofrequency and ultrasound devices, this type of shrinkage does not discriminate between your normal tissue and the injected material. So, I would personally be reluctant to recommend these devices for your particular problem. Admittdedly, robust and thicker volumizing fillers, such as Voluma, require somewhat higher concentrations of hyaluronidase, but in general, it does respond. It is important to bear in mind that although conventional wisdom says that hyaluronidase does not affect normal (non-injected) tissue hyaluronic acid, I have found that it can. So, it is possible that following proper treatment, you may need some filler to correct this. So, you would be wise to consult with a board certified aesthetic physician with experience and expertise with injectable fillers and volumizers. And, of course, make sure that you ask to see his/her personal before and after photos before agreeing to go forward. Best of luck.

John W. Tyrone, MD · Answer

Thank you for your question.  Your dermatologist is correct.  We have found using RF Microneedling will help break down the filler.  It might take a few treatments to break it down to your satisfaction, but in the mean time enjoy the benefits of RF.  We don't recommend it to anyone who has recently had filler and is happy with their results.  Good luck!

Davin Lim, MBBS, FACD - Account Suspended · Answer

The answer is no. Reason is that fillers are sterilised at temperatures over 105 degrees C for over 5 minutes. I published an article regarding this in Derm Surgery in mid 2019. Microneedling RF is an extension of microneedling with ‘energy’. Generation one devices such as Dermapen/ Skin Pen etc. use needles without heat to remodel collagen. Generation Two devices are microneedles that are not insulated, hence heat is delivered along the length of needles. Examples include Secret RF and Intensif. Generation Three devices use insulated needles to deliver heat at the point of the needle. Examples include Infini RF, as well as Genius. 
Newer generation devices will generally give better outcomes, however with insulation, the safety of microneedling RF devices is usually better than generation two machines. With insulation the incidence of skin colour darkening and ‘grids’ secondary to ‘stamping’ is less, however it is largely technique dependent. 
Microneedling RF should be viewed as a tool to be incorporated in the suitable clinical context. As with most other ‘fractional technology’ 3-5 sessions spaced 3-6 weeks apart will give the best results. Be guided by your specialist.  All the best, 
Dr Davin Lim and the team at Clinic Cutis
Brisbane. Australia.

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