Optimal settings on Infini RF treatments for acne scars. (photos)

Question

I had my first Infini RF treatment on 12-9-16 for 20 y.o. acne scars. My esthatician did 3 passes at 2.75, 2 and 1.5 mm -- all set at level 3 with 200 pulse rate. I told her that I had read that it should be more aggressive for scars, maybe 20 at 400 PR? She said new studies prove the lower setting is better for acne scars with a PR of 200. Is this accurate? I can't afford more than 3 treatments and I want the best results possible. I appreciate any elaboration from professionals.

Jeff Rapaport, MD · Answer

Two additional issues need to be considered when determining treatment protocol. The number of passes at each level is important. Concomitant use of subcision with infini is a helpful addition for deeper scars. Find an acne scar expert with experience in infini.

Jason Emer, MD · Answer

Acne scarring requires a combination approach to get the most improvement. I recommend a combination of lasers, microneedling/prp, subcision and fillers. The infini is a popular treatment, but I also recommend the Intensif because the needles are non-insulated and it gives more robust results. I recommend getting a formal evaluation with an acne scarring expert for the best results. Best, Dr. Emer

Katherine Dee, MD · Answer

Those settings are reasonable for a first Infini treatment for acne scarring. There is a software upgrade that allows you to toggle between these manual settings and a set range of recommended settings. The new settings do not raise the overall power above 3-4. It was found that higher energy levels do not improve outcomes. Instead, the pulse duration is increased at this lower energy level to increase the spread of damage in the dermis. So a pulse duration of 200 ms for the first treatment is reasonable. The first session is always the more difficult, both in terms of discomfort and recovery. I usually treat more aggressively for subsequent treatments when patients can better tolerate it. In general, it is recommended to use a longer pulse duration at the deeper pass, and decrease the pulse duration for shallower passes to protect the epidermis. The new software allows you to do this with minimal button pressing (rather than keeping one pulse duration for the entire treatment).

Hang in there! Infini is the best treatment for acne scarring! And the results just keep looking better and better for about 6 months after you are done!

Hang in there! Infini is the best treatment for acne scarring! And the results just keep looking better and better for about 6 months after you are done!

Jason Pozner, MD · Answer

I completely agree with Dr Weiners answer. He has the most experience in the US with the Lutronic Infini device. We both have helped the company with settings and protocols. For clarification the depth of the needles is in mm and the settings you had seem ok for acne scars. Level 3 is the power and that's our go to level these days - higher appears to be counterproductive. The last number is not the pulse rate but the pulse width - or how long the energy is applied to the needles - the bigger the number the longer the energy is applied to the needles. Generally this number is higher for deeper settings and lower as you get closer to the skin. You probably should have the pulse width increased as per Dr Weiners suggestion for the deeper passes.

Steven F. Weiner, MD · Answer

There is a new interface that most should have. The treatment levels are now low, medium, and high. However, if that is not available, TL should be 3-4 with pulse duration of 300-400ms (for the deeper treatments). It has been shown that higher TL are actually counterproductive and don't improve energy delivered. The higher energies cause too much heat and the tissue coagulates around the needles, preventing spread of the heat. Lower energies with longer pulse durations lead to larger areas of coagulation and more effective treatments. The depths appear to be appropriate. In general, as one gets closer to the surface, the energy and pulse duration must be decreased so as to protect the epidermis. (It is not true that Intensif gives more robust treatments as stated in another physician's comments. With ininsulated needles, the epidermis is at risk to hyperpigmentation, scarring, and prolonged healing. Energy levels have to be less to prevent this. If this type of treatment is desired, Infini is capable of superficial treatments without the benefits of its insulation if the needles are set at 0.5mm. In my opinion, at this level, lasers are better because the inguries/coagulation zones to the epidermis are smaller and the risks are less. By placing deeper energy and using insulation, the energy can be extremely high with minimal downtime and risk- the basis for the success of the Infini. )

Optimal settings on Infini RF treatments for acne scars. (photos)

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