Why Does Kim Kardashian Love Microneedling RF?

Dr. Furnas (00:07):
Kim Kardashian said Morpheus is a game changer. Besides a character in the Matrix, what in the world is Morpheus? Welcome to Skintuition. I am Heather Furnas.

Dr. Korman (00:22):
And I'm Josh Korman. From pimples to wrinkles, our skin affects how we feel about ourselves. As two plastic surgeons, we discuss what's new, what's safe, and what to look for when you're ready to hit refresh.

Dr. Furnas (00:36):
So Josh, what is microneedling RF? That's kind of the topic of the day.

Dr. Korman (00:43):
Well, that's a combination of things. I think we have to kind of break it down, literally break it down to like what's microneedling and then what's RF. I mean RF stands for radiofrequency, but microneedling. Let's talk about that first because a lot of people are focused on that. So what is microneedling?

Dr. Furnas (00:59):
Yeah, well it sounds kind of creepy with uh, you know, thinking of needles, but the, the key is the micro. So these devices that do microneedling, RF and microneedling itself have heads with little tiny needles that will go millimeters into the skin. And what does that do?

Dr. Korman (01:21):
Well, I think it probably cause a little bit of a reaction. I think that's how it always works with the skin. Like you want the right amount of reaction but not too much amount of reaction. So I think they create little microscopic injuries to the skin and that stimulates collagen. The trick word everybody wants to hear about is collagen. So what does it do?

Dr. Furnas (01:48):
Yeah, collagen is, of course  a protein that is common in our skin, but it comes in different forms. There is a very youthful collagen and there is collagen that is a little bit older. And when skin is injured it really revs up that collagen formation response rate as well as some elastin. And so that ends up rejuvenating the skin.

Dr. Korman (02:16):
So why are there all these things that, you know, they talk about rejuvenating the skin and you can see like in chemistry experiments they, the histology, the under the microscope. But how do we know what's, right skin is, so it's the biggest organ in the body, but it's so confusing cuz there's so many skin types. How do we know whether it works for us? Like what is microneedling good for? Is it good for darker skin, lighter skin or maybe all kinds of skin?

Dr. Furnas (02:45):
Well that's a great question because actually it's heat in a lot of devices that will cause depigmentation or scarring in darker skin. And the nice thing about microneedling is that it's not actually heating the skin. So that brings us to the radiofrequency cuz radio frequency is a certain type of energy wave, an electromagnetic wave that does heat up. But the microneedles in microneedling RF are insulated. So the, the needles go through the skin and the RF has a very long wave so that it can penetrate deep.

Dr. Korman (03:30):
Well that is interesting. Radiofrequency is kind of the energy of the decade. There are so many devices that are used radiofrequency, some are external, some are internal. It, it seems to be very popular. I think like you said, it's popular because it's pretty effective and does not cause a lot of damage unlike shorter wavelengths like microwaves or even visible light waves, the sun, things like that. But radiofrequency can target and pinpoint and without much damage cause a lot of tissue reaction and that's why radiofrequency is so popular. So if we're trying to understand radiofrequency, so when it says microneedling RF, so can you take us back just a little bit, Heather and explain. There were lots of microneedling devices. Is, were they not working well enough or does this make it, is this like supercharging microneedling?

Dr. Furnas (04:31):
Yeah, I would say it's a really supercharging microneedling because the, the microneedling is still doing its microneedling job and that is causing minor, minor little channels of injury into the skin. So we get that going, we get the inflammatory reaction, but then we heat the skin up or rather, the deep skin and in some of these machines that they, the needles can actually go into the fat and reduce the fat, which brings us to... What in the world is Morpheus?

Dr. Korman (05:07):
So just before we get to Morpheus, I want to know if it's gonna hurt. I wanted to like Morpheus from the Matrix, you know, he's a, and Morpheus the god of sleep, these are all interesting questions. But what is Morpheus? And I think the other next question that I'd like to know is, does it hurt? It sounds all interesting, but how does it work? And did I say does it hurt?

Dr. Furnas (05:32):
<laugh>? I actually had, not Morpheus, but another type of microneedling RF called Scarlet with microneedles are a little bit shorter than the Morpheus. And I put topical ointment on for a full hour. It was actually a little bit over an hour and that really made it a like a, on a scale of 10, I would say a one, maybe a two. It was extremely comfortable to go through. I had a series of four, which is pretty typical, three to six spaced by four to six weeks apart. And so that just tightens the skin kind of gives a little bit smoother look. It's not gonna be the same as surgery, but it's a great non-surgical approach to rejuvenating the skin.

Dr. Korman (06:27):
So full disclosure, I've had two Morpheus treatments and half an hour after we finish this podcast, I'm supposed to have my third treatment. And so I've had it. So it's actually, I think having the numbing cream on for about half an hour before or 45 minutes helps. And the other thing I found helps a lot is something called pronox. And pronox is basically laughing gas like they have at the dentist. And it's in a lot of aesthetic offices now, and you can, it's, you decide how much you want to breathe in of it, it's not addictive and you can uh, in normal situations and you can drive after like 10 minutes. A lot of people don't need it. I actually tried it with it and without it. And it, it's not that it that pronox helps so much it, but it, it doesn't take the pain away so much as it makes you forget that you care about the pain.

(07:19)
But it is really, it's not that painful. I didn't find Morpheus that painful. And the other thing that was really good that works with these microneedling radiofrequency devices is something called exosomes, which we talked a little bit on a previous podcast, but we can review that in a second. But let's get back to your question. What is Morpheus? So Morpheus is a radiofrequency microneedling device that works on the face and works on different areas of the body and the needles go a little bit deeper and in the area of the stomach, for example, it can work on the fat. It's not the same thing as liposuction, but it actually, I mean that's what Kim Kardashian, she had it on her stomach and she raved and raved about it. I find that it's been really helpful for people on their faces in a lot of, in a lot of ways. And actually it, the recovery is is pretty fast. And so I used to have a nurse that used to say there's nothing worse than a man in pain. But I would tell you I'm living proof that it's not that painful and I've had it, which is why I'm gonna have one more to complete the three treatment package.

Dr. Furnas (08:26):
Yeah, and I would agree my Scarlet was not bad at all and it is a very easy procedure to recover from because there is no downtime. Nobody could tell I had anything done. I think I looked like I had just a maybe a day in the sun or something. And it's, it's really the got a low complication rate, uh, compared to something like laser that where a, a laser can be, when aggressively done, can be associated with more side effects such as, you know, hyperpigmentation or even in the extreme case scarring. Lasers great, but radiofrequency really has a place because we can do it, as you said Josh, and people who are not great candidates for laser, uh, some people with dark pigmentation for example, are just much better candidates for radiofrequency.

Dr. Korman (09:26):
So my question, this was my question even before I did it, was how long does it last? So what'd they tell you when you had your Scarlet treatment? <laugh>?

Dr. Furnas (09:36):
Well come back, <laugh> come back for, you know, like one treatment a year is typically what people will do. It really varies on what your goals are and if you want to continue to improve, you could certainly take a break and have more than one in a year. You could have, you know, another series in a year. But typically we think of maybe six months one, uh, at six months. And, and certainly within that year,

Dr. Korman (10:06):
I think what I found is probably the biggest uh, result is it improves the texture. I think that's what it's really good for. It's good for texturing, it's good for a lot of things. You know, some of the benefits of radiofrequency microneedling improves acne or surgery scars. It can reduce fine lines and wrinkles, it can reduce the appearance of hyperpigmentation, it can reduce the appearance of stretch marks. It helps with dull or uneven skin tone. It sounds like everything that, all that ails you, shrinks in large pores, helps with loose skin, you know, in moderation, it reduces cellulite, firms upper eyelid skin and smooth lines on the upper lip skin. Wow. It sounds like the miracle, the miracle machine, the miracle technology, and obviously it's not a magic wand, but I think it does improve a lot of things without much downtime, without much panic that oh my gosh, I gotta not go to work.

(11:03)
I think it has a lot of, a lot of benefits. I think it's another example of in non-surgical technologies, the combination of different devices seems to be synergistic. And I think we've seen that a lot with, with different things like CoolSculpting and Emsculpt and to give you an example, but it, it's these combination treatments are really, can be very beneficial. And I think it's proven that there's so many different devices on the market because microneedling is tried and true and, and uh, radiofrequency has been used for a long time. So combining them has really, I think made people pretty happy. Both practitioners and their patients.

Dr. Furnas (11:47):
Exactly. I think, you know, you mentioned hyperpigmentation, of course you'd want to take products along with having the treatment done. Sometimes additional peels can help with that chemical peels and so oftentimes they do work synergistically. I think a lot of times people come in just thinking, I just want one treatment and I want it to last forever. We certainly see that with surgery and, and people are shocked when we say, you know, you really need these non-surgical treatments in order to enhance surgery. And they say, I want something permanent, I just want surgery. And surgery also benefits from these non-surgical things that surgery just can't replicate.

Dr. Korman (12:33):
Yeah, I, so I think we need to talk a little bit about the actual mechanics of the treatment. So how long, like what should it feel like? I can tell you for me it felt like a little bit of a sunburn, but really not too bad. What did you find in your treatment in terms of swelling?

Dr. Furnas (12:51):
I had swelling that I could barely see myself. And if I were to walk into a room full of people, even people who knew me, it would be hard for them to see that I had anything done. So for me it was really like a come and go type thing. I know that's not true for everyone. Some, some people get more red, uh, you know, have a little bit more swelling and you can use an LED light to soothe the inflammation. Uh, certainly elevation that night and, and you want to use sunscreen and stay out of the sun initially, but you can exercise the next day. I probably wouldn't go running right after the treatment, but it's truly a minimal downtime you can really carry on your day. 

Dr. Korman (13:41):
And what about exosomes?

Dr. Furnas (13:43):
Oh exosomes, we were talking about this the last time. They're like these little lipid sacks that are contained within cells and they're packed with growth factors and things that really help with healing and rejuvenation. There's a lot we don't yet know about what exosomes can potentially do. They can be injected, but in this case we use them topically because with the microneedling we have these miniature micro injuries and so the exosomes can go right into those small channels of open wound and really help with the healing. It's interesting, when I had exosomes placed, the physician's assistant who did mine noticed that she had not put exosomes and one little corner just by the angle of my jaw and she showed me how there was so much more redness there than where she had put the exosomes. So they really keep the redness down. Patients love it. The practitioners in our office absolutely love it.

Dr. Korman (14:52):
Yeah, I think it's, it's pretty cool. So when you say it's put on, it's like a cream, right? You just kind of 

Dr. Furnas (14:58):
Yeah. 

Dr. Korman (14:58):
Wipe it on? Yeah?

Dr. Furnas (14:59):
Yeah, just kind of massaged in and that way it can penetrate the treated area.

Dr. Korman (15:06):
So if we're trying to figure out, like if somebody's trying to figure out, okay, is Morpheus or microneedling or microneedling RF, why shouldn't I do it? What, what would be the reasons I shouldn't do it and, and how would I think that it would be so I'm, I have realistic expectations? That's always the big question. Like how, how do we figure that out?

Dr. Furnas (15:25):
That is one reason not to have the procedure is if you do have unrealistic expectations. Cuz there are some people looking at non-surgical treatments for a surgical result. I just mentioned that with surgery we encourage patients to really maximize their result with non-surgical treatments. But the opposite is true. A lot of people just don't want to consider surgery and yet they expect that their skin is gonna be tightened the way that only a procedure can can happen. I think if you uh, can't do a series, that's another reason not to sign up for microneedling RF because the benefit really builds on each session. And so if you just have one session, you can walk away and say, well didn't work and these procedures are not, you know, they're, they're not cheap. The microneedling can go from anywhere, depending on the treatment, the duration where you are from $700 to up to a thousand or 20, uh, $2200 per session. I mean there's a broad range and so you want to make sure that your expectations are in line with what really can be accomplished and that you do commit to that series within the recommended timeframe. Don't have one and then four months later have your second and then six months later have your third cuz you're just not gonna see results.

Dr. Korman (17:01):
So if you were going to try to recommend to your friend or your relative whether they should do it in the summer, in the winter, I mean here we are in the winter, in the spring, like do you want to do it ski season, or not ski season? What do you think?

Dr. Furnas (17:17):
It really depends on your lifestyle and your activities. We certainly have people who do it in the summer and they are able to stay out of the sun. You made a good comparison within the winter everybody says, oh winter's a great time to do it, but not if you're on the, the ski slopes every weekend. So it does mean that you do need to avoid the direct sunlight. You wear hats and sunscreen and UV protective glasses and that type of thing. But it can be done really any time of year as long as you take precautions.

Dr. Korman (17:54):
And can you do it at the same time or would you do it at the same time or have at the same time as Botox, or before Botox, after Botox? And when I say Botox, I of course mean Botox or Daxxify or Dysport or all the other many, as we've talked about those, neuromodulators from another podcast.

Dr. Furnas (18:14):
Well I wouldn't do it at the same session. The reason is that you do swell to some degree and when you inject a neuromodulator, the neuromodulator can travel with the swelling and so it can impact more muscles than the injector actually intended. So I would have Botox typically two weeks before, two weeks after. And filler is best done at another session. If you're, you know, that you want to do both, I would do the filler afterwards so that you don't have the heat above the filler cuz there can be a little bit loss of filler with heat. Certainly I wouldn't do it at the same session starting with the microneedling RF followed by the filler.

Dr. Korman (19:02):
And then what about, what kind of moisturizer, creams, regular routine would you say people should do the day of the day after, a couple days after a week later? People so often use a lot of stuff on their faces and they layer them, they put stuff on. But what, what do you think? 

Dr. Furnas (19:23):
Yeah, with this it's sort of minimal. We mentioned the exosomes. So that's really a wonderful product. Not everybody will provide it or not every patient's going to purchase it, but it really does promote healing. There are some other sort of recovery products that individual medical grade products will carry. Wash with a gentle cleanser and always, always use sunscreen and that's really it.

Dr. Korman (19:54):
So does the sunscreen do anything since I assume with these microneedling you get the pores are open, so that means the channels are open. So is that a good time to put other stuff in that's gonna help the skin?

Dr. Furnas (20:09):
Well typically we don't put it right after the treatment, but the next day you can put, you know, the exosomes at, cleanse, exosomes, any recovery cream and then the SPF because that the SPF has got to be weighed with no SPF and going to work and being outside. But you do want to have a sunscreen that is well tolerated. You don't want any reaction, any chemical reaction. So oftentimes one with zinc, very low reactivity works very well.

Dr. Korman (20:45):
Would you expect to have any purging, like if you have some acne, like it's, there's an acne setting for on Morpheus for example and probably a lot of different microneedling devices. How would you suggest somebody who has active acne use it? Would you have the treatment, not have the treatment, and what would you put on your face after and would you expect more pimples to come as you recover?

Dr. Furnas (21:10):
I would hold off on treatment with active acne. There are a lot of treatments that we will discuss at another session for active acne to really control that. But you don't want to have something that could lead to an infection. Speaking of which, if you do have a history of cold sores, you would want to take some kind of prophylaxis beforehand, like Valtrex so that you don't, uh, start a reaction, a cold sore reaction associated with the treatment.

Dr. Korman (21:45):
Yeah, I think that antiviral medicine is important for basically any of these treatments, these non-surgical treatments on the face, whether it's fillers and especially lasers. It, it's important cuz you don't want a herpes outbreak is, is can be significant. So better to, to let your clinician know what's what's going on. So if we could, we're trying to wrap up like how, how we choose to use and what, what age group is the right age to use microneedling with radiofrequency.? What, what, what do you think the right age group is?

Dr. Furnas (22:19):
Well, this is gonna be a treatment for, in younger people, acne, acne scars would be appropriate. A lot of people are looking for early anti-aging. So that's gonna be in sort of maybe the late thirties, forties, fifties. And, and then as we enter into the sixties, we can expect some minor improvements, but it's not going to really turn around and the, the aging changes in the face. It can improve but it's not gonna be a radical change. What would you say, Josh?

Dr. Korman (22:57):
I think it's actually good, like you said, for a lot of different age groups. I would also say there's certain people that have really beautiful skin even into their seventies and there's some people in their thirties who skin is more rugged. I would say smoking is a really, is really detrimental to the quality of your skin on your face. And so I would say you stop smoking and drink, be well hydrated. I think these are all things that, that improve. I think the results you'll get from the, these treatments are significantly dependent on a little bit of your genetics but also your lifestyle. I think it's really important to understand that lifestyle plays a big role in what your face looks like and ultimately you can do it early. It's, it's pretty safe and is actually healthy and rejuvenating for your skin. So it's not like if you start it now, you're gonna have to do it endlessly.

(23:53)
No, it doesn't work that way. And it's also if you don't do it, oh it's too late to do it. I think it's important just to, to get expert advice and to not be afraid to look at yourself in the mirror. And as a patient said to me last week when I said they'd look, you know, really good, they said, well it helps if you work at it. And I would say that's a, a motto to stick by. If you want to, if you want your skin and your face to look good, you need to work at it.

Dr. Furnas (24:20):
Just like staying fit. It doesn't just happen. Thank you for joining us. This is Skintuition.