Fractora

Fractora (Fractional Rejuvenation & Skin Resurfacing) is the most advanced fractional radio-frequency treatment providing anti-aging improvements on skin tone and texture for a more radiant appearance through ablation and skin resurfacing. It utilizes fractional bipolar radio-frequency treatments in order to achieve the most attractive and efficient results.

Fractora delivers RF energy to the desired area of the skin through an array of pins producing localized heat and small micro-lesion dots in the treatment area. The gentle heat generated by the Fractora pins to the sub-dermal tissue promotes collagen restructuring for skin rejuvenation and an improved appearance in the skin. The methodical scattering of micro-lesions allows the skin to heal faster than if the entire area was ablated.

Ekachai Hospital can offer a versatile fractional treatment that will provide non-ablative to minimally ablative results to the skin up to 1mm in depth.

Fractora can as well be used in areas that exhibit fine or deep wrinkles, scars or discolored red and brown skin tone. The most common areas that get treated are lower eyelids, upper eyelids, smile lines, cheeks and to areas of the mouth and neck.

RF energy gently heats the skin layers in a controlled scheme that transform deep collagen and improve the appearance of the skin.

Benefits

• Fractora delivers improvements in the broadest range of symptoms of aging skin including fine lines, deep lines, texture, pigment irregularities, blood vessels and redness.
• Fractora offers improvements for aging skin that might normally require two, three or even four different technologies.
• Ablation of the skin promotes skin resurfacing while untreated skin between the pins promotes faster healing of the treatment tissue.
• Versatility of parameters allows the user to vary the depth of ablation, coagulation and heating.

Fractora Tips

Small

• For small sporadic lesions (eg acne scars, fine vessels)
• Tip size 2x10mm

Large

• For full face (eg fine lines, textures or small body areas)
• Tip size 6x10mm

Pin spot size 150
Up to 2.5PPS (2.5 Hz)

Indications

• Wrinkles
• Depressed scars (like acne scars)
• Epidermal melanin pigmentation
• Superficial facial spider telangiectasis and skin texture

Contraindications

• Skin type V and VI patient
• Excessively tanned skin from sun, tanning beds or tanning creams within the last 2 weeks
• Pacemaker or internal defibrillator, or other implanted electronic device
• Avoid treatment if intra-dermal or superficial sub-dermal areas have been injected with Botox/Ha/collagen/fat injections or other augmentation methods with bio-material, until the products has been dissipated (up to 6 months), except Botox after binding to the facial muscles (3-7 days). It is possible to treat sooner over injectable products placed in the deep, periosteal plane, as soon as the area has healed (1-3 weeks)
• Current history of skin cancer or pre- malignant moles
• Pregnancy
• History of skin disorders, keloids, abnormal wound healing, as well as very dry and fragile skin
• History of bleeding coagulopathies
• Sever concurrent conditions, such as cardiac disorders
• Impaired immune system due to immuosuppressive diseases such as Aids and HIV, or use of immunosuppressive medications
• Use of Isotretinoin (Accutane) within 6 months prior to treatment
• Use of anticoagulants within 10 days

Possible Adverse Effects

• Possible adverse effects include but are not limited by: discomfort or pain, excessive skin redness (erythema) and/or swelling (edema), damage to natural skin texture (crust, blister, burn), change of pigmentation (hyper- and hypo-pigmentation), and scarring.
• Erythema lasting not longer than 24h and edema for 1-3 weeks is a typical skin reaction to the Fractora treatment.
• Red spots from the fractionally ablated tissue and crusting will appear 1-3 days post treatment and are typical and desirable effect. They will exfoliate naturally after a 1-3 weeks.
• Ocassionally, at energy levels >30-40 mJ/pin, there is a potential low level stimulation of branches of the facial nerve and there will be some involuntary contraction of the underlying facial muscle. This is transient and is not harmful, as the Fractora effect diminishes at the deeper level where parts of the facial nerve lie above the muscles.
• The patient must understand the importance of pre-treatment and post-treatment instructions and that failure to comply with these instructions may increase the probability of complications.

Anesthesia

• For low energy (10-25mJ/pin), topical anesthesia like EMLA may be used in different available lidocaine/prilocaine concentrations (5-10 percent) applied for 30-60min with occlusion prior to the Fractora procedure.
• For medium energy (25-40mJ/pin), local anesthesia, such as injected nerve blocks may be needed 10-20min prior to the Fractora procedure.
• For high energy (40-60mJ/pin), small amount of tumescent anesthesia may be needed 10-20min prior to the Fractora procedure.
• Use of cooling during treatment, such as air cooling, may give additional relief.

Desired Treatment Effect	RF Energy (mJ/pin)	Number sessions	Delay between sessions or (week)	Downtime Days	Clinical Improvement
Superficial Ablation	10-25	3-5	3-4	None	Texture, tone, very fine lines
Moderate Ablation	25-40	2-3	4-5	2-3	Texture, tones, pigment, fine lines
Deep Ablation	40-60	1-2	5-6	7-10	Texture, tones, pigment, fine lines, fine vessels, wrinkles, acne scars

Treatment Schedule
The number of treatment sessions depends on the individual patient, desired results and
treatment aggressiveness. Treatments are typically repeated every 3-6 weeks, depending on treatment depth. It is recommended to schedule follow-up session 2-3 days after the treatment to ensure a safe healing process. Treatment should be concluded when the results are satisfactory to the patient or according to the physician’s discretion. Generally 3-4 sessions are needed for mild to moderate depth settings. It is not typically recommend performing more than 5 consecutive sessions. In some instances, 1-2 sessions may be sufficient.

Indications

• Emollient cream should be applied immediately to the treatment area.
• Cooling the skin area can reduce discomfort
• Antibiotics may be prescribed if infection is suspected or as a prophylactic measure.
• Occlusive dressing may be used
• Tiny scabs may appear after 1-3 days and stay for several days following the treatment. The scabs should not be touched or scratched even if they itch, and should be allowed to flake off naturally.
• Blisters may be treated with a prescribed antibiotic ointment or burn treatment cream as per physician’s discretion.
• During the first two days following treatment, the skin be kept clean to avoid contamination or infection.
• Moisturizer may be applied 24-72 hours post treatment and should be applied regularly throughout the course of the treatment.
• Make up may be applied 24-72 hours after each treatment session. Patient may use regular soaps, but not scrub soaps or exfoliants to remove makeup after 24 hours of treatment.
• The patient should use high-factor sunscreen ( at least 30 SPF) and protect the treated area from over exposure to sunlight for at least one month after treatment, starting 24-72 hours post treatment.
• For skin type IV and light V bleaching ointment should be prescribed for 6-12 weeks, 2-3 times a week following healing of the treatment area (2 days after crusting gone, typically ~7 days post treatment), to minimize risk of post inflammatory hyperpigmentation. It should be stopped 48-72 hours before another Fractora session.