The Secret Is Out

Grow Your Practice with Cutera’s Secret™ RF, a Microneedling Fractional Radiofrequency Device

Close to three years since Cutera launched the Secret RF, the device continues to amaze and surprise leading aesthetic physicians with its versatility, treatment customization, and its ability to deliver excellent results for patients across all skin types.

Secret RF is a novel fractional radiofrequency (RF) microneedling system for tissue coagulation that precisely delivers bipolar radiofrequency energy for the treatment of photodamage, rhytides, acne scars, striae, and other forms of scarring.

“Secret RF continues to stand apart from other microneedling devices on the market, largely due to the versatility of the tips and the ability to control the depth and density of RF energy delivered to the skin,” says Anne Chapas, MD, Medical Director for Union Square Laser Dermatology in New York City.

By adjusting the microneedles, Secret RF can deliver energy at various depths, so that treatments can be tailored to address each patient’s individual concerns, including fine lines, wrinkles, photoaging and striae at the depth required. Specifically, Secret RF offers three types of tips: a 64-pin tip for use on large areas including the cheeks or body, and two smaller 25-pin tips, semi-insulated or non-insulated, which can be used for different skin types and treatment applications. All tips offer adjustable needle penetration from 0.5mm to 3.5mm for customized dermal remodeling based on the area and the depth of the condition being treated.

“The 64-pin tip can treat an abdomen in 15 minutes, which is much faster than other devices,” Dr. Chapas says. Moreover, she adds, many microneedling devices don’t give the provider as much control as Secret RF. “Other devices have a lot of presets, but with Secret RF, Cutera allows the physician to dial in what they want, they provide physicians complete control of the treatment, and the outcomes.”

She continues, “It’s great for a beginner and for an advanced physician who wants to push the limits of treatment, energy delivered, and pulse duration.”

Boca Raton, FL-based dermatologist Robyn Siperstein, MD agrees. “The Secret RF is a wonderfully versatile device, and it enables us to treat any skin type and any region of the body. We love the larger head for treating wider areas, and the insulated tips for those patients with melasma and hyperpigmentation,” she says.

“What I appreciate about Secret RF is that I can customize each treatment to the individual patient I am treating, and because we have two needle types, the treatments can be performed on all skin types and all year round,” adds Manu Aggarwal, MD, a family medicine doctor in Lima, OH.

Secret RF is effective for many skin conditions, and practitioners all have their clear favorite indications.

“I love to treat scars and hyperpigmentation in darker skin patients, as there was little I could do to help these patients without significant downtime and risk of hyperpigmentation prior to the Secret RF coming to market,” says Dr. Siperstein. “I was pleasantly surprised with the results the Secret RF produced while treating hypertrophic scars as I did not anticipate how highly effective it ultimately was,” she adds. “It has softened and lowered these scars without the need for steroids (which can cause a lightening of the skin). For those patients of darker skin types with hypertrophic scars, the Secret RF has been a complete game changer!”

Dr. Aggarwal can’t pick just one favorite Secret RF procedure. “We use it in multiple ways to treat deep rhytides, scarring (post-surgical, acne, and accidental), sagging skin, and enlarged pores.”

Anytime there is a patient with laxity in the jowls, Mira Kaga, MD, a physician in Marlboro Township, NJ, reaches for Secret RF. “I prefer to get ahead of the aging process in 30- to 40-year-olds and improve skin quality early on; we can build collagen early on to replace what is lost during the normal aging process as opposed to reversing more advanced cases.”

This procedure makes an “undeniable" difference in the lower face, she says. “No matter how old you are, treatments with Secret RF can improve lax skin, providing beautifully natural results and preventing us from needing to overfill anyone,” she says.

“We use it a lot on acne scarring, but also for that 25mm tip around the eye it’s a great standalone to reduce fat pads, rhytids, and provide a little tightening,” adds Dr. Chapas.

The depth of the heat gets down to the sebaceous gland where C. acnes resides. “The deep RF energy reduces breakouts too,” she explains. “The device can be used even if the patient is having a mild acne breakout, unlike other devices and treatments where patients need to be completely clear before we start chasing their scars.”

To achieve the optimal results across indications, three to four Secret RF treatments are typically recommended. Results appear gradually with optimal results visible within three months after the last treatment.

Winning Combinations

Many providers are achieving excellent results by combining Secret RF with other available modalities. Dr. Kaga often uses Secret RF and provides soft tissue filler. “I place a little filler where there is structural loss and address skin quality everywhere else,” she says. She also may use Secret RF and Er:YAG laser on the same patient for skin resurfacing. “We get dermal remodeling with Secret RF and a superficial revitalization effect with the Er:YAG laser, so we pack a one-two punch against aging.”

For very deep acne scarring, Dr. Kaga will alternate between these two treatments to achieve, “beautiful results.” Another favorite combination of hers is truSculpt iD for fat reduction and Secret RF for skin quality improvement.

Dr. Chapas is also a fan of using Secret RF as well as non-ablative resurfacing. “Secret RF really provides great collagen remodeling at deeper depths, but it doesn’t treat dyschromia or redness, so we can do non-ablative resurfacing at a shallow level to treat dyschromia.” Offering platelet-rich plasma can also improve results, by further boosting collagen production, she adds.

“People are really looking to get the most done in the least amount of time, and combinations provide the most benefit per visit.”

Patient comfort and the lack of significant downtime are big selling points for Secret RF, experts agree. “Secret RF offers the flexibility to adjust settings according to the individual pain tolerance and downtime needs of each patient,” says Dr. Siperstein. At her practice, the staff applies a topical numbing cream 30 minutes prior to treatment. “We have also used nitrous oxide (N2O) for those we wish to give deeper, stronger results.” Dr. Kaga uses a compounded topical numbing agent and a low-dose of N2O. “If a patient is very anxious then we can give oral medication as well just to help them relax,” she says, adding that most Secret RF patients are fine with topical numbing cream and N2O.

Tapan Patel, MBBS, a cosmetic dermatologist and director of PHI Clinic in London, UK, underwent treatment with Secret RF so he could speak from experience when discussing the treatment. “Subjectively, I graded the peri-treatment discomfort as 1/10 and this was on the maximum settings for my skin type,” he shares. Dr. Aggarwal uses topical EMLA cream and the Zimmer chiller to keep patients comfortable during Secret RF treatment.

All of this leads to enhanced patient satisfaction, Dr. Siperstein suggests. “Patients love the convenience of not having any mandatory downtime,” she says. “Before I offered treatments with the Secret RF, I needed to do fractionated laser resurfacing which required patients to stay at home for a week post-treatment while they healed.

“Now patients can wear a little makeup the next day, which covers it up so no one even knows that they had a procedure done. “This lack of downtime helps my patients get back to their busy lives without interruption or inconvenience, which also facilitates the flexibility of scheduling of multiple treatments,” she adds.

“Moreover, the mechanism is much softer than other devices I’ve used, and this translates to more comfort for the patient. It is also much less noisy during the treatment, which also enhances the patient experience,” offers Dr. Patel.

Another big plus, according Dr. Kaga, is the fact that there is less visible gridding with Secret RF than with other available RF microneedling devices. “The variability in the settings allow us to implement setting parameters when skin is over- or under-hydrated, which ultimately allows us to monitor and adjust settings based on skin type and condition,” she explains. “For example, if the skin is hydrated and therefore a better conduction of radiofrequency, we can decrease the intensity and radiofrequency to reduce the energy output.”

Largely due to its versatility, customizability and ability to treat all skin types, Secret RF remains a favorite among providers and can easily become a workhorse for a practice.

Fraxis PRO: Redefining Versatility in Your Practice

Cutera’s Fraxis PRO is uniquely versatile for a practice, addressing issues from the inside—with RF microneedling—and outside—with fractional CO2.

Fresh off the heels of the highly successful launch of truSculpt flex for muscle toning and strengthening, Cutera is now introducing Fraxis PRO, which combines two gold-standard skin rejuvenation technologies—fractional CO2 for skin resurfacing and radiofrequency (RF) microneedling for total dermal remodeling—in a single device.

While CO2 fractionally ablates the outermost layers of the skin, RF energy reaches the deeper dermal layers. With this unique combination of technologies, Fraxis PRO can treat the full thickness of the epidermis and dermis to address superficial photoaging while also stimulating neocollagenesis and increasing hyaluronic acid production under the surface for smoother, healthier skin. With two headpiece sizes for each modality, Fraxis PRO is able to quickly and efficiently treat the entire face and body.

By layering CO2 laser energy with RF microneedling, Fraxis PRO treats a wide range of skin conditions including fine lines, wrinkles, difficult-to-treat acne scars, burn scars, and stretch marks.

Leaders in the aesthetics field and early adopters are excited about Fraxis PRO’s versatility, customizability, ability to treat all skin types, and small footprint.

Four Unique Treatment Options

“The nice thing is that you have both fractionated CO2 laser and RF microneedling in one device, offering a solution for resurfacing and remodeling in a device with a small footprint,” says Ashish C. Bhatia, MD, Associate Professor of Clinical Dermatology, Northwestern University, Feinberg School of Medicine. “Some patients just need RF microneedling with very little downtime to remodel and tighten the skin, while others benefit from fractionated CO2 at a low setting for a micro peel with little downtime to get rid of brown marks, sun spots, and smooth the skin surface,” he says. “We can also use it more aggressively for lines and wrinkles and full resurfacing.”

The Fraxis PRO treatment offerings can be used alone or in combination based on patient needs, expectations, and downtime tolerance. For example, Fraxis PRO Refine is a light RF treatment that addresses fine lines, large pores, wrinkles, stretch marks and acne scars in a series of three to four treatments that can be performed on all skin tones, any time of year, and has little to no downtime.

“My recommendations are treating dark skin just with RF microneedling for rejuvenation, while treating lighter skin types with RF miconeedling plus fractional CO2 resurfacing, if needed,” Dr. Bhatia says.

“Because we have the RF microneedling, we can treat darker skin types and avoid CO2 if we have to,” agrees Bradley S. Bloom, MD, a dermatologist in New York City.

The Fraxis PRO Ultra-Light micropeel provides gentle exfoliation via CO2 laser technology. “We dial energy back to 3mJ to 5mJ, use topical numbing, and in a couple of passes, we can do a micropeel and address the skin’s very superficial layers to improve uneven texture, dull skin tone, and overall complexion quality,” says Dr. Bhatia. A series of three sessions is recommended to smooth skin with little downtime.

The Fraxis PRO Ultra utilizes high energy fractional CO2 to smooth, brighten, and enhance skin tone and texture and promote collagen production to address scarring, and crepey skin in a single treatment. “The Fraxis PRO is my go-to for micro peels as well as deeper fractional resurfacing,” Dr. Bhatia says.

Fraxis PRO Revive combines both CO2 laser and RF microneedling technologies in the same session for dramatic results in one to three sessions and can be performed on fair to medium skin tones with up to a week of downtime.

“For patients who don’t have severe textural changes, they can have a single fractional CO2 with RF microneedling treatment on the same day followed by three to four microneedling RF sessions, or we can wait two to three months if we are using repeated combination therapy,” Dr. Bhatia says.

Addressing all depths of the skin in the same procedure means less downtime and better results in fewer treatments, he says.

Fraxis PRO meets all patients where they are, adds Michael Somenek, MD, a Double Board-Certified Facial Plastic Surgeon in Washington DC. “Patients in their 20s and 30s may need a super light CO2 and very conservative RF microneedling,” he says, referring to the Fraxis PRO Revive. The downtime is two to three days. Several treatment sessions are usually needed for maximum aesthetic results. “We usually repeat every four to six weeks, and the results are really nice,” he says.

And it can be customized further, he says. Individuals in their late 40s, 50s, or 60s with reasonable photoaging may require more energy so we can combine resurfacing and dial up the microneedling in one treatment, according to Dr. Somenek. “The combination is a total game changer in the market,” he says.

This is a key differentiator, adds Dr. Bhatia. “With this system, we can dial it up or dial it down to customize the treatment for each patient. All skin types are candidates, even darker skin types can be treated with appropriate settings.”

Dr. Bloom opts for Fraxis Revive to treat perioral lines. “We use both modalities to treat perioral lines and are developing an ideal protocol,” he says. “We see improvement in the lines around the mouth without the downtime we see with traditional fractionated CO2,” he says. The RF microneedling to address deeper component, followed by light fractional CO2 for the surface lines,” he says. “The combination allows us to use a less aggressive fractional CO2 setting because we leverage the RF to generate heat under the skin, bypass the surface and then gently treat the surface,” he says.

This means less downtime. “We are seeing good results with less downtime and less redness than when we would if we treated this area with a more aggressive fractional CO2. It’s a win for everyone,” Dr. Bloom says.

Less downtime, same results

Choice of settings or procedure with Fraxis PRO depends on the patient’s willingness to accept downtime, Dr. Bloom asserts. “If they are willing to have downtime, I may treat differently with more aggressive fractional CO2,” he says.

Today’s aesthetic patients are more willing to accept downtime. “Everyone is wearing a mask and most are spending more time at home due to the COVID-19 pandemic,” Dr. Bloom observes.

For the most part, the downtime is minimal, shares Manu Aggarwal, MD, a family medicine doctor in Lima, OH. “With older technologies, patients needed to take at least a week off, but now they can return to their normal lives in as little as 24 hours. This is a game changer for practitioners as well as patients.”

Dr. Aggarwal says results from the Fraxis PRO last, but a good skincare regimen and use of sunscreen helps patients maintain the results for even longer.

Large spot sizes mean quicker treatments

Another benefit is that you can do more in one session for the patient, which is especially helpful post-COVID-19, Dr. Bhatia adds. “Perioral or periorbital areas take less than 20 minutes each for combination treatment and full face can be done in less than an hour. We can also treat the neck on a lower setting in about 35 minutes. We can get patients through treatment quickly because of the large spot sizes and incredibly fast scan speeds. You cruise along,” he says.

This versatility of Fraxis PRO is what appeals to Dr. Aggarwal. “With this device, we are able to address issues that arise deeper in the skin as well as the surface changes that patients notice first,” she says. “They come in and say, ‘I hate these wrinkles on the surface,’ but they don’t see the deeper layers, so by combining two technologies we can address the origin as well as what the patient is seeing.”

Once patients are educated about where the surface condition is originating from, they are open to combination. “Patients can see results in as little as one treatment,” Dr. Aggarwal says. “Some people who are older with deeper wrinkles or more skin damage may require two to three treatments,” she adds.

New options for scars

Dr. Somenek also uses Fraxis PRO for resurfacing acne scars. “It’s not a single modality treatment for acne scars, but I traditionally treat them with microneedling and CO2 separately so I am excited about the combination to see what types of results we can get.”

The two-in-one device allows for smart combination procedures for scarring, Dr. Bhatia agrees. “Patients who need microneedling can achieve remodeling of deep collagen in a burn scar or acne scars and then the fractional CO2 can get rid of surface irregularities and smooth the surfaces of skin with fresh new collagen,” Dr. Bhatia says.

“It’s a workhorse. This device provides the highest ROI in our office, because we can use it on so many patients all year round,” he adds. “We have bought two Fraxis PRO devices so far. It’s like a Swiss Army knife in that it has so many uses.”