Adam Rubinstein, MD, FACS, a Miami-based board certified plastic surgeon, talks about a new treatment that promises to smooth away wrinkles for good.
Interview conducted by Ivanhoe Broadcast News in December 2016.
When it comes to wrinkles, obviously no one wants them, especially women we’re always trying to get a more youthful appearance. This is very new technology, the ThermiRase; give us the name of it and tell us what it is.
Dr. Rubinstein: Thermie is a way to treat glabella, these frowns lines. It’s a way to treat them permanently. If you are able to knock the nerves out that make the muscle do this then you won’t be able to do this anymore.
This technology is a nerve destroyer, is that what it is?
Dr. Rubinstein: Yeah, well it’s a way to stop the nerve from working. Botox does it where it stops the nerve from communicating with the muscle but this treatment, ThermiRase, actually knocks the nerve out so it’s not working anymore.
This is really a permanent solution to wrinkles?
Dr. Rubinstein: Well it is permanent; you don’t always get a perfect block of the nerve where you’re trying to treat the length of the nerve. Sometimes there will be some re-growth, sometimes there could be other branches that you’re not quite reaching but you’re going to get a very significant reduction in muscle movement forever.
Tell us how it works; you are using heat?
Dr. Rubinstein: Yeah. We use heat but the way we introduce the heat is with radiofrequency. Radiofrequency energy comes down a cannula just like this one, and from the very tip of the cannula there’s a metal tip and that’s where the energy is released. The energy gets in to the tissue through this little metal tip on the cannula and raises the temperature. As the tissue absorbs the radiofrequency energy the temperature comes up and we get up to a very high temperature for this treatment eighty five degrees Celsius. That temperature is enough to damage the nerve and stop it from working.
But not burn the patient.
Dr. Rubinstein: Correct, this is a very safe treatment because at the tip of this there’s a sensor that tells us the internal temperature so we know we’re getting to the temperature we want. We’re also using an external camera that allows us to know the surface temperature and make sure we keep it in a very safe range so that the patient doesn’t get burned.
Prior to this you are doing the nerve mapping; tell us what you were doing with that.
Dr. Rubinstein: Well in order to begin the treatment we have to know where the nerve is that way you can treat it. The way we do that is taking a small probe and mapping the nerve over the skin. Take a little pencil probe put it along the path of the nerve and we’re stimulating some energy down in to the tissue. As we stimulate the tissue the nerve catches the energy and it makes the the muscle twitch. As we’re putting that energy in to the tissue along the nerve line the muscle is twitching. With each twitching area we make a little mark and that gives me a map of exactly where we follow with this cannula.
It’s a very precise procedure?
Dr. Rubinstein: Yes, it must be precise in order to be successful.
Are there any risks with this?
Dr. Rubinstein: Well the biggest thing that we see with ThermiRase treatments is you don’t always get a perfect treatment and people will have some movement. Frankly my opinion is that some movement is a good thing. It makes you look more natural. But sometimes we have more movement than we really want to have and it might require an additional treatment to reduce the movement even further. Theoretically you could have a burn on the skin if you’re not careful and not watching but because of the safety mechanisms using the external thermal camera we’re usually able to keep that risk to a very low level and I’ve never seen a burn doing this treatment.
How fast is the recovery process and what should you expect?
Dr. Rubinstein: Well the treatment is almost painless the only thing that hurts is the initial injections to numb up the area before we begin the treatment. Afterwards you can expect to have some swelling there will be swelling along the areas that we’re treating where the nerve branches run. That includes the inner part of the nose as well. That swelling can last one to two weeks. Apart from that really no pain and no discomfort you are just a little swollen in those areas one to two week and even immediately after the treatment you’re not going to move.
Is this good for anyone, anyone who wants to get rid of wrinkles and does it work all over the face or is it specific for certain parts?
Dr. Rubinstein: That’s a great question, ThermiRase right now is being used for the glabella or the elevens, the frown lines so that you can’t do that anymore and you won’t get those elevens or the lines in your glabella, in the middle of your eyebrows. It is also being developed to be use for the plastisma muscle which is your neck muscle that makes you expressive and gives you some bands sometimes. We’re working on treating those bands and other muscles around the face and body. But right now the glabella is the area that we’re treating with ThermiRase.
You mentioned Botox. How often do you need that for wrinkles as opposed to ThermiRase?
Dr. Rubinstein: Great question. Botox typically we recommend every three to four months. Every three months is the perfect interval you will never see muscle movement every three months with Botox or any other neurotoxin treatments. With ThermiRase once it’s done you’re not moving. You’re not going to move forever if the nerve is well treated. Sometimes there will be a little bit of residual movement and sometimes we have to do a second treatment. But once this works it works forever.
Basically it destroys the nerve?
Dr. Rubinstein: Correct. This treatment it meant to damage the nerve so it doesn’t work any longer.
That’s what prevents you from wrinkling?
Dr. Rubinstein: Right, it’s a very specific nerve. The only thing it does is make those muscle move and if we can stop that nerve from working you won’t move.
Basically any age group and skin tone you can work with?
Dr. Rubinstein: That’s right. This treatment can be used for any patient, any age, any skin color, any skin type. There’s really no limitation because underneath the skin everyone’s nerves and muscles are all the same. All we need to do is treat the nerve, stop the muscle from moving and it really doesn’t matter who we’re treating man or women, older, young, white, dark it really doesn’t matter.
Give us an idea of cost.
Dr. Rubinstein: Sure. Well in order to price this in my practice I usually charge $2,500 and we guarantee that you won’t have any movement for two years.
Two years, so no Botox after this?
Dr. Rubinstein: Well once we have a successful treatment you never need Botox again for that area.
FDA approved, anything else you want to say about this treatment using radiofrequency? How long does it take?
Dr. Rubinstein: This is a treatment you can go to your doctor and have done under local anesthesia very comfortably. You can drive yourself to and from, leave the office once you’re done. It takes about an hour to do the whole treatment and when you leave you’ll have some swelling around the outer parts of your eyebrow and the inner parts of your nose. But once that subsides you’re not going to have any movement, you won’t have those elevens anymore and it’s good treatment for anybody at any age, color, and type of skin.
The creative part of this it’s kind of like sculpting somebody. When you view somebody and you decide to do this what’s the creative aspect?
Dr. Rubinstein: Well this is a very precise treatment and in order to have a successful treatment you have to have that precision. You don’t have license to try and treat this way or that way it’s really more about knowledge of the nerves and the muscle and understanding where it may be so that you can find it when you’re mapping and make sure you treat it when you’re treating. And that’s the key making sure you’re well mapped and that you’re well treated.
You wouldn’t want to be in the wrong hands or someone could hit the wrong nerve is that possible?
Dr. Rubinstein: Well yes there are some sensory nerves that are nearby that can make this very painful, that can give you lasting numbness if you treat in the wrong area. That is possible but in the right hands and well trained experienced board certified plastic surgeon hands I think you’re going to be just fine and be very happy when you’re done.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Adam Rubinstein, MD, FACS
305-340-2191
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