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Objectives: • An updating technique of high intensity focus ultrasound for facial rejuvenation.
• An advanced technique of Monopolar RF for facial lifting.
• Superior therapeutic outcome from combination treatment of Monopolar RF with High Intensity Focus Ultrasound.

Introduction: High Intensity Focus Ultrasound seems to be the best innovation for facial lifting beside surgical procedure, which will affect directly at Superficial Musculoaponeurotic System (SMAS). But, for excess fatty area, it is difficult to reach SMAS and lead to unsatisfied result which in this indication, monopolar RF seem to be more effective for heat bulking and lifting effect at the sagging fatty area. So, it is exactly necessary to properly evaluate fatty layer above SMAS for the precisely technique and machine selection at the treatment area before the procedure.

Materials / method: There for, there is a good candidate patient for combination treatment including with fat pat thickness from ultrasound evaluation. The indication of combination treatment of Monopolar RF with High intensity focus ultrasound will be described.
This presentation will demonstrate facial fat thickness evaluation from ultrasound and the combination treatment of monopolar RF with High intensity focus ultrasound in a good candidate patient which will create a higher satisfied result.

Results: Combination treatment of monopolar RF with High intensity focus ultrasound in the same session with the good candidate patient seem to be modernize procedure for facial lifting.

Conclusion: Ultrasonography plays an important role for facial structure evaluation which beneficial for the precise selection of the proper machine for facial lifting needs.
Combination treatment of monopolar RF with High intensity focus ultrasound in the same session seems to create higher effective outcome in patient which had the excessive facial fat thickness at some part of their face.

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Objectives: To examine the clinical effects and the safety of radiofrequency microneedling device with repeated short pulses for melasma.

Introduction: Melasma is a common disorder of hyperpigmentation in Asian women with Fitzpatrick skin phototypes III or higher. Conventional micro-needling treatment is generally avoided in the melasma area because it may aggravate the melasma. Fractional RF micro-needling devices using a micro-pulsed electric signal can approach the basement membrane and vascular endothelial growth factor to improve melasma. We investigated whether micro-pulsed electric signal device can be used safely and effectively for Asian patients with melasma.

Materials / method: We introduced RF microneedling devices with repeated short pulses in 2020, and have performed treatment on a cumulative total of 13,750 cases as of July 2022. It was often used on the same day as treatment low-fluence Q-switched Nd:YAG laser. We investigated the standard protocol, safety, and patient satisfaction of this treatment at our institution. To evaluate the clinical effects, we used a skin analysis imaging system (VISIA® Evolution, Canfield Scientific, U.S.A.) to make records before and after each treatment. The end of our evaluation period was one month after the last treatment.

Results: We treat melasma, rosacea, and large pores by switching between using a continuous wave, which causes heat-induced coagulation throughout all layers of the skin, and a pulsed wave, which selectively causes heat-induced coagulation in the basement membrane and blood vessels. No severe adverse events including melasma worsening were noted. Comparing patient satisfaction regarding the treatment effect of laser toning and this treatment device, the score of laser toning was higher, but the score of patients who used the two treatments in combination was higher than that of laser toning alone.

Conclusion: This device has a rejuvenation effect on the skin, helps with vascular disorders, and can be used safely with patients with melasma.

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