The third generation of RF — 3DEEP® technology (EndyMed Medical Ltd, Caesarea, Israel) — uses multi-source phase-controlled RF. This multi-source system (EndyMed Pro; EndyMed Medical Ltd) uses six RF generators with a sophisticated algorithm to control the electrodes’ polarity, diverting RF energy from passing along the epidermis, and forcing it to take a longer and deeper route focused in the dermis and hypodermis. This technology enables the reduction of the amount of energy flowing on the skin’s surface, making the need for electrode cooling unnecessary. The 3DEEP technology allows a volumetric, focused, homogeneous dermal heating for non-ablative safe and comfortable treatment. Figure 1 shows the different RF technologies9, 10.

The 3DEEP by EndyMed Medical Ltd is a US Food and Drug Administration (FDA) approved RF technology for the reduction of mild to moderate facial wrinkles, using multiple generator RF technology to safely heat the deeper levels of the skin for effective collagen remodelling, wrinkle reduction, and eyebrow lifting.

In this study, the author evaluated a treatment protocol for non-invasive periorbital skin tightening and wrinkle reduction. The treatment was performed using the 3DEEP iFine handpiece of the EndyMed Pro multisource RF system (Figure 2). The iFine handpiece was specifically designed to treat the hard-to-reach, delicate areas around the eyes, and fine lines and wrinkles found in other delicate and small areas.

Materials and methods

Nineteen patients (14 female, five male), aged 25–77 years (average 51.9 years) were enrolled in this study, which used the iFine handpiece by EndyMed. The patients were recruited after meeting all inclusion/exclusion criteria and signing an informed consent form. The criteria were decided on with consideration to the safety of the patient and the efficacy of the treatment. The main inclusion criteria were healthy patients over 21 years of age, understanding the course of treatment, and having the needed indications for treatment. The main exclusion criteria were patients with implants in the treatment area or electrical implants in the body, pregnant or lactating women, patients with known sensitivity, and other common safety contraindications.

Figure 3 Thermal images. (A) baseline, maximum of 35.9°C under the eye. (B) After two passes of 30 seconds under the eye,  power 3 Watts. Maximum temperature is 41.1°C. (Image scale 22–48°C)

Figure 3 Thermal images. (A) baseline, maximum of 35.9°C under the eye. (B) After two passes of 30 seconds under the eye, power 3 Watts. Maximum temperature is 41.1°C. (Image scale 22–48°C)

The patients’ skin wrinkles were classified according to the Fitzpatrick Wrinkle Scale (FWS)11. All 19 patients were treated for facial wrinkle reduction at the periorbital area (Figures 3 and 4). Patients received six treatments, where the first four treatments were administered every week, and the last two treatments were administered every 2 weeks. Patients were scheduled for follow-up visits at 1 month and 3 months after the final treatment, which all attended.

Prior to the RF treatment, patients were photographed to allow for comparison and assessment of wrinkle appearance improvement following the treatment. Photos were taken before each treatment session.

Figure 4 Periorbital treated areas. Each eye has three areas for treatment: (1) under the eye; (2) under the eyebrow; (3) above the eyebrow. When treating these areas, it is important to pull the skin away from the eyeball

Figure 4 Periorbital treated areas. Each eye has three areas for treatment: (1) under the eye; (2) under the eyebrow; (3) above the eyebrow. When treating these areas, it is important to pull the skin away from the eyeball

The treated area was cleaned thoroughly with soap and water in order to remove any make-up and lotions, and the skin surface was then dried. The treatment power was set to 5 Watts for all patients. Following two passes of 30 seconds each, the skin surface temperature reached the optimal range of 40–42°C. Temperature was evaluated using an infrared thermometer. After the optimal temperature range was achieved, six passes were performed on each treatment zone (Figure 4). Immediately after the treatment, the treated area was visually assessed for skin responses, oedema and erythema.

The EndyMed Pro system uses safety features in order to prevent adverse effects. RF energy is not emitted if the handpiece is not in full contact or not in motion, preventing RF spikes of high heating, static shock and surface burns. The treatment is performed in circular motions, while the treated area is covered with ultrasonic gel for smooth movement of the handpiece.

Figure 5 Periorbital iFine treatment in a 77-year-old female patient. (A) Baseline and (B) immediately after the treatment. There is a noticeable reduction of ‘eye bags’ and tightening of upper eyelid

Figure 5 Periorbital iFine treatment in a 77-year-old female patient. (A) Baseline and (B) immediately after the treatment. There is a noticeable reduction of ‘eye bags’ and tightening of upper eyelid