There has been a steady increase in requests for in-office skin treatments in the last three years, what with selfies and the Zoom Boom's continued emphasis on close-up video conferences. Beyond individual laser, radiofrequency, and microneedling sessions to address skin texture, laxity, tone, and plumpness, patients are becoming savvy to more efficient combined technologies that incorporate multiple treatments into single devices. Radiofrequency microneedling — which offers the collagen-inducing and re-texturizing effects of microneedling, along with the skin-tightening effects of radiofrequency heat — has become one of the buzziest and most-requested combined treatments available.
Even as popular radiofrequency microneedling devices like Morpheus8 develop veritable fan followings, they are not considered suitable for all skin conditions. Those with melasma, for instance, run the risk of exacerbating unwanted pigment following aggressive, heat-based treatments. Others find that the degree of painfulness and downtime is simply not viable with their schedules in spite of the rejuvenating effects that can come from a series of treatments.
The latest radiofrequency microneedling device to launch Stateside, Sylfirm X, claims to remedy these concerns. Yet skeptics consider all of these devices to be virtually the same, so I decided to see for myself.
Read my experience with Sylfirm X, below.
What Is Radiofrequency Microneedling?
The fundamental technology at work is pretty much the same. The efficacy of all radiofrequency microneedling treatments comes down to the controlled injury method, wherein the skin's production of collagen, or neocollagenesis, is stimulated via intentional micro injury. While the needles puncture the skin to induce this surface-level retexturizing, radiofrequency heat is delivered through them for more pronounced rejuvenation. Boston-based, board-certified dermatologist Ranella Hirsch explains, "The purpose of radiofrequency microneedling is to heat up the dermis and deeper skin tissue, and in so doing, direct the formation of new collagen to try to improve skin laxity." As one of the skin's critical building blocks, new collagen formation can help to smooth away fine lines and wrinkles while improving the tone and appearance of skin.
Depending on the body part and skin concern being treatment, there are two forms of technology to note when it comes to radiofrequency microneedling. "The continuous wave form is designed for tightening the skin and tissue by stimulating collagen production. It helps with lifting, reducing fine lines and wrinkles, scar repair, and melting fat," says Beverly Hills-based doctor and integrative aesthetics expert Rahi Sarbaziha. As an example, she references the usage of this form of delivery under the chin or on the body. "The pulse wave form is designed to help improve skin texture and [to] treat skin conditions such as melasma, active acne, blackheads, diffuse redness or rosacea, and for [refining] pore size."
What Makes Sylfirm X Different?
These devices are incredibly costly, requiring dermatologists, plastic surgeons, and doctors to be discriminating when selecting which to invest in for their practices. Yet Beverly Hills-based, board-certified dermatologist Jason Emer calls it his "favorite device right now." Dr. Sarbaziha knew immediately that she wanted to offer Sylfirm X at her practice. The reasons why come down to its versatility: "I love it because it can do what other machines have been unable to do in the past; namely, it treats melasma — even in dark skin — and can treat all around the eyes," she says — along with a bevy of other conditions.
On top of that, Sylfirm X's claims of being less painful can be explained by its use of non-coated needles, or uninsulated electrodes, as opposed to Morpheus 8's coated needles. "This means that when the needles are inserted into the tissue, they emit radio frequency from the full length of the needles rather than [just] the coated tips, which leads to more pain," Dr. Sarbaziha says. This form of delivery is also more efficient, requiring only one pass of the device and simultaneously delivering the energy to all layers of tissue.
Dr. Emer also points to the robotic technology used in the Sylfirm X's handpiece as translating into a gentler emission of the needling and heat. "The way you deliver the energy from the handpiece taps it into the skin versus [the recoil] of pressurized devices." he says. While pressurized devices come with a snap that is reminiscent of a staple gun, the Sylfirm X handpiece allows for a smoother delivery.
Melasma, Rosacea, Post-Inflammatory Hyperpigmentation
Sylfirm X's ability for treating melasma is a major advantage over the other radiofrequency microneedling devices on the market. This is because melasma — a lingering and hormonally-linked form of stubborn pigmentation — is persistent and difficult to treat. Due to its exacerbation by heat and inflammation, it is unable to be treated by popular broadband light treatments (i.e., IPL, BBL) or intense fractionated lasers like Fraxel. This left practitioners limited to regimens of harsh topicals (think: retinol and hydroquinone) or the costly machine, Picosure, which is also used to remove tattoos until now.
"For melasma or rosacea, we use pulse wave mode [which allows] Sylfirm X to target damaged skin cells without affecting the neighboring, healthy skin areas," Dr. Sarbaziha explains. It does so using its Selective Regional Regeneration Radio (SR3) Repeated Pulse (RP) technology that targets abnormalities in the tissue and blood vessels (i.e., melasma, rosacea, hyperpigmentation) while strengthening the skin's basement membrane, the part of the skin that is responsible for creating healthy tissues moving forward. "This accelerates melasma treatment by targeting its root cause and decreasing the chances of recurrence," she adds.
Eye Area Laxity
Sylfirm X's ability to tighten up loose or sagging skin in the eye area gives it another edge over its competitors. "The eyelid area is difficult to treat because the tissue around our eyes is delicate," Dr. Sarbaziha shares, noting that past options frequently required surgery. While Thermage — a radiofrequency device without microneedling — is FDA-approved for the eye area, non-surgical devices to remedy skin laxity in the ocular area are indeed extremely rare.
Dr. Emer explains that it can be used in the delicate eye area due to the wide variability in its depth of penetration. He says that because Sylfirm X's depth can be adjusted all the way from .3 to 4mm, it can safely pass over sensitive areas like the eyelids. Dr. Sarbaziha notes that she adjusts the setting to 1 mm or less when treating this region, as well as sensitive areas like the forehead and around the mouth.
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What's It Like to Get Sylfirm X?
I can speak firsthand as a patient having tried Sylfirm X, Morpheus8, Potenza, and Vivace, and I do find the results to be noticeable and worth it. After a series of treatments, I saw improved elasticity and more even tone, and people constantly think that I am younger than I am. Because I struggle with unwanted pigmentation and mild melasma, I would choose to go with Sylfirm X moving forward — but I do think that Morpheus 8 and Potenza are quite effective, too.
As for pain, it is true that Sylfirm X is less painful than both Morpheus8 and Potenza. You will still want to spend a significant amount of time numbing — at least an hour — and the procedure will still be uncomfortable in certain areas. I personally find the forehead to be the most uncomfortable because it is the boniest area of my face, while I find the the neck to be virtually painless. At Dr. Emer's practice, I absolutely loved having the Zimmer Cooler on hand to blow cold air on my skin following the device. This makes the experience much more bearable, and worked better for me than PRO-NOX, or laughing gas, which was administered to me during Morpheus8.
Still, any claims that Sylfirm X is "painless" are a lie. It is not pleasant by any means — and I felt it without numbing along the front of my scalp, where Dr. Sarbaziha includes a pass for added lift. But it is much easier to sit through than either Potenza or Morpheus8, the reason being that it causes less twitching. During my Morpehus8 and Potenza treatments, my left leg twitched throughout the treatment, beginning with a sensation in my stomach that made me want to kick my leg. This, to me, was far more unpleasant than any pain, and I was so relieved when this bizarre impulse was not repeated during my sessions with Sylfirm X. (As for why the twitching takes place, Dr. Emer suggests it could have to do with the more precise application of the radiofrequency energy staying localized in my face rather than coursing through my entire body.)
Is There an Aftercare Regimen to Follow Post-Sylfirm X?
When it comes to downtime, I healed more quickly following Sylfirm X and I highly recommend the application of exosomes no matter which device you opt for. Exosomes helped me heal faster from Sylfirm X than both PRP and a session in a Hyperbaric Oxygen Chamber post-Morpheus. With the exosomes, I was visibly healed in three days (although my skin was still delicate). When I saw celebrity esthetician Joanna Czech just three days after receiving a Sylfirm X treatment with exosomes, she was actually shocked to see how rapidly I had healed.
While Sylfirm X does boast less downtime than its alternatives like Potenza or Morpheus 8, the true game-changer for reducing your downtime comes down to the application of exosomes, or extracellular vesicles (EVs), to the skin. The same company that manufactures Sylfirm X — BENEV — also sells synthetic exosomes that can drastically expedite healing and improve your collagen-producing effects. As Dr. Emer points out, the ideal time to apply an exosome serum is immediately following your treatment when the micro-channels in your skin are still open. This allows for their efficient delivery into the deeper layers of the skin, boosting your collagen production and rapidly promoting healing.
"Exosomes are lipid bilayer membrane micro-vesicles secreted by various types of cells, such as stem cells, that carry growth factors and mRNA," begins Dr. Roger Schechter, Chief Medical Officer of ExoCel Bio. "[These] have anti-inflammatory cytokines and reduce the effects of aging." The celebrity injector Cheyanne, a Los Angeles-based Physician's Associate and founder of The Private Suite LA, explains that exosomes can be either stem cell- or platelet-derived and were initially explored for helping to heal burn victims. However, clinical studies revealed them to be great for things like hair restoration — and for boosting collagen production in a statistically significant way.
Dr. Schechter notes that immediately following treatment, they can help alleviate the "burning sensation and redness, dramatically reducing post-procedure downtime." They essentially work by repairing damaged tissues caused by inflammation, relaying the cellular signals to "repair and regenerate cells" via growth factors, mRNA, and miRNA. This wound-healing mechanism also signals the production of structural proteins like collagen and elastin — hallmarks for skin rejuvenation. "Typically, the downtime associated with energy-based devices is reduced by up to 80%," Dr. Schechter says.
For a full course of treatment, Dr. Sarbaziha recommends anywhere from three-to-six sessions performed four-to-six weeks apart with Sylfirm X. Remember that the results won't come overnight, as building new collagen takes anywhere from four to twelve weeks. Directly after your treatment, you should be meticulous about applying a mineral SPF — I use ISDIN Eryfotona Actinica SPF 50+ — and avoid wearing makeup for several days.
Depending on your budget and schedule, exosomes will drastically decrease your post-treatment downtime more than anything else I have experienced. Keep in mind, I was able to go out and about in just three days with a bit of flaking texture. That being said, you can also use a red light device to help expedite healing at home, like the Celluma Pro Panel or Dermalux Flex MD — which are great because they will not sit directly on your skin — or the more affordable CurrentBody Skin LED Mask or Light Salon Boost Advanced LED Face Mask.
Finally, Dr. Emer points out that the way you care for your skin post-treatment matters for your results and their maintenance. Two masks that I find to be extremely soothing are the cooling Velez by Vesna Intense Hydration Mask and the redness-reducing Emer Skin Intense Hydration Mask, which are both anti-inflammatory. Because there will be micro-channels open in your skin, Dr. Emer recommends a post-treatment regimen from his own line — the Emer Skin Aerify Complexion Kit — to get the most of the skin-brightening effects. Other serums that I find to be incredibly beneficial post-treatment are the Eighth Day Regenerative Serum and SkinMedica TNS Advanced+ Serum, which contain growth factors and healing ingredients to help you along your healing journey.