Legato Treatment Results Skin Barrier Breakthrough System

Maria Claudia Almeida Issa, MD, PhD

Associate Professor, Department of Clinical Medicine Fluminense Federal University Rio de Janeiro, Brazil

Dr. Maria Claudia Almeida Issa is among the leading dermatologists in

Brazil and South America. She has had 9 articles published in dermatology trade journals, and has presented her findings at 15 international conferences. Dr. Issa holds a PhD in Dermatology from the Federal University of Rio de Janeiro (2008) and a MsC in Dermatology from the Fluminense Federal University (1997). Dr. Issa has been registered as a dermatologist with the Brazilian Society of Dermatology since 1995. Dr. Issa is currently an Associate Professor within the Department of Clinical Medicine Dermatology, at the Fluminense Federal University. Her research focuses on Photodynamic Therapy, non-Melanoma Skin Cancer, Lasers, Photoaging and Dermal Remodeling. In addition, Dr. Issa operates her own clinic called Dermavance Dermatologia, located in Niteroi, Rio de Janeiro.

Dr. Maria Claudia Almeida Issa

MD, PhD

]2[

Introduction:
The Legato Skin Barrier Breakthrough System for Trans-Epidermal Delivery. The Legato was developed to overcome the challenge of introducing cosmeceuticals beneath the skin without interference from the stratum corneum (outer layer of skin barrier). The Legato is a dual stage system that uses RF and ultrasound technologies to introduce cosmeceuticals beneath the skins surface. The protocol first calls for fractional skin ablation and creating microchannels in the skin. The Legato then harnesses the power of acoustic ultrasonic waves, pushing cosmeceuticals into these microchannels directly to the area that will most benefit from the active ingredients. The Legato is designed for the treatment of scars and stretch marks - two indications for which there is no effective solution which is not highly invasive. Other indications that may benefit from the delivery of cosmeceuticals directly beneath the skin include skin whitening and skin rejuvenation.

Cosmeceuticals The advantage of Trans-Epidermal Delivery compared to topical, oral, and hypodermic injections - is the ability to deliver the appropriate dose of cosmeceuticals directly to the location that will most benefit. When cosmeceuticals are introduced directly to biological tissue, they are more deeply absorbed and provide a stronger therapeutic effect. Until now, the main problem with effective delivery of skin care products/cosmeceuticals, was the fact that the stratum corneum is an effective barrier to outside elements. Cosmeceuticals are applied to the skin following the creation of the microchannels due to the fractional skin ablation. The cosmeceuticals are forced through the microchannels by the Impact Ultrasound unit.

Impact
Impact is the name of the ultrasound unit that acts as a vibrator, releasing acoustic waves that push the cosmeceuticals into the skin via the microchannels. The acoustic vibrations of the ultrasound leads to radiation pressure that gives the cosmeceuticals greater mobility and reactivity. This increases the amount of cosmeceuticals that enter the body, thereby increasing the affectivity of the cosmeceuticals.

iPixelRF
The first step of the Legato solution is to create microchannels in the skin. The Legato uses the iPixelTM RF, a radio wave generator that causes precise and controllable thermal damage and fractional ablation. As the iPixelRF makes contact with the skin, small plasma sparks are released that pierce the epidermis and cause fractional skin ablation - forming the microchannels. Each microchannel is 80-120 microns in diameter and has a depth of 100-150 microns, depending on the RF-power settings.

]3[

Legato Treatment Settings Face (iPixelRF)

Treated area Neck Chin Cheeks Periorbital Forehead Power [W] 40 40 45 40 45

(Of note, the skin color was closer to the natural color.) Other noted changes in the appearance of the skin following the use of the Legato include a decrease in skin tension by the scar and the reduction in height or depth of the scar. In addition, using basal blood flow assessment with a Doppler flowmeter, the edema of the adjacent tissue decreased due to improvements of the blood circulation.

Conclusions
It is the authors belief that the combined use of cosmeceuticals with a delivery system like the Legato is highly effective. In particular, the realized synergies between cosmeceuticals and a delivery system include improved clinical and functional effects. The author is not aware of any alternative solution that is comparable to the Legato. The Legato may be used for mature scars, post acne scars, stretch marks, skin whitening, skin rejuvenation, and immediately following the removal of sutures.

Body (iPixelRF)
Treated area Hand Abdominals Waist Hip Buttocks Power [W] 40 45 45 40 45

Treatment
The Legato Skin Barrier Breakthrough System was used on 30 patients with pathologic scars, including 13 patients with atrophic scars and 17 patients with hypertrophic changes. In addition, 27 patients had striatal atrophy of the skin. All of the patients received a minimum of 4, and maximum of 8 sessions. By the 5th session, a partial reduction in the scar tissue was indicated.

]4[

Legato Treatment Results Skin Barrier Breakthrough System Scars

Scars

Before

1 week after 2 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45 W, 3 passes Cosmeceutical: Triancinolona Impact: 60 Hz, 80%, 1 min

]6[

Scars

Before

After 2 Tx

Courtesy of: Dr. Igor Pinson, MD & PhD, Dermatologist, Moscow, Russia

RF: 45 w Cosmeceutical: Contractubex Impact: 40 Hz, 50%, 1 min

]7[

Scars

Before

10 days after 4 Tx

Courtesy of: Dr. Igor Pinson, MD & PhD, Dermatologist, Moscow, Russia

RF: 50 w 2-3 passes Cosmeceutical: Contractubex Impact: 40 Hz, 50%, 1 min

]8[

Scars

Before

1 week after 2 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 40W, 2 passes Cosmeceutical: Hyaluronic Acid + Vit C Impact: 60 Hz, 80%, 1 min

]9[

Scars

Before

After 4 Tx.

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 40W, 2 passes Cosmeceutical: Hyaluronic Acid + Vit C Impact: 60 Hz, 80%, 1 min

]10[

Scars

Before

After 1 Tx.

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45W, 3 passes Cosmeceutical: Triancinolona Acetonide Impact: 60 Hz, 80%, 2 min

]11[

Scars

Before

After 1 Tx.

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45W, 3 passes Cosmeceutical: Triancinolona Acetonide Impact: 60 Hz, 80%, 2 min

]12[

Legato Treatment Results Skin Barrier Breakthrough System Acne Scars

Acne Scars

Before

After 2 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45W, 3 passes Cosmeceutical: Tretinoin 0.05% Impact: 60 Hz, 80%, 2 min

]14[

Acne Scars

Before

After 3 Tx.

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45W, 3 passes Cosmeceutical: Tretinoin 0.05% Impact: 60 Hz, 80%, 2 min

]15[

Acne Scars

Before

After 3 Tx

Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic, Dubai

RF: 60 W, stationary and iPixelRF (In Motion), 6 passes Cosmeceutical: Dalacine (Clindamycin)

]16[

Acne Scars

Before

After 6 Tx

Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic, Dubai

RF: 40-50 W (Treatments 1-5), 100 W (Treatment 6), iPixelRF (IN Motion), ]17[ 7 passes Cosmeceutical: Locoid (hydrocortisone butyrate) Impact: 40 Hz, 50%, 2 min

Acne Scars

Before

1 week after 1 Tx

Courtesy of: Choi Jun, MD, PhD, MayLin Clinic, Seoul, Korea

RF: 55-65 W, 4-5 passes Cosmeceutical: PRP Impact: 60 Hz, 50%, 2 min

]18[

Acne Scars

Before

After 3 Tx

Courtesy of: Dr. Michael Shohat, Dermatologist

RF: 45-50W, 2-3 passe Cosmeceutical: Meso anti Wrinkle,1% HA, MicroAcne kit Impact: 60 Hz, 80%, min

]19[

Legato Treatment Results Skin Barrier Breakthrough System Strech Marks

Stretch Marks

Before

After 4 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45 W, 3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C Impact: 60 Hz, 80%, 4 min

]21[

Stretch Marks

Before

After

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45 W,3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C Impact: 60 Hz, 80%, 4 min

]22[

Stretch Marks

Before

After 4 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45 W 2 crosses (4passes) in motion tip Cosmeceutical: tretinoin 0,05% Impact: 60 Hz 80%

]23[

Stretch Marks

Before

After 1 Tx

Courtesy of: Dr. Michael Shohat, Dermatologist

RF: 55W, 2 passes Cosmeceutical: Meso Striae kit Impact: 60 Hz, 50%, 5 min

]24[

Stretch Marks

Before

After 3 Tx

Courtesy of: Dr. Michael Shohat, Dermatologist

RF: 55W, 3 passes Cosmeceutical: Meso Striae kit Impact: 80 Hz, 50%, 3 min

]25[

Stretch Marks

Before

14 days after 2 Tx

Courtesy of: Dr. Igor Pinson, MD & PhD, Dermatologist Moscow, Russia

RF: 45 W, 3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C

]26[

Legato Treatment Results Skin Barrier Breakthrough System Skin Rejuvenation

Skin Rejuvenation

Before

1 week after 2 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 40 W, 3 passes Cosmeceutical: Retinoic Acid 0,05% Impact: 60 Hz, 80%, 60 sec periocular +120 sec-malar and mandibular

]28[

Skin Rejuvenation

Before

After 4 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 40 W, 3 passes Cosmeceutical: Anti-Wrinkle+Retinoic Acid (RA) Impact: 60 Hz, 80%, 1 min

]29[

Skin Rejuvenation

Before

After 3 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45 w Cosmeceutical: Tretinoin 0,05%+ H 5% + VIT C 5% Impact: 60 HZ 80%

]30[

Skin Rejuvenation

Before

After 4 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 45 w Cosmeceutical: Glicolic acid 10% + Hydroquinone 4% Impact: 60 Hz 80%

]31[

Skin Rejuvenation

Before

After 2 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 40W, 2 passes Cosmeceutical: Vit C + Hyaluronic Acid Impact: 60 Hz, 80%, 1 min

]32[

Skin Rejuvenation

Before

After 4 Tx

Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic, Dubai

RF: 60 W, 2 stationary passes Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min

]33[

Skin Rejuvenation

Before

After 2 Tx

Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic, Dubai

RF: 55 W, 3 passes Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min

]34[

Skin Rejuvenation

Before

After 3 Tx

Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic, Dubai

RF: 50W, 4 passes stationary Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min

]35[

Skin Rejuvenation

Before

1 week after 1 Tx

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology, Rio de Janeiro, Brazil

RF: 40W, 3 passes Cosmeceutical: Meso DMAE Impact: 60 Hz, 80%, 2 min

]36[

Skin Rejuvenation

Before

After 3 Tx

Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic, Dubai

RF: 60W, 3 stationary passes and 2 IN Motion passes Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min

]37[