The Great Debate: IPL or RF…or Both?
Radiofrequency (RF) has been used in aesthetics, including at Essence Laser and Wellness, for skin tightening for decades. The deep heat that is generated in the skin enhances elastin and collagen production, improving skin quality. Recently, there has been discussion in the literature regarding the use of RF for Dry Eyes. The theory behind it is simple: The heat delivered to the Meibomian glands (MBG) in the eyelids helps open the MBG and allows for better function, much the same way IPL delivers heat to the eyelids, but RF uses high-frequency electrical energy, whereas IPL uses light-based energy. Better MBG function means a healthier tear film, less evaporation, and fewer dry eye symptoms.
Several reports in the literature describe improvements in Dry Eye symptoms with radiofrequency treatment. New technologies are claiming better results with the combination of RF and IPL. The question is: Does RF add anything to the treatment that IPL is not already providing? IPL already delivers heat, but the light-based IPL also targets the color red and coagulates the telangiectasias, tiny blood vessels that release inflammatory components to the eye. RF is color blind. It has no effect on the telangiectasias.
So, is there really any benefit to adding more heat with RF to the IPL treatment? Currently, there is no strong scientific evidence in the literature to support this.
There is a report in the literature that is cited by many to support the combination of RF and IPL; see the reference below. However, as the authors themselves admit, the study has many flaws. These include the fact that the comparison group for IPL alone came from an entirely different study that involved many other variables, and that the authors were paid by a device company that sells the RF/IPL combination device. The authors concluded that “A randomized controlled study comparing the combination of RF and IPL (…) with IPL (…) alone is required to further elaborate the relative contribution of RF.”
Here is what we know about the use of Radiofrequency and IPL for Dry Eyes
-
Both RF and IPL deliver heat to the MBG and can help relieve dry eye symptoms.
-
Both RF and IPL are safe therapies in the hands of skilled clinicians.
-
IPL additionally coagulates the telangiectasias that release inflammatory components; RF does not.
-
IPL cannot be used in patients with highly pigmented skin or with tetracycline-related antibiotics. RF can be used for these patients.
-
RF cannot be used in patients with any metal implants from the chest up or a pacemaker. IPL can.
-
RF has the added benefit of a cosmetic improvement in the skin quality around the eyes. IPL does not.
-
There is no good scientific evidence that the combination of RF and IPL adds to the effect of IPL alone on Dry Eyes. This is yet to be proven.
Conclusion:
Both IPL and RF can help with Dry Eyes. If there are no contraindications, IPL is most likely the superior therapy due to its added benefit in treating telangiectasias. For patients who have contraindications to IPL, RF may be a good alternative.
If a patient would like to try the combination, recognizing that there is no scientific evidence supporting it for dry eyes and that there are no contraindications to either therapy, or if the patient desires a cosmetic benefit, RF and IPL treatments may be combined.
At Essence Laser and Wellness, we have years of experience using monopolar Radiofrequency and IPL around the eyes. Our advanced RF technology with the BTL Exilis Device is a monopolar unit that combines Ultrasound with Radiofrequency for deeper tissue penetration, which may enhance heat delivery to the Meibomian Glands for Dry Eyes.
What is Radiofrequency and how does it work for dry eyes?
Radiofrequency delivers heat to the skin by high-frequency electrical waves. The heat delivered to the eyelids helps open the Meibomian glands, allowing for a thicker oily layer in the tear film and reducing tear evaporation, thereby improving the symptoms of Dry Eyes.
What to expect during your RF treatment
The BTL EXILIS technology at Essence provides the most advanced RF treatment, delivered safely, efficiently, and without pain. Initially, a grounding pad is laid on the back to ground the monopolar energy. A layer of gel is applied to the skin, and a handpiece attached to the energy system delivers heat to the area around the eyes in a circular, continuous motion. Most patients describe the sensation as comparable to a hot stone massage. The treatment is performed while you lie down so you can relax easily during the procedure. The procedure takes about 15-30 minutes. There is no downtime with the RF procedure alone. The presence of any metal implants from the chest up is a contraindication to RF therapy.
How many treatments will I need?
A minimum of 3 treatments is given, typically 4-5, one month apart. After that, maintenance treatments are given one to two times per year, depending on the severity of the condition.
Contraindications
Under the supervision of Melinda C. O’Rourke, MD, Essence Laser and Wellness is a referral center for specialty dry eye therapy and a medical aesthetics practice, not a routine ophthalmology practice. We ask that you provide a copy of a recent eye exam prior to treatment when seeking IPL for dry eye and/or the PReye™ shot. No exam is necessary for PReye™ drops or PRP for aesthetic purposes.
Ask us about our IPL/PReye/RF bundling packages.
References
-
Chelnis J, Garcia CN, Hamza H. Multi-Frequency RF Combined with Intense Pulsed Light Improves Signs and Symptoms of Dry Eye Disease Due to Meibomian Gland Dysfunction. Clin Ophthalmol. 2023 Oct 20;17:3089-3102.
