HOW I DO IT

Skin tightening: Fotona 4D protocol

S
kin tightening, especially on the there is also no need for any anaesthesia as
face, is currently one of the most there is merely a very tolerable sensation of
common aesthetic procedures. warmth during the execution of Frac3.
There are many approaches to facial Immediately after Frac3 I proceed to the “There is no need for any
skin tightening, many of them executed with
various energy-based devices, such as lasers,
third step – Piano mode, using R34 with
15mm spot, 100-300J/cm2 and 21 second
special postoperative
radiofrequency and ultrasound devices, all of
them acting on collagen with various levels
pulse duration. Piano NdYAG is a modality in procedure as the whole
of hyperthermia.
which extremely long laser pulses are used
(in seconds), producing a gentle painless
treatment is minimally
Several years ago I started to use a
combined, non-invasive protocol called
warming of the skin through all its layers. invasive that the only
As such, bulk skin heating is applied across
Fotona 4D in which two laser wavelengths
the whole face with a manual scanning side-effect is mild
(NdYAG 1064nm and ErYAG 2940nm)
are used in four different modalities
technique until the temperature at the erythema”
(SmoothLiftin, Frac3, Piano and SupErficial) skin surface reaches about 42°C. I usually
during the same visit with a goal to thermally maintain this temperature for about three
process various depths and structures of the minutes at each of scanned areas.
facial skin. For the last step, SupErficial, the laser
The first step of Fotona 4D protocol is wavelength is changed back to 2940nm
AUTHOR
SmoothLiftin, a solution for reduction of ErYAG and a very light peel is performed
nasolabial folds and perioral wrinkles. A to give a pearl finish, reducing the
special non-ablative modality of ErYAG imperfections and improving the appearance
called Smooth Mode is used intraorally giving a special glow to the skin. For this last
applying the bursts of four to six Smooth step I usually use the R04 handpiece with
pulses at intraoral mucosa and executing 10mm spot, MSP pulse duration, 0.7J/cm²
four passes across the whole accessible and 5Hz.
tissue beneath both cheeks and lips. A PS03 There is no need for any special
handpiece is used with 7mm spot, 9.0-10.0J/ postoperative procedure as the whole
cm² and 2.0Hz. No anaesthesia is needed as treatment is so minimally invasive that the Adrian Gaspar,
this intraoral treatment is not painful.
only side-effect is mild erythema which Obstetrics / Gynaecology Specialist,
For the next two steps, Frac3 and Piano,
could last up to a few hours. Cosmetogynecologist, Former Professor at the
the laser wavelength is changed to 1064nm Gynecology Department of the Faculty of Medicine
To get the full effect of the collagen
NdYAG. I first do the Frac3 mode in which at Mendoza University, Argentina; and Owner and
remodelling I usually do two sessions with Director of the Espacio Gaspar Clinic of Gynecology,
short pulses (0.1-0.3msec) are used with
one month apart and then, depending on the Anti-Aging and Bioregenerative Medicine in
a purpose of achieving shrinkage of deep Mendoza, Argentina
patient’s age, a maintenance session every
shrinkable structures (retinacula cutis) in
anchoring areas of the superficial muscular six months for patients younger than 50 and
aponeurotic system (SMAS). With this we every four months for patients older than 50.
Declaration of competing interests: The author has
can produce the vectors of tension in the skin In this way it is possible not only to maintain received honorarium and reimbursement for speaking at
along the SMAS anchoring areas mimicking good tightening and rejuvenating effect of conferences about laser treatments and for taking part in
educational workshops worldwide by Fotona.
the threads. For this modality I use the R33 the facial skin for a long time, but also to
handpiece, 4mm spot, 35J/cm², 0.1-0.3msec further improve it through time. I have many
and 4Hz. A few passes are delivered along satisfied patients who have been on this
the SMAS anchoring areas. For this modality regime for three and more years.

An example of a 59-year-old patient who initially received three Fotona 4D sessions and was then maintained with one session every four months. The figures demonstrate the patient before, after
three sessions, after six sessions and after three years.

The PMFA Journal | JUNE/JULY 2019 | VOL 6 NO 5 | www.thepmfajournal.com