Radio Surgery (Radiofrequency or Radiowave Surgery) is used to remove moles, warts, skin tags and other so called ‘lumps and bumps’. It can also be used to remove small blood vessels by thermocoagulation effect. The procedure involves the passage of radio waves into the epidermis or dermis of the skin to perform the removal or reshaping of a lesion. Different types of electrodes are used depending on the type of lesion, e.g. fine needle for incision and blood vessels, wire loop for intradermal nevi, scalpel blade etc. Patients can expect minor swelling, redness, bruising and tenderness in the area for a few days as it heals. There should not however be any bleeding due to the tissue coagulation during treatment.

1. An Introduction For the Treatment of
Radiosurgical Procedures
in Cosmetic Medicine
Presented by Dr Patrick J. Treacy
Ailesbury Clinic Dublin
IRELAND

2. DISCLOSURE:
• Dr. Patrick J. Treacy is a Cosmetic Doctor registered
in Ireland for the purposes of aesthetic medicine
• I have previously been registered in United Kingdom,
United States, Australia, New Zealand, South Africa.
• I purchased my own Radiosurgery equipment.
• I have no financial interest or stock in Ellman
• I receive no additional remuneration or other
compensation for equipment bought by you as a
result of your attendance at this IMCAS lecture.

3. THE ULTIMATE
RF ENERGY
SOURCE

4. MEDICAL APPLICATIONS
• Dental
• Dermatology
• Neurosurgery
• OB/GYN
• Ophthalmology
• Otolaryngology
• Plastic Surgery
. General Practice
……. and Cosmetic Medicine

5. HISTORY RADIOSURGERY
•In 1976, Dr. Irving Ellman was granted a U.S. Patent
on 3.8MHz high frequency 4 waveform dental
RADIOSURGICAL device.
There are now many studies showing the efficacy of
using the 3.8MHz Frequency and the different
waveforms for soft tissue applications.

6. WHY 4.0 MHz?

7. ELECTRICAL ENERGY IN MEDICINE
HIGH TEMP LOW TEMP

8. ELECTRICAL ENERGY IN MEDICINE
HIGH TEMP LOW TEMP

9. HIGH FREQUENCY VS. LOWHIGH FREQUENCY VS. LOW
FREQUENCYFREQUENCY
• Ultra High Frequency:
• Low lateral heat
• Excellent cosmetic
results
• Scalpel like incisions
• European and FDA
approved
• Safe
• Low Frequency:
• High lateral heat
• Poor cosmetic
results
• Poor surgical quality
• Limits on approved
procedures
• Unsafe

10. HISTOPATHOLOGICAL COMPARISON
TISSUE DAMAGE

11. FREQUENCY and LATERAL HEAT
HIGH FREQUENCY
LH =
T x P x W x S
F
H=lateral heat, T=time, P=power intensity,
=waveform, S=surface area, F=frequency

12. HISTOPATHOLOGICAL COMPARISON
TISSUE DAMAGE

13. HISTOPATHOLOGICAL COMPARISON
HIGH FREQUENCY LOW FREQUENCY

14. WAVELENGHT and LATERAL HEAT
LOW FREQUENCY
LH =
T x P x W x S
F
LH=lateral heat, T=time, P=power intensity,
W=waveform, S=surface area, F=frequency

15. Types and
Characteristics of
Waveforms

16. 3 BUTTON FINGERSWITCH HANDPIECE

17. CUT/COAG - Fully Rectified
• 50% Cut - 50%
Coagulation
• Cutting with Hemostasis

18. HAEMOSTASIS - Partially Rectified
• 10% Cut - 90%
Coagulation
• Coagulation/Retraction
Direct and Indirect

19. FULGURATION
• Intentional Destruction of Diseased
Tissue
• Deep Coagulation by Spark-gap

20. THE ELLMAN RADIOSURGERY unit
I use the Surgitron Radiolase

21. SURGITRON Patented 4.0 Dual RF

22. Comparison between
RADIOSURGERY and
LASERS in Cosmetic
Medicine

23. RADIOSURGERY vs. LASER
in Cosmetic Medicine
• Radiosurgery:
• Very reasonably
priced (Euro 2,995-
15,000)
• Great aesthetic
results
• Superior incisions &
excisions
• Less lateral heat
• Performs more
procedures
• Easy to use
• Laser
• High Cost
• (Euro 40,000-
130,000)
• High Maintenance
• Lacks tactile feel in
incisions
• High heat build up
• Inferior biopsy
results
• Poor in in dense

24. • Permits high degree of hemorrhage control
• Good visibility of tissues
• Sterilizes the incision site as it cuts
• No maintenance required
• Electrodes never need resharpening
Advantages of 4.0 MHz Radiosurgery::

25. CUT - Fully Rectified/Filtered
• 90% Cut - 10%
Coagulation
• Micro smooth Cutting
• Minimal lateral heat
• Fastest healing

26. • Permits precise planing of tissues
• Little thermal effect on adjacent tissues
• Good biopsy control
• Electrodes are self sterilizing
Advantages of 4.0 MHz Radiosurgery:

27. INCISION

28. EXCISION / BIOPSY
PROCEDURES

29. COSMETIC REMOVAL OF SKIN LESIONS

30. EXCISION / BIOPSY

31. HAEMOSTASIS
Monopolar Bipolar

32. BIPOLAR COAGULATION
• Discrete, Pinpoint Coagulation @ 1.7MHz
• Use in Hemo or Bipolar mode with Special
Bipolar Cord and Foot pedal.

33. PRIMARY CARE
APPLICATIONS

34. MATRIXECTOMY

35. LID LESION

36. PRIMARY CARE PROCEDURES
• Skin tags
• Spider Veins
• Venous Lakes
• Pyogenic Granulomas
• Dermatofibromas
• Benign Nevi
• Actinic keratoses
• Basal cell cancers
• Biopsy for pathology
• Sebaceous cysts
• Lipomas
• Wart Removal
• Matrixectomy
• Rhinophyma
• Snoring procedure
• Haemorrhoids
• Xanthelasma
• Lletz/Leep procedure
• Condyloma acuminata.

37. Excision of PYOGENIC GRANULOMAExcision of PYOGENIC GRANULOMA
from scalp tissuefrom scalp tissue
©EMZimmerman, 10, 2003
©EMZimmerman, 10, 2003

38. Excision of PYOGENIC GRANULOMAExcision of PYOGENIC GRANULOMA
from nail tissuefrom nail tissue
©EMZimmerman, 10, 2003
©EMZimmerman, 10, 2003
Pre Radiosurgery Post Radiosurgery 2 months

39. Excision of WARTS from hand tissueExcision of WARTS from hand tissue
©EMZimmerman, 10, 2003

40. Excision of WARTS from hand tissueExcision of WARTS from hand tissue
©EMZimmerman, 10, 2003

41. Excision Basal Cell Carcinoma from NoseExcision Basal Cell Carcinoma from Nose

42. Excision Basal Cell Carcinoma from NoseExcision Basal Cell Carcinoma from Nose
©

43. Excision of SEBACEOUS CYST from scalpExcision of SEBACEOUS CYST from scalp

44. SPECIALISED
PRIMARY CARE
APPLICATIONS

45. VASECTOMY
©EMZimmerman, 10,
2003

46. LLETZ/LEEP PROCEDURE

47. LLETZ/LEEP PROCEDURE

48. Excision of CondylomaExcision of Condyloma

49. Excision of CondylomaExcision of Condyloma
©EMZimmerman, 10, 2003
©EMZimmerman, 10, 2003

50. UPPER LID BLEPHAROPLASTY

51. MEDICAL AESTHETIC
APPLICATIONS

52. COSMETIC MEDICINE PROCEDURES
• Acne Scarring
• Peroral Commisures
• Milia
• Intradermal Nevi
• Skin tags
• Telangiectasia
• Spider Veins
• Venous Lakes
• Compound Nevi
•Scar Revision
•Epilation

53. LESION REMOVAL

54. Facial Teleangiectasia

55. Thermocoagulation of Leg VeinsThermocoagulation of Leg Veins
©EMZimmerman, 10, 2003

56. Thermocoagulation of RED Leg VeinsThermocoagulation of RED Leg Veins

57. NEW MEDICAL AESTHETIC
PROCEDURES

58. Excision of PERIORAL COMMISURES
from UPPER LIP
©EMZimmerman, 10, 2003
PRE RADIOSURGERY POST RADIOSURGERY

59. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES
from UPPER LIPfrom UPPER LIP

60. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES
from marionette areafrom marionette area
©EMZimmerman, 10, 2003
PRESENTING PROBLEM PRE PROCEDURE

61. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES
from UPPER LIPfrom UPPER LIP
©EMZimmerman, 10, 2003
PRE RADIOSURGERY PRE RADIOSURGERY

62. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES
from UPPER LIPfrom UPPER LIP
POST RS PROCEDURE POST RADIOSURGERY

63. RHINOPHYMA WITH LOOP
SHAVING TECHNIQUE

64. RHINOPHYMA

65. Excision of ACNE SCARRING from faceExcision of ACNE SCARRING from face
©EMZimmerman, 10, 2003

66. Excision of ACNE SCARRING from face
©EMZimmerman, 10, 2003

67. Protection of Dermis with Fixomull
•Leave on 3-5 days
•Depending on exudate
•Apply Olive Oil
•Remove after 30mins

68. Excision of MILIA from faceExcision of MILIA from face
©EMZimmerman, 10, 2003

69. Excision of KERATOTIC SCAR from faceExcision of KERATOTIC SCAR from face

70. Excision of Acne KERATOTIC SCARSExcision of Acne KERATOTIC SCARS
Special Electrode

71. Excision of large congenitalExcision of large congenital
COMPOUND NEVUS from lumbar areaCOMPOUND NEVUS from lumbar area
Histopathology required

72. Removal of Benign INTADERMAL NEVI

73. Removal of Benign COMPOUND NEVUS

74. Removal of Benign Intradermal Nevus

75. Excision of COMPOUND NEVUS from lipExcision of COMPOUND NEVUS from lip

76. Removal of VENOUS LAKE from LIPRemoval of VENOUS LAKE from LIP

77. VENOUS LAKE on LIPVENOUS LAKE on LIP

78. Removal of Benign Intradermal Nevus

79. Removal of Benign Intradermal Nevus

80. EARLOBE REPAIR
Electrode is suited to
precision incision
.
Excellent healing is
demonstrated

81. Excision of SEBACEOUS CYST from NeckExcision of SEBACEOUS CYST from Neck

82. Excision of Dermal Nevus from AbdomenExcision of Dermal Nevus from Abdomen

83. Excision of Dermal Nevus from AbdomenExcision of Dermal Nevus from Abdomen

84. Excision Seborrheic Keratosis from BackExcision Seborrheic Keratosis from Back

85. Excision Seborrheic Keratosis from BackExcision Seborrheic Keratosis from Back

86. CUTTINGCUTTING

87. 4.0 MHz DEVICE,
ELECTRODES
AND ACCESSORIES

88. SURGITRON Patented 4.0 Dual RF

89. VAPOR-VAC™II

90. THE RADIOSURGERY SYSTEM

91. 3 BUTTON FINGERSWITCH HANDPIECE

92. STANDARD
PRIMARY
CARE
ELECTRODES

93. DISPOSABLE
ELECTRODES

94. EMPIRE NEEDLE
ELECTRODES:
for Cutting and Coagulation

95. HAEMOSCALPEL

96. INSULATED MATRIXECTOMY
ELECTRODE

97. BIPOLAR FORCEPS

98. LLETZ ELECTRODES

99. for treating broken FACIAL RED VEINS
(telangiectasias) and SPIDER VEINS
INSULATED MICROELECTRODE

100. INSULATED NEEDLE ELECTRODE
for Telangiectasia and Epilation

101. COAGULATION /HAEMOSTATIS
• Partially rectified, partially filtered.
• Direct touch or grasp (bipolar forceps)
• Tissue damage minimized by lifting area or vessel
to be coagulated.
• Penetrates more deeply, more tissue damage
• If carbon/eschar forms, it acts as an insulator and
will not control bleeding. Wipe it away or use
another form of haemostasis.

102. RELATIVE CONTRAINDICATIONS
• Pacemakers
• Pregnancy
• Bleeding disorders
• Systemic and local infections.

103. INFORMED CONSENT:
• Should educate the patient about the procedure,
• risks and expected, realistic results for a procedure.
• Should include all components of the procedure,
• Cleaning, anesthesia to care and cosmesis.
• Gives you a chance to establish patient rapport

104. QUESTIONS??

105. THANK
YOU!

106. An Introduction For the Treatment of
Minor Cosmetic Procedures
in General Practice
Presented by Dr Patrick J. Treacy
Ailesbury Clinic Dublin
IRELAND