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using a 1-cm2 tip for 21s The second patient was involved in a dose response study and was treated with energies of 104, 133, and 181 J with a 1-cm2 tip for a duration of 23 s Pre-, parallel-, and postcooling was applied In this small pilot study, the authors observed increased bril diameter and a loss of distinct bril edges in biopsy samples from both patients However, the dose response patient exhibited greater changes, which repaired slowly over 8 weeks The 181 J energy level caused signi cantly more damage to collagen brils than the 104 and 133 J levels, and the treatment effects were most apparent at a depth of 3 4 mm Mild perivascular and perifollicular in ammation occurred 45 minutes after treatment with 104 and 181 J energy levels However, this in ammatory response was not found at 8 weeks posttreatment.

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18 In both cases, collagen mRNA expression was elevated in treated skin immediately and 1 week after treatment However, at 3 and 8 weeks after treatment, treated skin mRNA levels were just below control mRNA levels Overall, while neither patient showed evidence of collagen contraction, the treatment did seem to cause thermal injury, which appeared to stimulate a wound-healing response, and extracellular matrix remodeling, as evidenced by elevated collagen mRNA expression18 In 2007, Suh et al reported on the effects of an MRF device on the abdomens of 37 patients with striae distensae4 Striae duration ranged from 6 months to 30 years (mean 95 years) Thirty-six patients had striae alba, and one patient displayed striae rubra Subjects (skin types III-VI) received combined Thermage and pulsed dye laser (PDL) as their rst treatment, while PDL was used alone in the next two treatments, at 4 and 8 weeks.

The ThermaCool operated at uences between 53 and 97 J/cm2 using a standard tip for 2 3 passes The 585 nm PDL operated at a uence of 3 J/cm2, with a pulse duration of 05 ms and a 10 mm spot size Elasticity improvements were graded as very good (76% 100%), good (51% 75%), moderate (26% 50%), mild (1% 25%), and no improvement (0%) After treatment, 22/37 (591%) patients showed good or very good improvement in elasticity, while 12/37 (324%) patients had moderate improvement and 3/37 (81%) patients had mild improvement Posttreatment, nine biopsy samples were taken All nine specimens showed increased collagenesis, but only six had increased elastic bers Overall, this combined therapy seemed to both increase elasticity and promote neocollagenesis4.

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