Legato Case Study

7/31/2019 Legato Case Study

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Legato Treatment Results

Skin Barrier Breakthrough System

Maria Claudia Almeida Issa, MD, PhD

Associate Professor, Department of Clinical MedicineFluminense Federal University

Rio de Janeiro, Brazil


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Dr. Maria Claudia Almeida Issa is among the leading dermatologists inBrazil and South America. She has had 9 articles published in dermatology

trade journals, and has presented her ndings 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[


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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 rst

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 areathat will most benet 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 benet from the delivery of

cosmeceuticals directly beneath the skin include skin whitening and skin

rejuvenation.

iPixelRF

The rst step of the Legato solution is to create microchannels in the

skin. The Legato uses the iPixelTMRF, 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.

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 benet. 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 increasingthe affectivity of the cosmeceuticals.

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Legato Treatment Settings

Face (iPixelRF)

Treated area Power [W]

Neck 40

Chin 40

Cheeks 45

Periorbital 40

Forehead 45

Body (iPixelRF)

Treated area Power [W]

Hand 40

Abdominals 45

Waist 45

Hip 40

Buttocks45

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.

(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 thereduction in height or depth of the scar. In addition, using basal blood

ow assessment with a Doppler owmeter, 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.

]4[


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Scars




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Before

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,Rio de Janeiro, Brazil RF: 45 W, 3 passes Cosmeceutical: TriancinolonaImpact: 60 Hz, 80%, 1 min

1 week after 2 Tx

Scars

]6[


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Before

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

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

After 2 Tx

Scars

]7[


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Before

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

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

10 days after 4 Tx

Scars

]8[


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Before

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

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

1 week after 2 Tx

Scars

]9[


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Before


After 4 Tx.

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

Scars

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Before


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

After 1 Tx.

Scars

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Before

Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,


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

After 1 Tx.

Scars

]12[


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Acne Scars




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Before

Acne Scars



After 2 Tx

RF: 45W, 3 passes Cosmeceutical: Tretinoin 0.05%

Impact: 60 Hz, 80%, 2 min ]14[


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Before

Acne Scars



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

After 3 Tx.

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Before

Acne Scars

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

After 3 Tx

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

Dubai


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Before

Acne Scars

RF: 40-50 W (Treatments 1-5), 100 W (Treatment 6), iPixelRF (IN Motion),

7 passes Cosmeceutical: Locoid (hydrocortisone butyrate)Impact: 40 Hz, 50%, 2 min

After 6 Tx

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Dubai


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Before

Acne Scars

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

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

1 week after 1 Tx

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Before

Acne Scars

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

After 3 Tx

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Strech Marks




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After 4 Tx

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

Impact: 60 Hz, 80%, 4 min

Before



Stretch Marks

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Stretch Marks

Before After

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



Rio de Janeiro, Brazil ]22[


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Stretch Marks



RF: 45 W 2 crosses (4passes) in motion tip

Cosmeceutical:tretinoin 0,05% Impact: 60 Hz 80%

Before After 4 Tx

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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[


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Stretch Marks

Before After 3 Tx

RF: 55W, 3 passes Cosmeceutical: Meso Striae kit


Courtesy of: Dr. Michael Shohat, Dermatologist]25[


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Before

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

Moscow, Russia

14 days after 2 Tx

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

Stretch Marks

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Skin Rejuvenation




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Skin Rejuvenation

Before 1 week after 2 Tx

RF: 40 W, 3 passes Cosmeceutical: Retinoic Acid 0,05%

Impact: 60 Hz, 80%, 60 sec periocular +120 sec-malar and mandibular


Rio de Janeiro, Brazil]28[


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Skin Rejuvenation



After 4 Tx

RF: 40 W, 3 passes Cosmeceutical: Anti-Wrinkle+Retinoic

Acid (RA) Impact: 60 Hz, 80%, 1 min

Before

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Skin Rejuvenation

Before



After 3 Tx

RF: 45 w Cosmeceutical: Tretinoin 0,05%+ H 5% + VIT C 5%

Impact: 60 HZ 80%]30[


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Skin Rejuvenation

Before After 4 Tx



RF: 45 w Cosmeceutical: Glicolic acid 10% + Hydro-

quinone 4% Impact: 60 Hz 80%]31[


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Skin Rejuvenation

Before

RF: 40W, 2 passes Cosmeceutical: Vit C + Hyaluronic Acid


After 2 Tx


Rio de Janeiro, Brazil]32[


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Skin Rejuvenation

RF: 60 W, 2 stationary passes Cosmeceutical: Vitamin C, Alphalipoic

acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min

After 4 Tx

Before

]33[Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,

Dubai


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Skin Rejuvenation

Before After 2 Tx

RF: 55 W, 3 passes Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc,

Silicium and Manganese Impact: 60 Hz, 60%, 2 min]34[


Dubai


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Skin Rejuvenation

Before After 3 Tx

RF: 50W, 4 passes stationary Cosmeceutical: Vitamin C, Alphalipoic

acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min

]35[Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,

Dubai


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Skin Rejuvenation

Before

RF: 40W, 3 passes Cosmeceutical: Meso DMAE


1 week after 1 Tx



]36[


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Skin Rejuvenation

RF: 60W, 3 stationary passes and 2 IN Motion passes

Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc, Silicium and ManganeseImpact: 60 Hz, 60%, 2 min

Before After 3 Tx


Dubai

]37[

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