Patients are frequently seeking efficacious yet little or no downtime procedures. These procedures, however, do require a series of treatments to achieve optimal cosmetic results.

In the author's practice, the use of devices employing a combination of optical energy and bipolar radiofrequency (RF; Syneron Medical Ltd.) has proven successful in meeting patient expectations and patient concerns as well as treating a wide range of conditions and reducing side effects experienced from the use of RF alone. The combination of optical energy and bipolar RF is believed to result in a synergistic effect, resulting in a more effective treatment, while using decreased energy levels to treat a range of skin types. Unlike unipolar RF devices, the energy in a bipolar RF device passes between two electrodes at a set distance, regulating the energy that is delivered (Sadick and Makino 2004).

There is a wide range of devices available that employ optical energy and bipolar RF that can be used for a wide variety of conditions. However, this chapter will cover the FotoFacialRF (intense pulsed light [IPL] plus RF), ReFirme WR (diode laser plus RF), and ReFirme ST (broadband infrared [IR] plus RF) devices alone and in combination with one another as well as the VelaSmooth (IR plus RF) device (Figures 57.1 and 57.2).

Determining the most appropriate treatment is based on a three-step process used in our practice to achieve patient satisfaction, while providing the patient with optimal rejuvenation results.