**2. InMode and the morpheus innovation**

Now, would it not be even **COOLER**, even more accessible to providers and patients, if this RFAL lipo-coagulation, "enhanced Liposuction" and significant soft tissue contraction and remodeling was available **EXTERNALLY,** a sort of **PERCUTANEOUS RFAL ACCUTITE**? *WELL, now you have it…. the Morpheus Family of soft tissue remodeling applicators and tips,* a trans-epidermal, percutaneous, fractional adipose coagulation, soft tissue contraction and skin remodeling device. In just a few short years, the Morpheus has become the world's #1 fractional skin tightening, wrinkle reduction and soft tissue remodeling tool!

#### **2.1 Trans-epidermal RF systems**

The fact that your BodyTite workstation also comes loaded with the world's most successful effective transcutaneous, fractional skin and soft tissue tightening, wrinkle reduction and elastotic treatment device (The Morpheus 8) makes BodyTite system your Total Tissue Contraction, lifting, tightening and smoothening tool. The concept was to take 12–40 pins/electrodes, coat them with silicone, but leave the tip uncoated. Each needle, or micro-electrode is positively charged, like the tip of your AccuTite, or FaceTite electrode. The needles area inserted into the dermis (Fractora) or the adipose tissue and sud-dermal space (Morpheus 8) and then, like with AccuTite, FaceTite, or BodyTite, the RF does not flow between two closely spaced positive–negative needles (micro-needling) BUT the RF thermal energy creates a large monopolar ablation in the fat (Morpheus) or dermis (Fractora) and then, the energy flows up to the negative, return electrodes far away on the skin, creating a non-ablative heating of the superficial papillary dermis.

#### **2.2 Fractora: dermal fractional RFAL resurfacing**

This was InMode's first generation of *OUTSIDE-IN*, transcutaneous RFAL for *DERMAL* skin resurfacing and tightening. There are several trans epidermal, needle-based heating technologies that also provide dermal contraction and skin tightening. The most notable is the Profound (Syneron Candela), which is a series of six paired silicone coated needles that have significant bipolar RF ablative energy between them. Each of these coated needles have internal thermistors built into them, they sense the temperature and are able to cut-off the RF energy when the endpoint is met. An endpoint of 67–70 degrees is sustained for 3–5 seconds between these six pairs of internal electrodes providing dermal contraction.

The other effective deep dermal RF system for soft tissue contraction is the Fractora (InMode), which has silicone coated needles that are 3000 microns in length with the proximal 2200 microns being silicone coated and the distal 800 microns being uncoated (**Figure 2**). Multiple passes or stacking in the Fractora tip sustains the Monopolar ablations with the gentle bipolar RF flow to simulate the types of contraction energy that needle-based technologies such as the Profound can achieve [2–6].

The epidermal thermal sparing effect of the Fractora and the newer Morpheus fractional adipose technology make these devices safer on darker skin types [2, 3].

The other needle-based RF technologies such as the Infini, Intensif and Intercell are very different to Fractora or Profound, as they have small micro-current flowing between narrowly spaced positive and negative electrodes and the amount of ablative index or power density is relatively low, accounting for a minimal thermal contraction and the need for multiple treatments to achieve modest improvements. The eMatrix (Syneron Candela) is a low epidermal impact, trans-epidermal, smooth electrode system that can deliver mild to moderate skin tightening after 3–6 treatments. HIFU, or Ulthera, is a fractional trans-epidermal focused ultrasound dermal ablative system, that, like the eMatrix, can deliver noticeable, modest skin tightening after 2–3 treatments.

The advances in esthetic medicine have led to a wide array of trans-epidermal fractional and non-fractional laser techniques, high frequency focused ultrasound and non-ablative RF technologies that can enhance skin tightening. These technologies are ideal when combined with multiple approach protocols for mild to moderate results, but never compete with deep subcutaneous heating techniques such Smart Lipo laser lipolysis, mono.

probe, Monopolar ThermiRF heating *systems or, the market leader in soft tissue contraction and safe thermal coagulation, bipolar RFAL technologies.* It is the combination of the externally applied Morpheus 8 and the internal RFAL that has resulted in

#### **Figure 2.**

*The Fractora family of treatment tips. The 60 pin (low density) and 126 pin (high density) 600 micron depth, uncoated needles for general skin resurfacing. The 24 pin, uncoated and silicone coated, 3000 micron needle tips applicators for transdermal ablation. The 24-pin silicone coated needle affords the valuable epidermal thermal sparing effect for selective deep dermal, thermal ablation and remodeling.*

*Internal and External Radiofrequency Assisted Lipo-Coagulation (RFAL) in the Control of Soft… DOI: http://dx.doi.org/10.5772/intechopen.97031*

the extraordinary soft tissue contraction and non-excisional face and body contouring opportunities outlined in this chapter.
