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
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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.
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Scars
Legato Treatment Results
Skin Barrier Breakthrough System
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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
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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
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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
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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
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Before
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,Rio de Janeiro, Brazil
After 4 Tx.
RF: 40W, 2 passes Cosmeceutical: Hyaluronic Acid + Vit CImpact: 60 Hz, 80%, 1 min
Scars
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Before
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,Rio de Janeiro, Brazil
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,
Rio de Janeiro, Brazil
RF: 45W, 3 passes Cosmeceutical: Triancinolona AcetonideImpact: 60 Hz, 80%, 2 min
After 1 Tx.
Scars
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Acne Scars
Legato Treatment Results
Skin Barrier Breakthrough System
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Before
Acne Scars
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
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
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
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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Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
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
Legato Treatment Results
Skin Barrier Breakthrough System
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After 4 Tx
RF: 45 W, 3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C
Impact: 60 Hz, 80%, 4 min
Before
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
Stretch Marks
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Stretch Marks
Before After
RF: 45 W,3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C
Impact: 60 Hz, 80%, 4 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil ]22[
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Stretch Marks
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
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
Impact: 80 Hz, 50%, 3 min
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
Legato Treatment Results
Skin Barrier Breakthrough System
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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
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil]28[
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Skin Rejuvenation
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
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
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
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
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
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
Impact: 60 Hz, 80%, 1 min
After 2 Tx
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
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[
Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
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
Impact: 60 Hz, 80%, 2 min
1 week after 1 Tx
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
Rio de Janeiro, Brazil
]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
Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
Dubai
]37[
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