Michael J. Weidmann
A New Combination Therapy: Injection lipolysis and Genius – fat reduction and tightening is ingenious
In recent years, however, the network has also dealt with the topic of "combination therapies in minimally invasive aesthetics" in a number of articles [1-5]. The combination of PRP with mesotherapy for the treatment of hair loss has proven to be very effective, the same applies to PRP and needling as well as lipolysis and cryolipolysis or lipolysis and ketogenic diet.
Last year, our practice purchased a new device for skin tightening, a needling radiofrequency device called Genius (Lutronic company). The background to this was that there are no really good alternatives for improving skin structure, especially in the neck area. In addition, the device is particularly suitable for dark skin types. Since I frequently treat the face with lipolysis and also achieve very good results there, the topic inevitably arose of achieving volume build-up and skin structure improvement after tightening the neck region with lipolysis using the Genius in order to take advantage of this synergistic effect.
The mechanism of action of injection lipolysis should be sufficiently known to readers, so here is just a very brief summary: It is the chemical destruction of adipocytes, on the one hand by deoxycholic acid (DOC, fat cell necrosis) and polyenylphosphatidylcholine (PPC, apoptosis)  in the well-known network compound that has been used for 20 years, and on the other hand the strong lipolytic effect (=rapid depletion of fat cells) and additionally apoptosis in the nano PPC, the new injectable of the network. In particular, the former is associated not only with the reduction of fat compartments, but also with the tightening of the skin initiated by the inflammation. The latter is not causally associated with inflammation, and therefore the tightening effect is less.
The Genius is a radiofrequency device with needling (so already itself a combination of heat and collagen induction!). I must openly admit here that for years I was critical of the use of radiofrequency in aesthetics because of the lack of temperature control and regulation. First, regarding the risk with the Genius, in the 18 months our practice has been using the device, I have not had a single complication. The intelligent, self-regulating system of energy delivery in the Genius stops immediately when certain values are exceeded. This is new and therefore of great importance for the future of this minimally invasive therapy. Regarding the effect, some publications have shown that we are dealing with a real volume increase, which consequently means that excess skin is reduced. At the recent meeting of the DDL in Stuttgart, I gave a presentation on my results with the device and was very surprised that some colleagues reported severe pain of the patients during the treatment. These reports were in contrast to my own experience and therefore the discrepancy of the different experiences did not give me any peace. I immediately had the technician come and check the device to rule out the possibility that the energy was too low. I can now only explain the differences with the surface anesthesia that I use: Anesthesis L cream (Mohren Apotheke zu St. Lorenz, Nuremberg), which I exceptionally apply occlusively and at least 45 minutes before the treatment. In addition, cold air cooling is applied during the treatment. In principle, the treatment is of course painful, but with the above-mentioned procedures, a sufficient pain management can be carried out from my point of view.
I am thrilled with the results of each procedure, regardless of their combination, because both round out my facial treatments perfectly. But I am even more enthusiastic about the synergy that can be achieved with both procedures. Normally I treat first with lipolysis, after 4 weeks a first treatment with the Genius and so on in a 4-week rhythm. In particular, the indication of sagging cheeks in conjunction with additional loss of elasticity of the lower third of the face, including the neck region, have again increased patient satisfaction.