Who is Dr Mickey Karram?
Dr Mickey Karram is a board-certified obstetrician gynaecologist. He is also board-certified in what is now termed female pelvic medicine and reconstructive surgery what used to be called urogynecology. He’s been practising for over 30 years dealing with a variety of female pelvic health and pelvic floor disorders.
What is unique about EmpowerRF? Is there patient demand?
“What's unique about EmpowerRF is that it allows you to treat a variety of conditions, and it has multiple capabilities. So I'm sure a lot of you are thinking, will patients really pay out of pocket for these various treatments? I've had the opportunity to practise in Ohio for the majority of my career. Currently, I'm practising in Orange County, Newport Beach and Beverly Hills. I can say hands down they definitely will because the platform does provide an opportunity to address areas unmet by traditional medicine. Whether that be treating vaginal atrophy and general urinary syndrome of menopause or the various aesthetic issues they want to address. So hands down, there is a huge opportunity here because most women are suffering in silence. They're not coming forward with these complaints, and they are happy, almost ecstatic when you're able to offer them an office-based treatment with minimal downtime."
What EmpowerRF technology are you most excited about?
“The technology on EmpowerRf that I am very excited about is something called V Tone. Pelvic floor rehabilitation and the patient's ability to isolate their pelvic floor is something we know is lacking in probably north of 50 per cent if not more north of 70 percent of women. That's because these muscles are deep, patients have healthy muscles, but because they're surrounded by their thighs, buttocks and abdominal muscles, they can't find them and isolate them. V Tone is electro muscular stimulation that is performed in an office setting and can do everything a pelvic floor physical therapist can do, but now you (an aesthetic practitioner or physician) can control this and have the patient come to you directly for this rehabilitate rehabilitative process.”
How it help with menopause?
“When we talk specifically about who would be a good candidate for this, I'm going to start with conditions that I would term as actual disease states. The first is genital urinary syndrome of menopause, more commonly termed vulvovaginal atrophy. This is when a woman loses her natural estrogen from the ovaries when they pass into menopause; the average age is 50. Within three years, 50 percent of women will develop vaginal dryness, pain with intercourse, and irritative bladder symptoms of urgency and frequency. Until recently, the only thing you could offer these patients was to replace the oestrogen. It has to be done locally, it's messy, and many women can't take oestrogen, such as breast cancer survivors, patients that have had blood clots, and patients that get migraine headaches. Many women have concerns and fears and don't want to take oestrogen. So having a non-hormonal therapy resonates well with and is highly beneficial for many women.”
How does it help with urinary incontinence?
“RF radiofrequency has had a long history of being a therapy for urinary incontinence. EmpowerRF includes microneedling, which is much more robust than traditional radio frequency, which just bulk heats the area. It improves that connective tissue as the device allows the needles to penetrate up to three millimetres. This generates all the things that you need to improve the strength and the support of the periurethral tissue.
We're also seeing tremendous improvement in the overactive bladder aspect of incontinence. Again the mechanism of action here is not entirely clear, whether it's an improvement in their pelvic floor or whether it's that heat potentially at that level of invasiveness of three millimetres is doing something to modulate nerves that control the bladder.
We've got ongoing trials in all of these areas, what we term stress incontinence and mixed incontinence which is an overactive bladder. It's important to understand that many patients don't want surgery if they're surgical candidates, which would be stress incontinence patients. The overactive bladder is not a surgical condition, therefore you're talking about costly medicines that have a lot of side effects, and if they fail, you're talking about something like a neuromodulator which is very invasive lifelong therapy that modulates your nerves or botox injections for example that needs to be done every six months.
So we're studying all of this, and the preliminary success that we're seeing is extremely encouraging in those areas.”
How does it help with postpartum?
“Postpartum patients are at high risk for developing pelvic floor abnormalities and separation of the rectus muscles. They are very attracted to this platform as it will rehabilitate their pelvic floor with the V Tone and, and if and if they are breastfeeding, they're great candidates because they can't take oestrogen. MorpheusV is also great for those who are breastfeeding. We know that if you rehabilitate someone's pelvic floor, it's prophylactically successful in preventing a lot of this stuff down the road.”
Contact the InMode team if you are interested in EmpowerRF for your practice or clinic.