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Legato Treatment Results
Skin Barrier Breakthrough System
Maria Claudia Almeida Issa, MD, PhD Associate Professor, Department of Clinical MedicineFluminense Federal UniversityRio de Janeiro, Brazil

Dr. Maria Claudia Almeida Issa is among the leading dermatologists in Brazil and South America. She has had 9 articles published in dermatology trade journals, and has presented her findings 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

The Legato Skin Barrier Breakthrough System for Trans-Epidermal
The advantage of Trans-Epidermal Delivery compared to topical, oral, Delivery.
and hypodermic injections - is the ability to deliver the appropriate dose of cosmeceuticals directly to the location that will most benefit. When The Legato was developed to overcome the chal enge of introducing cosmeceuticals are introduced directly to biological tissue, they are more cosmeceuticals beneath the skin without interference from the stratum deeply absorbed and provide a stronger therapeutic effect. Until now, the corneum (outer layer of skin barrier). main problem with effective delivery of skin care products/cosmeceuticals, The Legato is a dual stage system that uses RF and ultrasound technologies was the fact that the stratum corneum is an effective barrier to outside to introduce cosmeceuticals beneath the skin's surface. The protocol first calls for fractional skin ablation and creating microchannels in the skin. Cosmeceuticals are applied to the skin following the creation of the The Legato then harnesses the power of acoustic ultrasonic waves, microchannels due to the fractional skin ablation. The cosmeceuticals pushing cosmeceuticals into these microchannels directly to the area are forced through the microchannels by the Impact Ultrasound unit. that will most benefit 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 benefit from the delivery of Impact is the name of the ultrasound unit that acts as a vibrator, releasing cosmeceuticals directly beneath the skin include skin whitening and skin 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 increasing The first step of the Legato solution is to create microchannels in the the affectivity of the cosmeceuticals.
skin. The Legato uses the iPixelTM RF, 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.
Legato Treatment Settings
(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 the reduction in height or depth of the scar. In addition, using basal blood flow assessment with a Doppler flowmeter, the edema of the adjacent tissue decreased due to improvements of the blood circulation.
It is the author's 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. 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. Legato Treatment Results
Skin Barrier Breakthrough System
1 week after 2 Tx Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45 W, 3 passes Cosmeceutical: Triancinolona
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 1 min
Courtesy of: Dr. Igor Pinson, MD & PhD, Dermatologist,
RF: 45 w Cosmeceutical: Contractubex
Impact: 40 Hz, 50%, 1 min
10 days after 4 Tx Courtesy of: Dr. Igor Pinson, MD & PhD, Dermatologist,
RF: 50 w 2-3 passes Cosmeceutical: Contractubex
Impact: 40 Hz, 50%, 1 min
1 week after 2 Tx Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 40W, 2 passes Cosmeceutical: Hyaluronic Acid + Vit C
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 1 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 40W, 2 passes Cosmeceutical: Hyaluronic Acid + Vit C
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 1 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45W, 3 passes Cosmeceutical: Triancinolona Acetonide
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 2 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45W, 3 passes Cosmeceutical: Triancinolona Acetonide
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 2 min
Legato Treatment Results
Skin Barrier Breakthrough System
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45W, 3 passes Cosmeceutical: Tretinoin 0.05%
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 2 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45W, 3 passes Cosmeceutical: Tretinoin 0.05%
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 2 min
Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
RF: 60 W, stationary and iPixelRF (In Motion), 6 passes
Cosmeceutical: Dalacine (Clindamycin)
Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
RF: 40-50 W (Treatments 1-5), 100 W (Treatment 6), iPixelRF (IN Motion), ]17[
7 passes Cosmeceutical: Locoid (hydrocortisone butyrate)
Impact: 40 Hz, 50%, 2 min
1 week after 1 Tx Courtesy of: Choi Jun, MD, PhD, MayLin Clinic, Seoul, Korea
RF: 55-65 W, 4-5 passes Cosmeceutical: PRP
Impact: 60 Hz, 50%, 2 min
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
Legato Treatment Results
Skin Barrier Breakthrough System
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45 W, 3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 4 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45 W,3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 4 min
Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45 W – 2 crosses (4passes) in motion tip
Rio de Janeiro, Brazil Cosmeceutical: tretinoin 0,05% Impact: 60 Hz 80%
Courtesy of: Dr. Michael Shohat, Dermatologist
RF: 55W, 2 passes Cosmeceutical: Meso Striae kit
Impact: 60 Hz, 50%, 5 min
Courtesy of: Dr. Michael Shohat, Dermatologist
RF: 55W, 3 passes Cosmeceutical: Meso Striae kit
Impact: 80 Hz, 50%, 3 min
14 days after 2 Tx Courtesy of: Dr. Igor Pinson, MD & PhD, Dermatologist
RF: 45 W, 3 passes Cosmeceutical: Hyaluronic Acid + Vitamin C
Legato Treatment Results
Skin Barrier Breakthrough System
Skin Rejuvenation Skin Rejuvenation 1 week after 2 Tx Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 40 W, 3 passes Cosmeceutical: Retinoic Acid 0,05%
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 60 sec periocular +120 sec-malar and mandibular
Skin Rejuvenation Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 40 W, 3 passes Cosmeceutical: Anti-Wrinkle+Retinoic
Rio de Janeiro, Brazil Acid (RA) Impact: 60 Hz, 80%, 1 min
Skin Rejuvenation Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45 w Cosmeceutical: Tretinoin 0,05%+ HÁ 5% + VIT C 5%
Rio de Janeiro, Brazil Impact: 60 HZ 80%
Skin Rejuvenation Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 45 w Cosmeceutical: Glicolic acid 10% + Hydro-
Rio de Janeiro, Brazil quinone 4% Impact: 60 Hz 80%
Skin Rejuvenation Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 40W, 2 passes Cosmeceutical: Vit C + Hyaluronic Acid
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 1 min
Skin Rejuvenation Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
RF: 60 W, 2 stationary passes Cosmeceutical: Vitamin C, Alphalipoic
acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min
Skin Rejuvenation Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
RF: 55 W, 3 passes Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc,
Silicium and Manganese Impact: 60 Hz, 60%, 2 min
Skin Rejuvenation Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
RF: 50W, 4 passes stationary Cosmeceutical: Vitamin C, Alphalipoic
acid, Zinc, Silicium and Manganese Impact: 60 Hz, 60%, 2 min
Skin Rejuvenation 1 week after 1 Tx Courtesy of: Maria Claudia Issa, MD & PhD in Dermatology,
RF: 40W, 3 passes Cosmeceutical: Meso DMAE
Rio de Janeiro, Brazil Impact: 60 Hz, 80%, 2 min
Skin Rejuvenation Courtesy of: Maria Angelo-Khattar, PhD, Aesthetica Clinic,
RF: 60W, 3 stationary passes and 2 IN Motion passes
Cosmeceutical: Vitamin C, Alphalipoic acid, Zinc, Silicium and Manganese
Impact: 60 Hz, 60%, 2 min

Source: http://www.lbtlasers.com.br/files/artigos/legato_case_study.pdf