Novoxel’s Tixel breaks the skin, botox breaks the flushing


Here is a new (ok novel if you have to use that term) treatment for the most difficult to treat redness and flushing of rosacea.

Researchers used a thermomechanical device to break holes into the surface of the skin, and topical botox to treat the most severe redness and flusing of rosacea. How does it work and is it for you? read on to find more.

The Toxic Edge

The paper introduces this new treatment as the toxic-edge, and right from the start this treatment yells at you as being extreme. It would be difficult to recommend this treatment to any rosacea sufferer. The potential for harm seems to be high. Surely if any treatment needs to be used only under the close supervision of your doctor, this is one.

First the surface of the wand, called Tixel – from a company called Novoxel, is used to create a series of small breakages in the stratum corneum, and them topical botox is applied. The warmth of the wand, and increased permeability of the skin – that is how easily topicals now absorb into the skin, leads to a new way of treating the redness and flushing of rosacea.

Whether or not this form of applying botox proves more effective and safe compared to the usual injection via needle is yet to be determined.

On a positive note, this may be an interesting new treatment for those with the most hard to treat redness and flushing.

Read more about how Tixel works,employing a hot titanium tip to heat the upper demis.

“The tip consists of an array of tiny pyramids which are heated to a temperature of 400°C . The apex of the pyramids transfers energy to skin by very brief controlled contact. Treatment is nearly painless.”

Note that the web site tells us that Tixel is not approved for marketing in the USA.

Article Abstract

The toxic edge-A novel treatment for refractory erythema and flushing of rosacea.

Lasers Surg Med. 2018 Oct 12;:

Authors: Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O

PURPOSE: Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. The primary objective of the study was the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system (Tixel, Novoxel, Israel) to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea.

METHODS: A retrospective review of 16 patients aged 23-45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100U of abobotulinumtoxin.

A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment.

Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA), and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument.

RESULTS: The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a P-value <0.001).

DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P < 0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping.

CONCLUSION: Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe


User jrlhamcat2 at the Rosacea Forum has found a link to the full PDF that contains before and after pictures –

Conclusions and Questions

Limitations of this study include the small sample size, the short 6 month follow up period, and the lack of a control group.

The use of botulinum toxin is a rational approach if one assumes that neuron-mediated vascular dysfunction plays essential pathogenic roles in rosacea.

The use of multiple modalities: thermomechanical device, botulinum toxin, ultrasound device, and Biafine limit our ability directly describe the mechanism of action leading to our observations.

Each modality has been chosen based on its published literature and the end result seems greater than the expected additive effect.

However, this study raises many questions:

  • What is the role of the Tixel device?
  • Is it only a drug delivery enhancing system?
  • Does the heat transfer affect the papillary dermal blood vessels or decrease the number of parasites (Demodex folliculorum)?
  • What is the role of sonophoresis?
  • Could the same effect be achieved without the concomitant
    use of the Impact device?
  • Could the same results can be achieved with only topical application of BTX and sonophoresis?

All of these questions more substantial, randomized, blinded, and placebo-controlled studies.

Additionally, further investigation is needed to elucidate the mechanism of action by which botulinum toxin improves facial flushing of rosacea.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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3 Reader Comments

  1. “Okay now this sounds interesting!!!!
    Argh I’ve just read the article and it seems like you think it’s a very extreme treatment and wouldn’t recommend. I wish they’d just sort out a treatment for flushing that works!!!”

  2. ” I wouldn’t use it. I’d rather companies put their money into researching the root cause of rosacea. It affects 10% of the population so it would be nice if money was put towards an actual cure.”

    • Tealc says:

      Tixel wasn´t designed for treatment of rosacea. The technology was developed for skin rejuvenation and to have a similar effect like a co2-laser. The effect of creating small channels is a big add-on in non-ablative mode which leads to manage different diseases by transdermal delivery of topicals into the skin. If someone is suffering from rosacea and had different treatments which had no effect this is kind of a treatment which can easily reduce the redness and the appearance of rosacea. The use of open channels which is described with this technology can be also used for pdt, scars and many other more. I tried it for my rosacea and i was happy to find such an option. Now after more than 8 month my skin isnt red anymore and i would use it again if necessary.

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