It’s a rare delight when aesthetic treatments additionally have a fully functional medical benefit that positively improves the daily lives of patients. Tixel is one such treatment, not only rejuvenating the skin but also offering relief for those suffering from dry eye disease – a condition that affects comfort, vision, and overall quality of life. Paola Chellew discusses the multiple benefits of just one such treatment technology with Professor Hamzah Mustak – Tixel.
When we talk about the benefits of having aesthetic treatments, the most impactful are on emotional health: an increase in self-confidence and self-worth, which may in turn bolster a patient’s interpersonal skills. The physical benefits are the obvious: smoothing fine lines and restoring more youthful contours to the face and body. Of course, these are typically why patients have aesthetic treatments done in the first place. But having an added physical advantage by default sounds too good to be true; yet for instance, laser technology has been used for hair removal, teeth whitening, and skin resurfacing, but also to improve eyesight.
These are treatments that are all done separately, but there is one that can deliver a two-in-one. And it’s called Tixel.
Professor Hamzah Mustak, ophthalmologist at Groote Schuur Hospital and specialist ophthalmologist at The Atlantic Eye Centre in Cape Town, sheds some light on the advantages of Tixel treatments for the eyes.
There are many treatment modalities for improving the skin’s surface, such as lasers and IPL (intense pulsed light), which emit radiation, and therefore could be hazardous in the periorbital region, as the skin is thin and delicate. So, what is the non-surgical alternative?
Prof Mustak: Lasers, IPL, and broad-band light all use various forms of light energy/radiation to stimulate the tissue. The effect on tissue depends on the specific wavelength, as well as the type of tissue. Most of these treatment modalities make use of the absorption of the light energy by melanin pigment or blood within the tissues. The energy absorbed is usually converted to heat energy.
These lasers are used for tissue resurfacing, as well as the treatment of pigment and fine blood vessels in the skin. The skin of the eyelid is thin and the eye itself has to be protected from the effects of this radiation.
Non-surgical alternatives for peri-orbital skin treatment include gentle chemical peels, retinol creams, and heat-based therapy, like Tixel.
How does Tixel work?
Prof. Mustak: Tixel is a non-invasive treatment that utilises thermal energy to improve collagen synthesis, as well as improve meibomian gland dysfunction without the use of radiation or lasers. This means that no burns, bleeding, fumes, or carbonisation happen during treatment. Tixel effectively rejuvenates and tightens skin in delicate areas, including the periorbital region (upper lid, lower lid, and crow’s feet).
Tixel uses the patented Thermal Mechanical Action (TMA) technology. It employs a medical-grade titanium tip, transferring thermal energy through a matrix of tiny, pyramid-shaped pins. This fractional technology covers an area of 0.3 cm², delivering safe, quick results without the need for lasers. The tip heats up to a temperature of 397 degrees Celsius and the contact time and depth of treatment can be adjusted depending on the desired treatment, skin type, and condition. The tiny pyramids do not break the skin, but rather indent it and create channels through which topical medications can better penetrate the skin.
What are the effects and how long before a patient sees them?
Prof. Mustak: The thermal energy delivered via Tixel stimulates collagen synthesis in the skin. Combined with targeted topical treatments such as hyaluronic acid gel, vitamin C, and various other skin serums, the effect is a tightening and hydration of the skin. The effects take place over a couple of weeks and several treatments are often needed to obtain visibly noticeable changes in the quality and elasticity of the skin. Around 6–8 weeks after your final session, you’ll notice refreshed, healthier skin, with full results typically visible after four treatments.
How many treatments are needed? Or does it differ from one patient to the next?
Prof. Mustak: Normally, 4–6 treatments of Tixel are recommended in order to appreciate the collagen synthesis and its effects on the skin. The number of treatments will depend on the indication for treatment. Deep, established lines or wrinkles may require more than six sessions to see improvement, while finer lines may respond to just two treatments.
What exactly is dry eye disease?
Prof. Mustak: Dry eye disease (DED) is a diverse pathology of the eye surface that causes a disturbance in the stability of the tear film. It is a global disease that may affect up to 30% of the population aged over 50 years. There are two types of dry eye disease – aqueous deficiency and evaporative dry eye.
The tear film is an important component in maintaining the health of the surface of the eye. It is an intricate substance containing three main layers.
The top layer is an oil secreted by the meibomian glands, which are found just behind the eyelashes. Aqueous (water) makes up the second and most abundant layer. The third layer is a thin layer of mucous that helps tears stick to the eye surface. In aqueous deficiency dry eye, the cells that produce the water component are affected and do not produce adequate water. In evaporative dry eye, also known as meibomian gland dysfunction (MGD), the oil layer that prevents quick evaporation of the tear film is abnormal. As a result, the tear film evaporates too quickly, and your body responds by increasing water production through reflex tearing. Aqueous deficiency accounts for 20% of cases, while MGD accounts for 80%.
The symptoms of DED include itchiness, red eyes and eyelids, dryness, foreign body sensation, light sensitivity, and intermittent blurring of vision. Although they improve after treatment, it is usually a chronic disease, which can be frustrating for both the patient and doctor.
MGD is the main cause of DED. The oil that is required to coat the tear film is called meibum. It should have a thin, liquid oil consistency. Inflammation of the eyelid margin (blepharitis) can change this consistency to a thicker one, obstructing the ducts. Since the meibum cannot coat the tear film effectively, the tear film evaporates too quickly.
There are many different causes for blepharitis: rosacea, infection with the Demodex mite, allergies, eczema, and other skin inflammatory conditions. There are several standard treatment modalities for improving MGD (e.g. heat compresses, lid margin hygiene, anti-inflammatory agents, antibiotics, omega-3 fatty acids supplementation); however, these agents may be insufficient in many patients. Recent advances in treatment, such as IPL and Tixel, provide more targeted approaches to addressing MGD.
How does a Tixel treatment help DED?
Prof. Mustak: Tixel works in two ways to address MGD. The heat helps to liquefy the more solid oil at the gland surface and thereby improve oil secretion. The second mechanism is the creation of porous channels by the pyramid tips, which remain open for up to 48 hours post-treatment. These channels allow for topical medications such as anti-inflammatories and antibiotics to better penetrate down to the meibomian glands, where they alleviate inflammation and improve overall gland function.
How long does a treatment take for both eyes?
Prof. Mustak: Each Tixel treatment session lasts about 15–20 minutes per eye. Local anaesthetic cream and drops are applied beforehand to ensure patient comfort. Unlike IPL, no eye protection is required during the treatment, as no radiation is being emitted that could harm the eye.
Are there any potential side effects to treatment?
Prof. Mustak: After treatment, mild redness, swelling, or heat sensation may occur but should subside within a few days. Small, superficial micro-crusting may also appear but will disappear within a week. Patients receive a home care kit to manage these side effects.
Is an added benefit of doing Tixel treatments for DED an improvement in the texture of skin around the eyes?
Prof. Mustak: Yes! In fact, Tixel was designed as a minimally invasive device aimed at improving skin quality and elasticity. Patients with dry eye due to MGD who had received Tixel for skin rejuvenation happened to notice an improvement in their dry eye symptoms as well. This prompted the investigation and use of Tixel for treating DED.
Patients who receive Tixel treatment for dry eyes can also expect an improvement in the skin quality as an added bonus.
How long does the improvement of symptoms for DED last?
Prof. Mustak: Tixel’s effects on the skin typically last a year or two. While Tixel helps to rejuvenate and tighten skin, it is important to maintain good skincare to prolong the results. For DED, depending on the severity, the effects can last 6–24 months. Typically, Tixel is combined with other treatments for dry eye to work synergistically to improve dry eye symptoms. Many patients only require a single top-up treatment every 6–12 months to help control their symptoms.
It appears as though there are various fake machines on the market, so how can a patient ensure that the machine being used on them is a genuine Tixel?
Prof. Mustak: Tixel was developed by Novoxel. It is a patented device that has approval for use as a medical device by various regulatory authorities. The applicator temperature and contact time are carefully controlled. Patients must be warned against counterfeit Tixel devices, which pose significant safety risks. The use of counterfeit devices carries a significant risk of thermal burns, which may result in scarring of the eyelid skin.
Authentic Tixel devices are distributed solely through licensed channels and meet strict regulatory standards. Patients should enquire whether the device is the authentic Tixel and can contact the local distributor or Novoxel to confirm if a device being used is authentic.
Tixel patient testimonials
“I was referred to Prof. Mustak after struggling for many months with what I thought was some type of allergy in my eyes. In the morning, my eyes were so sticky and bunged up that I could hardly open them. Prescribed eye drops didn’t help, and I was really struggling with itchy, scratchy, and blurry eyesight, which was affecting my life and work.
“Prof. Mustak explained the complexities and symptoms around dry eyes and recommended a few Tixel treatments. I was a bit nervous, as I’ve never had anyone work near my eyes, but Fat