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Archive for September, 2009

YAG 1064 nm Lasers Intense Pulsed Light (IPL) Devices
Applications Hair Removal, Photorejuvenation, Skin Tightening, Active Acne treatment, Telangiectasias (spider veins), Rosacea, Sun & Age Spots, Pseudofolliculitis Barbae. Hair Removal, Photorejuvenation, Sun & Age Spots, Rosacea.
Efficacy High power to dermis: more energy to follicles, vessels, collagen, sebaceous glands. High power absorption in epidermis: less energy to deep dermal structures.
Comfort Less painful due to shorter pulse durations. Very painful due to tendency to super heat epidermal melanin. Skin cooling gels or equipment needed.
Risk of Side Effects Safe on all Skin Types. Higher risk of burning skin; not recommended for use on skin types 4-6 or tanned skin because of pigmentary risk.
Consumables Few or none. Frequent head replacements (on average after 30,000 pulses), filters and gels – annual cost $5,000-$10,000.

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  • Filed under: Device Review, Laser Treatments, RS | IPL and Lasers
  • Dangers of Spa Hopping

    We stumbled upon an old (March 7, 2007) article in ABC News – Spa Left Woman With Skin ‘Like Raw Meat’ – a story about a 52-year-old stay-at-home mom who saw the ugly side of medical spas. She went to one in Panama City, Fla., for what she thought was a routine procedure – laser treatments to remove sunspots on her back and chest.

    “They put a topical ointment on my skin called Leveline, which intensified the laser,” Miles said. “After it was over, I was already burning. During the treatment, it was very excruciating pain, but I was lead to believe that this was normal.”

    The pain, which she said felt like someone pressing hot curling irons in to her back, was not normal. After leaving the spa, she said that her back was on fire and that she was vomiting from the severe pain. When she finally looked in a mirror, Miles was shocked at what she saw.

    “It looked like raw meat. I had horrendous blisters all over it. It was in a zebra-stripe type pattern. It was scary,” she said.

    See the graphic pictures of what an IPL machine can do in the hands of an untrained medical spa technician.

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  • Filed under: MedSpa, RS | IPL and Lasers
  • The Basics of the Fractional Technology

    Why the newer fractional technologies are so popular?

    The latest fractional laser technologies offer a better balance of efficacy, patient tolerance and lack of side effects compared to older lasers.

    For better results the depth of the laser beam penetration and the depth of skin resurfacing are important. But even more important is an optimal combination of depth, microspot size, density, as well as the ratio of ablation to coagulation.

    How fractional laser works

    Depth is a simple term that indicates how deep the thermal damage extends into the skin tissue. It is the depth of the microcrater or hot cylinder.

    Microspot size is the diameter of the microscopic wound.

    Density is the percent coverage over the skin surface, e.g. 20 percent density means 20 percent of the skin surface is damaged.

    The “ratio of ablation to coagulation” can be explained as follows: one pulse of laser beam produces a crater (coagulation area), which is 100 µm wide, and the lateral thermal damage (area of ablation) of 50 µm in radius (100 µm in diameter) ; therefore in this case, the total width of coagulation is 100 µm, and the total width of ablation is 100 µm, therefore 1:1. This ratio is an indication of the downtime. Coagulation is a type of thermal damage, which greatly influences wound healing.

    The problem is that no one knows the precise best recipe among all of these variables to achieve the best ratio of cosmetic enhancement to days of “downtime.”

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  • Filed under: LT | fractional
  • CO2 and Erbium laser skin resurfacing is a very efficient procedure to remove wrinkles, acne scars, blemishes, growths, and sun-damaged skin blemishes. The laser allows the body to produce new collagen and generate new skin. The result is usually “years younger” skin. Improvement continues as the aged and sun-damaged deep collagen areas continue to regenerate and repair for three to six months after treatment.

    Laser skin resurfacing basics

    How long will the improvement last?

    No one can say for sure, but many laser physicians believe that you can expect the results to last for several years. How long may depend on your unique skin type and upon your post-treatment skin care. Think of the laser as “turning back the clock” so to speak, so that your skin again resembles its fresher appearance of years past. Your new skin remains dynamic and alive and it should take many years before your skin appearance manages to catch up with where it was before your treatment. Much depends on how carefully you protect your new skin from damaging sun-exposure. You have a second chance at slowing down the sunlight-related aging process. (more…)

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  • Filed under: LT | skin resurfacing
  • A White Paper by David J. Friedman, MD

    I recently completed a clinical study of laser hair removal using the LightPod Neo, a 1064nm Nd:YAG laser from Aerolase. I was requested to conduct this study because I have a well established cosmetic dermatology practice in which I perform the laser treatments myself, and hair removal is a key area of my laser dermatology expertise.

    I became intrigued by this laser’s unique 0.65msec pulse duration, which is below the skin’s thermal relaxation time; this unique feature negates the need for skin cooling during treatment that is common with other systems, and it allows for treatment that is virtually pain-free on any skin type. But the main question in my mind at the outset had to do with clinical efficacy: would this device have the capability of delivering long-term results?

    The parameters of the study, conducted during the Winter of 2006/2007, were as follows:

    • Total of 12 patients treated (11 females, 1 male)
    • Ages from 30 to 42
    • Skin types II through VI
    • Multiple anatomic sites: chin and neck, cheeks, upper lip, back, axillae

    Patients were treated without any form of cooling or application of gels or anesthetics, either before, during or after treatment, regardless of skin type. The laser delivered fluences that were appropriate for hair removal, causing hairs to singe and creating perifollicular edema as expected; transient erythema was observed in just a few instances and patients reported that the treatment pain ranged from painless to tolerable. Patients were treated monthly for a total # of treatment sessions ranging from 3 to 7, and they were followed to assess long-term results. The majority of patients reported >75% clearance; those treated 5 to 7 times reported 82% clearance on average and as high as 93%. These assessments were made, on average, 8.3 months after the patients’ final treatment sessions.

    This study demonstrates that, from the standpoint of clinical efficacy, the Neo has the ability to perform hair removal in a similar fashion to Nd:YAG 1064nm lasers that employ substantially longer pulse durations. This is true not only in terms of % hair clearance for a given number of treatment sessions but, of particular importance, in terms of long-term results. When combined with the other advantages of the 0.65msec pulse duration mentioned above – no skin cooling with virtually no treatment pain and the ability to safely treat any skin type – this makes the Neo a unique addition to the field of Nd:YAG lasers from a clinical performance standpoint.

    The physical characteristics of the LightPod Neo laser are also very unique.

    LightPod Neo - Nd:YAG 1064 nm portable aesthetic laser from Aerolase

    Due to its air-cooled emitter design, it is a compact and portable device, in marked contrast to large conventional water-cooled laser systems. The Neo design has eliminated the water circulating system as well as fiber optic cables common in other systems, which results in a highly affordable device that is essentially maintenance-free.

    In summary, the LightPod Neo offers a new and unique set of capabilities to laser hair removal, enabling it to be a foundation laser for a hair removal practice focusing on higher-profit facial, axilla and bikini treatment areas or an extension of an existing practice into treatment of darker skin types, pain-free performance and/or any practice where the laser’s compact size, portability or lack of required maintenance are deemed beneficial.

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  • Filed under: Device Review, New Lasers, Research
  • blotchy skin with spots

    Treatment of pigmentation is a complex subject. Determining the type of lesion will help to establish which laser or light device to use and what parameters to set.

    Hyperpigmentation is a broad descriptive term, offering us little information about etiology or pathophysiology of the lesion. Dividing this expansive category into primary versus secondary helps with treatment decision-making and predicting outcome.

    Moreover, hyperpigmentation can stem from epidermal, dermal or a combination of these locations. Discrete lesions, such as lentigines, ephelides (primarily epidermal lesions) and nevus of Ito or Ota and decorative tattoos (primarily dermal lesions), show the most favorable response to laser and light-based therapies.

    Postinflammatory hyperpigmentation would be the main component of the secondary hyperpigmentations. Melasma can also be considered in this category, as it generally behaves similarly to postinflammatory hyperpigmentation after laser treatments, showing the most unpredictable response to laser and light-based therapies.

    Primary pigmented lesions are generally easier to treat than secondary lesions. For localized lesions on the trunk and face, the Q-switched lasers are very successful at removing pigmentation. These include Q-switched ruby (694 nm), Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (both 1,064 nm and 532 nm). For darker skin types, choose the longer-wavelength Q-switched lasers, as their emissions have less absorption by melanin and hence less competition/absorption from normally pigmented skin.

    To learn more about the use of IPLs, long-pulsed dye laser (LPDL) and Q-switched lasers for the treatment of solar lentigines, photoaging and flat seborrheic keratosis read The right tool: Lesion type determines which laser, light device is best choice, opinions of Joely Kaufman, M.D., assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group, and Vic Narurkar, M.D., the chair of dermatology at California Pacific Medical Center and director and founder, Bay Area Laser Institute, and associate clinical professor of dermatology at University of California Davis School Of Medicine.

    Just like Dr. Kaufman and Dr. Narurkar, I believe that there is a potential of further development of “do it at home” lasers:

    “It remains to be seen what type of contribution the at-home devices will play in the treatment of pigmentation. The newer devices coming to the market look very promising as both preventive and adjuvant therapeutic options.”

    Laser lasers and light-based devices for home use cannot be considered as a replacement of medical office treatment, but some of the products in the laser industry pipeline can be used as ancillary tools to enhance the effectiveness of a medical treatment plan.

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  • Filed under: LT | pigmented lesions
  • Noteworthy Facts About Your Skin

    1. It’s your body’s largest organ: an average adult’s skin spans 21 square feet, weighs 9 pounds and contains more than 11 miles of blood vessels.

    2. The skin releases as much as 3 gallons of sweat a day in hot weather. The areas that don’t sweat are the nail bed, the margins of the lips, the tip of the penis and the eardrums.

    3. Body odor comes from a second kind of sweat – a fatty secretion produced by the apocrine sweat glands, found mostly around the armpits, genitals and anus. The odor is caused by bacteria on the skin eating and digesting those fatty compounds.

    4. Fetuses don’t develop fingerprints until three months of gestation (the period during which an embryo develops (about 266 days in humans)). Some people never develop fingerprints at all. Two rare genetic defects, known as Naegeli syndrome and dermatopathia pigmentosa reticularis, can leave carriers without any identifying ridges on their skin.

    5. Globally, dead skin accounts for about a billion tons of dust in the atmosphere. Your skin sheds 50,000 cells every minute.

    6. There are at least five types of receptors in the skin that respond to pain and to touch. One experiment revealed that Meissner’s corpuscles – touch receptors that are concentrated in the fingertips and palms, lips and tongue, nipples, penis and clitoris – respond to a pressure of just 20 milligrams, the weight of a fly. In blind people, the brain’s visual cortex is rewired to respond to stimuli received through touch and hearing, so they literally “see” the world by touch and sound.

    7. “In the buff” became synonymous for “nude” in 17th-century England. The term derives from soldiers’ leather tunics, or “buffs,” whose light brown color apparently resembled an Anglo-Saxon backside.

    8. White skin appeared just 20,000 to 50,000 years ago, as dark-skinned humans migrated to colder climes and lost much of their melanin pigment.

    9. The Cleveland Public Library, Harvard Law School and Brown University all have books clad in skin stripped from executed criminals or from the poor. Hopefully, they didn’t have to reprint it: One such volume is Andreas Vesalius’s pioneering 16th-century work of anatomy, “De Humani Corporis Fabrica” (On the Fabric of the Human Body).

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  • Filed under: Questions & Answers
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