J Cosmet Laser Ther. 2008 Jun;10(2):67-71

Authors: Carniol PJ, Dzopa N, Fernandes N, Carniol ET, Renzi AS

BACKGROUND/OBJECTIVES: To determine the efficacy of the 1100-1800 nm infrared device for facial and cervical skin tightening.

METHODS: Ten female patients, with a mean age of 56.5 years, received two treatments 1 month apart with a chilled tip infrared device (Titan; Cutera, Brisbane, CA, USA). Individuals were examined and photographed prior to treatment and at 1 and 3 months post-treatment. Three treatment-independent evaluators compared the photographs and graded them on a standardized scale applied to seven regions subdividing the face and neck. After evaluating the photographs, the difference in pretreatment and post-treatment scores was expressed as a percentage. The patients also rated their results.

RESULTS/CONCLUSION: The greatest tightening was achieved over the malar region, the upper neck and the body of the mandible. In these areas the average tightening was 10%, 10%, and 12% respectively. The patients reported a 32% improvement in the appearance of their cheeks and a 20% visible improvement in their necks. Overall, they were pleased with the result of this non-surgical skin tightening.

PMID: 18569258 [PubMed - indexed for MEDLINE]

J Cosmet Laser Ther. 2009 Mar;11(1):34-44
Bousquet-Rouaud R, Bazan M, Chaintreuil J, Echague AV.
Dermatological Laser Unit, Millenium Clinic, Montpellier, France.
http://www.ncbi.nlm.nih.gov/pubmed/19214861

This article presents the first evaluation of the use of a high-power pulsed Nd:YAG laser for the treatment of cellulite.  Three of the four authors are employees of Candela Corporation, the maker of the laser.

The study at first appears to be well-designed.  Quantitative endpoints of dermis thickness and ultrasound density were chosen, and preliminary studies were performed to show that measurement methods were not subject to intra-observer or inter-observer error.  Twelve patients were treated, with one thigh randomized to treatment and the other randomized to control.  In addition to pre-treatment ultrasound measurements, follow-up measurements were performed at 1 month and 3 months after the final treatment of the series of three treatments.  Adjunctive photographs were taken before each treatment, and presumably at the follow-up visits.  The example photograph appears to be of high quality.  The treatments were appropriately standardized to minimize the impact of dosage variation on outcome.  Likewise, the patient population appears to be reasonably homogenous in terms of age, body mass index, and pre-treatment evaluation of cellulite severity, to minimize the impact of patient variation on outcome variation.

Given the apparent care taken in the study design, the analysis was extremely disappointing.  The analysis presents only the variation in ultrasound measurements of the treated thigh, and completely ignores the control thigh.  The authors claim that the mean dermal thickness of treated thighs decreases from the beginning to the end of the study, but this is a flawed claim.  Because they do not present data on the control thigh, we cannot know if this result stems from a treatment effect, or from a natural variation in the patient population over time.  For all we know, the dermal thickness of the control thigh improved more than the treated leg.  This is the whole point of having a control thigh.  No other control variables, such as BMI or weight, were presented.

Further, the authors include the raw data for the dermal thickness measurements in all 12 patients, but offer no explanation why some patients have increased thickness at 1 month follow-up which then decreases at 3 months, while other patients show decreased thickness at 1 month with subsequent increases at 3 months.  Presumably, the treatment effect would go in generally the same direction in this homogeneous group that recieved the same treatment regime.  This variation adds to the concern that something else was going on with these patients during the study that might effect dermal thickness.  The same comments apply to the raw data on dermal echogenicity.

The exclusion of measurements of the control thigh from the analysis renders any conclusions moot.  The authors further present patient satisfaction data.  This type of data is notoriously challenging to interpret, as patients often feel satisfied that they are taking steps towards treating a condition. In this case, on average the patients reported being somewhat satisfied, and no patients reported being very satisfied.  Readers of the article should not be satisfied at all.

AAD launches today include the Aesthera’s acne system with the peer reviewed clinical paper titled “Treatment of Acne with Photopneumatic Therapy,” by Tina S. Alster MD et al. The paper studies the clinical efficacy of Photopneumatic Therapy for the treatment of mild to severe facial acne. “Our study noted greatest improvement in patients with severe acne. We are pleased with treatment outcomes, especially for severe acne,” said study co-investigator Dr. Alster. The study was performed using Aesthera’s ISOLAZ system, the only FDA cleared device for the treatment of Comedonal and Pustular Acne.

Aesthera is launching Profusion(TM) – (Pro for Professional and Fusion is a Combination) – a skin therapy that combines the Photopneumatic light treatments with the delivery of Aesthera’s proprietary skincare to enhance skin treatment outcomes for acne, skin rejuvenation and body tightening. “Profusion’s novel mechanism has tremendous therapeutic potential for innovative new applications. We are very excited about its clinical potential,” says Vic Narurkar, MD, Chair of Dermatology at the California Pacific Medical Center (CPMC) in San Francisco, CA. “Profusion Skin Therapy is the fastest growing procedure in our practice. We routinely perform it in combination with the majority of skin treatments we offer,” he adds. New applications of the technology include body tightening and skin lightening.

Body Tightening Technology. What’s it all about?

It is about Photopneumatic(TM) Technology, a delivery mechanism, and the applicator that will allow for high treatment precision and focused energy delivery. The patient benefits of Aesthera’s unique solution will be fast, painless, and extremely precise treatments.

Photopneumatic Therapy, that powers the Isolaz(TM) and Isolaz Pro(TM) system, is a proprietary combination of pneumatic energy and broad band light. Photopneumatic devices are the only laser or light based devices cleared by FDA for the treatment of inflammatory acne, comedonal acne and pustular acne. They are also cleared for the treatment of mild to moderate inflammatory acne. Photopneumatic treatments have an immediate visible impact on acne 24 – 48 hour post first treatment and are painless. Facial treatments take approximately 10 minutes, require no anesthetics or numbing creams and provide additional cosmetic benefits such as smoother appearing skin. Additionally, Photopneumatic treatments have an immediate visible impact on acne 24 – 48 hour post first treatment and are painless. Facial treatments take approximately 10 minutes, require no anesthetics or numbing creams and provide additional cosmetic benefits such as smoother appearing skin. Additionally, Photopneumatic Therapy is also cleared for the treatment of benign vascular and pigmented lesions and hair removal.

Cynosure has a new machine for the American Academy of Dermatology’s 67th Annual Meeting in San Francisco – Elite MPX for its Smartlipo MPX laser lipolysis workstation.

Through the company’s patented MultiPlex(TM) technology, Elite MPX combines two wavelengths — 755nm Alexandrite and 1064 nmNd:YAG – along with Xenon Pulsed Light (XPL2) technology to create one of the industry’s most powerful workstations for vascular treatment, hair removal and skin rejuvenation. In addition, Cynosure is introducing two new intelligent delivery systems for the Smartlipo MPX workstation for laser lipolysis: SmartSense with ThermaGuide and ThermaView, the world’s first subcutaneous temperature sensing technology and thermal imaging system for Laser Body Contouring.

Elite MPX incorporates Cynosure’s proprietary MultiPlex technology, which sequentially fires two wavelengths for more effective treatments than single-wavelength systems. A completely new software system runs the graphically enhanced Graphic User Interface, which makes its operation simple and easy.

The workstation also features a built-in Zimmer SmartCool(R) skin cooling system that is exclusive to Cynosure. Rather than requiring a separate SmartCool device, Zimmer technology is integrated into a single compact module, saving precious office space and reducing treatment time. In addition, the Elite MPX includes eight different spot sizes, including an 18mm spot size that results in 44% more treatment area per pulse than standard spot sizes.

“Cynosure’s Elite MPX is a powerful and versatile system that enables clinicians to customize treatments for a broad range of skin types and conditions, including sun-damaged skin, pigmented lesions, dyschromia and rosacea,” said Emil Tanghetti, M.D., Clinical Professor of Dermatology at the University of California, Davis and Director of The Center for Dermatology and Laser Surgery, Sacramento, California. “As practitioners, we are seeing a growing cultural diversity within our patient base, and I expect the Elite MPX will provide benefits across the spectrum of applications for these patients.”

According to InMedica, the worldwide demand for hair removal, pigmented lesion removal and vascular lesion removal is expected to increase from $650 million in 2007 to $750 million by 2010.

SmartSense with ThermaGuideis equipped with a thermal sensing cannula for measuring temperatures in the subcutaneous areas of the body. This technology allows the practitioner to set temperature thresholds to achieve targeted and controlled energy delivery for a safe and optimal clinical endpoint.

The ThermaView thermal camera system measures skin surface temperature and provides a visual map of temperatures within the treatment area in order to provide a homogeneous delivery of thermal energy. This intelligence is integrated into the Smartlipo MPX system. As a result, thermal energy is delivered to a targeted temperature setting, helping to ensure the safe and effective treatment of the superficial layer of the surface area.

LaserOffers.com comment

Many people will call these advances bells and whistles. We disagree. Cynosure has come up with a lot of real technological advances rolling out this system. High capacity, large volume clinics will benefit from it, if they can afford it. All it takes to get your money back is a few hundred patients a month. Every month.

This week is the AAD 2009 week. American Academy of Dermatology annual meetings (this year in San Francisco) is traditionally used by all developers and manufacturers of laser, light-based and radio-frequency devices for surgical, aesthetic, and ophthalmic applications to announce their new blockbusters of the year to jolt up sales.

Lumenis has announced today plans to launch the LightSheer(R) Duet(TM) Diode Laser System for high-speed permanent hair reduction. “The LightSheer Duet is the most exciting innovation in laser hair removal since LightSheer first revolutionized the industry in 1998. LightSheer Duet reduces hair removal treatments up to 75% and vastly improves patient comfort, eliminating the need for topical anesthetics. These ground-breaking changes will significantly improve practitioner and patient acceptance of hair removal, as well as increase the revenue potential for physician practices and clinics,” said Mr. Robert Mann, General Manager of Lumenis Global Aesthetics and Dermatology in the corporate press release.

The original LightSheer diode laser introduced by Lumenis many years ago was the preferred system used by the first generation of hair removal professionals. The pioneers of the business still swear by it and sometimes use the brand name as a definition of the laser hair removal.

The laser was great for its time, and the second generation of laser hair removal became aware of its obvious limitations: skin type I-III only and pretty expensive for a start-up.

The new LightSheer Duet is the same 800 nanometer diode laser, but faster thanks to the a large 22×35 mm diode array, which is useful for the treatment of larger body areas such as legs, arms, chests, abdomen, shoulders and backs. Dr. Mitch Goldman, a dermatologic and cosmetic surgeon in La Jolla, CA. says, “For example, with the LightSheer Duet, it is possible to treat an entire back in 15 minutes instead of an hour or more. That makes back and leg procedures a lot more viable than before, and will enable our practice to be more competitive in our market”.

The new LightSheer is expandable and can include a vacuum assist technology to lift skin into the treatment aperture prior to applying laser energy. With this approach, the targeted tissue is gently stretched and thinned, minimizing competing chromophores by blanching vessels and spreading skin pigmentation over a larger area, in addition to pulling the hair follicle closer to the skin’s surface.

LaserOffers.com comment

We believe that clinical efficacy may in fact be better than other diode laser hair removal systems. Time used to laser a man’s back has to include the prep work: applying cooling gels, numbing, etc., and if a physician does the procedure himself (no offense, but we do not see Dr. Goldman actually spending his time doing a hair removal treatment himself), he or she will save a few minutes.

Besides the obvious constraint to working only on untanned Caucasian skin, the hurdle in adopting the new LightSheer diode system will be the economics of this investment: saving a few minutes versus a very expensive investment with questionable return on the current market, which is very saturated with cheaper machines and disappearing legs and backs to work on.

Many consumers bombard laser manufacturers looking to buy a hair removal laser for home use. “The price for a full body hair removal at a medical aesthetic clinic is over $3,000. Why can’t buy a laser and do it myself and share the laser with the family?” Most people are surprised that even for a used light-based device for hair removal medical professionals have to pay upwards of $50,000.

Why laser manufacturers do not make devices for consumers?

The simple answer is: laser hair removal devices are not a consumer technology. It’s not a matter of cost. Some consumers might consider footing a $50K bill for personal use. It’s not a matter of making the laser technology cheap and affordable to general public. Due to safety considerations lasers should never be used without medical supervision.

The home-based market for aesthetic devices is a potential source of significant growth for the aesthetic industry.  While this seems to represent a considerably larger market opportunity than the professional aesthetic equipment market, we believe that even cheap low power home-based hair removal devices will be competing against conventional razors, electronic razors, waxing products, light-based epilation, electrolysis, bleaching, and hair growth inhibitors. For skin rejuvenation, some of the leading alternatives include conventional facials, chemical peels, and microdermabrasion, which are competitively offered by day spa kind of outfits.

What consumer laser devices are avaialble now?

Palomar Medical Technologies has made the most advanced attempt into the field. Years ago they forged a what seemed a guaranteed success partnership with Gillette to develop and commercialize a home-based hair removal device. It was very long in the making and recently Gillette waived the exclusive distribution rights to the device, which seems like a clear indication that the device did not meet internal expectations during the 12-month consumer assessment trial. The future of the project is unclear.

Privately held Radiancy introduced its homebased hair removal device, no!no!, in October 2007 in the U.S., which is exclusively offered through cosmetics retailer Sephora at $250 per unit. The company’s approach to market was unique in that it contracted directly with a single retailer that has a national presence as opposed to consumer products distributor capable of reaching multiple retail outlets (the approach currently being pursued by Syneron and Palomar). We believe that Radiancy is expanding its home-use line to include solutions for acne and facial skin rejuvenation.

All patients who used Silk’n, a low-energy pulsed-light device intended for home-use hair removal, showed a positive clinical response to treatment in a controlled study by the Washington Institute of Dermatologic Laser Surgery, which was published in mid-March 2009. Hair counts were reduced 37.8% to 53.6% 6 months after three treatments. Skin region influenced clinical response, with lower legs exhibiting greater hair reduction than arms and inguinal and axillary areas. Mild erythema was experienced in 25% of patients, but no other side effects or complications were encountered. Patient satisfaction scores were high, with all patients stating that they would purchase the device for future home use.

It appears that this low-energy pulsed light device can be applied safely and effectively for at-home hair removal in a variety of nonfacial locations and skin phototypes I-IV. These devices are available via a limited number of physicians in the U.S.

Other devices, such as nuFace and Zeno, are not using laser technologies.

LaserOffers.com. It is highly unlikely that consumers will see an affordable but effective light-based device for permanent hair reduction or photorejuvenation in a store near you in the many years to come. The long-term efficacy of the experimental devices listed above is incomparable to any hair reduction treatments offered by professional IPLs and lasers.

Prolonged exposure to UV-radiation induces photo-aging and a variety of visible skin changes such as lentigines, actinic keratoses and solar elastosis. Laser skin resurfacing using ablative lasers (CO(2) or Erbium:YAG) is a popular procedure to reduce these marks and improve the aesthetic appearance of photoaged facial skin . Skin resurfacing is defined as an ablation of the epidermis (the upper layers of facial skin).

The use of pulsed or scanning Carbon Dioxide, and pulsed Erbium-YAG lasers allows the programmable and reproducible photocoagulation of thin layers of the epidermis and superficial dermis. Thermal damage depends on the type of laser and is greater with CO(2) lasers. The degree of neocollagenesis is proportional to the thermal damage and is better with CO(2) lasers. Their main indication is the correction of photoaged facial skin but they can also be used for corrective dermatology, e.g. for scars and genodermatosis.

Ablative laser resurfacing is the most effective treatment for many conditions of the photoaged skin. Results are highly satisfactory but the technique is invasive, edema and prolonged erythema are commonand, and the patient experiences a social hindrance of about 7 to 10 days (“downtime”). Possible side effects are hyperpigmentation, hypopigmentation and, at worst, scarring.

A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. The fractional techniques such as the 1,550 nm erbium fiber laser (Fraxel Laser , Reliant Technologies) are used to treat non-adjacent microzones without ablation of the epidermis. Around 25 p. 100 of the affected region is treated per session without ablation of the epidermis. Each fraction is only mini-invasive and is performed under local anesthesia. Social hindrance is reduced. Fractional laser was an attempt to bridge the gap between the ablative and nonablative laser modalities to treat the epidermal and dermal signs of skin aging. By targeting water as its chromophore, the laser induces a dense array of microscopic, columnar thermal zones of tissue injury that do not perforate or impair the function of the epidermis. The significant skin remodeling that ensues can be used to treat, with limited downtime, epidermal pigmentation, melasma, and rhytides, as well as textural abnormalities that include acne-related and surgical scars.

LaserOffers.com comment

Nonetheless, the results are inferior to those obtained with ablative lasers, especially regarding deep wrinkles. The treatment is costly and four sessions are usually required to treat the whole affected area.