Aesthetic Lasers Blog

The concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, skin resurfacing techniques. Unlike conventional ablative (CO2 and Erbium) and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair.

Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. Many practitioners would agree that this first wave of fractional lasers has delivered very limited clinical efficacy.

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In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide (CO2) laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. (more…)

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  • Filed under: Device Review, LT | fractional
  • 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
  • FDA Clears Another IPL for Aesthetics

    Advanced Technology Laser Company (ATL) has received 510(k) clearance from the US Food and Drug Administration (FDA), enabling the Company to manufacture and market its Angelite family of intense pulsed light skin therapy systems.

    The Angelite Family of Intense Pulsed Light Systems will be used in the area of photothermolysis, photocoagulation and dermatology, especially for aesthetic and cosmetic applications in the treatment of acne, various benign pigmented lesions and hair removal.

    Angelite Intense Pulsed Light System uses the following wavelengths:

    • 400 – 950 nm for the treatment of inflammatory acne,
    • 560 – 1200 nm are indicated for the treatment of benign pigmented (epidermal and cutaneous) lesions including warts, scars and striae, and for the treatment of benign (cutaneous) vascular lesions including hemangiomas, facial, truncal and leg telangiectasias, rosacea, melasma,angiomas and spider angioma, poikiloderma of civatte, leg veins, facial veins and venous malformations,
    • 700 – 1200 nm are indicated for the treatment of unwanted hair.

    There is no shortage of IPL machines on the market. We will see how these devices will stack up and fare in the saturated aesthetic market affected by the global recession.

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  • Filed under: New Lasers
  • Aesthetic Modalities in Dermatology

    podcastAesthetic modalities

    This podcast brings you the latest research from that pile of peer-reviewed journals on your desk. This month’s coverage includes: combination laser treatments, aesthetic modalities and Photodynamic therapy.

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  • Filed under: Podcasts
  • We have rediscovered an interesting article published by Cosmetic Surgery Times in July 2008.

    Mark Solomon, M.D., F.A.C.S., of Bala Cynwyd, PA, a clinical associate professor of surgery, Drexel University College of Medicine, Philadelphia, and medical director for LaserTight, explains that the Bleph Makeover procedure takes a different approach to lower lid blepharoplasty.

    This is a simple office procedure performed under local anesthesia, minimum of downtime and a lasting effect with the results comparable to transconjunctival blepharoplasty. It needs to prove the test of time, and it’s not for every patient. The new device is made by EyeTight (LaserTight LLC; Philadelphia, PA), and it is FDA cleared for use in lower lid blepharoplasty.

    “Unlike Fraxel or CO2, both of which are surface treatments, for instance, the EyeTight procedure is under the surface,” Dr. Solomon says. “We use local anesthesia, it’s performed in the office in about 15 minutes, and the patient is on his or her way with minimal downtime.” Using a 980 nm laser energy delivered through a 20-gauge EyeTight endoprobe, a puncture is made, the probe is inserted, and the fat bags under the skin are vaporized. The probe, about the size of a typical catheter, is removed, and the procedure is done. “The skin then shrinks, because the fat underlying it is gone — so the skin shrinks secondarily,” Dr. Solomon explains. comment

    We have checked the EyeTight website today and were quite disappointed to see that there is no further information about this laser and the Bleph Makeover. The current trend in laser technology development is to make versatile devices to provide multiple procedures. Devices for niche applications, especially the ones that can be done by other devices or by hand, typically have hard time surviving the test of time and market competition. We will keep track of this laser and additional data and peer reviewed studies, whic may come out in the future.

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  • Filed under: Device Review, LT | skin tightening, New Lasers
  • Fractional skin resurfacing technologies like Fraxel, Lumenis ActiveFX, DeepFX, Palomar Starlux 1540 and Starlux 2940, and are quickly becoming familiar to many cosmetic, dermatology, plastic surgery and medical spa practices.

    The history of laser skin resurfacing goes back to 1995, when the first full face CO2 laser resurfacing for wrinkle removal was performed. The procedure was a revolution in facial laser surgery. A flock of lasers were developed primarily for plastic surgeons. The procedure was done under general anesthesia and created a burn wound, which took 7-10 months to heal. The hypo pigmentation that followed for about another 10-12 months was normal and fairly well accepted for a few years due to lack of other options.

    The next advance in laser skin resurfacing was the development of Erbium (Er:YAG) lasers. They became available to plastic and dermatology surgeons around the year 2000. These were, and continue to be very effective for the resurfacing. Erbium lasers are a lot safer and cause a significantly reduced downtime for the patient. At about the same time fewer patients wanted to have a full face resurfaced as a nicely done areas around the eyes and mouth created a very comparable overall aesthetic result with even faster healing and shorter downtime. A mild laser peel will give most patients an excellent result with about one week of “take it easy” time.

    Fractional laserswere introduced to the aesthetic market in 2002-2003 with a big bang and glitzy and very effective promotions by Reliant, which pioneered the fractional photothermolysis. The idea was to bring about a laser that would be non-ablative,  but as effective as the ablative lasers (the CO2 and Erbium) before it.

    Fraxel laser by Reliant was the first non-ablative fractional laser for the cosmetic medical market and it gave birth to the first generation of non-ablative fractional lasers. While there were a lot of hype about these non-ablative fractional lasers, the clinical fact is that they had categorically fallen short of the goal of ‘profound results with zero downtime.’ As we have seen with these devices, patients had to tolerate painful treatment in multiple sessions while still enduring disruption of the epidermis and thus multiple episodes of downtime, before the final outcome, which also failed to meet expectations. Fraxel has been upgraded and improved by a number of other competing fractional laser skin resurfacing technologies such as the Lumenis DeepFX and ActiveFX, Palomar Starlux 1540, and Starlux 2940. The newest fractional skin resurfacing technologies employ the use of erbium lasers and may be non-ablative (Fraxel re:fine, Fraxel re:store, Palomar Starlux 1540) or ablative (the newest generation of fractional lasers). The laser beam is ‘fractionated’ into tiny micro-lasers, treating only a small portion of the skin (MTZ – microthermal zone, or sometimes called microscopic treatment zones) and leaving surrounding skin tissue undamaged. The goal is to speed up the healing.   These MTZs cause enough injury to the dermis to trigger new collagen production and stimulate the replacement of collagen damaged by aging and sun exposure. This production of new collagen ‘fills in’ or ‘plumps’ the underlying dermal tissues and smoothes wrinkles. The surrounding, untreated skin speeds the healing process to a mere 3-4 days. Since most of the pigment cells remain intact, hypo pigmentation is effectively prevented. The Fraxel re:fine, Fraxel re:store and Palomar Starlux 1540 are non-ablative lasers that don’t actually vaporize or remove the skin. Instead, the laser instantly heats MTZs, causes the thermal damage, which stimulates new collagen growth during the healing process. Results for wrinkle removal and skin tightening are less dramatic than with any ablative lasers, but some patients may appreciate the benefit of reduced recovery time and fewer side effects.

    Fractional Ablative Laser Resurfacing

    The newest generation of fractional lasers (Starlux 2940, Lumenis ActiveFX and DeepFx systems and Fraxel re:pair) use the ablative skin resurfacing, i.e. CO2 10600 nm or Erbium 2940 nm. They are designed to offer the best of both worlds: fractional treatments with less downtime and reduced complications and ablative laser skin resurfacing for better wrinkle removal and facial rejuvenation. These lasers actually remove tissue in the micro treatment zones, providing much better cosmetic result for patients with heavily wrinkled and sun damaged skin. These lasers provide “rapid remodeling from the inside out”: the fractional treatment results in both rapid reepitheliazation of the epidermis as well as collagen remodeling to depths of 1.6 mm. The skin heals much faster than if the entire area were treated at once, because the treatment uses the body’s natural healing process to create new, healthy tissue that replaces skin imperfections – such as wrinkles, melasma, dyschromia, actinic ketatosis, pigmented lesions, acne scars and surgical scars.

    Actifirm Post Laser Gel combines skin-soothers like Aloe and Chamomile with a Mushroom-derived, exfoliating enzyme, Mucor Miehi Extract, to inhibit pain and inflammation, while helping renew your skin to its freshest form. You’ll be looking your best in no time.

    More skin care recommendations by

    Fractional treatment works on and off the face, including delicate areas like the neck, chest and hands. This is a huge advantage over previous generations of ablative lasers, which required a truly skilled hand to work on these areas.

    There is some increase in recovery time:  clinical downtime of 2-3 days (reepitheliazation of epidermis) and 5-7 days of social downtime (time for patients to resume regular activities). Thus the overall downtime is comparable to the downtime after a traditional non-fractional erbium ablative laser treatment. comment

    Leaving the laser skin resurfacing by pulsed non-fractionated CO2 lasers in the past (where it belongs now), most experts agree that the newest generation of fractional lasers, which uses ablative technologies (Erbium or CO2), have approached the clinical efficacy achieved by traditional Erbium resurfacing. The pain for the patient, downtime and potential side effects are comparable. It is up to the physician to define what patient will benefit more from the subtle difference between these lasers. In time when value and ROI are particularly important, the cost of acquisition of either type of the ablative laser will be the best helpers to the physician.

    In addition to the LightSheer(R) Duet(TM) Diode Laser System, Lumenis(R) rolled out another laser at the 2009 American Academy of Dermatology (AAD) Annual Meeting in San Francisco.

    The system is called UltraPulse 4x for Fractional C02 Rejuvenation, which will significantly reduce treatment times to provide cost-effective-high value cosmetic options during challenging economic times.

    “The cosmetic industry is certainly feeling the effects of the economy and the resulting decline in elective, fee-per-service procedures. We have focused our development efforts on time and cost saving innovations that will provide physicians with innovative and competitive solutions that can sustain, differentiate and grow their business during challenging times”, said Mr. Robert Mann, General Manager of Lumenis Global Aesthetics and Dermatology.

    The UltraPulse CO2 Laser System delivers ActiveFX, DeepFX and TotalFX fractional resurfacing in a single treatment with only a single pass. The new UltraPulse 4X upgrade now covers twice the treatment area and twice the speed. These changes significantly improve practitioner and patient acceptance of fractional resurfacing, as well as increase the revenue potential for physician practices and clinics.

    The UltraPulse 4X has a micro-second pulse, which allows efficient ablation, lower downtime and more comfortable treatment. The UltraPulse 4X now covers twice the surface area per scan, expanding from 7x7mm to 10x10mm and delivers twice the pulse speed, from 300Hz to 600Hz. comment

    Fast is good when patients, for whom time is money, are lining up at the door of the physician’s office. What’s the rush in a slow economy? These days, esthetic practices are looking for patients who are looking for jobs. Bothe have time to spare. Affordability of a laser procedure is key, but it is unlikely that with the high cost device physicians will be able to drop their fees.

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