Part VI of this series discussed a bit about the history of laser resurfacing up to current uses of these technologies. Indications and patient preparation were mentioned, as well as treatment recommendations and post-treatment expectations. This article will discuss a few of the specific units that are available and also focus on some of the newer technologies.
CO2
There are many companies and CO2 units on the market that are constantly changing.
Lumenis has the UltraPulse® that penetrates deeper into the tissues, consisting of Active and Deep Fx modes. SCAAR FX™ allows for the deepest penetration for treating complex lesions. Pigment FX is a low, sub-ablative fluence setting for mild treatment of dyschromia. Precise FX is a collimated 2.0mm handpiece for precise tissue ablation and coagulation. Incision FX is a 0.2mm focused handpiece for surgical incisions.
Quanta makes the YouLaser™ CO2 with HyperPulse and Stacking technologies. This device has three firing modes — pulsed, single pulsed and continuous and can be used for fractional resurfacing or non-fractional incisions for surgery.
Alma Lasers makes the Pixel CO2 fractional laser that delivers energy through a holographic lens that pixelates the beam to 7, 49 or 81 microscopic beams or pixels in a variety of patterns. Alma also has an IMPACT module that helps deliver topical products beyond the epidermal-dermal junction by emitting acoustic waves and air pressure, pushing the topical compounds through the micro-channels.
Syneron-Candela has the CO2RE®, a device that has six settings ranging from low energy for more superficial pathology to high energies for deep pathology. The settings can be combined as fusion. There is also a dermal excision mode.
Lutronic has the eCO2, which features the patented Controlled Chaos Technology (CCT), an algorithm to pseudo-randomize delivery of each micro laser beam, maximizing the distance between beams to eliminate cross thermal diffusion.
Solta has the Fraxel® Re:Pair — a CO2 unit that ablates up to 1600 um of tissue depth by going up to 70 mJ. There is also a 0.2mm handpiece for surgical incisions.
Erbium
Sciton has the Contour TRL™, which employs a dual-mode erbium:YAG laser. The user can adjust the depth of ablation and coagulation independently. The energy can be modulated to deliver supra-ablative pulses in order to vaporize any depth of tissue from four to 200 microns per pass or sub-ablative energy delivered in a train of pulses that heat the tissue without vaporizing it. Sciton’s ProFractional™ utilizes a 250 um spot size and offers a range of treatment densities from 1.5 to 30 percent coverage as a fractionated treatment rather than full field resurfacing, minimizing downtime. ProFractional XC utilizes a 430 um spot size with predefined densities and has the ability to add depth-selectable tissue coagulation for collagen remodeling.
Cutera has a “near-erbium” wavelength ablative laser called the Pearl and Pearl Fractional, which operates ate 2790 nm. The affinity for water is a bit less, but this laser still provides an ablative resurfacing treatment. Pearl, offering a more superficial full epidermal procedure, can be combined in problem areas with Pearl Fractional, a fractionated, deeper penetrating treatment to create Pearl Fusion.
Ellman manufactures the Cortex™ CO2 and Er:YAG laser combined in one unit. There are no disposables and has surgical capability.
Non-Ablative Units
Solta Medical makes Clear + Brilliant®, which is a fractional non-ablative laser, but is lower wattage, so is less invasive, staying in the superficial layers, which makes it useful for those doing laser for the first time who want to take baby steps, or those who just need maintenance. The original version of this laser is 1440 nm and the Permea is 1927nm, both with a 140 um/mtz spot size. This laser requires minimal training and there are only three predefined settings — low, medium and high.
The original 1440 nm laser only goes 200-300um in depth. Clear + Brilliant Permea (1927 nm) only goes 170 um deep, targeting the skin where melanin resides. This laser creates superficial but wider lesions, which increases skin permeability. The treatments can be combined with topical products, such as vitamin C, for better penetration.
Solta Medical also makes the Fraxel Duel, a device which combines 1550 nm and 1927 nm. The 1550 nm setting can go up to 70mJ and penetrate down to 1400 um. The 1927 nm setting can be used up to 20mJ to a depth of about 230um to target more superficial lesions like melasma or actinic keratosis. Both modalities can be combined for optimal treatment of certain conditions.
Radiofrequency
Radiofrequency (RF) is a relatively new technology that can be used safely in all skin types and works to stimulate collagen while keeping the epidermis intact resulting in skin tightening via soft tissue coagulation.
Lutronic has Infini for radiofrequency microneedling that delivers 50,000+ micro-coagulation zones per treatment session. Users control the treatment depth and energy levels to customize treatments that can be approached in multiple layers.
Pelleve is another radiofrequency device that induces collagen contraction without damaging the epidermis. Their S5 platform allows the delivery of aesthetic and surgical treatments. There is also the new PelleFirm system that can be used on the S5 platform for the improvement in the appearance of cellulite.
Solta also manufactures Thermage® — a radiofrequency device used to tighten the skin. Their newest technology includes a vibrating handpiece that aids in patient comfort. There are four tip sizes: total tip for face, neck and body; eye tip for the eyelids; face tip for treatments with less volumetric bulk heating compared to the total tip; and body tip for larger areas such as the abdomen, arms, legs and buttocks.
Ultrasound
Merz owns Ulthera, an ultrasonic device used to lift the skin. Ultherapy® micro-focuses the energy beneath the skin’s surface to cause cellular friction and pin-point heating to 65 degrees, causing collagen contraction, denaturation and synthesis.
Solta has Liposonix®, which uses a high-intensity focused ultrasound energy at a depth of 1.3 cm to tighten the skin of the abdomen and flanks.
Conclusion
Devices are a great addition to an aesthetic practice. After a certain comfort level with injectables has been obtained and a good clientele is established, devices can be a great supplement to offer patients for a more comprehensive cosmetic result.