The promise held by lasers used a decade ago for skin rejuvenation was quickly dampened by reports of complications such as scarring, persistent erythema and infections. For those of us who were proponents of this modality, these issues combined with the high costs for these devices rendered them useless despite the best pitches of the laser companies.
Kinder, Gentler Lasers?
Recently, however, some of the devices introduced have the potential to realize the majority of the benefits expected of those earlier versions with a fraction of the risk for complications.
These newer technologies utilize lasers whose beams are divided into fractions to allow pixels of the skin to be vaporized while adjacent areas are unaffected. Viable epidermis fosters rapid skin repair and recovery, while the beams that permeate stimulate new collagen formation and epidermal replenishment.
At the present time, there are two flavors of fractional resurfacing: ablative and non-ablative, which is discussed below.
Non-Ablative Technology: What’s What
Non-ablative technology uses wavelengths in the 1540 nm and 1550 nm range. These are created by an erbium source. Several different companies manufacture these products including Sciton, Palomar and Reliant. Each of the respective companies has its own iteration that it claims is superior to the others, and there are in fact some significant differences between them. You be the judge.
Reliant
The Fraxel Re-store from Reliant Technologies (Mountain View, CA) has a Zimmer air chiller that helps to minimize the discomfort associated with the procedure. Its handpiece incorporates a disposable tip, which has a software chip that tells the device when to inactivate it.
The problem with this is that it renders it useless after a few treatments and is a source of considerable ongoing cost (something to consider when choosing devices). The tips for the device have two metal rollers that move across the skin while the computer generates a laser pulse that treats the skin in its field. Moving too rapidly causes the sensor to emit a beeping noise that signals the user to slow down so as to avoid having gaps in the treatment area.
One nice feature of the device is its ability to scan a given body area and define the amount of energy (in Joules) needed to provide the treatment level desired. A second feature that is a welcome feature for this laser is its ability to move quickly with large treatment areas.
Treating the average face requires about 25 minutes of treatment time as each strip of skin must be treated several (usually about eight) times.
Palomar
Palomar Lux 1540 (Palomar Medical Technologies, Inc., Burlington, MA) with a nonablative handpiece has the advantages of an integrated chiller tip, which is not the source of an additional charge. Another advantage is the fact that it does not require any consumable tips; the entire handpiece can be used repeatedly. It does require replacement after a certain number of pulses, but the company has been reasonable in its policies with respect to this.
The main issue with the device was its slow speed, with too much time between pulses; it took an unreasonable amount of time to treat a whole face (about an hour). Recently, the device has improved with higher energy levels and more rapid pulses, which enable treatment times to be much more tolerable (for physician and patient alike).
Sciton
The ThermaScan from Sciton (Sciton, Inc., Palo Alto, CA) is an Nd-Yag-based fractional laser that has its adherents as well. The device has a spot size that enables treatments to be performed at a reasonable rate. It does not require costly consumables on an ongoing basis. It has a wavelength of 1319 nm. It is capable of energy outputs as high as 40 J/Cm2 and has a skin chilling system that relies on skin contact. Like the Palomar system, there are no consumables for this device. The Sciton device is fast and one can treat the whole face in about 15 to 20 minutes.
How to Pick ’Em
Cost. When selecting a device to purchase, it is important to understand all of the costs associated with operating it and how the amortized costs of the laser will effect your practice.
‘Grief Quotient.’ Speak with other dermatologists about their results with the device and their ‘grief quotient’ associated with maintenance and patient complications. (Purchasing a device that increases your headaches is the last thing one needs to do in the present economic environment.)
Your Practice. Finally, think about whether adding the device is something that fits your practice vision. You may or may not be the type of doctor who wants to be tethered to a device that has large operational costs and time demands.
How to Use ’Em
All of these devices require several sessions to deliver optimal results. Typically, treatments are spaced about 3 to 4 weeks apart, and a planned series includes three to four visits.
The Bottom Line
As with any aesthetic procedure, the real measure of a device or treatment is patient satisfaction. I have used several of these devices and have chosen one as my preferred fractional erbium laser. Several of my colleagues have selected a different device, and each of us has aspects of our decisions we regret and others that we love.
The promise held by lasers used a decade ago for skin rejuvenation was quickly dampened by reports of complications such as scarring, persistent erythema and infections. For those of us who were proponents of this modality, these issues combined with the high costs for these devices rendered them useless despite the best pitches of the laser companies.
Kinder, Gentler Lasers?
Recently, however, some of the devices introduced have the potential to realize the majority of the benefits expected of those earlier versions with a fraction of the risk for complications.
These newer technologies utilize lasers whose beams are divided into fractions to allow pixels of the skin to be vaporized while adjacent areas are unaffected. Viable epidermis fosters rapid skin repair and recovery, while the beams that permeate stimulate new collagen formation and epidermal replenishment.
At the present time, there are two flavors of fractional resurfacing: ablative and non-ablative, which is discussed below.
Non-Ablative Technology: What’s What
Non-ablative technology uses wavelengths in the 1540 nm and 1550 nm range. These are created by an erbium source. Several different companies manufacture these products including Sciton, Palomar and Reliant. Each of the respective companies has its own iteration that it claims is superior to the others, and there are in fact some significant differences between them. You be the judge.
Reliant
The Fraxel Re-store from Reliant Technologies (Mountain View, CA) has a Zimmer air chiller that helps to minimize the discomfort associated with the procedure. Its handpiece incorporates a disposable tip, which has a software chip that tells the device when to inactivate it.
The problem with this is that it renders it useless after a few treatments and is a source of considerable ongoing cost (something to consider when choosing devices). The tips for the device have two metal rollers that move across the skin while the computer generates a laser pulse that treats the skin in its field. Moving too rapidly causes the sensor to emit a beeping noise that signals the user to slow down so as to avoid having gaps in the treatment area.
One nice feature of the device is its ability to scan a given body area and define the amount of energy (in Joules) needed to provide the treatment level desired. A second feature that is a welcome feature for this laser is its ability to move quickly with large treatment areas.
Treating the average face requires about 25 minutes of treatment time as each strip of skin must be treated several (usually about eight) times.
Palomar
Palomar Lux 1540 (Palomar Medical Technologies, Inc., Burlington, MA) with a nonablative handpiece has the advantages of an integrated chiller tip, which is not the source of an additional charge. Another advantage is the fact that it does not require any consumable tips; the entire handpiece can be used repeatedly. It does require replacement after a certain number of pulses, but the company has been reasonable in its policies with respect to this.
The main issue with the device was its slow speed, with too much time between pulses; it took an unreasonable amount of time to treat a whole face (about an hour). Recently, the device has improved with higher energy levels and more rapid pulses, which enable treatment times to be much more tolerable (for physician and patient alike).
Sciton
The ThermaScan from Sciton (Sciton, Inc., Palo Alto, CA) is an Nd-Yag-based fractional laser that has its adherents as well. The device has a spot size that enables treatments to be performed at a reasonable rate. It does not require costly consumables on an ongoing basis. It has a wavelength of 1319 nm. It is capable of energy outputs as high as 40 J/Cm2 and has a skin chilling system that relies on skin contact. Like the Palomar system, there are no consumables for this device. The Sciton device is fast and one can treat the whole face in about 15 to 20 minutes.
How to Pick ’Em
Cost. When selecting a device to purchase, it is important to understand all of the costs associated with operating it and how the amortized costs of the laser will effect your practice.
‘Grief Quotient.’ Speak with other dermatologists about their results with the device and their ‘grief quotient’ associated with maintenance and patient complications. (Purchasing a device that increases your headaches is the last thing one needs to do in the present economic environment.)
Your Practice. Finally, think about whether adding the device is something that fits your practice vision. You may or may not be the type of doctor who wants to be tethered to a device that has large operational costs and time demands.
How to Use ’Em
All of these devices require several sessions to deliver optimal results. Typically, treatments are spaced about 3 to 4 weeks apart, and a planned series includes three to four visits.
The Bottom Line
As with any aesthetic procedure, the real measure of a device or treatment is patient satisfaction. I have used several of these devices and have chosen one as my preferred fractional erbium laser. Several of my colleagues have selected a different device, and each of us has aspects of our decisions we regret and others that we love.
The promise held by lasers used a decade ago for skin rejuvenation was quickly dampened by reports of complications such as scarring, persistent erythema and infections. For those of us who were proponents of this modality, these issues combined with the high costs for these devices rendered them useless despite the best pitches of the laser companies.
Kinder, Gentler Lasers?
Recently, however, some of the devices introduced have the potential to realize the majority of the benefits expected of those earlier versions with a fraction of the risk for complications.
These newer technologies utilize lasers whose beams are divided into fractions to allow pixels of the skin to be vaporized while adjacent areas are unaffected. Viable epidermis fosters rapid skin repair and recovery, while the beams that permeate stimulate new collagen formation and epidermal replenishment.
At the present time, there are two flavors of fractional resurfacing: ablative and non-ablative, which is discussed below.
Non-Ablative Technology: What’s What
Non-ablative technology uses wavelengths in the 1540 nm and 1550 nm range. These are created by an erbium source. Several different companies manufacture these products including Sciton, Palomar and Reliant. Each of the respective companies has its own iteration that it claims is superior to the others, and there are in fact some significant differences between them. You be the judge.
Reliant
The Fraxel Re-store from Reliant Technologies (Mountain View, CA) has a Zimmer air chiller that helps to minimize the discomfort associated with the procedure. Its handpiece incorporates a disposable tip, which has a software chip that tells the device when to inactivate it.
The problem with this is that it renders it useless after a few treatments and is a source of considerable ongoing cost (something to consider when choosing devices). The tips for the device have two metal rollers that move across the skin while the computer generates a laser pulse that treats the skin in its field. Moving too rapidly causes the sensor to emit a beeping noise that signals the user to slow down so as to avoid having gaps in the treatment area.
One nice feature of the device is its ability to scan a given body area and define the amount of energy (in Joules) needed to provide the treatment level desired. A second feature that is a welcome feature for this laser is its ability to move quickly with large treatment areas.
Treating the average face requires about 25 minutes of treatment time as each strip of skin must be treated several (usually about eight) times.
Palomar
Palomar Lux 1540 (Palomar Medical Technologies, Inc., Burlington, MA) with a nonablative handpiece has the advantages of an integrated chiller tip, which is not the source of an additional charge. Another advantage is the fact that it does not require any consumable tips; the entire handpiece can be used repeatedly. It does require replacement after a certain number of pulses, but the company has been reasonable in its policies with respect to this.
The main issue with the device was its slow speed, with too much time between pulses; it took an unreasonable amount of time to treat a whole face (about an hour). Recently, the device has improved with higher energy levels and more rapid pulses, which enable treatment times to be much more tolerable (for physician and patient alike).
Sciton
The ThermaScan from Sciton (Sciton, Inc., Palo Alto, CA) is an Nd-Yag-based fractional laser that has its adherents as well. The device has a spot size that enables treatments to be performed at a reasonable rate. It does not require costly consumables on an ongoing basis. It has a wavelength of 1319 nm. It is capable of energy outputs as high as 40 J/Cm2 and has a skin chilling system that relies on skin contact. Like the Palomar system, there are no consumables for this device. The Sciton device is fast and one can treat the whole face in about 15 to 20 minutes.
How to Pick ’Em
Cost. When selecting a device to purchase, it is important to understand all of the costs associated with operating it and how the amortized costs of the laser will effect your practice.
‘Grief Quotient.’ Speak with other dermatologists about their results with the device and their ‘grief quotient’ associated with maintenance and patient complications. (Purchasing a device that increases your headaches is the last thing one needs to do in the present economic environment.)
Your Practice. Finally, think about whether adding the device is something that fits your practice vision. You may or may not be the type of doctor who wants to be tethered to a device that has large operational costs and time demands.
How to Use ’Em
All of these devices require several sessions to deliver optimal results. Typically, treatments are spaced about 3 to 4 weeks apart, and a planned series includes three to four visits.
The Bottom Line
As with any aesthetic procedure, the real measure of a device or treatment is patient satisfaction. I have used several of these devices and have chosen one as my preferred fractional erbium laser. Several of my colleagues have selected a different device, and each of us has aspects of our decisions we regret and others that we love.
