Praising the Platform: Why a Multi-Modality System is the Best Choice for Your Practice

Platform devices providing multiple modalities in a single system have always had a place in the aesthetic practice. As a result, new combinations and evolutions are always emerging. Ultimately, the appeal of platform devices can be summed up in one word: versatility.

“Whether it is a multiwavelength laser device or a platform offering completely different modalities in one system, versatility is the goal after safety and efficacy,” stated Michael H. Gold, MD, director of the Tennessee Clinical Research Center and Gold Skin Care Center (Nashville, Tenn.). The con we don’t always consider though, is that you tie up a lot of functionality in a single device. In some ways this reality benefits the smaller practice more because they want to offer variety, but don’t have the traffic. A larger practice with more patient traffic throughout the week is going to focus on throughput. Thus, having a greater number of dedicated devices may be advantageous, but it depends on the practice.”

Another related downside is the loss of functionality when a device goes down. “When a platform goes down, you may lose the ability to use all of the attachments until it is back up,” said Edward M. Zimmerman, MD, director of Aesthetic Revolution Las Vegas (Las Vegas, Nev.). “This is admittedly rare with platforms based on solid state technology, and they can often diagnose problems remotely, send a new circuit board to you and fly out a technician to take care of it. However, if things are more complicated, you can be down for a month.”

Early platform devices – as well as many today – were multi-function IPL, multi- wavelength laser, or combined lasers and IPL systems; an intuitive choice, according to Dr. Zimmerman. “The first platform device I can remember was the ESC Photoderm VL/PL/HR from the mid-90s, and quickly grew from there to include multi-wavelength laser systems and combination laser/IPL,” he recalled.

“This makes perfect sense because the medical use of light has been an important and continually evolving segment of our armamentarium, and dermatology is where we see the obvious transition between the medical and cosmetic. Much of what we do leads down both paths,” Dr. Zimmerman continued.

“Most of the current big players in the industry had their platforms, and still do. Now, we have a new variety of non- invasive radiofrequency (RF) – bipolar and minimally invasive mono- and multi- polar – boxes for skin tightening and wrinkle reduction, even surgical RF generators for cutting and cautery, as well as subdermal tightening and full-on skin resurfacing,” Dr. Zimmerman pointed out.

Cost was, and remains, a factor. “One multifunction box generally costs less than the sum of several stand-alone treatment devices,” Dr. Zimmerman added. “It also means paying for one warranty instead of several.”

Some platforms are modular, so you can equip your unit for whatever level is suitable for the practice at the time and then add functionality as you grow. “A new or established practice can get just the IPL and Nd:YAG modules, for example, and add other available wavelengths or fractional and short pulse width lasers (Q-switched and pico) as needed, which is a practical way to manage cost with growth,” Dr. Zimmerman expressed.

There may never have been a better time than now to adopt a platform device. For a while, the downside of the platform device was ‘Jack of all trades, master of none’ because the highly sought versatility seemed to require a sacrifice in efficacy. “If you asked me years ago about platform devices, I was not as enthusiastic as I am now, for that very reason,” said Elizabeth Tanzi, MD, director of Capital Skin & Laser in Chevy Chase, Md. “That is simply not a concern at this point. Reputable companies with long experience are putting out safe, reliable, user-friendly and versatile devices that provide excellent outcomes. These kinds of devices can grow with the practice, it is what they were going for originally and are achieving now.”

The rise of combination therapies has contributed to the ubiquity of the platform device. “Attacking an indication from multiple vectors has shown time and time again to be the best way to achieve maximum results,” Dr. Gold said. “Platforms offering different versions of one modality, such as a multiwavelength laser system, or devices that combine modalities in a single box, can allow users to easily perform a combination therapy with few hassles and very little transition time between modalities.”

As such, a powerful aspect of platform devices is the way their versatility lends itself to adjunctive use, according to Harvard-trained plastic surgeon Erez Dayan, MD, medical director of Avance Plastic Surgery Institute in Reno, Nev. “So many of our gold standard surgical procedures have benefited enormously from the addition of energy-based therapy to reduce scarring or give patients a more natural-looking result.”

Some examples include emerging body contouring devices harnessing multiple modalities to improve fat, muscle and skin. “We use one that builds muscle with electrical muscle stimulation, and also reduces fat and tightens skin using different RF components,” Dr. Dayan shared. “Devices such as these give us remarkable results on their own, but work with surgery to give us better results than we have ever seen.”

“Also, there’s a growing trend toward customizable treatments,” Dr. Dayan added, “and nothing supports this like platform devices that allow you to account for patient individuality in the way you manage different components of therapy. Think about it: every patient is different and has different needs. For body shaping we see the overweight, the athletic and everything in between. With new capabilities we can treat each of them differently, based on their own unique needs, using a single device. I am sure this is as true, or more so, for laser systems treating skin.”

In turn, this expands the patient base. “Aesthetic practitioners can treat a much broader spectrum of patients nowadays than ever before,” Dr. Dayan stated, “because we have safe, effective tools at our disposal that can treat with a realistic expectation of outcomes. Platform devices are part of what makes that possible.”

The flagship multi-module JOULE X^® platform from Sciton (Palo Alto, Calif.), as well as its little sister, mJOULE^TM also bring IPL – termed broadband light (BBL), their proprietary pulsed light offering – together with lasers. JOULE is recognized worldwide for its expandable design, customizable approach and sustainable profitability path. Trailblazing technologies include the new BBL HERO^TM, Forever Young+^TM, and Forever BodyTM, plus award-winning favorites HALO^®, BBL^TM, Resurfacing Perfected, Clear Suite and diVa^®. Its onboard intelligent cloud computing data tools, known as Sciton iQ^TM, monitor system health and usage metrics.

Dr. Tanzi uses JOULE every day. “The BBL is used daily in my office, whether it is in conjunction with a resurfacing procedure like HALO, the microlaser peel or on its own. Sciton has a decades-long reputation for making robust, workhorse devices, some of which are still in use after many, many years. In my office, they are the most reliable devices I own. Currently, this is the only platform in my practice, and it serves me well.”

The affordable, expandable mJOULE offers versatile and synergistic treatments from single targeted applications to regular skincare regimens with BBL HERO and MOXI^TM, a 1927 nm fractionated thulium laser that is taking the industry by storm, according to dermatologist Sherrif F. Ibrahim, MD (Rochester, N.Y.). “MOXI provides low downtime resurfacing that is even appropriate for younger patients looking to maintain their youthful appearance rather than restore it. It is great to have that with BBL HERO in a unit which is so portable and plugs into a standard 110V outlet,” he expressed. Buyers can choose either module or both, depending on their needs.

“Simplicity, portability and expandability give you a very useful platform that grows with your practice. We have JOULE, but we augment that using the more portable mJOULE with both modules to make us more efficient,” Dr. Ibrihim added.

The robust and easy-to-use Icon^® from Cynosure (Westford, Mass.) not only offers industry-leading IPL plus seven handpieces of versatility with a non-ablative 1540 nm laser, it also features their signature Melanin Reader, called Skintel^®. Users can choose treatment parameters using individual patient skin data and adjust them on the fly to treat facial and leg veins, scars of various types, wrinkles and striae as well as perform resurfacing and hair reduction.

Offering four different lasers and an IPL in one convenient platform, the extremely portable Spectrum from Rohrer Aesthetics (Homewood, Ala.) can be used for a variety of cosmetic procedures including skin resurfacing (Er:YAG), tattoo removal (Q-switched Nd:YAG/KTP), removal of pigmented lesions (IPL), vascular reduction (long-pulsed YAG), and hair removal (810 nm diode). “The Spectrum has a capable IPL handpiece in the platform. Many physicians rely heavily on IPL. I don’t, I’ll usually go to specific laser wavelengths,” said Fred G. Fedok, MD, director of the Fedok Plastic Surgery and Laser Center (Foley, Ala.). “With Spectrum you have IPL plus four laser wavelengths which, together, will cover most, if not all of your clinical needs. Its utility and versatility will lend itself to almost any practice. I’ve had this device since its inception and am extremely happy with it.”

Dr. Fedok uses the Spectrum for many things, he shared, but he believes the laser shines particularly for hair reduction and for various levels of resurfacing. “The 810 nm diode laser for hair removal – we have used it on skin types I through V – is superb, we achieve excellent results with it. Resurfacing depends on the patient’s aesthetic needs, coupled with the downtime they are willing to undergo. With the Er:YAG for lighter resurfacing we get refreshment and textural improvement appropriate even for patients in their late 20s or early 30s. Perioral radial lines are among the most frustrating signs of aging for patients. I use the Er:YAG with the 6 mm aperture for global improvement in the perioral region, going to the 2 mm or 3 mm aperture for a second pass to treat any deeper, fine radial rhytides on the lips. Downtime is modest.” Spectrum easily separates into two pieces, making it easy to transport and share among operators and move to different offices.

The eight key benefits of the non-inva- sive, hands-free Ultracontour NG from MedixSysteme AG (Ruggell, Liechtenstein) start with high focalized fractionated ultrasound (sonodynamic therapy) to treat subcutaneous fat in the arms, belly, legs, buttocks, love handles and hips with simultaneous point-by-point targeting at the precise depth of local adiposity between 0.8 cm and 1.3 cm. The unique, intense pulsing causes an ultrasonic mechanical drainage (UMD) effect delivering intense pulses to the fat in larger areas automatically. Treatment also boosts blood flow and neocollagenesis to restore elasticity of skin tissue. Up to five levels of UMD power can be selected, based on fat thickness and the area treated, with automatic programs for men or women. The six flexible UMD belts adapt to body areas on each individual patient for a total of 18 custom-programmed emitters that, together, can treat an entire body in one 20- to 30-minute session. Treatment is painless with no needles, no suction and no downtime.

As the world’s only solid-state laser producing both 589 nm and 1319 nm wavelengths, ADVATx features more than 15 FDA/CE cleared indications including vascular conditions, acne, scars, warts and wrinkles. This unique combination of 589 nm and 1319 nm provides the ideal solution to not only eliminate undesired superficial abnormalities but provides total dermal restoration by stimulating the production of collagen types I, III and VII, as well as elastin.

According to dermatologist Adrienne E. Stewart, MD, in Denver, Colo., ADVATx is particularly suited to dermatology practices such as hers that treat both aesthetic and medical indications. “In many cases the line between aesthetic and medical treatment is blurry, they go hand-in-hand because we are talking about skin,” she said. “We use it a lot for reds – rosacea or vessels – but I love it for acne and acne scars. I will use the 589 nm for active acne and redness, then the 1319 nm to treat acne scars, and for the redness as well. This allows me to treat both at the same time, which is very commonly requested in my office, but not easily achievable until I had ADVATx. I’ll use it with fractional resurfacing for collagen stimulation, doing the 1319 nm first, then the fractional treatment. We commonly use it for sebaceous hyperplasia as well. ADVATx lends itself well to delegation to staff if your state allows that. And overall, we see little, if any, downtime with this device.”

It is not so much about having the best platform, as much as the best platform for your practice. “Whether you are the new kid on the block or an established physician, you need to consider the unique needs of your practice,” said Dr. Gold. “It is about where you are now and where you plan to go. Platforms are often an excellent solution to cost-effectively expand your capabilities or move your practice in new directions, but you have to self-assess and then look at your options. There is a lot out there and if you take the time, you’ll find a quality device that suits your needs.”