Dr. LeeChoosing the right laser devices can add to the bottom line and patient satisfaction; choosing the wrong devices can be a drain on a practice’s viability.
To help sort through the decision-making process of which lasers to add and which ones to avoid, Min-Wei Christine Lee, M.D., M.P.H., dermatologic surgeon and director of The Skin and Laser Treatment Institute in Walnut Creek, Calif., presented on “Emerging Laser and Aesthetic Technology,” at the 2017 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Fla.
Keeping up with technological advances is important for dermatologists whether they offer treatment with specific devices or not. Dermatologists are the specialist’s patients seek for laser treatments, as well as guidance and information on what’s available, according to Dr. Lee.
“It’s also important for doctors to know the differences between the devices, so they can make smart decisions about acquiring devices. The worst thing is for a doctor to invest $150,000 or more on an expensive laser and later feel they made the wrong decision,” Dr. Lee tells Dermatology Times. “Every doctor’s practice is different—some doctors may only need one laser to suit their needs, whereas, other doctors may actually need to invest in multiple lasers.”
Six considerations before making that laser purchase
Dr. Lee’s top tips for helping dermatologists decide on which lasers to buy are:
- Compare lasers based on gold standard, best in class, cost benefit and practicality. Dermatologists should consider whether they’d be better off with a multi-modality system, offering many cosmetic and medical applications. At the same time, they should consider that quality might suffer if they settle for a low-cost multi-platform system—one that has many applications but is too low powered to do anything well.
“For example, an IPL multi-platform device might be able to do facial rejuvenation and laser hair removal very well but [may] not [be] capable of treating individual pigmented lesions. If you want to treat tattoos and pigmented lesions, you might need to get either a pico laser or a nanosecond laser, such as the Fotona QX-Max [Fotona], in addition to getting the IPL system. Or if you want to treat individual blood vessels and leg veins, then you might need to get the Excel V [Cutera] in addition or in place of the IPL system,” Dr. Lee says.
- Consider what a laser would add to your practice. Will it add something new or simply duplicate what you already have?
- Is this a workhorse laser that you will use every day or simply the latest fad?
- Research your local market to make sure the need or market for the laser you’re considering is not already saturated. For example, if there are 10 CoolSculpting [Zeltiq] lasers or 10 Ulthera [Merz Aesthetics] devices in your local area, you will need to consider carefully if there is enough demand to justify purchasing this for your practice.
- Survey the patients in your practice to see what the actual need or desire for a procedure is before committing to a purchase. Ideally, you should be able to pay off the device within six to 12 months. If you don’t have enough volume to cover the cost of the laser, you may end up making payments for many years. Salesmen usually only talk about best case scenarios.
“[They might say:] ‘Doctor, if you just do 10 of these treatments a month, you’ll pay off the device in six months.’ What they don’t tell you is some of their doctors are only doing one to two treatments a month, and it’s going to take forever at that rate to pay off the laser (in fact, you may never pay it off, so you just made an expensive donation to that laser company),” she says.
- Talk to doctors who are actually using the laser about their experiences with it. Don’t forget, however, to consider the demographics—whether that doctor is the only one in his/her area doing lasers versus being in a very tight market with lots of competition. Consider also the type of patients that doctor sees and determine whether those patients are similar to yours in terms of socioeconomic class, ethnic diversity, etc. Yet another consideration: Does that doctor have a practice in a very affluent metropolitan area versus rural area?
“If you are considering a laser hair removal device for treating predominately dark skinned patients, you should talk to a doctor who is successfully treating a large population of dark skin patients using the device you are considering,” she says.
Dr. Lee’s favorite lasers
Dr. Lee shares her top picks for laser devices, combinations and why she thinks they work so well.
The Fotona SP Dynamis Pro [Fotona].
It’s like having 20 lasers in one device. There are many devices (mainly IPL-based) that claim to be like 20 lasers in a box but the difference is they are the "Jack of many trades; king of none.”
The SP Dynamis Pro is best in class for many applications and is “king of many.” It is a dual wavelength laser that has erbium and Nd:YAG lasers, featuring unique properties that aren’t available with other erbium or Nd:YAG lasers. First, it’s the world’s first nonablative erbium: YAG laser that can safely be used inside the oral mucosa, vaginal mucosa and lower inner conjunctivae of the eyelid. It causes immediate contraction or tightening of the tissue by heating the tissue, without burning it. Other erbium lasers are ablative because they have short pulse durations of 1.5 milliseconds. This Erbium laser has a super long pulse of 250 milliseconds, which allows providers to safely use this device on all tissues, skin and mucosa, without the fear of causing tissue ablation. When used inside the mouth, in addition to causing tightening and contraction of the oral mucosa, it also causes tightening and contraction of the facial muscles, due to its proximity to the muscles. The thermal heating leads to tightening of facial muscles, which helps with facial skin tightening. Heating of the oral mucosa also causes plumping and smoothing of the lips and nasolabial folds.
The unique effects of this laser on mucosal tissue are also why the Fotona is the gold standard and only nonablative laser available on the market to help tighten the vagina. It was the world’s first laser used for nonsurgical vaginal rejuvenation and tightening. Fotona has the only nonablative Erbium laser (called the Intimalase and Incontilase) for treating the vagina without causing any mucosal injury. Fotona has the most studies showing efficacy and safety for treating vaginal laxity, genitourinary syndrome of menopause, stress urinary incontinence, and uterine and pelvic organ prolapse. All the other lasers (MonaLisa Touch (DEKA), FemiLift (Alma Lasers), FemTouch (Lumenis), Co2RE Intima (Syneron Candela), Petite Lady (Imdad), Juliet (Asclepion Laser Technologies), Beladona (WON Tech), DiVa (Sciton), etc.) use either fractional CO2 or ablative erbium, which causes injury to the vaginal mucosa and has greater risk of side effects. Radiofrequency devices are also noninvasive but have been used primarily for treating vaginal laxity and genitourinary syndrome of menopause and have fewer studies published compared to the nonablative Erbium laser. The radiofrequency devices are Ultra Femme (BTL), Geneveve (Viveve) and ThermiVa (Thermi).
The intraoral nonablative erbium handpiece, NightLase (Fotona), is the gold standard for treating snoring and sleep apnea. Patients experience immediate improvement after only one treatment. Patients with severe snoring due to oropharyngeal obstruction get immediate improvement. Best results are with three treatments, a month apart; and then maintenance treatments every six to 12 months.
SP Dynamis Pro has many improvements over the previous SP Dynamis—especially exciting is TightSculpting (Fotona). The new laser has a new handpiece with a large scanner capable of treating large body areas. It is used for fat melting, body contouring and skin tightening on the entire body. The results rival those of all existing fat melting and body contouring devices.
The Fotona nonablative erbium laser, when used in the lower inner conjunctivae of the lower eyelid is called “Smooth Eye.” It causes immediate tightening or contraction of the conjunctival tissue and infraorbital fat pad, which helps to reduce infraorbital laxity, wrinkles and improves fat bulges, lower lid bags and tear trough deformities.
The intraoral procedure works even better when combined with the other lasers that are part of the SP Dynamis Pro: a nonablative fractional Nd:YAG (Frac3) and a super long-pulsed Nd:YAG (Piano mode), which are powerful pulse modalities that come with the device. There is a four-step laser procedure called Fotona Laser4D, which involves using the intraoral laser inside the mouth, followed by Frac3 and Piano on the outside of the face, to help cause even more skin tightening. There is also the option to perform an ablative or fractional erbium laser, which is part of the SP Dynamis Pro. That can result in greater reduction of rhytides and perform all resurfacing needs.
Fotona Intimalase and Incontilase for vaginal rejuvenation. Vaginal rejuvenation with these lasers are especially exciting because women with gynecological disorders used to have to undergo high-risk, painful surgery and endure long recoveries. The use of noninvasive lasers to help women with disorders, such as vaginal laxity, symptoms associated with menopause, stress urinary incontinence and uterine prolapse, can be a Godsend to women.
BTL combination of Exilis Ultra, Vanquish ME and Cellutone for body contouring.
Exilis Ultra is BTL’s most recent upgrade of the company’s radiofrequency device, which is more powerful and delivers more homogeneous and consistent energy, resulting in superior skin tightening of the body and face. Vanquish ME is BTL’s most recent upgrade of its fat melting device. It’s unique in that it has the largest spot size on the market and is the only device which can passively treat the entire abdomen in only 20 minutes. Cellutone is a therapeutic vibrator which “shocks” the fat and increases lymphatic drainage, circulation and fat absorption. Combining these three devices is a cost effective, painless and noninvasive treatment with no recovery time, and has the advantage of having the fastest treatment time for covering large body areas.
The Vanquish ME also has the advantage of being able to treat the entire abdomen or back or thighs or arms in the fastest time in a passive fashion, without requiring an operator. It has no expensive consumables.
This combination has been producing impressive results for noninvasive fat melting and body contouring. These treatments can also be combined with other devices, such as CoolSculpting or Sculpsure, which can only target small areas at a time and take longer for the treatment. One way physicians are combining these devices is to target certain smaller areas with CoolSculpting, and then treat the entire larger area with the BTL combination.
New picosecond options for treatment of tattoos and pigmented lesions.
The new picosecond lasers, Enlighten by Cutera and PicoWay by Syneron, and higher power nanosecond lasers, with the highest powered one being the QX-Max by Fotona, are capable of removing resistant colored tattoos and traditional tattoo colors faster and more efficiently than other approaches. Fotona will be coming out with an even higher powered version with revolutionary pico-in-nano pulse structure called the Starwalker, which is available internationally but not yet in the U.S. This system has picosecond micro pulses combining the pico tissue interaction with nano energy in the whole pulse. The Starwalker brings the best of pico and nano technology with higher energy in one device thus maximizing the speed, efficacy and safety of treatments.
Disclosure: Dr. Lee is a consultant to or speaker for BTL Industries, Cutera, Cynosure, Fotona, Lumenis, Solta Medical, Syneron and Ulthera.