PracticalDermatology

The use of energy-based devices in dermatology has exploded in recent years and sired a revolution in how skin laxity, pigmented lesions, excess fat, and other concerns are treated. And the innovation continues. Here, Thomas E. Rohrer, MD, a dermatologic surgeon at SkinCare Physicians in Chestnut Hill, MA, and the President of the American Society for Laser Medicine and Surgery (ASLMS) provides a brief but compelling history of laser medicine, with a glimpse toward what is yet to come.

What has been the biggest development in energy-based devices this past year?

Thomas E. Rohrer, MD: There has been a constant evolution of energy-based devices over the past several decades. Some ideas have come and gone, but most undergo continual refinement and become both safer and more effective with each subsequent modification. While the devices we use on a daily basis in our office have been around for some time, none are the same as they were when they were originally introduced. Some of the newer technologies that are very exciting right now are the concepts of nano-pulse stimulation to treat benign and potentially malignant lesions in a non-thermal manner, electromagnetic stimulation to build muscle, and the injection of a cold slurry to destroy fat cells. All of these new technologies are very exciting and have the potential to change the way we treat patients in the near future.

What were the biggest game changers you have seen in your career?

Dr. Rohrer: The biggest game changer was the concept of selective photothermolysis and the development of the pulsed-dye laser using those principles. That opened the way for most modern devices and changed laser medicine forever. It was really an exciting time to be a part of laser medicine. New advances were made rapidly with devices to treat vascular lesions, pigmented lesions, hair, and rhytids. It seemed like every meeting there was some new groundbreaking technology introduced and more heated debates about the best way to approach any issue. The next big advancement was the advent of fractionated delivery of energy. By only partially injuring the skin, it was possible to treat more safely and in some cases more effectively than we had ever been able to before. The latest game changer has been body sculpting with energy-based devices. Effectively and safely targeting fat had been elusive for decades. Now we have several different ways to target fat and non-invasively alter the shape of someone’s body.

Can we get facelift-like results with energy-based devices?

Dr. Rohrer: No. The tightening we get from these devices is roughly 5mm, which is good, but not what you can get with a surgical facelift. On the positive side, you also will not get the unnatural looking pulled cheek, corner of the mouth, or earlobes that we can see with facelifts. Likewise, we can only remove 50ccs or so when targeting fat with our energy-based devices, a far cry from the liters of fat that can be removed with liposuction. Again on the positive side, energy based devices are more safe, have no recovery time, and do not have the scars that are associated with the more invasive liposuction.

Where is this field going?

Dr. Rohrer: Identifying patient needs and figuring out ways to solve them has been the driving force of medical advances for quite some time now. If we look at the aesthetic arena, we are able to do so much more now than we could even a few years ago. I expect that trend to continue. We will see not only safer, more effective, and less invasive ways of approaching the conditions we treat today; we will likely also see the advent of technologies that allow us to treat things we can only observe today.

Any tips on assessing technologies?

Dr. Rohrer: I always like to base my decisions on scientific evidence. Waiting to see the results of large clinical trials is always a safer bet than relying on the word of a sales person. Getting information from a trusted source like peer-reviewed journals and CME meetings is the most reliable way to evaluate any device. When listening to a lecture or reading a journal article it is always good to know what conflicts of interest the speaker or author may have. I also like to speak directly to other physicians who have used the device and get their input on how it is performing and if there are any reliability issues. Making sure you have a good service contract and someone ready and able to repair the device on short notice is also very important. Lastly, I would ask to get a device on a trial basis for a little while to evaluate it personally in your office.