PracticalDermatology

Resurfacing
DermaSculpt Offers Er:YAG Trifecta.
Proponents of Er:YAG resurfacing now have the option of utilizing the 2940nm wavelength in three different ways. The new DermaSculpt from HOYA ConBio (conbio.com) provides a fractionated mode (Sculpturization), light to deep ablation (Polish Peel), and targeted treatment of discrete lesions (Chisel Touch). Clinicians can use the three available settings for comprehensive treatment of a single patient or selectively apply individual settings to address specific concerns in a given patient.

The fractionated Sculpturization mode allows for treatment of fine lines and photodamage, using a scanning handpiece. Penetration depths of up to 180 microns into the dermis are available at the 15J/cm² setting. Non-ablative, no-downtime or light ablative treatment are possible. Multiple pattern shapes are available to customize treatment. The Polish Peel ablative setting permits light-to-deep ablation, including treatment of deeper rhytides and scars (including acne scars). Handpieces are available in 3, 5, and 8mm.

Finally, the Chisel Touch setting utilizes 400 and 600 micron tips for treatment of small anatomic sites, such as crevices and sides of the nose. It is also ideally suited for treatment of discrete lesions, such as seborrheic keratoses (SKs).

In a single patient, a PolishPeel could be used to improve tone, texture, and pigment, while Sculpturization could be applied for collagen remodeling and overall skin smoothing and tightening.

DermaSculpt can be used in darker skin types, including types IV and V. Modalities can be obtained all at once or customized.

Fractional and Ablative Fusion for Pearl. Relatively new to the market from Cutera (cutera.com) is the Pearl Fusion, the latest Fractional and Ablative Solution from the Cutera Aesthetic Solutions family of devices. The Pearl Fusion combines the benefits of Pearl ablative resurfacing with those of Pearl Fractional into a single therapy. Pearl, Pearl Fractional, and Pearl Fusion feature Cutera's exclusive YSGG 2790nm wavelength. Pearl ablative resurfacing is a minimal down-time (three to four days, no weeping and oozing) procedure performed with only topical anesthetic for the treatment of fine lines/wrinkles, dyschromia, and improvement of tone and texture. Pearl Fractional offers deep fractional ablation (more than 1mm) for treatment of significant dermal damage and photoaging, also with minimal downtime. The novel Pearl Fusion, indicated for wrinkles, fine lines, dyschromia, pore size, skin tone and texture, offers full ablation plus deep fractional energy deposition, while maintaining minimal downtime. Cutera says treatment can be delivered rapidly. The combined therapy provides the benefits of each individual laser in one treatment session.

Rejuvenation/Tightening
C5 Added to MedLite C Series.
Another new offering from HOYA ConBio is the MedLite C5, a new addition to the MedLite C series Q-switched Nd:YAG lasers. The system delivers two wavelengths: 1064nm and 532nm with nano-second pulse widths (PhotoAcoustic Therapy or PhotoAcoustic Technology Pulse (PTP)). PTP delivers high peak power with short pulse durations. The nanosecond pulse configuration is intended to deliver a photoacoustic and subtle photothermal effect.

Intended for skin rejuvenation, wrinkle/scar reduction, and basic red and black tattoo removal, the MedLite C5 is offered as an affordable entrée into the MedLite C platform. The C5 system can be upgraded to the C6, which adds 585 and 650nm wavelengths via the Multi-Lite dye handpieces.

Reaction Introduces Multi-Channel RF. For radiofrequency skin tightening and body contouring, the multi-frequency Reaction from Viora (vioramed.com) permits 144 different treatment settings. Three frequency channels are available for various depths of penetration, and a fourth multi-mode option delivers all three frequencies. Reaction features Channeled Optimal RF Energy or CORE Technology that enables the multichannel approach. Each frequency (2.4Hz, 1.8Hz, 0.8Hz) provides a different depth of penetration, targeting of the dermis, subcutaneous layer, and hypodermis. Multi-RF targets all three depths. Treatment can be customized for skin tightening, lipolysis, or cellulite treatment and circumferential reduction. The inclusion of vacuum therapy facilitates deeper energy penetration and, according to Viora, it can “increase local blood circulation, promote lymphatic drainage and induce lipolysis.”

Treatments can be applied to the face, arms, belly, buttocks, hips and thighs, and legs and range from about 20 to 30 minutes, depending on the treatment site. There is no downtime and no significant discomfort associated with treatment.

Reaction joins Viora's other product offerings, including the Trios IPL for long-term hair reduction, removal of vascular and pigmented lesions, photodamage (age spots, fine lines/wrinkles), and acne. The system provides a large spot size (7.5cm2) with fast repetition rates to support rapid treatments.

Thulium Laser a Market First. The 1927nm Thulium laser is new to the aesthetics market and is featured in the Fraxel re:store Dual system from Solta (soltamedical.com; fraxel.com). The Thulium fiber laser targets unwanted pigmentation, while the 1550nm Erbium fiber laser allows non-ablative skin resurfacing. According to Solta, the 1927nm Thulium laser is associated with greater patient comfort, allowing treatment of large areas. Focal cooling is also built into the handpiece. A new scanner design is intended to increase procedure speed by 25 percent.

Early data suggest the benefit of the Fraxel re:store Dual laser to treat actinic keratoses (AKs) on the face or other photodamaged areas of the body. Initial results from an ongoing clinical study found that treatment with the new Fraxel re:store DUAL laser resolved 86 percent of AK lesions while improving skin texture and pigmentation.

Thermage Introduces CPT.
The new Thermage CPT system featuring Comfort Pulse Technology from Solta Medical offers improvements over older Thermage systems (thermage.com). Thermage delivers pulsed radiofrequency energy for skin tightening and contouring. According to Solta, CPT features a new energy delivery algorithm that is designed to mimic Transcutaneous Electrical Nerve Stimulation or TENS therapy, which is commonly used to manage chronic pain conditions by interfering with the brain's neural response mechanisms. The new algorithm interweaves pulsed radiofrequency delivery with cooling bursts. Additionally, a vibrating handpiece offers another approach to pain control. Solta notes that controlled, splitfaced clinical studies involving over 40 patients found that treatment with vibration was preferred to treatment without vibration.

Additional features of the new system include a redesigned Face Tip 3.0 and seamless integration with the Thermage Body Tip 16.0 for faster, more comfortable face and body treatments.

Lux2940 Gets in the Groove. Now available from Palomar (palomarmedical.com) is the Groove Optic for the Lux2940 fractional handpiece that creates a unique, grooved injury pattern on skin to increase ablative tissue coverage while maintaining the benefits traditionally associated with fractional approaches.

Other fractional ablative devices remove vertical columns of tissue, however, the Groove Optic ablates lines of tissue. According to Palomar, this results in a uniform, high-coverage pattern that “more effectively disrupts the structural memory of wrinkles.”

Hair Removal
Sciton Rolls Out ClearScan. More comfortable, speedy hair removal may be possible with the new 755nm Alexandrite ClearScan ALX from Sciton (sciton.com). The ClearScan ALX uses a high-speed scanner and Large Area Pattern Generator (LAPG) technology for non-sequential energy delivery that is intended to provide precise, uniform coverage. Continuous contact cooling adds to the comfort of treatment. The scanning alexandrite technology is designed for rapid treatment.

The ClearScan ALX can also be used to treat vascular lesions, benign pigmented lesions and wrinkles, and the wavelength is suitable for use in all skin types.

Single spot settings are also possible. The system has no consumables, and treatment has no downtime.

Striae
First Clearance for Striae Granted. The first device cleared by FDA for treatment of striae is the Lux1540 Fractional nonablative laser handpiece from Palomar Medical Technologies, Inc. The StarLux laser and IPL platform permits a range of aesthetic treatments through the selection of specific handpieces. The Lux1540 fractional non-ablative laser is also used for skin resurfacing and treatments of surgical and acne scars, and melasma. In ongoing clinical studies, subjects treated with the Lux1540 have had an average improvement of between 51 and 75 percent in the appearance of striae, based upon a blinded review of pre-treatment and three-month post-treatment photographs.

Research and Industry News
Iridex ‘s 532nm long-pulsed Nd:YAG laser (Gemini, iridex.com) offers greater efficacy and lower risk of postinflammatory hyperpigmentation compared to other systems in the management of freckles and lentigines in darker skin tones. That's according to a recent comparison of the efficacy of four lasers (595nm long pulsed dye (LPDL), 755nm LP Alexandrite , 532nm QS Nd:YAG, and 532nm LP Nd:YAG) in the treatment of 40 (randomized 10 per laser) Chinese patients with Fitzpatrick skin types III and IV that was presented at the American Society for Laser Medicine and Surgery last month (Abstract No. 136). Subjects received one to four sessions provided four to six weeks apart and were assessed after three to 12 months. In the Gemini group, 70 percent of subjects had optimum improvement after six to 12 months, compared to 50 percent of LPDL patients after three months and 60 percent of QS Nd:YAG patients after three to 12 months. Alexandrite laser therapy did not provide statistically significant improvement. There was no risk for postinflammatory hyperpigmentation in the LP Nd:YAG group, compared to 38 percent risk with Alexandrite, 33 percent risk with QS Nd:YAG, and six percent risk with LPDL.

Solta Medical, Inc. entered into a definitive agreement to acquire privately-held Aesthera Corporation for $5.25 million in Solta common stock and cash, with potential additional baseline milestones of $750,000 for a consideration of $6.0 million. Aesthera's Isolaz and Isolaz Pro platforms, based on proprietary Photopneumatic technology, are the only laser or light based devices with FDA marketing clearance for the treatment of inflammatory acne, comedonal acne, pustular acne, and mild-to-moderate inflammatory acne.

Candela Corporation, a Syneron companywill begin the sales process and launch official marketing programs for the Alex TriVantage multi-wavelength, Q-switched laser system and the GentleMax multiple wavelength workstation for sale throughout the People's Republic of China, including Hong Kong, following recent SFDA (State Food and Drug Administration) of China approval. The Alex TriVantage laser provides 755nm, 532nm and 1064nm output wavelengths, The GentleMax integrates the GentleLASE and GentleYAG, into a configurable, upgradeable workstation featuring both 755nm and 1064-nm wavelengths for permanent hair reduction on all skin types and tanned skin as well as the treatment of vascular and pigmented lesions, wrinkle reduction and skin tightening. Syneron completed its acquisition of Candela in January (candelalaser.com).

Sciton has established its Sciton Japan subsidiary and opened a corporate office in Tokyo. According to the company, the Joule system is especially appropriate for Japanese clinics where quality expectations are high and space is typically at a premium. The Joule offers a combination of 10 best-in-class modules on a single platform with multiple methods of delivering laser and light energy. Physicians can start with one or more modules and add more based on practice demand.

Ulthera, Inc., a therapeutic ultrasound medical device company has launched a first-of-its-kind technology to achieve a non-invasive eyebrow lift following FDA clearance for the use of its Ulthera System (ulthera.com). The device combines visualization beneath the skin's surface using “DeepSEE” technology with non-invasive delivery of ultrasound energy at depths that enable significant lifting of the skin. Focused ultrasound energy triggers the body's natural healing response, resulting in new and improved collagen support and gradual firming, tightening and actual lifting of skin tissue over time, Uthera says.