NOV-DEC 2013

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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GOING DEEPER Before These patients (top and bottom of page) underwent ablative fractional laser treatments with Alma Lasers er:YAG Pixel to reduce deep wrinkles around the mouth and the eyes. "The advent of the 600µ Fraxel Re:pair handpiece has allowed for achieving results that approach that of macroablative fractional resurfacing with the use of topical anesthesia alone," adds Dr. Narurkar. "Blended treatments can also be accomplished for deeper rhytids of the perioral area with the original Fraxel Re:pair" Fractionated RF devices create a different kind of wound pattern. Devices like the eMatrix (Syneron,, the Fractora (InMode Aesthetic Solutions, and Lutronic INFINI use pin arrays to place the heat energy directly into the dermis with minimal disruption to the superficial dermis. Fractional lasers create distinct columns of injury that diminish in width from the skin surface as the energy travels deeper. Fractional RF columns of injury are narrowest at the surface, increasing in width as they go deeper. "For deep wrinkles, we use CO2 or RF RF is positive . because you don't have to worry about skin types, and we see similar results to fractional CO2 resurfacing," says Bruce Katz, MD, director, Juva Skin & Laser Center & MediSpa, New York City. A study led by R. Stephen Mulholland, published in the September 2012 Journal of Cosmetics, Dermatological Sciences and Applications presented the results of Fractora treatments on 30 Asian and 20 Caucasian patients. All received a single, full-face fractional ablative RF treatment with evaluation at three to six months. The authors concluded that the Fractora delivers significant improvements in wrinkles, laxity, brown pigmentation, skin tightening and acne scars. Healing was complete in four to seven days and there were no significant adverse events. RECENT ADVANCES "There have been significant advances in every phase of laser skin surgery in the last six years," says Dr. Bernstein. 38 NOVEMBER/DECEMBER 2013 | MedEsthetics Before After PHOTOS COURTESY OF BRUCE KATZ, MD After "CO2 AFR lasers are faster and more precise, limiting side effects while allowing better control for optimal outcomes." Versatile platform devices allow practitioners to easily switch from nonablative all the way to macroablative in the same procedure. "Fraxel Dual is my go-to device for acne scarring and some photodamage," says Dr. Bernstein. "It offers great duality as the name implies, allowing me to do both ablative and nonablative fractionated resurfacing. I also use the Active and Deep FX, which are derived from the groundbreaking Coherent Ultrapulse laser, a gold standard in laser resurfacing. And the Syneron CO2RE is an amazing device that combines both superficial and deep CO2 laser resurfacing in a single pass laser. This novel approach delivers superior results you can see clinically. The superfast DEKA SmartXide Dot can also deliver superficial or deep treatments and gives superior clinical results." The Syneron CO2RE, introduced in November 2010, is one of the newest fractional CO2 lasers to hit the market. It features dual laser waves that can be adjusted to penetrate the skin at both superficial and deep levels simultaneously. While other CO2 systems require either a change in handpieces or a change in lenses to switch between superficial and dermal ablative modes, CO2RE's Scanning and Fusion mode provide a "tunable" superficial to deep ablation in a single scan pass. "Another significant advance is the Fraxel Re:pair SST, which allows us to perform ablative resurfacing with topical anesthesia," says Dr. Narurkar. "The SST makes treatments much more comfortable for patients. And it is safer. You can use it on the neck and chest, although I still prefer nonablative in these areas." Solta Medical introduced the Fraxel Re:Pair SST Laser Platform in the United States in May 2012. The device offers patients fast, single-pass skin resurfacing with more comfort

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