MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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GOING DEEPER PATIENT SELECTION and less healing time than the traditional Fraxel Re:pair. The device has four handpieces: two fractional handpieces for both shallow and deep fractional skin resurfacing needs, including the 600µ Fractional Micro-Dermal Ablation handpiece that allows for a 20-minute, high-coverage, single-pass treatment to address sun damage, fine lines, texture and tone, and two fully ablative handpieces for incisions, debulking and full-coverage skin resurfacing. "The devices in the marketplace are more alike than they are different," says Dr. Ross. "For me the most important factor is how powerful the laser is. More powerful lasers allow me to do procedures in less time. For example, if I can do a complete facial resurfacing in 20 to 30 minutes versus 60 minutes, that is not only better for the surgeon; it also means less discomfort for the patient." The most powerful fractional lasers in the marketplace are the Lumenis UltraPulse, a CO2 laser and the Sciton "The first question you ask a patient wanting significant facial rejuvenation is: 'How much downtime can you manage?'" says Dr. Zachary. "If downtime isn't a problem you then need to know how they might cope with a few days of oozing wounds, such as would be expected after deep ablative laser resurfacing. For those who would not be able to tolerate this, it's time to discuss nonablative fractionated or other devices. Presenting this to the patient can be tricky, however. The following well-known story illustrates why: A man goes into a bookstore and says he wants to buy the Encyclopedia Britannica for his 10-year-old son. The clerk asks, 'Which one, the traditional or the junior?' The man walks out without either the traditional or the junior version. The point is that, while any one of several treatments might achieve the desired results, offering a choice might throw the client into a stupor. Sometimes, keeping it simple is best. In practice, I'm constantly giving the patients all the options, because in an academic program, such a discussion is an important part of the educational experience. Having established the patient's likely tolerance, if the patient has moderate to deep wrinkling, he/she could be a good candidate for AFR." Both Dr. Narurkar and Dr. Bernstein recommend AFR to older, light-skinned patients with significant photodamage, especially around the eyes and mouth. "It is my go-to treatment for women with crepiness around the eyes," says Dr. Narurkar. "Some problems cannot be solved even with a series of nonablative treatments. They require AFR or even fully ablative treatment, and someone with serious scarring may require a series of ablative fractional treatments," says Dr. ProFractional, an erbium laser. Both have shown the ability to penetrate up to 4mm. The UltraPulse SCAAR FX, introduced by Lumenis in 2012, targets severe hypertophic scars from burn injuries, surgery and acne. Using up to 150mJ per pulse, the laser can penetrate into scar tissue as much as 4mm. Histological studies show its unique ablation/coagulation ratio actually changes the structure of contracted scars. One of the newest NFR devices is Alma Laser's ClearLift fractional Q-Switched YAG laser. "When the company said there's no pain and no downtime, I thought it wouldn't work," says Dr. Katz. "But it is effective, particularly for loose necks and jowls. It does require multiple treatments, typically four to six treatments spaced two to three weeks apart." 40 NOVEMBER/DECEMBER 2013 | MedEsthetics Kilmer. "AFR is the gold standard for scarring. It's a miracle worker, bringing light or dark scars, flat, indented or raised scars back to normal. Ablative resurfacing removes the old, damaged skin and allows new healthy skin to grow. You need to adjust settings for different types of scars. For thick scars, I will go really deep, for colored (white or pink) scars, I will go less deep. It also depends on where the scarring is located. I will go deeper on the face than on the neck or chest, for example. "I also use AFR for port wine stains, sebaceous hyperplasia and birthmarks in children," continues Dr. Kilmer. "I use AFR on all ages and sexes for a variety of conditions." For facial rejuvenation, Dr. Katz finds that his patients prefer multiple treatments delivered at lower energy levels. © ISTOCKPHOTO.COM "For me the most important factor is how powerful the laser is. More powerful lasers allow me to do procedures in less time."