MAY-JUN 2014

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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"Pico looks promising for resistant tattoos and reducing the number of total treatments. It might also enjoy other applications beyond tattoos, for example, for treating melasma, skin rejuvenation and scars, but more studies are needed," says San Diego dermatologist E. Victor Ross, MD. Pico (which is short for picosecond) is a Latin term for 1x10-12 seconds. "The advent of the Q-switched laser was an improvement, but the Picosure takes these gains and runs with them," says Dr. Dover. "Instead of breaking down pigments from big to small like the Q- switched lasers, the Picosure turns them to dust." The Picosure device does hurt, so topical or local anesthesia is recommended. Patients will experience some downtime in the form of oozing, crusting and bleeding after each treatment, similar to Q-switched lasers. The typical protocol is six or more treatment sessions, spaced six to eight weeks apart. According to Dr. Dover, it is safest and most effective on skin types I – IV. "But it does work and it works well especially on notoriously hard-to-treat tattoo colors such as blues and greens. It is revolutionary. It works twice as fast at clearing tattoos," he says. According to Roy G. Geronemus, MD, director, Laser & Skin Surgery of New York, "The Picosure laser works better for almost all colors, and some colors, such as blue and green, that were very diffi cult to re- move previously, are now our easiest colors to remove as we see a complete response many times in one to three sessions." The downside is the price of the laser, which is considerably higher than anything else on the market to date. The price per treatment ranges from approxi- mately $400 to $800, with prices varying across the U.S., while the average laser tattoo removal session hovers around the $300 mark. This may be a deal breaker for some physicians. "It does not make sense for me to purchase a single wavelength tattoo laser for that price. It is hard to charge more for each treatment, when with an individual patient you cannot guarantee how many treatments it will take to make them happy with the clearance," says Dr. Zelickson. The Picosure system is also being used for benign pigmented lesions including lentigenes and café au lait marks. "We are using the Picosure for other indications including scars, stretch marks and photorejuvenation. It has a fractional-like handpiece that allows one to rejuve- nate the skin without wounding and works particularly well in patients with darker skin types who are diffi cult to treat with other technologies," say Dr. Geronemus, who notes that the picosecond concept will likely im- prove further as new wavelengths are introduced. And new picosecond devices are already on the horizon. At the 2014 annual meeting of the American Academy of Dermatology, Cutera (cutera. com) introduced enlighten, a picosecond laser with two wavelengths: 532nm and 1064nm. "It will be good to have competition and a different picosecond wavelength," says Dr. Dover. Though picosecond lasers offer shorter pulse- durations than nanosecond Q-switched lasers, and may offer some increased clearance over currently available systems, Dr.Bernstein notes that since lower fl uences are required when using the shorter pulse-duration lasers, comparisons have to take that into consideration. INNOVATIVE SOLUTIONS An overriding goal among engineers and laser surgeons in the tattoo arena is to make the removal process more predictable, faster and with fewer treatment ses- sions required. With that in mind, ON Light Sciences ( is developing a patented method utilizing PFD (perfl uoradecalin) that will allow physicians to perform multiple passes in one session. "We found that this solution, which can also be in a dressing form, allows for rapid resolution of the steam bubbles seen immediately following laser treatment of a tattoo," says Dr. Geronemus. "A previous effort to perform multiple treatments in one session required a 20-minute delay between treatment sessions, which is not practical for most patients and physicians. The perfl uoradecalin ERASING THE PAST Before After 46 MAY/JUNE 2014 | Med Esthetics The Q-switched Nd:YAG laser in Ellman's Medley platform is well-suited to remove black ink tattoos. PHOTOS COURTESY OF ELLMAN INTERNATIONAL E r a s i n g t h e P a s t M E D 5 - 6 1 4 . i n d d 4 6 Erasing the Past MED5-614.indd 46 4 / 1 6 / 1 4 4 : 4 5 P M 4/16/14 4:45 PM

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