JAN-FEB 2016

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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Page 22 of 67

preparation and aftercare products. We also do a test spot, which should be done on every patient. We have a 98% or better consultation conversion rate." USE THE RIGHT TOOLS All of our panelists agree that today's hair removal devices offer enhanced safety through better computer technologies and more effective cooling. "They are also faster and don't break down as often," says Dr. Goldman. "We use a number of lasers for hair removal, including a long-pulsed alexandrite (Cynosure and Syneron Candela) and a long- pulsed Nd:YAG (Cynosure and Syneron Candela), but our workhorse is the Lumenis LightSheer Duet because it offers a combination of wavelengths and settings that allow us to customize the service for the patient." Like Dr. Goldman, all of our panelists have multiple devices at their disposal and can choose a device based on the individual's skin type, treatment area and hair color. Dermatologist E. Victor Ross, MD, of Scripps Clinic Carmel Valley in San Diego also takes the patient's ability to handle pain into consideration. "My preferred systems in patients with a reasonably good pain threshold are the long-pulse alexandrite and 810nm diode lasers for lighter skinned patients, and the Nd:YAG laser for darker skinned patients," he says. "The advantages of these systems are high effi cacy and good safety. For patients with lower pain thresholds or those who want to forego the use of a numbing cream, motion techniques with diode lasers and/or intense pulsed light devices—as well as large-spot, low fl uence devices—might be preferable, although more treatments might be necessary." Some of the latest device introductions in this category include systems like the Soprano ICE (Alma Lasers), the Cutera excel HR and the Clear + Brilliant pélo from Solta Medical. The Soprano ICE is an 810nm diode laser that features Alma's Super Hair Removal technology, which allows operators to treat at 10 hertz per second. It also offers multiple cooling mechanisms for greater comfort. Cutera's excel HR combines a 755nm alexandrite and a 1064nm Nd:YAG with sapphire contact cooling. A touch screen allows operators to shift easily from one wavelength to the other and treat large areas with an 18mm spot size. The newest device in this category, introduced in September 2015 by Solta Medical, combines an 808nm THE YEAR 2016, which marks 20 years since Grossman and associates reported the fi rst use of a laser to remove unwanted hair, may also prove to be a watershed year for energy-based hair reduction. Laser and light-based devices for hair removal are better than ever, and for the fi rst time, physicians now have the option of a microwave energy device. In July 2015 miraDry (Miramar Labs) became the fi rst microwave device approved by the FDA for the treatment of underarm hair of all colors as well as the permanent reduction of underarm sweat. Another innovator, Sienna Labs, is developing a totally new approach: metal-coated nanoparticles that can be delivered through the skin to enable energy devices to more effectively target and kill unwanted hair follicles of all types and colors. To bring you up to speed, we asked a panel of four experts to tell us how their hair reduction procedures have evolved with new technologies and a better understanding of potential outcomes. THE NEED FOR CLEAR EXPECTATIONS "The FDA came up with the phrase 'permanent hair reduction,' but in my opinion there is no such thing," says dermatologist and cosmetic surgeon Mitchel P. Goldman, MD, founder and medical director of Cosmetic Laser Dermatology in San Diego. "One thing we have learned in our practice is to say we're offering 'semipermanent hair reduction.' Some patients see 20% to 30% of treated hair grow back lighter and thinner, and so naturally they don't believe you are providing permanent hair reduction. Honesty is so important in medicine. Physicians have been burned by using this terminology." Setting realistic expectations begins with the initial consultation. "In our practice, we ask a wide range of questions about skin problems, sun exposure, previous procedures and general health, which can take 30 to 45 minutes," says Warren B. Seiler III, MD, of Seiler Skin Cosmetic Laser & Aesthetics Center in Birmingham, Alabama. "We also ask why the patient wants permanent hair reduction. We then give a conservative estimate of the number of procedures needed—adding that it could be more—and let patients view information on the cost of each procedure along with a long list of things they should and should not do during the treatment term, including the requirement to purchase some medical-grade skin | JANUARY/FEBRUARY 2016 21 "What makes this technology unique is that hair reduction is not achieved by targeting the pigmentation of the hair, but instead the level of skin where the hair resides."

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