What is the efficacy of Sciton Profractional vs Fraxel vs Palomar fractionated 1540 vs Palomar Fractionated IR?

You should look into the affirm 1440

Hey guys, We really need feedback in these things. Lasers are very expensive, and this site is all about doc to doc to nurse to esthetician on personal experience. Let's hear it. Thanks in advance.

Curious,

Sciton ProFractional will not be released for another month or so. I know one of the docs who is doing the preliminaries and he has shared photos. They look good for both texture and wrinkles.

Fraxel is good for pigment, texture etc. but I still have not seen any reproducable results for wrinkles as promised. They are looking into a CO2 version like the Lumenis Active FX. Their newer table top version has a consumable tip. For 100K I don't see how it can be justified this late in the game.

I really don't know much about the Palomar fractionated IR. Sorry.

Fraxel is the next big thing that everyone will be introducing in the next couple of year.

You didn't mention Pixel by Alma. It's a joke, as is a lot of their stuff.

Actually Pixel by Alma is not a joke, we've been successfully using the Pixel system for 6 months and the results have been good for texture, pigment, wrinkles, and acne scarring. Our clients that have had Fraxel prefer Pixel hands down. I haven't tried the Palomar, Lumenis, or Sciton fractional versions, but I can't imagine any of them are too bad.

I think you need to look at your purchase decision from a number of angles, including but not limited to:
1. Efficacy - does the system provide results and are the results within 20% of the competitive technologies?
2. Pricing - for its results, is the pricing comparable to other technologies? What are the consumables and long term service costs?
3. Marketing - what is the manufacturer doing to promote the technology to consumers? (Fraxel was good at this)
4. Servicing - If you do need servicing how will the company minimize your downtime?

HI,
I have used fraxel since it came out and like anything there is a learning curve. My patients love it and so do I- acne scars, wrinkles, pigment, resurfacing... its great. Its totally replaced our erbium. I now recommend minimum 4 treatments and we augment with products.

Everyone using Fraxel or the hyndai alma lasers:::::


Fractionated CO2 by lumines -- ACTIVE FX

no wonder why Fraxel (Reliant) is going CO2 next year; their fractionated ERBIUM (FRAXEL) sucks.

who has had experince with the active fx versus current fraxel 1500 and which one do you think has better tissue tightening? does anyone know for sure when reliant is coming out with a fractionated co2 including fda approval. reliant reps seem to put down the active fx as a modification only of the old ultrapulse and not as a true fractionated laser. any opinions or experience?

MD1,

The Feb 2007 issue of ASLMS has their initial study out of Stanford university on Fraxel or Reliants fractionated CO2. Study includeds in-vivo and exvivo. It was also announced at the AAD meeting last month.
The problem with Erbium laser fractionated or not is that erbium wavelength at 2900 or 1500 CANNOT coagulate blood. Thus cannot put enough heat into the dermis. Reliant is having hard times not to infringe on patents by Lumenis Laser who have been in the CO2 market for over 10 years.

The top 20 PS (including Brooke Seckel (auther of Save your Face) has the Active FX by Lumines.

Active FX is not for the boutique medspa or faint at heart. This is truly ablative but fractionated. It is a true procedure. I have had excellent results and blow all the guys with Scitons erbium, or Fraxel, or Plasma out of the water.

But I have had fellowship in CO2 resurfacing.

PLEASE SEE LUMINES WEBSITE FOR PREVIOUS WEBINARS

You have to coagulate blood to put heat into the dermis to finally tighten skin. You get the most heat with CO2. Please see the wavelength curve !

co2MD,

For the most part you are correct. However, our Sciton erbium can coagulate up to 100 microns, similar to CO2. I think it is the only erbium that can do this.

Dexter

it seems like the reliant fractional co2 is still only in the multi-center study stage. does anyone know when it will be released?

Just read some articles in the ASLMS journal on InVivo and Ex Vivo studies of the fractional CO2. I would guess sometime within the next year. they are not releasing that info yet. Just had the Reliant rep in my office. i would wait as the Reliant will likely be very expensive and have consumables. There are a lot of companies that make CO2's.

What is the verdict on the Lux 1540 Fraxel. Does this work as good as the Reliant Fraxel. What is Fraxel II. Does the fraxel (Lux 1540) work on the melasma of skin types 5 and 6. Can you treat the glabellar folds with this. I have the base unit and is it worth buying the LUX 1540 for $60,000.(That is the current quote). Just for the hand piece. What is the ROI on this hand piece.
What are the different skin conditions you can treat with this hand piece?. How good is this.Please comment your experience only if you have a worked with this hand piece.


Thank you

I own the fraxel and have been talking to others. The Lux 1540 is not getting as good of results. I am going to stick with my fraxel and erbium. I have not worked with the Lux though.

We've been using the Palomar Fractional for about 5 months now. We are seeing amazing results. The sales rep said that the clients wouldn't see any improvement until after the second treatment. I would say that 90% of our clients are seeing improvement after the first treatment. The trick is knowing what levels to treat at and how many passes. Patients who have acne scars are thrilled with their results after just one treatment. Overall texture and wrinkles improve more after the second treatment.

It is astonishing to see how much difference of opinion we are hearing on this site regarding the efficacy of the various non-ablative modalities now on the market. It seems that the leading companies are on a mission to further complicate things (i.e, Palomar has just introduced four additional treatment "heads" for the Star Lux). The acid test for ALL of these devices will be the satisfaction of the patient who is paying fairly significant amounts of cash to look better or younger as a result of these treatments. My concern is that virtually ALL of the devices will produce SOME improvement. But I have always found that most patients expect more than SUBTLE. Most of the collagen remodeling documented in published clinicals seems to take up to six months-- and the other characteristic of most Americans is that they are impatient. I'm just not convinced that ANY of these"non-ablative" collagen devices are there yet considering the high prices you will be paying for them.

I come from an area where approximately 95% of women less then 65 work. This makes down time of great importance. They are willing to have multiple treatments with minimal downtime verses being down for a week or longer.

Great to hear that you are seeing good results from the palomar fractional. Keep us up to date.

Another laser has just hit the market from cutera called the pearl. I have not seen much about it but be ready they have FDA approval and they will be marketing to all of us.

Has anyone heard of complications such as lipoatrophy with the Fraxel 1500 going deeper into the dermal layer? I know there was a problem with Thermage and lipoatrophy.

No, because the Fraxel is a laser and can be set to diferent energy levels and depths. The reason you have fat atrophy with the thermage is because of the radiofrequency energy being too high and penetrating too deep. Thsi is no longer a problem with the new protocols. Radiofrequency energy is more difficult to control.

I have just returned from ASLMS 2007. The fractional CO2 was presented at the Reliant booth. It will be named re:pair and it is to be expected on the market Q4 this year (well ... that is their plan at least).

The histological pictures looked quite promising - but it is difficult to predict the clinical outcome based on this alone.

Have anyone seen any data on clinical follow-up?

Does anyone know what the price is going to be?

The only advantage that the CO2 has over the current fractional erbiums is the extra heat which can cause some tightening of the skin. This will also be its drawback as thermal injury is the reason for hyperpigmentation and hypopigmentation.

I will wait and see.

Please read all peer to peer papers co2 vs erbium. you can do a medsearch. CO2 is always superior to erbium. Please also see recent article in Cosmetic Surgery Times this month 5/2007.

Watch out for the fluff. Review the laser physics. Erbium is just that, sorry. Co2, yes whether fraxi or not is the ultimate. But who wants the down time and cost of the technology is an issue. Best to watch for the next generation of Fraxal-Like Mosaic coming in 2007 (Lutronic) @ ASLMS. Price is actually more in line to be able to offer a safe bet to your patients and keep the the difference.

Watch out for the fluff. Review the laser physics. Erbium is just that, sorry. Co2, yes whether fraxi or not is the ultimate. But who wants the down time and cost of the technology is an issue. Best to watch for the next generation of Fraxal-Like Mosaic coming in 2007 (Lutronic) @ ASLMS. Price is actually more in line to be able to offer a safe bet to your patients and keep the the difference.

Bo,

Here's the downlow I got on pricing for the Sciton-Profractional.

To add the additional technology you will need the Sciton Profile platform with the erbium as a foundation. I believe this is called their MicroLaserPeel. To upgrade to the Pro-Fractional will be an additional $40,000. I know Sciton usually has an added $6,000 upgrade stand alone fee. (Don't know if this would apply to this.) I also hear they will introduce the technology at $37,500. Existing accounts can already purchase at that rate.

I don't know where you are located, but I am viewing a live demo of the technology on June 9th in the Minneapolis area.

If you need a contact for the technology I have a rep in Minnesota who is a wonderful resource. I'd be happy to pass along his info.

Der...Bo..you weren't even asking about the Sciton. I'm a dork. Well..now we ALL know what the Pro-Fractional will cost...lol.

Co2 is Co2 is Co2... Let's not forget what the Coherent Ultrapulse (which is not to be confused with the encore from Lum) has taught us since its popular release in 1991. Beautiful machine with state of the art engineering, but a very hot wavelength with way too much heat for rapid healing and widespread acceptance in today's modern aesthetic marketplace.

NO one can argue with the fact that after much fanfare CO2 full depth resurfacing has come and gone as a tool strictly for the most seasoned of laser professionals. The initial buzz about immediate visible contraction was lost in a sea of complications associated with using a wavelength that introduces way TOO much heat into treated tissue. To this day the majority of CO2 based systems sit in the corner of the o.r. collecting dust. Why is this? What did CO2 at 100% surface coverage teach us? One hard lesson we learned involved permanent pigmentary loss due to massive heat deposition at the DE junction. Another HEAT related involved extensive healing periods with erathema up to 6 months post treatment. Heat is intrinsic to CO2... In fact, if you treat 100 microns of tissue with CO2, you get roughly 60 microns of ablation and 40 microns of thermal damage. For reference, if you treat 100 microns of tissue with a DUAL-MODE erbium, you get 95 microns of ablation and 5 microns of thermal damage. Why does it take 3X longer to reepethlialize with CO2 vs. Erbium. Because, PULL YOUR WAVELENGTH CHART OUT CO2ers, Erbium is 15X more effective at ablating water than CO2. Why the red face for so long after CO2. Quite simple, the body is doing everything in its power to remove the dessicated tissue and is rushing in as many healing mechanisms as possible. Hence the pungent red and tremendous neovascularity.

Fyi... There is one erbium laser available that offers complete coagulative capabilities. The Sciton Contour, which has arguably replaced the ultrapulse as the gold standard for resuracing. one dual-mode erbium on the market and it was created by the same principles of the UltraPulse this makes it and the resultant ash of post delayed PERMANENT hypo pigmentation cases.

Oooopppps... Hit send too quick...

Anyways. What I was saying is the Contour was created by Drs. Dale Koop and Jim Hobart. Jim FOUNDED coherent in the late 60's and Dale was the chief engineer who designed the Ultrapulse while with Coherent in the 80's.

In searching for the BEST skin rejuvenation treatment with the LEAST downtime, we have gone full circle from 100% surface coverage heavy downtime resurfacing, to non-ablative no downtime treatments (cooltouch etc) to non-ablative fractional resurfacing (fraxel 750) to minimal downtime ABLATIVE fractional resurfacing. Now that we're back to focusing on which ablative fractional therapy is best, let's not forget that CO2 is CO2 is CO2 - redness galore, serious discomfort and who knows what the future holds for lightening. Remember, when CO2 was released in 1991, no one expected to see post delayed onset hypopigmentation. Regardless of if you're at 100% surface coverage or 20% fractional coverage with a 500 micron spot. The natural properties of CO2 make it troublesome regardles of it is a whole or fractional beam.

Rumor has it Profractional can be adjusted to treat anywhere from 10 microns to 1.5 mm in a single pulse, or scan. Also, the percentage treatment area can be varied from 1.5% to 60% of area treated. Food for thought when comparing one fractional device to another.

It boils down to two things: RESULTS and DOWNTIME. How can we best sacrifice one for the other? The answer should yield which fractional device you purchase. Oh, don't forget propreitary disposable costs..

We just got the Affirm come to Australia. Anyone cam give me some feedback on the clinical effects of Affirm versus Fraxel or Starlux fractional resurfacing laser. What is the cost of disposibles of these?

Midwest:If you have the Sciton PROFILE platform without the Erbium module,do you know what is the cost to upgrade to the PROFractional,including the cost of module,the cost of all?I think that if you take the erbium module then you can get either the PROFractional hanpiece or the Microlaserpeel hanpiece or both of them.

I own medspas for nearly 4 years now and have experience with traditional CO2 and fractional 1500 ER, both Fraxel and Lux1540. It is fair to say CO2 is past its time as most patients do not want the down time and the risk is too great for skin types in Latin America. Having said that the hoopla about FX is way over blow as unusual with Lumenis products. Most of the plastics that got them for trails from Lumenis no longer use them. Very limited published work… Yes the one Doc listed above is a paid luminary who speaks for Lumenis regularly. Richard’s comments are good, know your products capabilities and cost efficacy. Unfortunately Alma to me is a copycat company with underpowered products that do produce limited results.

Here is one of many links to patient experiences with the FX.. http://hollyhodder.typepad.com/moment_magnitude/2006/10/active_fx.html I do not see happy stories about great results. As to the ongoing argument about CO2 vs. Er-YAG the facts are simple that Er-YAG has 10x the absorption in water of CO2. That is why it is the better choice for ablation of tissue, but coagulation is a different story. You need to heat tissue not vaporize it, you can only get very minimal coagulation with any Er-YAG laser so do not believe the hype of the manufacturers. There are dozens of reports about the effects of Er-YAG, when set low depths you have an expensive microderm abrasion machine and when set to 100 or 150um you have down time, but way less than CO2 for sure as there are very minimal thermal injury effects.. The precise affects that produce new collagen and removes wrinkles and scars (texture not color)…

Fractionalizing an Er-YAG laser will never produce the same effects of a fraxel or the lux1540 laser on scars or wrinkles just because it cannot produce heat in the dermal tissue beyond 10 or 20um outside of the ablative zone and cannot reach to the same depth…an fractionalizing a CO2 laser will never give you the penetration depth of either the lxu1540 or the fraxel into the dermis (1mm) so you will not be able to get the same results for deeper wrinkles and scars.

As we continue our quest for the Holy Grail, this debate will continue to accelerate. The truth we all already know is that there is no silver bullet.

Once our patients have created enough sun damage in their skin to seek us out they are NOT going to be satisfied with the results of a "no down time procedure". Most of them will not even stay out of the sun, post tx, to avoid PIH and come back in to see us complaining of this "complication" they created themselves.

Everything stated in previous posts regarding CO2 creating too much heat at the DEJ is well-doucmented in the literature. It doesn't matter what your delovery mode is for the CO2, i.e., collimated, fractionated, whatever. It's a ticking bomb for hypopigmentaion. This fact is undeniable.

Er:YAG, in my opiniion, is TOO far up the water absorption curve to collaterize heat well enough to adjacent tissues to give my patients the tightening they demand. It'll peel, but it will never give my patients the relief they seek. I can peel them with very inexpensive chemicals.

CO2 is the gold standard and, in the hands of a very laser-savvy clinician who can PROPERLY select surgical candidates, is a thing of beauty. Our issue with our patients is they ALL seem to know someone, either a freind or family member, who has told them the horror stories and they are particularly leeery of my CO2. It wouldn't matter what new delivery system we purchased, they don't want CO2. They want results, they just want them safely and they don't consider CO2 to be safe.

The results we've seen with fractional treatments do not satisfiy them either.

Our most successful device, currently, is our Portrait. We can approach the results of our CO2, and, to date in over 115 procedures performed over the past 16 months, we have seen no significant complications and a tremendous rate referrals. We have also had many patients return to have additional anatomical areas treated. With our Portrait, since it is not light-based, we are much less concerned about the sun exposure our patients get here in Southern CA,

No one knows your patients better than you. Don't believe the sales reps or company luminaries. We all know why they say what they do. Do your homework and trust your own judgement. Hope this helps some of you.

The problem with the psr is if you go deep enough to make significant changes you still have all the down time.

No pain no gain.

I do have a friend with psr and he did what I believe he called level 3 and did have some hypopigmentation.

As we know, it takes the right laser with the right physician working on the right patient and you can have great results.

The biggest problem with the therapy options is down time. Pts have been told by companies as well as the media that you will look 30yrs younger in a 5 minute treatment with no downtime. We all know that not to be true.

The better the results including the CO2 the more risk.

I had our office manager call Rhytec, the manufacturere of our Portrait, and they still have no reported cases of hypopigmentation worldwide. You should have your freind call and report theirs.

We do PSR 3 (level 3) on almost all our patients. We have yet to have a patient that cannot wear make up on day 7. Most can on day 6. While this is more downtime than most of the other manufacturers claim, we can approach he results of CO2 without much hand holding. There is never an open wound or oozing. We treat them and don't see them again until the peel is complete. Our patients love the outcome, tolerate the procdure quite well and refer their friends and family members to us for treatment.

I do, however, totally agree with your statement of "the right device, the right patient, ....."

The bottom line is that without thermal injury to tissue the results will not be sufficient to satisfy the needs of patients we see in our practice - 40 to 60 year olds with lax, severely sun damaged skin.

We prefer the safety profile, ease of use and results of our Portrait to any device we've had to date. And we have a bunck of them.

Best of luck to all.

I will talk to him and get more info.

Has anyone tried using fraxel for Stretch marks? Does it soften the appearance? I figure trying fraxel for dark skined individuals on low settings might be able to reduce he appearance and improve the texture. I've seen studies but haven't confirmed this yet. Any other lasers to suggest on darker skinned indiviuals for this problem?

I have the Fraxel and have used on small areas with fairly good results. Most of my pts are lighter skin so I use 18 to 22 j/cm2 at 125mtz trying to achieve between 1000 to 2000 mtz/cm2.

Just make sure you do not sell it as a complete fix. I have had people ask about stretch marks for larger areas but no one wants to pay the price. It gets expensive for larger areas.

I really want to try and combine Thermage with the Fraxel for abdominal stretch marks. Again cost is a factor. I would think with the 2 combined you could get at least 50% reduction.

Active FX lumenis rocks. Plasma Portrait we have one in the office has been "ok" I call it the bunsin burner because it it not consistent in depth of penetration remember its pockets of hot plasma gas. By the way it anyone out their want to purchase mine, its for sale 20 grand ? any takers? email me.

Fractional CO2 IS the next generation.

Fractional CO2,

One cannot contact you regarding the purchase of your Portrait unit without your email address.

We would purchase your device for US$20K, assuming it is in good working condition, etc. We are about to buy another unit for our newest location and would love to save the 45K!

Please let us know how to reach you to further this discussion.

so what it the best laser for acne scars. is the sciton better than fraxel .
i know th sciton offers fraxel in the sciton profractional

ive seen pix of dark skinned patients after undergoing fraxel 1 treatment on reliants site. the results seem good enough for shallow/minimal scarring. what conclusions could be drawn? i mean, is it person-to-person when it comes to results? some people just respond and some dont? I mean dark skinned people that is.

I am attending a Sciton Profractional Seminar in Minneapolis tomorrow. I believe they have a few live demonstrations set up. If I find out more in regards to applications/techniques/capabilities/pricing I'll post tomorrow night or this weekend.

I have a fraxel and use it a lot for acne scarring. I think it works very well. We tend to see at least a 50% improvement in scarring. I have even used it on previous CO2 pts and they improved even more. Of course, nothing works well for ice pick scars so they must be punched out or grafted. I have used my erbium to take down the edges of ice pick scars with some benefit.

I have seen some fairly nice results at Sciton seminars. I recently went to one with Dr. Pozner he is one of Sciton's luminaries. He showed some of his own as well as Dr. Remington out of Canada. I am not sold that it is superior to anything else on the market.

I do think that CO2 total resurfacing for acne scars is a thing of the past. I would never do CO2 on a 20yo female that now instead of acne scarring has to cover up hypopigmentation for the next 60 years. If you look at the studies on CO2 resurfacing for acne scars the results do not seem to be as good as the newer choices. They were mostly in the 20 to 50% improvement.

I have not seen any recent studies on fractional CO2 for scarring and its results.

does fraxel work for keloid scarring?

LH: I've tried layering TCA in the base (only) of the ice- pick scar (to the point of light frost) w/ pretty good results after 2-3 txs. A nice option if pt doesn't want to get "punched".

DermaRogue,

Thanks, I may have to give that a try.

Thanks for the feed back LH. Really appreciate it. I'll start trying fraxel for stretch marks soon. Hopefully we can start seeing some good results.

http://www.thebostonchannel.com/asseenon5/13462040/detail.html

This article came out on June 7th, Just another doc trying fraxel on straie.
Although fraxel is not a complete fix i guess patients who wants to see visual improvement as far as texture and tone goes, this is a good start.

I have used the fraxel for some smaller keloids with fairly nice results. I treat at 20 to 22j, 125mtz and make 6 to 8 seperate passes. I also use a zimmer and give the skin a chance to cool between each pass (about 2 minutes).

The keloids tend to flatten out and become less promanent. They will soften and feel more like the surrounding skin. Of course pigmentation is always a problem. I have seen the edges of the scar repigment a little.

1540 fractional and Straie. I have begun treatments on FST 2-5 using 3-4 passes on the Palomar 1540 at 70-90mj/mb (about twice the energy available with the fraxel) after seeing the results in Panama by a group of Derm's there doing it for 7 months or so. the photos and the patients show very good clearance and then they follow with tightening treatments also. Palomar says there are 2 or 3 papers being presented at the world dermatology congress this year on their results for this treatment. US research is being done on this treatment by several docs including Dr. R. Weiss. As for acne I have treated many cases of severe scars in Latino FST 3,4, and 5 with very good results again at higher energies then Palomar currently recommends...