Cutera Xeo - Laser Genisis? Fraxel? Titan? Does it work?

I've just brought in a Cutera Xeo.

After hearing a lot about Cuteras Xeo with Fraxel, Laser Genesis and such, we're going to check it out side by side with our Palomar IPLs, Cooltouch Lasers and Thermage. The scuttlebutt is that Fraxel's still largely unproven and Laser Genesis is something of a joke but we'll see. We have a number of patients we're going to use to see if we can determine a victor. We'll post the comparisons and thoughts here.

Cutera has been heavily promoting Fraxel and Titan. We shall see. 

Comments

[mdlaser]

Fraxel unproven ? They are the ONLY FDA approved laser for melasma (3 kinds of melasma) . Laser Genesis unproven have you read Dermatology Times February 2005 issue ? See Cutera's clinical papers? Both are probably some of the top technologies in the aesthetic market. Our office has Cool touch, Quantum, Thermage which we will be trashing them all (selling them to used dealer) they are old school and pretty useless in
our office.

PS -- genesis minimum of 15000 shots at 15 - 17 J
every two weeks for 5 sessions ; technique
is key.

[Medical Spa MD]

Call me a cynic. If there's one thing I don't believe on face value it's that FDA approval and positive press make a treatment that actually works. Palomar's V head 'works' for acne, just not good enough. There's a world of difference between a press release and a happy patient.

If you look on Cutera's web site at the before and after pictures... Unimpressive to say the least. And I'd bet my last dollar that they're putting the best ones on there.

While the Xeo platform is new to us we'll give it a shot. If it works better than anything else, we'll switch out all our devices. I'm just hard to please.

PS.Question: mdlaser, I'm curious as to how much you're charging for the 5 sessions and 15,000 shots, and how much time (physician & staff) is spent? Just curious.

[mdlaser]

hmm. Each of our genesis sessions takes about 30-45 minutes face / around $375 and we give discounts when signing on for five. minimal results if only doing one session so we don't do them. we have been using combo treatments for better results: titan + genesis. before and after photos are crucial....
check out cutera web site for past webinars they some great info. ..... good luck !!

[Dermgal]

mdlaser,
Could you provide some more detail on what results you're seeing? I'd also appreciate a few links to webinars etc that you think are helpful?
Dermgal

[mdlaser]

sure ! dermgal ... great info for past webinars on www.cutera.com website ; goes through basics and physiology on lasers in general but why certain lasers are unstable. Kevin Smith MD in Canada great colleague and friend. you can call cutera for a password ; results for the genesis procedure not extreme but great for tissue texture , redness, pore size , and reduce thickness in pink ribbon scars. dollar for dollar its a way better investment on your money with long term effects > 9 months than a microderm procedure. our patients get both tho. pictures from laser companies always take the best ones, we show our patients in our office (with permission of course...) the patients we have treated, that way there is no fuss. of course more invasive treatments, more pain, more downtime may give better results (ie fraxel or portrait psr) but the down time, peeling not worth it for many patients.... good luck.

[mdlaser]

oh, dermagal : one other thing check out

http://www.hmpcommunications.com/sa

article on:: Controversies and Conversations in Laser and Cosmetic Surgery


Its the low down. No snake oil; voodoo ; article.
Subscribe free online !

[lurkerdoc]

mdlaser,
Thanks for the info. I wish I'd found this site two years ago. Nice to have a place where you can hear from other docs in the trenches. I appreciate your willingness to share.

[Jabber]

$375 x 4-5 treatments seems substantial. I'm wondering if anyone sees pricing pressure for these laser genisis treatments and how these treatments are presented to the patients. It would seem that patient expectations would need to be managed carefully.

[PCPmd]

I think aesthetic procedures can be added to any medical practice PCP, derm, plastics or otherwise. But I have to agree, more than just getting a laser, few things to work through:

1) Malpractice (ie CAP MPT) now requires see 15 procedure and DO 15 procedures; to be covered.
2) Training is crucial for safety; weekend "seminars" which are really sales pitches by laser companies, and franchise companies ie - Solana, Dermcare, BEWARE. and Ill always tell you:"Told you so." Keep in mind about 98% of all these infomercials never are not about training but about selling; The theme goes like this: basically your PCP life as we all know it HMO,PPO, disability forms... blah, blah.. This Laser will change your life."......
3) Aesthetic medicine is fun and has been really lucrative for me. I can spend more time with my difficult dialysis patients (about one hour); but my point is::: Get the lowdown :: ask colleagues and friends in the business of aesthetic medicine recommeded equiptment. If there is an opportunity to use equiptment by renting a friends or companies then
5-10 thousand is not much compared to the 100-200 thousand you will be investing in.
4) Other questions to be looking into::: Marketing ? How to conduct an adequate skin evaluation and consultation ? How to ensure not only good outcome but complete the circle with good products ? Good diet affecting skin - vegetables/ fruits / nuts/ fish....Progress notes ? Maintenence ? Follow up ? A great office that offers aesthetic procedures is not as easy as just buying a laser ..... be prepared and think through everything ! good luck.

[Sally]

Our office is contemplating buying a Cutera Xeo w/ Titan. What is a competitive price for a new one or a demo model?

[dexter]

They will sell a Xeo E with one IPL handpiece for $120,000 to $130,000. List is $155,000. If you add titan then it can range from $40-50K on top of that. If you want additional handpieces they are $20,000 and you will need them. They will sell a loaded Xeo that is a "demo" with 3 handpieces for $150,000 if there any left this time of year. What you need to be careful of is the cost of what I call consumable handpieces. The titan XL is only good for 10,000 pulses. When it has to be replaced it will cost $7250. that is 72.5 cents per pulse. They recommend 3-4 passes with a 10 x 30 tip. You want the XL and not the V or S. They would be too slow. It doesn't take long to go through those pulses. this is part of a replacement business model. there are other manufacturers in the business who guarantee their pulse counts for 100,000-300,000 pulses or are unlimited. 3 come to mind. Cutera does have some handpieces that are good for 100,000, primarily the ProWave and LP560. They should cost about $6000 to replace. The acuTip 500 lasts for 25,000 pulses and cost around 6K to replace. If you need to know more just let me know. Don't know much about LimeLight but I do know they have always had a relative inferior IPL product when compared to some others for reds and browns. They need to address that.

[LA MD]

Hi
Fraxel is not a Cutera device on the Xeo. As far as FDA approval for melasma-I have had patients melasma get worse after treaments with the Fraxel. I was using low settings and even those without melasma still hyperpigmented. 9 mos later they are starting to fade even with HQ. Needless to say my patients were NOT happy. I avoid it on the patients with melasma. Any thoughts?

[Karen PA-C]

http://www.aesthetic.lumenis.com/wt/page/educational_eSeminars

This is a great webinar site, offered to everyone, not just Lumenis clients. There are af ew recordings on their RF. In particular there are two great ones on marketing and the perfect consultation. They have been very helpful to us.

[Debbie]

How can you tell how many pulses a Titan or Genesis Laser machine has used? How do I know that the doctor's office treating me is using a laser or hand piece that has notbeen over used?

[lexMD]

Hello Debbie,
Let me anser your question as simply as possible.

You will never know.

If you don't trust the physician and staff that you're going to receive the best care available, go somewhere else.

[emtrustee]

I had two fraxel treatments to address my melasma on my upper lip and forehead and ended up with two brown patches on my cheeks. My face is worse than it ever was. Be very careful!

[MEG]

The Titan hand piece stops working after its 10,000 pulses. It just will not allow you to go over, so the tech or DR using it will not be able to go over, the lime lite, and genesis and prowave are not expendible and do not need to be replaced. The Titan handpiece counts down from 10,000 and shows onthe display screen how many pulses are left in the top right corner and how many have been used on you in the center bottom.
To address the comment on IPL and cutera, I have been using limelite for about six months now and we are seeing great results, comparable if not better than vasculite.

[Ron Berglund]

Meg: Do you have any idea what the charge is to "refurbish" the Titan hand piece once you reach 10,000 pulses? Do you know if the reason it stops working is simply a need for flashlamp replacement?

[Dexter]

It cost $7250 to replace the Titan XL. It stops working at 10K because they want you to buy another handpiece. It is explained as replacement of the flashlamp which is in the handpiece. Additionally, while the other handpieces do not countdown per se, they need to be replaced at 100,000 shots, which I think is pretty fair. This does not include the genesis becuase that procedure utilizea the 1064. You should get a lot more than 100,000.

[Charry]

For your information the SkinTyte which is simply an accessory of BBL Sciton (with no aditional hanpiece) has similar results to Titan.The BBL needs flashlamp replacement >300.000 shots.

[ohyeah]

Cutera will be releasing the NEW YSGG ablative 2790 nm !!!.
Look out people.

[Fiona]

ohyeah,

Do you work for Cutera, by any chance? Or have you been an investigator?

[ohyeah]

Nope. Just a big fan and user.
The Pearl Treatment YSGG by Cutera NOW FDA approved 3/28/07 . This is NOT erbium.

[LH]

The only concern I have with Cutera is that they do not do much unless they are trying to sell you something. They have a lot of seminars and webinars but the entire focus of all of these is to sell you something.

We have the xeo and titan. They have never really been of much assistance when trying to tweak your results. We have used the Titan for almost 2 years now and they still do not have much of a handle on the best protocol.

It is as if they have sold it and their job is done. They were recently back and wanted me to look at the prowave and limelight. These would have been cheaper for me up front but I chose another company to work with.

Cutera also only lets their laser techs work on their lasers and they are expensive once you are not on their "warranty". The warranties are the most expensive on the market.

[R2]

We are actually dumping cutera after 5 years. The last straw was their inability to fix our system in a timely fashion. We were down for a 3.5 week stretch last year. We had to reschedule clients several times and had 5 or six visits from 3 different tech's to try to fix the problem. For 2006 I think our Cutera system was inoperable for about 6-7 weeks from various issues and slow maintenance.

[truth]

R2,

You have got to be kidding. Cutera has a 24/48 hour turnaround on their service tech's. I have used it and the guy (Jim) was out the next day from somewhere in Michigan.

What was the diagnosis? Why did it take so long to fix? One thing that sold me on the Cutera Xeo was they manufacture ALL their parts. I flew out and took a tour of their headquarters in San Francisco and met ALL the engineers and executives which happen to be engineers themselves......very impressive.

[truth]

Dexter,

I am a Cutera user and i asked the question when i bought the titan. why is it that i have to replace the handpiece at 10k-15k depending on which handpiece? Safety. The titan handpiece, actually ALL of Cutera's handpieces have real time calibration which moniters the pulse before, during and after the pulse to ensure each and every pulse is optimal and consistent. While on the tour of their headquarters i asked the engineer who was my tour host and they found that 10,000 pulses ensures consistent optimal delivery. I will pay for safety.

[Dexter]

Truth,

You bought that? Why do their other IPL handpieces last for substantially more pulses. They utilize the same lamp. It's just a different filter. Why do other IPL company's get so many more pulses out of their lamps and handpieces. We own 2 Sciton's and the handpiece last for 300,000 pulses and they have a filter which is just like Titan. We own two Palomar systems (Medilux- which is the lower priced model and two years old) and their handpieces are good for 100,000 pulses. Cutera could do it, they just don't want to. Here is another reason why "safety' is a BS answer. Lamps over time degrade. In other words they become less efficacious, not more harmful. So, it's either a poor design issue if it can't get more than 10,000 pulses, or a greed issue if it can. One thing I do know is that safety has nothing to do with it. Sounds good, but B.S.

[Dexter]

Below is copy and pasted from the latest Cutera balance sheet. Notice the part that says "titan refills". I think the language they use is pretty indicative of how they view replacing the Titan handpiece. I don't think it's a coincidence they term is a "refill". Also notice how it is listed out as it's own category. It's as if they see titan "refills" as a specific revenue source. That's because they do and it accounted for over 1 million dollars last quarter. The good news for them is that "refills" are up by 17% compared to last quarter. Safety? I don't think so.



Revenue By Product Category:
Products $ 18,316 $ 17,556 +4%
Product upgrades 1,922 1,136 +69%
Service 1,917 1,121 +71%
Titan handpiece refills 1,102 944 +17%
---------- ---------
$ 23,257 $ 20,757 +12%
========== =========

[LH]

I agree with Dexter. I am beginning to think that truth works for Cutera.

[Dexter]

Truth,

Also, Cutera does not manufacture ALL their parts. In fact, most of the components that usually go bad in the laser (laser rods, flashlamps, power supplies etc.) are all by third party companies. They probably do manufacture some components (panels, handpieces etc.), but if they told you they do all parts then they were being misleading.

[mhestrin]

Has anyone found any after-market supplier of refurbished Titan handpieces that can "fool" the Xeo platform into thinking that it has a 'new' handpiece attached?

Thanks very much

Mark Hestrin, M.D. 310-903-1980

[Betty Minor, President Laser Resource, Inc.]

I found it interesting that you indicated that the weekend laser infomercials are just that and they NEVER include laser safety. I have taught laser safety since 1980 and it is like the deer in the headlight look when I tell them at these meetings they NEED to understand the ANSI-Z-136.3 Standard and without laser safety and how it will effect the Med Spa and/or clinic I.m on the ANSI Standard Committee the non-beam issues. There are so many mom and pop laser spas opening and closing because they were sold a bill of goods to get rich quick. It is very scary what is happening. I found that Cutera supports laser safety how refreshing.

[plasma]

Betty,
The problem with National Laser Standards Institute is it is not geared for the physician. The recertification process is complete waste of time to attend conferences to get "points" which are not even CME approved. No wonder why many physicians are NOT certified. I am currently a physician and certified medical laser safety officer. I will NOT renew; its pretty much a joke. We are currently working with ASLMS w/ Ross for a better process.

[melanie]

Just reading to get an idea of what is out there. I am a patient. I have been to spa treatment centers locally as well as to my dermatologist for treatments.

I recently had a proceedure by the dermatologist. It was for acne scarring. They used the 1540 Palomar. I was not impressed with the results after 2 treatments so I stopped there.

I also had an IPL with the same machine prior to the acne treatment. It did not remove or even lighten my freckled chest area. It was expensive and the Doc. did not even suggest a complimentary 2nd treatment. What was I to do, ask for a refund?

I've read in the above postings how some Docs think the companies selling this equipment are "greedy" ie, 10,000 pulses per piece prior to replacement, but what about the Doc who uses equipment that does not produce results but still charges the patient? Is this too not greed? Why not at least attempt a second proceedure or an alternative without cost to the patient.

Just food for thought guys. In the end, your patient's pay a high price to
keep all this greed going.

If any of you would like to comment or at least suggest where a patient can do research regarding what were are buying in the line of treatments, it would sure benefit those of us footing the bill at the bottom line.

Thanks,
Mel
red hair, freckles and old red acne scars. YUCK

[md]

Melanie,

Acne scarring is probably one the hardest skin conditions to treat. You can try Fraxel, Palamor etc with mutiple treatments these are all considered NONablative. To get a dramatic result you need to ABLATE (surgically remove layers of skin ) ie - CO2 / Erbium / YSGG . It does carry significantly more risk and downtime. One rule still exists in cosmetic derm - you have to pay the price (downtime) to get some significant results.

MD

[LH]

md,

I agree that acne scarring is one of the most difficult conditions to improve but I would have to disagree with the assumption that you must ablate to have significant improvement. If you look at the studies in ASLMS journal CO2 may show as little as 20% improvement to as high as 80%. A similar study done for the Fraxel showed similar results.

It really comes down to depth. You will need to be a minimum of 500 microns in depth to show improvement. I prefer to be at least 700microns in depth and have seen nice results. If Melanie had 2 treatments at say 50 to 100 microns then she will show minimal improvement. I tell patients that we need to be about 700microns or more in depth and it will take 4 to 6 treatments. The worst we have seen for improvement is about 50%. You alse need to tell them that they will have more swelling and it will last longer.

The biggest concern for the CO2 is hypopigmentation. Just think of telling a 20yo girl that her acne scarring is 50% better but now she has white waxy skin that she will have to cover up with makeup for the rest of her life. I would definitely prefer the erbium in this scenerio long before the CO2. As of now the only YSGG I know of is Cutera's and it will only go 30microns per pass. So to get deep enough you will need to make 20 passes.

Ice pick scars are the worst and most difficult to deal with. I have used my erbium to take down the vertical edges of some more shallow icepick and boxcar scars with some success. Then I will either use the erbium or the fraxel for treatment of the face or area.

[med spa guy]

LH: Do you feel confident about the depths to which your various technologies claim to be delivering energy? Have they proven these claims with punch biosies or some other clinical measurement? Have you seen studies proving that these particular depths are optimal for collagen remodeling? Have you worked much with the 1320 nm wavelength which supposedly delivers most of its energy precisely to the DEJ to stimulate fibroblasts and ultimately collagen?

[LH]

1. depths - yes

2. Biopsies - yes

3. Optimal - no one has proven optimal depths with any laser for induction of collagen. It is still an unknown. I have seen some studies looking at it. If you have a non-bias study that was not done by or paid for by one of the laser companies I would love to see it.

4. The key word in the next question is "supposedly"

5. Now I want you to prove that the 1320 delivers the majority of its energy precisely to the DEJ. Sounds a little like Cutera marketing hype to me.

6. Show me that you get stimulation of fibroblasts and "ultimately" collagen using the 1320. Again, I want to see a study not done by Cutera.

Most feel that you need to be in the dermis for best results. Talk to the guys that have been doing it a long time and the will tell you the deeper the better. I guarantee the CO2 guys are not stopping at the DEJ.

[LH]

Sorry, number 6 should not have said Cutera as Cutera does not make a 1320 as far as I know. The 1320 Nd:yag is non ablative and has shown benefits with acne scars and I think it woud be a great adjunct therapy to ablative lasers or the Fraxel. Therefore acting similar to the ablative devices. I know the Fraxel is considered non-ablative but it causes coagualtion of the cells with in the beam column (depths have been proven with bopsy). I have seen some studies with the 1320 but have never seen results comparible to the ablative lasers or the Fraxel when it comes to acne scars.

[Sharon]

I am not a doctor, just trying to be an informed patient.
What is the difference between FRAXEL and GENESIS lasers? Each derm I speak to is selling "their" laser as the best, one has Fraxel, the other has Genesis. I just want to get the truth, not a salesman's pitch.
My probs are brown spots, uneven skin color and slight eye wrinkling.
Thanks!
(I don't mind downtime, just want results)

[TF]

Sharon, leaving aside your issue of eye wrinkling for the moment, it sounds like you have some "dyschromia", with your pigmentation complaints. Since I haven't examined you, there are probably some things I'm missing, but.... typically I'll start the patientwith these issues on the Obagi / Retin-A skin care system, and consider IPL on the darker areas if the patient is fair skinned. Sometimes, various bleaching compounds are also helpful with this. There are a number of these available - hydroquinone, kojic acid, azelex, etc.

My point is:it isn't clear to me that either Fraxel or Genesis treatments would be particularly helpful for your dyschromia issues, although they may help with other skin issues. You may want to specifically ask your local physicians about these other treatments first.

[Sharon]

Ok thanks for answering me!
I am olive skinned, my derm told me it is tricky to treat my skin type without stimulating excess pigmentation, exactly what I'm trying to avoid.
I have used both Retin A and Hydroquinone.
Also had a treatment on my face with a "Yag" (spelling?) laser last year. It was expensive, and there is still residual discoloration.
Perhaps my expectations are unrealistic, I'm wishing I could be freckle and spot free.
Thanks again!

[LH]

Actually the Fraxel shows significant inprovement for the dyschromias but the genesis is useless for it. IPL is definitely and option.

With the choices Sharon listed I would recommend the fraxel and the Obagi.

[md]

2006 Laser & Light Technology Choice Awards™
Recipients & Honorable Mentions - Final Poll
Category Award Company Device
Most Diverse Hair Removal Laser Recipient Cynosure Apogee Elite
All Skin Types Honorable Mention Candela GentleMax
Best Hair Removal Laser Recipient Cutera CoolGlide Excel
Dark Skin Types tie Honorable Mention Candela GentleYAG
tie Honorable Mention Cynosure Acclaim 7000
Best Hair Removal Laser Recipient Candela GentleLase Family
Light Skin Types Honorable Mention Cynosure Apogee 5500
Best Laser for Superficial Recipient Cutera CoolGlide Excel
Leg Veins tie Honorable Mention Candela GentleYAG
tie Honorable Mention Cynosure Acclaim 7000
Best Laser for Facial Recipient Iridex Diolite 532
Telangectasias Honorable Mention Candela Vbeam Aesthetica
Best IPL for Photo Facial Recipient Palomar StarLux
Treatments Honorable Mention Lumenis Quantum SR
Best Laser for Vascular Recipient Cynosure Cynergy III
Malformations Honorable Mention Candela Vbeam
Best Laser for Acne Recipient Sciton Profile
Honorable Mention CoolTouch CT3
Best Non-Laser Device for Acne Recipient Photo Therapeutics OmniLux
Honorable Mention CureLight MultiClear
Best Non-Ablative Laser Recipient CoolTouch CT3
Collagen Remodeling Honorable Mention Cutera Vantage
Best Device for Skin Laxity Recipient Thermage ThermaCool
Honorable Mention Cutera Titan
Best Fractional Technology Recipient Cynosure Affirm
Honorable Mention Reliant Fraxel SR
Best Laser Resurfacing: Er:YAG Recipient Focus Medical NaturaLase Er:YAG
Honorable Mention Sciton Contour
Best Laser Resurfacing CO2 Recipient Lumenis UltraPulse Encore
Most Promising New Aesthetic Recipient Alma Accent XL
Technology Honorable Mention Cynosure SmartLipo
Best IPL Technology for Hair Recipient Palomar StarLux
Removal Honorable Mention Lumenis Quantum HR
Most Affordable IPL Device Recipient Novalis Solaris
Honorable Mention Aesthera Aesthera PPx
Best Tattoo Removal Laser Recipient HOYA ConBio MedLite C6
Honorable Mention Focus Medical NaturaLase QS
Most Diverse Aesthetic Device Recipient Cutera XEO w/ Option Pkg E
Honorable Mention Alma Harmony
Best Customer Service / Support Recipient Syneron
Honorable Mention Candela
Best Stand-Alone Epidermal Recipient Zimmer Cryo 6
Cooling Device Elektromedizin
2006 Laser & Light Technology Choice Awards™
Awards Criteria
Awards Criteria
1 Efficacy
Includes substantial, scientific clinical evidence, and technical specifications.
2 Training
Includes clinical, technical, and marketing.
3 Cost
Incorporates average selling price, value of average warranty provided,
weighted average of disposables, average repair costs not under warranty.
4 Support
Includes clinical, technical, and marketing.
5 Reliability
Includes annual average service incidences, average required
troubleshooting, average downtime of unit.
6 Patient Comfort
Pain Score Range: 1 = Painless 10 = Severe
7 Ease of Use
Includes user interface, ergonomics, portablitiy, and weighted average
treatment(s) speed.
8 Warranty
Includes coverage, length of time, and value.
Aesthetic Trends & Technologies
11622 El Camino Real, Suite 100
San Diego, CA 92130 USA
858.605.0470 telephone
858.605.0469 facsimile
The Laser & Light Technology Choice Awards is a trademark of Aesthetic Trends & Technologies, Inc. www.AestheticTrends.com

[Kim]

I am trying to decide whether I should have another Fraxel laser treatment or try the new Portait plasma procedure. The latter is alot more expensive but not painful. I am looking to improve wrinkles, get a little tightness around the eyes and improve some left over scars from the days I battled cystic acne. Which procedure is more effective?

[LH]

Kim,

Read some of the posts on here from others that have had the Portrait done. My understanding is that it can be uncomfortable. This is so that you know.

[Kim]

Thanks for the heads up! I guess no pain, no gain. I'm still hoping someone will post an answer of how these procedures fair with what I am looking to accomplish.

[LH]

Kim,

The only way for any of us to accomplish what you ask is to meet in person with you. Both should benefit but you must be realistic as even a Deep CO2 peel will not get rid of 100% of the acne scars.

[TF]

Deep acne scars can be very challenging to treat, as mentioned above. Even with a CO2 laser, which is one of the most powerful modalities we have, I would say one gets a "moderate" degree of improvement only with acne scars- certainly not "gone" or "fabulously better". Resurfacing is much more successful, in general, for fine lines & wrinkles or photo-aging issues than it is for acne scars.

And of course, the deeper the peel - the longer the downtime / recovery.