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« Radiance Medspas & the 23 franchise class action lawsuit. | Main | Thermage, Mesotherapy, Medical Marketing & whatever. »
Friday
Apr272007

IPL Reviews & Comparisons: Download the Dog & Lemon Guide PDF.

There's always mucho demand for reviews and comparisons between IPL and laser technologies and companies.

12-01-3.gifDownload the IPL Dog & Lemon Guide PDF


Ican't vouch myself for any of the info or reviews. Midwest sent me the link to his report so she's responsible for cudos or blame.

The link at the end points to a spam farm of text ad links which is somewhat unpromising but I'll leave that for you to judge. Certainly the report is well written and at 41 pages is much longer than the usual reviews.

I'd welcome comments on the report, or the voracity of the author if anyone knows. 

Reader Comments (127)

I have already read it. I think it has good scientific info behind it. It helped me to make decisions on my recent purchase of a newer IPL system.
04.27 | Unregistered CommenterLH
Your information is some what true. So that leads me to believe that if you are incorrect on the few that i know its definately possible that you can be incorrect on others.

I have worked with a Cutera product for almost a year now and i know that they are advocates of ongoing training and education. They have a whole archived database of training videos and monthly they conduct multiple webinars with well respected physicians. These webinars are great ways in which to talk openly about questions on treatment parameters and tricks of the trade. Let alone they invite all current owners and potential owners to a clinical forum every year. This is a great event for networking, exchanging treatment ideas. I enjoyed it and i dont think ANY other company would put all their owners in one room.........that would be horrifying.

Cooling? I think you need to review the Cutera information on cooling, the engineering is beyond any of the other companies.

i did not have time to read your full review but i will revisit it and follow up.
04.27 | Unregistered Commentertruth
Truth,

I would have to disagree with you. I currently own Cutera 1064, w/ 600nm IPL and the Titan. I have had mine for over 3 years. Cutera is basically no where to be found unless they are trying to sell me something. The only thing the webinars are good for are if you have had your laser less than 3 months. The webinars main focus are to sell you something. The webinars really do not help you tweak your treatments if you already own the product. They still do not have a great protocol for the Titan. I like the Cutera 1064 but the rest of it was a mistake and I should not have purchased. I recently looked at both the Limelight and the Prowave. I compared them to the Palomar, Alma, and Sciton. So put it this way they ended up 3rd on my list and they would have been less expensive for me to add to my current Xeo.

I also read the Dog and Lemon and found that they are right on about the cutera. I did not see any problems with what they wrote. You need to remember they were comparing the Cutera Solera not the limelight so there are some changes since the comparison was written.

By the way I did read the entire review word for word.
04.27 | Unregistered CommenterLH
I'm with LH on this. Cutera's reps fail miserably. They might as well be that Botox sales guy Jeff talked about.
04.27 | Unregistered CommenterVexedMD
Well my technology was panned in this article but I still think it will work fine and I'll do great with it.
04.28 | Unregistered CommenterMichMD
They mention the Palomar Medilux has contact cooling which us does not-the Starlux does as well as the square pulse. I find the support and continuing education (user seminars etc) to be excellent IMHO. I have had my system for almost 3 years.
04.28 | Unregistered CommenterLA MD
To a large degree they all work. The most important thing is to become comfortable with the unit you use. As we all know, we change the parameters as we become used to the machine.

We also need to look at long term costs. So we need to look at the results we get as well as initial costs and costs of upkeep. I have been a little harsh on Cutera but do feel it is not the top of the line if you are looking at new equipment.
04.28 | Unregistered CommenterLH
I would like to know the qualifications of the person that wrote this Dog and Lemon Guide? Many of the points are just wrong. I am a doc and have a PhD in Physics. There are so many errors in their logic and claims of features I can only suspect that it is from a sales rep. of one of the companies (clear which is evident if you read their conclusions).

Starting with hair removal the objective is not to destroy the follicle but to destroy the stem cells. Anyone in this industry knows that you can remove a follicle with waxing but the hair comes back.

The claim that photo recycling is a marketing hype shows this persons lack of understanding of the physics of light. There have been many reports about the effect of photo recycling producing better results with lower fluence. This is very easy to understand as we are mostly talking about refection off the surface of the skin and immediately returning those photos to the skin via a mirror. It is true that photon energy falls off as 1 over the square of the distance in an open system, however far more photos are lost in systems using gels and without reflectors.

Next they claim that having two lamps is better than one, that is true for one reason only especially when stacked, each lamp can produce half the fluence and extend its life before replacement so one only need look at the manufactures warranty period to decide this point.

Next we talk square pulse and here again this person fell into the marketing hype. A true square pulse is just that square not a series of short bursts. When you try to emulate a square pulse with short bursts of pulses you create more heat in the dermal tissue even with surface contact cooling… remember the goal for some treatments is to put the energy deeper than the cooling can protect, which is primarily for epidermal protection. The reason again many do not use true square pulse is cost of power supply.

Their discussion about head size is at best confusing as most manufacturers quote joules/cm2 not total energy. Therefore a large delivery window with 20j/cm2 is much more effective than a small delivery window with 20j/cm2, for say Hair removal period. It penetrates deeper at this same energy density. Vascular lesions are another story. Here again they miss the point. Beyond epidermal cooling for protection, pulse width and energy are very important. Yes some manufactures can achieve results with multi-pulsing but remember the more pulses the higher risk of damage to the treated area. As a user of both Lumenis and Palomar I can say whoever wrote this guide does not know his facts. Palomar not only has a true square pulse but they hold a patent on the power supply system that can deliver it in a small package.

Next is the discussion of contact cooling crystals. Palomar was the first in the industry (to my knowledge) to use Sapphire not quartz. Then everyone followed suit. It had nothing to do with pitting as he claims, which is usually due to using a cheap gel on the skin and not cleaning the HP between treatments, but rather the thermal conduction properties of Sapphire vs. Quartz which is an insulator. This is the type of nonsense spread by poorly trained sales people once again.

Next is the filter technology and again their data is wrong. First in the report this person claims it is best to only buy IPL with the wavelengths above 950nm (IR) removed as they only heat water and do damage. In some cases that is exactly what you want! For a good photo-facial or an acne treatment (with or without levulan) you need some IR to induce heating of the collagen and create thermal damage to make new collagen, for acne (like the old Candela smooth beam laser) you benefit from having 410nm light for the acne bacteria or to activate levulan at its first peak and IR (900 to 1200nm) spectrum to help heat and shrink the sebaceous glands. That was the entire concept behind the smooth beam laser. Palomar does in fact offer a luxV HP for this effect for over 4 years now (when I bought my first one).

The biggest fantasy is the profit model on page 29, which lists a medilux at $135K and a Lumenis Quantum at 30K. Lets remember that Sciton does not even recommend its BBL IPL for HR as it is underpowered. They claim an average of 5 tx per patient, even using Lumenis that was more than I used. And with the Starlux for photo-facial or vascular it is very rarely more than 3 treatments.

Lastly I will say that this person who submitted this article (no doubt a Sciton rep) really needs to go back to school not only to learn to read the specs of other manufacturers but also to understand the skin light interaction process better. His claims about head life (shots and cost) are mostly wrong. Palomar for instance is and has always been 100,000 shots and 2 years since I bought my first medilux in early 2003. Sciton has changed their web site and story on warranty 3 times in the 2.5 years I have talked to them (it was 1,000,000 shots on the old web site, now it just says one year).

What is more interesting to me is that the writer chose to compare the Sciton and several relatively unknown IPL’s to Palomar’s 6 year old machine and Lumenis Quantum (also old design), perhaps even he knew that it could not hold a candle to a Starlux machine, not just on specs but on clinical results. Sciton makes a good Er-YAG and a so-so Nd-YAG (no Nd-YAG is really that good for HR as years of studies have show). And now they too are offering a 1320nm smooth beam type laser for acne and “claimed” skin tightening. But when it comes to IPL machines Sciton is not even in the top 3, I am sorry to say. Do your homework and talk to doctors using the equipment for a few years then make your decision not from this Misinformation Guide written by a Sciton rep or distributor.
05.20 | Unregistered CommenterSpaDocinCR
SpaDocinCR,

Thanks for the insight. I appreciate hearing from anyone that has a better understanding of the laser/light based physics than I do.

I also have some questions for you. Where did you hear that Sciton does not recommend the BBL for hair removal? They have 2 filters mostly for hair removal. I compared the Palomar and BBL side by side on pts w/ Fitz I to III (the majority of our pts) and had very similar results. These are the pts we were having trouble with as the 1064 would thin the pts hair and decrease the pigment.

I am also not sure where you got it that the BBL is underpowered. We have seen results for hair removal w/ the BBL and have not come close to using all of the energy available even on my Fitz I pts.

My personal opinion (I am not a phD in physics) is that the top 2 IPL systems on the market are the Palomar Starlux and the Sciton BBL. I looked at 5 seperate systems and the other 3 did not even come close to these systems.

Your post seemed to be a little one-sided to Palomar. So I thought I would give some insight into my reasoning to use the Sciton. As we know on this site, we do not want to use just one persons opinion as fact. I do agree that the Dog and Lemon seemed to be a little too pro Sciton. But it does show the Palomar in pretty good light as well. I always take this kind of info with a grain of salt as I am definitely not a physicist. When I read it I was dissappointed that it did not list all of its scientific references. I also talked to an unbiased person with 15+ years in the laser/light aesthetic industry and he felt that the paper was fairly close to accurate but not perfect.

I chose the Sciton as I felt the cost per shot over the long term was much less with the Sciton and I did not have to keep buying heads (otherwise known as consumables). I also thought the results were comparable. With the Palomar you have to buy a new head for each procedure at a cost of $12,000 and up. Palomar's heads are only guaranteed for 100,000 pulses and if something happens before the 100,000 pulses they pro-rate replacement.

With the Sciton the warranty is 3 yrs unlimited pulses after that the head is 300,000 pulses and only cost $7,500 to replace. I also liked the fact that I only had to change the filter and not the head. Palomar has gotten a little carried away with the heads. You need to purchase a small head and a large head for hair removal (i.e. $25,000). Then a large head and small head for photorejuvenation. Then a head for acne. Then a head for 1064. Then a head for fractional non-ablative treatments etc. I think you get the picture. I just wanted things to be easier than the Palomar system. I just simply pull the filter out and put a different filter in and I am done. I will often use more than 1 filter on the same pt.

Please do not get me wrong I think the Palomar is a very good system but felt the Sciton was a better choice for my clinic. I hope that everyone reading this will look at as many systems as they can before deciding what to purchase. Do not let one individual including me be your sole source of information for your purchase. I bought what I felt was the best choice for my clinic and it is working nicely.
05.20 | Unregistered CommenterLH
Spacedoc,

What are your top 3 IPL machines in your opinion? I agree this seems totally written by a Sciton rep or someone who in some way/shape/form is associated with them. Do you like the Quantum?
05.20 | Unregistered CommenterMichMD
SpaDocinCR,


Sorry, I forgot this part. You can e-mail Paul Kadar at paul.kadar@cosmedicreviews.com. He apparently played a role in the writing of this piece. I think he should hear your concerns.


Jeff,

Do you think that you could get ahold of these guys and find out who they are and their backgrounds? I would like to see them post on here like Thermage did. They need to backup their information and correct errors in their guide.

05.20 | Unregistered CommenterLH
I am a Dermatologist far away from USA,in Greece.I have purchuased three years ago the Sciton's Nd YAG 1064 and two years ago the BBL.I also have the Alex of Cynosure (the previous model of Apogee),so i can compare the three in hair removal.I am finding that BBL has similar results to Alex but you do the treatment very quickly (e.g two legs in 40 min in a calm way).With 5-6 sessions in hair removal in legs i have a very good and quickly result!!Recently i upgraded with ST which i think is very good too.I am not using any more in hair removal in large areas the Alex or the Nd YAG.I think that BBL is the best in the market and very low costly to doctor.
05.21 | Unregistered CommenterCharry
LH,

I guess I should say that my biggest issue is with non-factual reporting. I gave you real physics and real life experience, mine. To address you questions and also to let you know I did demo Sciton and reviewed the equipment at ASLMS 2 yrs ago and AAD last year. It seems that perhaps they have a different warranty program in the US than out as it appears to be up to the distributor outside. My first quote was 1,000,000 shots no time limit for the IPL Hand Piece. Then it went to 300,000 and now I am told that it is 1 year. Hard to say as there is no info on their web site or their brochures to confirm. It is not hard to understand a lifetime of 300,00 shots when you use two flash lamps to produce a max of 30 joules/cm2. They are running only half as hard to produce the same total fluence as one lamp in say a Palomar machine, hence all things equal I would expect a life twice of Palomar HP’s. And they produce 33% less fluence than Palomar for the same size treatment window. BTW the life of a Palomar HP is not just 100,000 shots but it is down on output at 100,000 by about 10%. I met some docs from Japan at a congress in Argentina that are still using them with 260,000 shots. I can only imagine the reduction in output for Sciton at 300,000 shots.

As to who did not recommend IPL for HR, it was the rep himself at the show as we have mostly FST 3 and 4, and a few 2 and 5’s here. They recommend Nd-YAG for this app and having used Nd-YAG it is less than a good choice for HR. Especially when the hair gets finer and lighter towards the end of treatment. All the longevity studies show it is less permanent as well. To get any speed with Sciton you need two Nd-YAG modules and a scanner, which put it way to costly for our rates here.

As to energy I have used Esc, medilux, quantum and starlux IPL’s and found that for light skin using a 600-640nm filter 20-30J is plenty at 20ms pulse for HR. However using IPL on more resistant hair such as facial hair or back hair on Latin or European type III or IV we use much more energy sometimes 40-60 joules with a 650-675nm filter HP (luxRs). Clearly the Sciton should compare very well on light skin using 640nm and 695nm filers but the max of 30 joules is a concern to me as for years here we have given a one year warranty on HR and I have never found 30 to be enough for difficult cases, such as lip hair or chin hair on women. Often we do a double pulse treatment on difficult cases using short 20ms and long pulse 100 or 200ms as they have some studies in Europe that seem to indicate this protocol gives good results on difficult cases.

More importantly is the issue of IPL on the face where here after using quantum HP’s I find I really like the smaller LuxG (12x15mm) spot size. Much easier around nose vessels and the lip for example. And speaking of vascular lesions you will always need more than 30 joules for real blood work on the face unless you also have a Dye or KTP laser or want to work at the higher and more risky energies of Nd-YAG (too much risk in sebaceous tissue). Try to do an alar vessel on the face or a blue malar vessel with your machine and let us know what happens. We use 44-46 j at 20ms or 60j at 100ms for this typically. BTW there is only one Photo facial HP the luxG but if you are just removing epidermal pigment then you could use the luxY, which is a large HP, however it will do nothing for blood and nothing for heating the dermal tissue to improve tone and texture.

Regarding your thoughts/comments on head cost and usage I do not like the idea of slide in filters for a few reasons… I have used them and found that the coatings do not last as long as the manufactures claim. Sciton is not the only one to use them, as it is a way to cut costs as you identified. On the other hand, even if these coatings can give you equal filter ability they are only a cut off filter and Palomar uses two kinds of filters including a band blocking filter so the photo-facial HP (luxG) does not have light in the HR spectrum from 650nm to 840nm and hence I do not need to explain to my male patients that they will have some loss of hair after 2 or 3 photo facials. The other problem is that people do not always pay attention to what they do and can insert the wrong filter and burn someone. Heck my people even use the wrong HP sometimes and do the same thing. I just think it is easier to mix up a little coated slide in then a hand piece. As far as the cost of an Nd-YAG HP you are right I paid 30K, but then how much is the Nd-YAG from Sciton? You are not saying you can do the work of an Nd-YAG with the BBL?

Also remember that the warranty price to change a HP for a new one after 2 years is not the same as a new HP like you quote. I paid $6K for two swaps in the last 12 months. We do about 50-60K shots a year on the HR hand pieces (yes I have a luxR for backs and full legs) and luxRs for the rest; about 45K shots on the LuxG (vascular lesions and photo facials) and only about 15K on the acne HP. We are not doing the volume of a US clinic I am sure. However in just one year you can use up your warranty of 300,000 shots it would seem using on HP for all treatments. You are also wrong on the pro-rated issue. I have had HP’s stop working (IPL & Laser), develop water leaks (maybe from a drop I am not saying) and other issues. They were replaced for free with new ones, however the warranty continued only for the balance of 2 years.

Then there is the option of adding fraction skin tightening LuxIR and 1540 non-ablative skin resurfacing. These have added immensely to our revenue and Sciton has nothing to offer here. Please do not repeat the sales guys pitch for a 1320nm laser to do tightening. I was using a Candela smooth beam 6 years ago and if it worked on tightening we would have a lot of happy people and I would have kept it…Sciton is a laser company with a short history in IPL. Palomar has been at it a long time and holds many patents which they get lots of royalty $$ from (yes I do own a little stock). Personally I like the idea of putting a few dollars more into the technology of these hand pieces and keeping the platform for a longer time. I never liked articulated arm machines and I have had plenty… they always require more maintenance. They are not the most expensive and not the cheapest but for my money I wanted someone in the biz for the long haul with lots of experience and a commitment to the future.

Look we all like what we bought mostly but that is not the point of this forum is it? There are manufactures out there than seem to specialize in misrepresentations and I try to avoid them and their products. It is like someone else said about the guide to lemons and dogs… if it has some untruths usually you will find more and I did without having to look to hard, that is the best example of what I do not like about Sciton. Everyone wants to go after Palomar they have become #1 in the US I hear and for good reason I feel. We all wish the price was less and so others come to market and claim to offer equal or better products for less but as a scientist also I find the reason is the technology is not there…

If you and your patients are happy with the results of your machine that is what counts. I have no idea how much experience you have or what other platforms you have used. Often what I see when doing a talk at a congress is people have strong opinions but little experience or maybe a lot but using one machine only. I told a doctor in Guatemala a year ago about our spas and what we used (he had a little experience with CO2 only) then 3 month later I saw him at a dermatology congress in Honduras and he was giving a talk on using his Syneron elaser (with 2.5 months experience and not one photo was his patient just stock photos from Israel) Draw your own conclusions, as that is always best.
05.21 | Unregistered CommenterSpaDocinCR
MichMD,

hard for me to answer that without knowing more about what the use is. I do like the quantum (IPL only not the Nd-YAG or Q-YAG) and used one for 2+ years (and a light sheer too). Now they can be bought here new for $50K as they an old design with short head life. but like I said what you plan to do with it makes a difference. If just doing FST 1-3 and pigmented lesions and photo facials the medilux is a buy now as they lowered the price a lot...I used this for 2 years and it never broke once... like a tank.Then there is Alma which has a knock off of the medilux also with many more HP's however most are under powered for the job.. be a bit more specific and I will try again.
05.21 | Unregistered CommenterSpaDocinCR
SpaDocinCR,

Thank you for your input. I think it is great to hear from someone with your experience. Don't get me wrong I think the Palomar is a very good machine. I was to some degree playing devil's advocate. As we know, we have some people on here that are sales reps and act as if they are physicians.

I definitely look forward to hearing more from you. I was torn between the Palomar and the Sciton. I chose the Sciton so I could use the erbium for resurfacing and I got a good deal on the BBLs.

Do you feel going over the area for hair removal with a shorter pulse width then again at higher pulse width is very beneficial? Are you increasing the energy level on the second pass?

Just to let you know it was the Palomar rep that told me the heads were pro-rated. That was one of the reasons I did not buy the Palomar. Also, most of my patients aer Fitz 1 to 3 with an occasional Fitz 4 or 5.

Again, I want to thank you for your input.
05.21 | Unregistered CommenterLH
LH and SpaDocinCR

When i upgraded the PROFILE system two years ago with the BBL module the local representative here had told me that i couldn't use it in hair removal and i had to get another Nd YAG module with the scanner.I insisted in the fact that BBL could work very well in hair removal (because i am a Dermatologist and i know a little of physics) and so i purchuased it.After few months the factory did i hair removal protocol and started to promote it in hai removal.Now i am using BBL on any large areas (e.g back,legs...) because it is very guickly,low cost and i get very good results similar to my Alex 755nm.
05.22 | Unregistered CommenterCharry
LH
I did try to contact the guy at cosmedicreviews and site has expired? As to the long/short pulse protocol I can only tell you that my nurse is using it on difficult cases and that it came out of Europe for treating middle easter/Indian and other genetic types which respond poorly. I have only seen studies which state better long term clearance from long pulse (100ms) then short pulse (20ms) on IPL, nothing on this double pulse strategy. Hair is no longer a large part of our practice.. to many people offer it and the prices are too low.

She tells me it seems to give better results for the slow responders and only uses it after 2 or 3 treatments when she feels they are no seeing the avg. results. For large HP 1st pass is in the 20-24j range 20ms, then 35-45j 100ms depending on FST.
05.22 | Unregistered CommenterSpaDocinCR
SpaDocinCR,

Thanks for the input. We started doing the double pass on our more problematic pts about a month ago. We have not had anyone return yet. I do not want to beat a dead horse but I have mostly Fitz 1 to 3 and with my new BBL have only had to go up to 17 joules with it. We are seeing good results. I hope that means that I will not run out of power. We learned that the hard way with the Cutera 600nm IPL. It only went to 20joules and was not enough for our Fitz 1 or 2.
05.22 | Unregistered CommenterLH
Sorry I did not write this above. I have read some studies that showed long pulse by itself may work better than the short pulse treatments. Has anyone tried it and if so do you feel it works as good or better.

Hair removal is also a small portion of our gross revenue but I always want to try to improve our results as much as possible. I am always looking for insight from people like you and many of the others on this site.
05.22 | Unregistered CommenterLH
LH

I am using it in Fitz 1-3 with pulse width >15msec up to 25msec with very good results.For Fitz >4 you need longer pulse width (>20msec).I think that for Fitz 1-3 using pulse width<15msec with BBL and any IPL would be very aggressive and not without complications.
05.22 | Unregistered CommenterCharry
We are actually using a technique that we borrowed from Michael Gold. We are doing a pass of 640nm at 18-20J/15-20MS then folloed immediately by 1064nm. Our results have been extraordinary. We try and limit this to smaller areas obviously.

05.22 | Unregistered CommenterDexter
Dexter

Why first BBL and the Nd YAG and not the opposite?As we know after the session the new hair is lighter and finer.For this hair the Nd YAG is not so good compared to BBL.Why you are not doing first the 1064nm for dark hair and then immidiately the BBL for the light hair?
05.22 | Unregistered CommenterCharry
Thanks for your input. It helps a lot. We are still in the learning curve with the BBL. I am always looking for help with those more problematic pts. We have a lot of Fitz 1 to 3. Many have brown or light brown hair which tends to thin out with the 1064 but after 2 to 3 treatments we do not see a lot more benefit. That is where we want the BBL to step in.

I assume Dexter is doing both treatments on the same day. I have read the article from Dr. Gold as well. I was trying to decide on some new techniques. I was deciding if I wanted to start doing a double pass with the BBL (1st pass at lower pulse width and second at higher energy with a longer pulse width) or if I want to treat with the 1064 and the BBL on the same day.

I did read though that it is better to do the deepest treatment first followed by the more superficial treatment. This would mean doing the 1064 first followed by the BBL.
05.22 | Unregistered CommenterLH
LH

You agree with me to do first the 1064 followed by the BBL and not as Dr.Gold does.You also take very good results with two passes,but not immediately,of BBL as you told (1st pass at lower pulse width to removal the fine hair and second at higher energy with longer pulse width for the dark hair).
05.22 | Unregistered CommenterCharry
Just curious how long you have been doing treatments on these BBL's? Sounds like most less than 6-9 months.. if that is the case it is way to soon to be claiming success with these devices. Even the old radiancy skin stations got short term results with 10-12 joules... at least for 4-6 months. The proof is how it looks in a year.

I also caution listening to close to Dr. Gold as he has come out over the years and claimed the old ESC IPL gave great results in only a few treatments, has said many favorable things about Palomar and now seems to be signing the praise of Sciton. Of course he is a paid consultant for them now...I really think it is quite ridiculous to have to do 1064 and IPL to treat hair. if that is something you are doing you should just get a lightsheer (great for FST 1-3) for your HR. The reason we all went to IPL was to gain speed, and equal results, remember? There are lots of studies which show 1064nm laser is the poorest of the choices behind 810nm, 755nm and IPL (the study was only Palomar IPL)._
05.22 | Unregistered CommenterSpaDocinCR
SpaDocinCR

I have been doing treatments on BBL two years know and from the first moment i am doing hair removal with it.I have great results and know in large areas i use it instead of using 1064 or Alex.Personally i agree that is ridiculus to have to do 1064 and IPL at the same time.It's logical the opposite (first 1064,then BBL) but not as Dr.Gold 's proposal.
05.23 | Unregistered CommenterCharry
Spacedoc,

Can't you get a 755nm on an IPL machine? So in theory, shouldn't that be effective for HR?
05.23 | Unregistered CommenterMichMD
SpaDocinCR,

I agree that it is rediculous to have to do both the 1064 and an IPL device. We are not talking about using it on everyone just the more difficult cases. I have many Fitz 1 to 3 and some with lighter brown hair which did not respond well to the 1064 as I was told by Cutera that it would. That was my bad. This was when I first entered the aesthetic arena and did not think a rep would stretch the truth.

The reason I have not purchased a lightsheer or similar laser as I would basically be using it for hair removal only. More of an investment than I want to make as hair removal is a small portion of gross income.

I will likely buy an Alex at some point but just not now. We have a number of patients that come to us from a derm office using an Alex. They did not see results.

Yes, I am new to the BBL so I am looking for as much insight for its use from you guys as I can get. I hope I see permanent results and not just stunning the hair follicle. I appreciate everyone's input.

Charry,

You wrote about the pulse width you are using but what energy settings (joules/cm2) are you using? Again I am mainly using the BBL on my Fitz 1 to 3.
05.23 | Unregistered CommenterLH
LH

I was using the 695nm at 18-19 J/cm2 and pulse width 15-25msec in Fitz 1-3 because i was afraid of burn.Recently i am using 640nm at 15-17 J/cm2 and the same pulse width (15-25msec).Of course at Fitz >4 i am using only 695nm at the same fluence but in pulse width >20msec.
05.23 | Unregistered CommenterCharry
LH

In Fitz >4 i mean that i am using only 695nm at 18-19J/cm2 but in pulse width>20msec.
05.23 | Unregistered CommenterCharry
LH

Alex is between ruby and 810nm diode in melanin absorption so properly used it gives very good results on I, II and light III's. Studies show it equal to the LS. Also many have somewhat larger spots and faster rep rate than lightsheer (although new model coming lumenis says). You all know that Palomar invented the lightsheer right and sold it for money to develop IPL. However you are right it is hard to justify a dedicated laser for HR if it is only a small part of your practice. That is why we all wanted a flexible IPL system for multiple treatment options.

MichMD. I understand why you think that but the answer is no. IPL relies on a spectrum of light wavelengths so to be effective with enough fluence you need to involve a range of wavelength such as 650nm to 90nm, then you have all the photons in that range doing work on heating the melanin in the shaft and root, which in turn (by conduction) heats the stem cells and wella we get clearance. Your flash lamp makes a fixed amount of photons (fluence) over a broad spectrum from around 400nm to about 1200nm for Xenon and if you filter out wavelengths below 755nm you just will not have enough fluence left to do the job, especially on lower powered machines like the BBL these guys are talking about.

Lastly on darker skin types Iv-VI ideally you should use about 100ms pulses to minimize the risk for surface burn and maximize the heating effect. However you can grade this up say from 60ms on IV’s to 100 and even 200ms on VI's. Again a big reason I bought Palomar as they can produce a single sustained long pulse not a series of short pulses like BBL or Quantum...hence much less risk on dark or tanned skin.

05.23 | Unregistered CommenterSpaDocinCR
LH

If you treat any hair (medium,not very dark) with 100msec or 200msec pulse width as SpaDocinCR talks about,please....phone me!!Everyone knows that the best pulse width for hair removal with any laser or IPL is 10-40 msec.
05.24 | Unregistered CommenterCharry
LH

Read carefully...you added "medium not very dark hair" I said FST 4 -6. You rarely, if ever, find “not very dark hair” on dark skin types IV-VI. Even by your own admission you have little experience with these FST’s as you said you mostly have 1-3’s as patients. Also I did not say laser although on the newer LS and Alex both offer 100ms or greater pulse widths to treat dark skin IV-VI (which implies) dark thicker hair...why do you suppose they did that when everyone knows the best is 10-40ms? There are a few published studies which show better permanence with longer pulse IPL also.

“Everyone knows that 10ms to 40 ms is the best for laser and IPL”. Perhaps by everyone you mean people that do not have an IPL machine capable of producing a longer pulse? We were not talking about laser. I think you are showing your lack of IPL experience here. 10ms is very short and risky on FST 3 or 2’s with any sun exposure, unless you like to burn people.

Look I posted here because there was a lot of misinformation in the “guide” on this site, then you asked for my experience and advice. This takes time to write and I gain nothing for doing it so perhaps you are better off here taking advice from Sciton reps, or the people that sponsor this site and own a medspa, regardless of their experience or qualifications.
05.24 | Unregistered CommenterSpaDocinCR
Sorry LH that post should be for Charry I first read it and saw LH so I made the mistake...
05.24 | Unregistered CommenterSpaDocinCR
I've been out of the loop for about a week and it's seems I've missed a lot. It's been fun catching up. I would agree that it does seem like the Dog and Lemon was written with some bias and there are certainly some misleading statements. What isn't written with bias? Does this come as a surprise to anyone? If you are reading this site it shouldn't. Take it for what it is. It does certainly seems to be more information that misinformation in my view.

Regarding why treat with IPL before 1064, I don't think it really matters. The reason we decided to do that however is because there is some absorption of relative superficial redness by the 640 at higher fluences. When we use 1064 we get a significant amount of erythema. I did not want the 640 to absorb in the redness. I'm not concerned about superficial absorption with the 1064 due to the wavelength. There it is.

Regarding the pulse width argument ,you only need to worry about long pulse widths with modalities that have a high degree of melanin absorption when used on darker skin. The long pulse widths used on the Alsx. and LS are applicable on dark skin not due to the size of the hair but because you will burn them at optimal settings. That's why you can't effectively treat darker skin types with those modalities. The reason they have those longer pulsed widths is so they can claim you can use the lasers on darker skin than is really optimal. Yes you won't burn them, but you also won't treat them effectively. It's all marketing BS. However, once you lengthen the pulses that long the settings are no longer optimal due to heat flowing laterally out of the follicle which produces a lower peak temperature. The optimum time duration heats both the bulb and the bulge to 70 degrees. Low fluences and long pulses will not accomplish this.

Regarding Palomar inventing the Llightsheer there is a slight correction. Actually, it was Star Medical that created the Lightsheer and then Palomar bought them and then sold to Coherent (now Lumenis). Not quite the same.

Regarding how ridiculous it is to use both 1064 and BBL I would say that I don't "have" to do anything. We choose to do this with the hope that we can the best possible results for hair removal for our clients. It's a choice, not a necessity.


I'll post later on some other nonsense I've been reading.

Dexter


05.24 | Unregistered CommenterDexter
I do think we need to listen to SpaDocinCR. He has a very good knowledge of the Palomar system. I have also been hearing rumors and a few studies have shown that longer pulse widths and higher fluences MAY have better long term results for HR even in Fitzpatrick 1 to 3 but using a much higher fluence. The Cutera rep even mentioned it while in my office. So, I was wondering if anyone had any exposure to this idea. Please remember the vast majority of my pts are fitz 1 to 3. Midwest scandanavian's.

Dexter, I think your choice to use the BBL prior to the 1064 sounds logical. I agree it really may not matter.
05.24 | Unregistered CommenterLH
SpaDocinCR

When i said that the best pulse width for hair removal is 10-40msec it was a general proposal not especially for Fitz 4-6 and not exclusively for the IPLs.I said which pulse width i am using on my IPL system (BBL).This pulse width is mainly a rule for lasers like Alex,Nd YAG...On IPLs you have to be more conservative with the pulse width especially in Fitz>3 (4-6).So we agree SpaDocinCR.
On the other hand i agree with Dexter with this "The long pulse widths used on the Alsx. and LS are applicable on dark skin not due to the size of the hair but because you will burn them at optimal settings. That's why you can't effectively treat darker skin types with those modalities. The reason they have those longer pulsed widths is so they can claim you can use the lasers on darker skin than is really optimal. Yes you won't burn them, but you also won't treat them effectively".He is right!!So if you using 100msec or 200msec even in Fitz 4-6 ,even with Alex you would not get hair removal!!
05.25 | Unregistered CommenterCharry
I am beginning to wonder if you guys read this stuff or just react to a few words in a sentence? My post above was a reply to Charry who made the comment that he treats "medium not very dark hair" using a short pulse in reply to my comments on FST's 4-6. My point is that you only find dark thicker hair on them... not that the long pulse option on a laser/IPL is for thick hair. Clearly on laser as with IPL the long pulse is to reduce the surface burn risk due to higher epidermal absorption in these skin types. If you re-read the post on the 23rd (the part addresses to MichMD) you would see that.

Dexter: No idea what your background is but what IPL modalities do not have sufficient epidermal absorption in dark skin that would allow a short pulse, such as Charry says?

You would have to use a cut off filter above 900nm and then you have almost nothing left of your spectrum to deliver energy from your flash lamp. The only safe way to treat FST 4-6 is with long pulse. As to the argument that long pulse will not work you are just wrong. No one said long pulse and low fluence except you. Remember the idea here is to heat the stem cells thru lateral conduction of the heat if you want to achieve permanence. We routinely use 22-36 joules/cm2 and 100ms on 5 and 6’s with great results.

As to your comment on Palomar I will say you stumped me so I did some Internet and phone research and again I say you are wrong. Star Medical was acquired in 1993 by Palomar well before the lightsheer existed. Star Medical only had cardiovascular technology at that time. Yes it was a subsidiary of Palomar but the R&D funds and program, which created the lightsheer, was managed by Palomar with the idea of getting Palomar into the skin care/dermatology market. I do not think anyone really cares to hear this history lesson nor do I get the value of this argument. My point was only that Palomar was not new in the biz, had extensive laser and IPL experience and used the $70MM from the sale 6 years after the acquisition to develop their IPL platforms.

Lastly I see you have posted on the thermage/Fraxel thread also. Here again you make a claim only Sciton makes that their Er-YAG can coagulate up to 100um. I have owned 2 Er-YAGs and studied the physics thoroughly and can find no evidence that any Er-YAG can coagulate tissue beyond 5-15um below the ablative layer. There are many published studies on this effect and it is due to the 10x higher absorption in water than C02. For tightening or wrinkle improvement (wrinkles or scars deeper than 150um) you need to coagulate collagen by heating the water in the tissue not the blood. Fraxel and Palomar’s 1540 do this using a wavelength that does not boil the water from the tissue as does Er-YAG & CO2. CO2 gets some tightening as it heats the water much slower the Er-YAG owing to its 90% lower absorption in water and has an added effect of sealing the top layer of tissue, which allows the energy to heat some tissue below the cap layer. This is all published in many laser physics books and medical laser textbooks used in med. schools today.

Clearly I am out of place here on a BBL biased web site as it seems you prefer to listen to what you want to hear, a Sciton/BBL credo.
05.25 | Unregistered CommenterSpaDocinCR
SpaDocinCR, Dexter et al.
Let's not get everyone's knickers in a twist. Certainly everyone has an opinion even if they don't. Clear, concise and logical posts carry the day. While you may feel that you've been patted on the head, all other readers can detect credibility where it exists.

BTW: This is not a BBL site. Surface uses Palomar.
SpaDocinCR,

Let me explain how a erbium can coagulate. Let's just say for arguments sake that the ablation theshold of tissue for erbium is 1J/cm2. Basically that means that fluences above 1J/cm2 will ablate tissue and those well below the threshold will heat tissue. The laws of thermal conduction apply here. If a sub-threshold pulse is delivered over a certain amount of time it will heat tissue to a depth based on the amount of time it is applied. For example, a sub threshold pulse stacked over a 2 millisecond time period you can coagulate 25 microns of tissue. Now the depth of this coagulation is quadratic. If you deliver a sub-threshold pulse of 8 milliseconds it will coagulate 50 microns. 32 seconds will coagulate appoximately 100 microns. All other erbiums deliver pulses that are restricted to 200-300 microseconds, not milliseconds. This gives them a higly ablative pulse. I will post the articles or abstracts that were histologies performed on yucatan pigs by Vic Ross M.D. (who I believe has a tremendous amount of credibility) and another done by David Goldberg M.D. demonstrating the above. Please give me a little time to find them.

Regarding the argument about Charry's comment I do believe that IPL's should not be used on dark skin. I would feel safe saying that even if you extended the pulse it would not make a difference. I beleive it's the wrong spectum of light for dark skin. I don't think it would be effective. However, like anything else how can you argue with someone who is doing it and getting results? I will say I am surprised but initially I didn't really believe IPL in general was a good treatment for hair yet now I find we use it often. I've always been a laser guy. We use 1064 for dark skin and all dark, course hair (all skintypes) and IPL for lighter skin, lighter hairs. As mentioned we are experimenting with using both. However, as the hairs become lighter and finer with 1064 we switch to 640 IPL.

Regarding the Palomar and New Star argument I would also agree it was a petty argument that was not important. Again, sorry for being combative. I still disagree with your facts, but it doesn't really matter what I believe.

Now as far as this site being Sciton biased I can see your point. However, keep in mind that you are blogging with some current Sciton customers. Of course, we love our technology. That's why we bought it. I would argue though that as biased as we are, you have a Palomar bias. You also have a tendancy to cite Palomar rhetoric and are clearly biased that way. No big deal, but please at least acknowledge that. It's natural, but is still very apparent.

I can see that you feel attacked, but keep in mind blogging is easy for those at the other end of the line to to make inferences that may not have been intended. However, it does appear that some of your comments could easily of been perceived as confrontational. I did that as well.

With that said, please don't stop your comments. It's good to get all sides of any issue and everyone benefits from that. Most people only read these posts and don't actually interact. You just happened to hit on a topic that appears to bring defensiveness on some of the more vocal bloggers. I hope you stay involved. If we all play nice these type of discussion can be beneficial for everyone. I promise to do my part better.

Dexter
05.25 | Unregistered CommenterDexter
For the record, I wrote the above before I saw Jeff's post. I really hope SpaDocinCR stay's with us.
05.25 | Unregistered CommenterDexter
SpaDocinCR

I don't want to add anything else in what i said.I am using like yesterday BBL in hair removal with these parameters even in Fitz4 (like yesterday) and i am taking very good results with not much post-treatment erythema.You are using Palomar's IPL with great results.I except it if you do it.There is no issue!!All here we have different lasers and IPLs and we are doing our job!!
05.26 | Unregistered CommenterCharry
I am trying to decide whether to buy a Palomar or Harmony ( Alma), for photofacials, rejuvenation and veins. Sales reps have been very aggresive, I leaning more toward Harmony. Any advise???
I would appreciate any comments, thanks.
05.26 | Unregistered CommenterIrelmon
Irelmon,
Read all the threads about choosing lasers and IPL's on this site. It should take about three days. Then make your decision and know that you did the best you could.

BTW: All salesmen in this field exaggerate. Many will lie outright.
05.27 | Unregistered CommenterLurker MD
Irelmon,

I think you find general (not all) consensus on IPL's. If you hae been reading the posts you will notice palomar and sciton seem to be leading the pack. If you get enough response you will likely find a number of people that like the Harmony as well.

Choose the one that will be of the most LONG TERM benefit for you. I would recommend that you at least take a peak at the Sciton before you decide.
05.28 | Unregistered CommenterLH
Irelmon

Well that this is one I can post on with some experience.. What model Palomar, MediLux or Starlux? The harmony is a multi-hand piece platform like the starlux but with less power than the older medilux and less than the Sciton BBL. I played with one in the US with a rep some time back. It is also limnited to just a few pulse widths which will not work for most vascular lesions and some other options they claim. for ex. their web site shows the 540nm filter with 10,12 an 15ms pulse only for pigment and blood. this is too short a pulse for say a FST3 for facial vessels and to low energy (20j/cm2). The QYAG is way underpowered and has a long pulse for a q-switched at 20ns (typical is 2-4ns) such a long pulse reduces its effectiveness on tattoo ink.. Having to use a 1mm spot to get 1.2J will only give you pin point bleeding. I have done 1,000's of tattoos and 3-6mm spots for deeper penetration and less surface reaction are the way to go. The Nd-YAG is also way underpowered compared to Sciton, Palomar or Candela. For all its fancy packaging it lacks speed, power and performance. There are much better choices.

Dexter
You got your wish I am still here but you have still not told me about your background/exp. in this field? Just curious.
05.29 | Unregistered CommenterSpaDocinCR
Irelman,

I think you are getting a good point of view from SpaDocinCR. There are definitely better choices than the Harmony for IPL platforms.
05.29 | Unregistered CommenterLH
I have an old Vasculight and I use it for hair(Type I-III), lentingos and spider veins/rosacea. Works great. The Nd:Yag laser is like an etch a sketch in reverse, but it would be nice to be painless. Is there other other machines out there that are better IPL's, Yags? Also, besides these treatments is there a demand for skin tightening or more for resurfacing and which machine offers results for the less investment. In my small town, only can afford used machines.
05.30 | Unregistered CommenterUltima
Ultima,

You will not find many Scitons on the Market but they are out there. None of them will have the BBL you wil have to add it new from Sciton. You will also find a few Palomar Starlux's on the used Market.

I do not want to be a commercial for anyone but call and talk to Jim at thelasertrader.com. He is very knowledgable and can help you. He will even talk to you and help you make decisions even if you do not buy from him on the secondary market.

I talked to him at a conference this weekend and I believe he had access to a couple of Starlux's.
05.30 | Unregistered CommenterLH

New to thread. Thanks to all for your comments.

Question: I had understood that only Palomar (Starlux) and Lumenis (Quantum and One) have chilled handpieces - does Sciton's BBL as well?

Hadn't considered Sciton BBL for my upcoming purchase till now.

DT

05.31 | Unregistered CommenterDT

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