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Monday
May192008

IPL Systems: Review and Analysis

The IPL Dog and Lemon Guide: Review and Analysis

 
Download the IPL Guide here

The Dog and Lemon is an IPL Guide which helps us decide which IPL System is best for our practices. You can get this guide from the internet or from Sciton. I suggest you get it and read it. This guide strongly suggests that Sciton is the best IPL System. Is this because Sciton is really the best or is this guide is biased towards Sciton. Those who would try to discredit this guide claim that it was done by Sciton and is biased. In this review and analysis, we will examine the points made by this report, understand why they are important and then try to assess whether it is biased or whether it correctly identifies the best IPL system.

I have no financial interest or other interest in the companies in this report. I am considering buying an IPL for my practice and this is why I started to look into IPLs. I own Reliant, Lumenis, Cutera and ConBio. I have been a full-time cosmetic physician with a busy cosmetic practice. This review and analysis is my opinion and is based from extensive reading and research. - CHMD

The Dog and Lemon Report suggests that the Sciton is the best IPL for many reasons. Let’s examine these reasons. I am hoping that other cosmetic physicians and company representatives will comment on the report and comment on my review and analysis. This review and analysis is meant to stimulate a lively debate and discussion of IPLs.

The report was done “to provide you, the cosmetic clinician practical, unbiased, objective information that empowers you to purchase equipment that best serves the interests of your patients and business alike”. There is a huge void in this type of information in the cosmetic dermatology field. There is so much hype and misinformation when it comes to lasers and light devices that it is difficult to find the best technology and the best companies when we want to purchase a piece of capital equipment for our clinics. We need a “Consumer’s Report for Cosmetic Medicine” - hopefully Paul Kadar and The Cosmetic Dog & Lemon Guides are it. Making the wrong decision when buying a laser or light device can be devastating. This is outlined on page 4 of the guide. The name of the game is excellent clinical outcomes and happy patients. In order to achieve this you have to have an IPL that will enable you to get excellent clinical results in all skin types. This type of guide - “The IPL Dog & Lemon Guide”, if unbiased and objective can help us all. Hopefully the laser companies are paying attention to this guide because it makes a lot of great points and it make intuitive sense.

Uniform Delivery of light energy to the target tissue: Perimeter Loss, Photon Recycling and Twin Flash Lamps.


Pages 7-9: These pages discuss how light intensity decays with increased distance from the light source. This means that the intensity of the light at the perimeter of the head is less than the intensity of the light at the center of the head. This loss is proportional to the square of the distance from the source, “if light that has traveled 10 mm produces a fluence of 20 m/cm2, that same light will produce a fluence of 5 j/cm2 if it has to travel another 10 mm (i.e. a doubling of the distance produces a quarter of the fluence).

The two main ways to overcome Perimeter Loss are Photon Recycling and Twin Flash Lamps. We won’t discuss “small surface area of treatment head” here because this is technique is counterproductive for many other reasons (speed of treatments, depth of light penetration, life of flash lamps) and we won’t discuss “long light guide” (“a crystal that is too long will loose some of the light through the walls and hence the fluence delivered at the treatment area may be sub-therapeutic” -I will assume that crystals are not used for this reason and this assertion is correct).

Photon Recycling:


“Photon Recycling is nothing but a marketing gimmick deceitfully used to entrap unwitting clinicians . . . It doesn’t take a rocket scientist to figure out that by the time this light is reflected from the skin into the treatment head and then back again, its fluence will have all but petered out.” This is a very strong statement but the physics make sense to me. It seems to me that the recycled light will have very little energy left once it is “recycled”. I am not convinced that “photon recycling” has any beneficial clinical effect.

Palomar uses photon recycling and tries to convince you that it works by showing you a slide to demonstrate that it works. This is the slide: there is an area of skin treated by IPL #1 without photon recycling and an area of skin treated by IPL#2 with photon recycling. The area of the skin that does not look treated was treated with an IPL that does not have photon recycling. The area of the skin that looks great was treated with a different IPL with photon recycling. We are expected to believe that the difference in the results is due to the photon recycling and not due to the difference in the IPL devices.

Based on my knowledge of physics and the fact that the intensity of light decreases by the square of the distance traveled, I think that photon recycling probably does not have a clinically significant effect on treatments. Palomar’s attempt to prove it works was critically flawed. I look forward to someone from Palomar explaining and proving that photon recycling can and will work in a clinically significant manner.

Twin Flash Lamps:


“Currently, an effective way of producing a uniform fluence across the entire face of the treatment head while maintaining a relatively large treatment area is through the use of two flash lamps in an over-under or figure “8” configuration”. The first flash lamp transmits light with the usual perimeter loss. “However, the second flash lamp fires in “the shadow” of the first and consequently transmits light in a polar opposite manner to the first”.

This gets a little fuzzy here, I am not sure I fully understand the duel flash lamp reasoning. If the second flash lamp is further away from the head than the first flash lamp, it has to transmit light at a higher initial intensity in order for the intensity of the light to be the same at the perimeter of the head. Does it do this? Is the intensity of the light really more uniform than a single flash lamp? I look forward to someone from Sciton helping me here. This will require diagrams and drawings, so please provide them on a website we can link to. If you send them to me, I will post them on my geocities website.

“Of the 8 top selling IPLs reviewed, 6 employ a single flash lamp. The only two models utilizing twin flash lamps are Sciton BBL and CyDen iPulse i300. However, only the Sciton BBL has the essential over-under (figure “8”) twin flash lamp configuration”.

Range of Wavelengths:


“Not all IPLs deliver the full spectrum of therapeutic wavelengths. Naturally, you’ll enjoy greater returns on your investment the more treatments you can deliver.”

This is how I see the wavelengths and the condition they treat (by looking at the Absorption Curves of Melanin, Hemoglobin and ALA (Levulan) and by reading the manufacture’s literature:

  420 nm: acne
  500 nm: pigment
  510 nm: pigment
  515 nm: pigment
  520 nm: vascular and pigment
  525 nm: light, fine hair (Palomar)
  560 nm: vascular and pigment
  590 nm: pigment in skin types 4 and 5
  615 nm: larger facial veins (Lumenis)
  640 nm: superficial leg veins (Lumenis)
  650 nm: Hair Removal (Palomar)
  695 nm: thicker vascular lesions (angiomas, hemangiomas), superficial leg veins, Hair removal light skin
  755 nm: thicker vascular lesions (angiomas, hemangiomas), superficial leg veins, hair removal darker skin

Please go to www.geocities.com/DogLemonIPL to see the Absorption Curves. Note where the absorption is high for melanin and high for hemoglobin. On the ALA Absorption Curve, note where absorption is high.

Palomar does not have a head for the 590 nm wavelength area. This is a very big deficiency in my opinion. You need this wavelength to treat skin types IV and V for pigmentation, hyperpigmentation and PIH (postinflammatory hyperpigmentation). Without this wavelength you cannot treat East Asians (Japan, China, Korea), South Asians (India, Middle East), Mediterranean (Italian, Greek) and Latin (South & Central America). In my practice, a large portion of my patients are “patients of color”.

The IPL Dog and Lemon Guide also talks about Fundamental Requirements of an IPL, Critical Factors for Producing Predictably Excellent Clinical Results, Head Size, Variable Temperature Control, Pulse Widths, Fluences, Clinical Training, Clinical Exchange Programs, Square Wave Deliver (this is very interesting and sounds very important. It makes intuitive sense to me), Sapphire vs. Quartz Crystals, Ongoing Education and Support, Adverse Reaction Plan, Optimizing Return of Investment, Portability, Marketing Support, Technical Support, Consumables, Profitability Analysis, Multi-Platform Options and System Summaries.

These issues are all summarized very well and will prompt you to think about these issues and ask these questions of your sales representative. I would encourage you to get and read The IPL Dog & Lemon Guide to review these issues.

Working with many Laser Companies, one of my big problems with most of these companies is their Continuing Education. their Clinical Exchange Programs, their On-Call Clinical Support and their Formal Ongoing Education.

The correlation between clinical competence and clinical outcomes should be obvious . . . Just as comprehensive initial training gives rise to predictably excellent clinical outcomes, the ability to exchange ideas and experiences with other IPL operators dramatically magnifies your clinical competence . . . a worthwhile clinical exchange program should utilize one or more of the following media: online forums, Teleseminars, Webinars and live phone support . . . any IPL that’s purchased with access to an established clinical exchange program can only benefit you and your patients . . . as the field of IPL therapy advances, all new clinically relevant finding and advanced techniques should be made readily available to you via a continuing education program. This may take the form of newsletter, website, DVD/Video and/or live workshops.

All companies have to do a much better job helping us learn the latest advancements and facilitating communication between providers so best practices can be communicated and propagated. Continuing education efforts must be made easily available, inexpensive, and convenient. For example, providers learn by different methods and they prefer to access information differently. Information should be made available in multiple formats so the greatest number of providers can access this information. Material should be presented in written format, by audio cassettes & DVDs, via the internet (Webinars) and live presentations. Once the material is presented in these varied formats, interaction and discussion should be encouraged and facilitated via conference calls, internet bulletin boards and blogs. Clinical experts and industry luminaries should be available to participate on these bulletin boards and blogs.

The IPL Dog & Lemon Guide must be updated. The information about Palomar is not current. They have a StarLux 500 which is very different than the reviewed Medilux. Hopefully Palomar can update some of the missing information and tell us how the StarLux 500 overcomes some of the objections raised by this report. Hopefully the other companies can provide updated information.

These are the questions that I have after reading The IPL Dog & Lemon Guide. Who is Paul Kadar? What are his qualifications? Does he have any conflicts? When was the report written? Is “Photon Recycling” clinically important or is it a marketing ploy? Do “Twin Flash Lamps” in a figure “8” configuration overcome “Perimeter Loss” and how does this work (in detail)? How big are the light sources (lamps) in the heads and how far are they from the edges of the heads? How important is “Variable Temperature Control” & “Integrated Cooling”? Can you truly use less fluence with equal or better clinical results with twin flash lamps and “square wave delivery”? What are the best wavelengths and algorisms for treating Rosacea and Pigmentation in “patients of color”? Is IPL Hair Removal as good as Hair Removal with the 810 nm Diode or the 770 nm Alexandrite? Is IPL treatment of Rosacea and Veins as good as vascular treatments with the 532 nm KTP Laser, the 595 Pulsed Dye Laser and/or the 1064 Nd:YAG Laser? Is the Sapphire Crystal really better than the Quartz Crystal?

I hope this summary and analysis of The IPL Dog and Lemon Guide is helpful. I hope it helps you find the best IPL for your practice and I hope it helps generate questions which we all can answer by participating on the resulting blog. I also hope that this summary, analysis and report will stimulate the IPL companies to provide better IPL devices and provide better continuing education and support.

My opinion of The Dog and Lemon Guide is that it is a great start and a great tool to start to understand IPLs. For those companies that did not fair well, you should tell us why the Guide is wrong or you should make your devices and your support better. I would not assume that Paul Kadar is biased. I am going to assume that he wrote a genuine guide to help us all. Read his introduction on page 4. He hits many issues right on the head! I hope he writes more guides. His guide is well written and thorough and makes sense. What he says “rings true” to me.

So let’s start the discussion!!! We should have a very lively debate. Please convince me to buy the device you have or you sell. If you have the device or sell the device, please identify yourself as a user or seller EACH time you comment.

Reader Comments (98)

MORE IPL INFORMATION: I believe the IPL "Dog and Lemon" document is somewhat helpful (I agree that it is a good start) but many of the comments need additional discussion. Although pulsed light devices seem rather simple, I have found through a lot of digging that they are far more complex than I first thought. The technology of the flashlamps, "free discharge" capacitators, dichroic vs. absorbative filters, "cut off" vs. pass through filters are all critical--and the list goes on and on. I have found a couple published articles that are much more in depth and will REALLY educate you about the key parameters for a first rate IPL system. Check out--

"Relevance of the Structure of Time-Resolved Spectral Output to Light Tissue Interaction Using Intense Pulsed Light" (C. Ash, G. Town and Peter Bjerring) Published in Lasers in Surgery and Medicine, 2008 Wiley-Liss, Inc.; and

"Measuring Key Parameters of Intense Pulsed Light Devices" (G. Town, C. Ash, E. Eadie and H. Moseley) Published in the Journal of Cosmetic and Laser Therapy, V. 9, Issue 3 2007.

In the latter article- which I have not yet been able to obtain in full (I have only the abstract right now)-- the authors identified the FIVE KEY PARAMETERS which they believe play the most important role in the way light interacts with skin and devised simple methods to measure these five parameters. Then they measured these parameters for 18 popular IPL devices and assessed variations in output. Their results show discrepancies between measured outputs and the values claimed by the manufacturers.

The first article ("Relevance of the Structure...") explains that there is a direct correlation between the ELECTRICAL discharge current profile and the output energy profile and suggests that IPL manufacturers should provide time-resolved spectroscopy graphs to users. BEFORE YOU CAN ASK FOR SOMETHING YOU NEED TO KNOW WHAT IT IS AND WHYIT IS IMPORTANT!!! Has anyone ever received these graphs from a manufacturer other than Cyden??

P.S.-- You need to know that these two studies were most likely paid for by Cyden, Ltd (the maker of the iPulse System). Nonetheless the information is excellent.

Hi,

thanks for the info.

One thing, you list a series of wavelengths for different treatments.

I would not think that IPL is the best or Firt line treatment for telangiectasia and reticular veins. Sclerotherapy is. AND, you don't have spent 50 K to do it.

OR, 1064 ND-YAG works much better than IPL and it works for hair removal.

So, since we are talking about truth about IPL, Why would I buy an IPL if I only wanted a hair removal and telangiectasia treatment machine?

Next there is the issue of Photofacials and IR, fractional etc.

A nice used IPL (I think sciton, plalomar etc are basically the same) would get results.

OR,

A good Erbium laser on low setting can get good results for pigmented lesions with one to two treatments and with a stronger setting work on wrinkles as well.

SO, why get IPL at all?

Isn't it really just an inferior device?

05.21 | Unregistered CommenterEMD

Anybody have any experience the Flex / I2PL unit from Ellipse?


05.21 | Unregistered CommenterTF

Well, I'll tell ya why you want an IPL; for flexibility mainly in treating caucasian pts...can do acne, HR, and photo rejuvenation. Yag is good for darker skin types and for vessels. But as long as I've been on these boards you want either a BBL or a Palomar (w/ on board cooling) to start with (IPL). anyways my 2 cents.

05.21 | Unregistered Commenterdermarogue

To download and print the complete IPL Dog & Lemon Guide, go to:

www.geocities.com/doglemonIPL/

Also posted there is the Absorption Curve for Oxyhemoglobin, Melanin and Water. Email any pictures or drawings to doglemonIPL@yahoo.com and I will post. "A picture is worth a thousand words"

05.22 | Unregistered CommenterCHMD

Anyone who can not see where a good IPL fits into any cosmetic practice has either never used one before or has been using inferior devices. I know we all want to believe that an IPL is an IPL just so we can justify paying a lower price for a Chinese knock-off but when you do your side-by-side comaprison, the differences are blatently obvious and I think the IPL D&L Guide lays down some very sensible guidelines.

Regarding the Elipse, I have to agree with the guide - it is over priced and does not measure up against good IPL's. It uses a quartz applicator without cooling, you need several handpieces to do all your applications, the tip size is small and the lamp only lasts about 30K shots - the dual cutoff filtering is just a marketing tool to turn a negative attribute into a positive one - if only they designed it properly with sapphire integrated cooling!

Service Tech,

What type of IPL do you have? Do you like it? Are you an owner or do you work for one of the companies? Which IPLs do you like and which do you think are inferior?

05.22 | Unregistered CommenterCHMD

EMD,

We use our BBL for diffuse redness and very small telangectasias. We have a 1064 as well but BBL gives us better results for this. The absorption is so low in superficial structures that the above treatments are better suited for BBL. Regarding hair, we also use our 640 filter to treat the finer, lighter hair that 1064 doesn't seem to treat very well. Again, without much of a chromophone 1064 just doesn't work as well as BBL (and yes, we use very short pulse widths with 1064 to treat these smaller structures). There just isn't enough melanin to target. We commonly use both modalities together (same treatment) and find that our results are better than a single technology. Obviously we don't do this on large areas like back and legs but most of our hair removal is axilla, bikini, face etc. The BBL pigment filter allows us to treat browns on the face without any downtime. I agree with you that erbium is also good for this. However, we don't like to use erbium on the chest, hands, arms etc. so BBL is a better choice for us. We also have a blue light filter that we use for reduction of acne and non-invasive skin tightening that we can use on the jowls, stomach etc. In my opinion BBL is not an inferior device to erbium and 1064, it's just different. It allows a broader menu of services for our clinic. with that said, we love our erbium laser. And by the way, I'm a Sciton homer but I think the same theory would apply with other IPL manufacturers if you get the correct one.


05.22 | Unregistered Commenterdexter

In addition to med spa guy comment you should also read the following paper:

"Time-resolved measurement shows a spectral distribution shift in an intense pulsed light system" (Eadie E, Miller P, Goodman T, Moseley H) Published in Lasers in Medical Science, 2007

It explains a lot of the physics but BE VERY CAREFUL!!! This paper can only hypothesise about the clinical implications, nothing has been proven clinically. The same goes for the CyDen papers. Useful information but don't rely on them for purchasing an IPL and don't be fooled by pretty pictures. Look for the scientific content!

05.22 | Unregistered CommenterDJ

Dexter,

Thanks for your response.

So I guess to be a complete cosmetic clinic one should have both a quality Laser and IPL in the office.

I see many practices choosing one over the other due to financial constraints.

In my area most use lasers but there are a couple of large practices that chose to go with palomars starlux 500 system due to it's numerous applications.

I have looked at this system and wonder if it will be enough or if I should have a 1064 or 810 diode just to be able to get the maximum results with the combination the IPL and Laser.

05.22 | Unregistered CommenterEMD

we owned a lightsheer and put over a million pulses on it. great laser, but I have to say our results are equivalent with 1064 and BBL and this combination gives us many more revenue streams for the dollar invested. Lighsheer only does hair removal. I hear good things about the Starlux. We actually own a medilux (it was our first ipl) and it has been great, but we only use it now as a backup to our Sciton bbl. i've been posting on this site for a long time and it seems the consensus is that Palomar and Sciton are the best ipl's. If you are considering palomar give the sciton a try as well.

05.22 | Unregistered Commenterdexter

Dexter

Which sciton?
Does sciton have a machine with both IPL and 1064?

05.22 | Unregistered CommenterEMD

Yes they do. Our system has BBL, 1064 and an erbium with profractional. Our other system has 2 1064's, 1320, erbium and BBL. We also have a EVLT/Laserlipo unit with fiber delivered 1320 and 1064. I told you I was a homer didn't I?


05.22 | Unregistered Commenterdexter

dexter,

I use a diomed for my EVLT cases. Now they are out of business.

I appreciate all your info. I will look into the Sciton.

05.22 | Unregistered CommenterEMD

CHMD

I am a service engineer for Sciton and I have years of experience with their products. I am very impressed with the precision and accuracy of the BBL at all the filtered wavelengths but what is most impressive is the long term stability of the device. I have some systems with 341K pulses and still performing like new. Without giving away too much I can say that the BBL is technically different from common IPL's - there are several key design factors that make the BBL king of IPL's in my opinion. The clever design of not just the BBL, but the entire Profile Modular Platform is a real credit to its developers - well done!

Service Tech: Perhaps you can answer a question about the BBL filters. The Sciton literature mentions a 590 nm "filter". I suspect that it must not be a standard "cut off" filter as absorption by oxyhemoglobin falls off precipitously at 600 nm and does not come back until about 1000 nm. Do they use a pass through filter instead???

How much does a sciton with BBL and 1064 cost?

05.23 | Unregistered CommenterEMD

in the $120,000 to $130,000 range.

05.23 | Unregistered Commenterdexter

dexter what % of hair is removed with Sciton after the 5 or 6 treatment sessions are done. 50, 60 70, 80% etc.

05.23 | Unregistered CommenterEMD

med spa guy: Most of the vascular work with the BBL is done with the 560 filter. The 590 filter is used for FST V @ 10-13J/30ms/15 deg cooling where we want more protection for the pigment. Although the protocols dont indicate the 515 for vascular, it works wonderfully on redness and vessels up to 1mm ... but only use on FST I-II. The larger the vessel, the longer the PW and the higher the fluence, and watch for the endpoints. With the exception of the 420 filter (bandpass 410-430) and the SkinTyte (800-1350), all other sciton filters display a sharp cut-off below the specified wavelength).

Wow..didn't know there were so many different kinds of treatment.
Thanks for pointing this out!

Service Tech,

Do “Twin Flash Lamps” in a figure “8” configuration overcome “Perimeter Loss” and how does this work (in detail)?

Could you explain this in more detail? Palomar says that it does not matter.

05.30 | Unregistered CommenterCHMD

Everyone,

Working with many Laser Companies, one of my big problems with most of these companies is their Continuing Education. their Clinical Exchange Programs, their On-Call Clinical Support and their Formal Ongoing Education.

Check out:

www.geocities.com/clinicaleducationexchange/

for more information about Continuing Education and Clinical Exchange Programs.

Where is Palomar? I would think that if they had a better IPL they would have one of their reps blogging here to educate us. I am ready to buy a Sciton IPL, but would love to hear why I should buy a Palomar IPL.

Hey, Palmar. The duel flashlamp sounds great! Why should I buy your IPL if all you have is photon recycling and photon recycling does not work?

Service Tech,

What are the best wavelengths and algorisms for treating Rosacea and Pigmentation in “patients of color”?

05.30 | Unregistered CommenterCHMD

Where is Cutera? Don't they have an IPL (LimeLight)? Don't they have something to say about IPL technology? The IPL Dog and Lemon Guide basically says not to even consider Cutera.

I am trying to get Palomar to answer some simple questions posed by the Dog and Lemon Guide. They won't engage in any meaningful discussion. All they say is that "we are the best", "the guide is biased" and "we invented everything and we are suing everyone".

It sounds like Palomar sucks. It sounds like they don't know anything. I seems like they don't care to convince me that the Dog and Lemon Guide is wrong.

They are so arrogant that I am beginning to think they are idiots!!!

Are they idiots?????????? Do they think I am an idiot? Do they thing we are idiots?

I am beginning to Hate Palomar. It is this type of attitude which holds this field back and allows horrible products to be sold to naive doctors.

My advice to Palomar is to engage in this discussion. Stop being so arrogant or your sales will plummet because no one will think you know what you are doing or selling.

What is up with Cutera,

The dog and lemon was written before Cutera had the LimeLight. They only had the 560 and 600 IPLs when it was written and they were way underpowered. I used the LimeLight on about 7 patients and felt that both the Sciton BBL and the Palomar were superior.

06.2 | Unregistered CommenterLH

I think the Dog and Lemon is a great jumping off point for all the IPL companies to make their case that they have a device worth considering. Cutera should be on this blog making the case that they should be considered. Why is LimeLight as good as or better than Sciton or Palomar. Their silence is deafening!

CHMD

I do watch alot of doctors using the Sciton but I do not actually treat patients myself so it would be irresponsible for me to offer clinical advice. Perhaps Charry would be a good person to ask as he treats predominantly Mediterranean skin types - sorry.

CHMD

Flash lamp life decreases exponentially as the lamp current increases so the twin lamp design offers several major advantages over single lamp systems. The main advantage is dramatically extended handpiece life (>300K) and long term stability because the load is shared. Another is the spectral output of a short-arc lamp compared with a long-arc, hence the extended BBL bandwidth of 410-1400nm. Light decays in proportion to the square of the distance from the source so picture a fluorescent street light and imagine the street is the skin, the most intensity is directly under the lamp and this decays to either side. This is a typical characteristic of IPL's which some manufacturers try to overcome by making the tip phicically narrow or by requiring spot overlap. The BBL uses the second lamp behind and a parabolic reflector to "fill-in" the edges where the front lamp fades - this allows the device to offer a wide applicator (15mm x 45mm) with very homogenious energy delivery. Another factor contributing to this even energy distribution is the 50mm long sapphire light guide. Another key feature of the BBL is the square spectral output across the entire bandwidth - how exactly this is achieved I will not tell but you can prove it for yourself with a laser power meter. The tip is 6.75cm2, so if you set the output to 20J/cm2 you will see 135J on the meter. This output is maintained irrespective of the pulsewidth or the inserted filter. There is far more behind a good IPL than you can imagine so it is far easier to leave these things to the experts. Simply try different devices side-by-side and compare the results for yourselves, and always do your sums regarding lamp replacement cost vs lamp life vs shots per Tx etc... what may seem to be a cheap IPL can cost you dearly in the long run.

I am considering a fotona 1064 and erbium. any practice experiance? comments?

06.5 | Unregistered Commenterbvbmd

Fotona seems like a bit player. I don't know much about them. Read the IPL Dog and Lemon Report to find out what to look for in a laser company. This is about IPLs but you can use it for any type of laser.

Make sure the laser works and make sure the company has great support. Make sure the sales people are telling you the truth. Make sure you contact people who have that laser to find out how they like it and how they like the company. Make sure they have had the laser for at least one year.

06.6 | Unregistered CommenterCHMD

I am re-reading "IPL & Lasers, Technology Reviews, Studies + Reports".

There is a great discussion between LH, SpaDocinCR, Charry and Dexter. It is from April - May 2007. If you want to hear some great stuff about the Dog and Lemon Guide, abaout Sciton, Palomar and Laser Hair Removal, I suggest you print the discussion, read it and study it.

The truth comes out in great discussions like this.

This is what I love about The IPL Dog & Lemon Guide. Finally someone had the balls to write a report about IPLs.

Sure it might be biased and is probably not completely correct, but at least someone took the time to write a well-written, thorough review of the IPL systems on the market.

Instead of whining about it and attacking it, I think Palomar and Cutera and Cynosure should write their own Guides, their own reviews. These laser companies don't have the balls to write anything down. They are a bunch of whimps who whine and complain about everything. Their corporate lawyers tell them not to put anything in writing. They don't want to be "deep pockets" in case someone sues someone. They are a bunch of cowards who want our money and want us to believe all their lies.

The thing I love about The IPL Dog and Lemon Guide is that it gives us something to read and to debate. The thing I love about MedicalSpaMD is that it gives us the platform to have this debate.

The laser companies hate "The Guide" and they hate "MedicalSpaMD" because they don't want us sharing information and communicating. They can't lie to us and decieve us and sell us lasers that don't work if we are all taking and sharing experiences.

God bless "The Guide" and God Bless "MedicalSpaMD".

Let's keep talking and lets keep sharing information. This is the only way to keep the big companies honest. This is the only way to make sure we do the best treatments for our patients. This is the only way to be the best doctors and best providers we can be.

LH, SpaDocinCR, Charry and Dexter. Thank you for sharing your experiences and your thoughts. It has helped me a great deal.

06.7 | Unregistered CommenterCHMD

Sorry I meant this tread:

"IPL Reviews and Comparisons: Download the IPL Dog and Lemon Guide PDF"

06.7 | Unregistered CommenterCHMD

CHMD: If you REALLY want to get into the thicket about the true science and technology of IPLs, try to get and read a copy of each of the articles I cited in my May 21 comment on the thread you mention above. The spectral output of each selected wavelength utilized, the various types of capacitors used (i.e., partial discharge vs. full discharge, etc.) and different types of filters (cut off filters, band pass filters, "electronic" filters, etc.) other such factors make a great deal of difference in the efficacy, safety and comfort of each device.

Med Spa Guy,

Could you repost the articles. I would love to read them.

06.8 | Unregistered CommenterCHMD

Med Spa Guy, This was your Feb 28, 2008 post. Is this what you were referring to? I belive that pmdoc had a few concerns with the reliablility of this souce. I will look at it and comment. I encourage others to do the same. Med Spa Guy, you are a spa owner and an attorney. Is that correct?

"I recently came across an interesting article posted by a consultant at www.brianmarshall.com which contains a number of interesting observations and opinions about pulsed light devices. Since I have heard a great deal about "pulse trains" being touted by both laser and pulsed light manufacturers over the years, I was surprised to read his comment about this as follows: "Some manufacturers suggest that they have 'variable pulse' or 'pulse trains' in order to achieve a wide pulse. These systems are still the early generation of ...systems that use a series of bnarrow (under 7 msec) pulse widths with high wattage and with pauses in between each short pulse."

"This offers no protection against hypopigmentation as each pulse is of short duration combined with a high wattage output. Or each pulse is of very low power with too long a pause in between to sustain correct heating. Pulse trains DO offend the Thermal Relaxatin TIme theory, which states that the TRT is the time it takes a body to lose half its heat. This means that the long pauses in between the spikes are wasting the effect of the energy applied. With no pulse width in the nanosecond range, protecting the skin from thermal damage, vitally important factors are CONTACT COOLING and SINGLE wide [long] smooth pulse widths."

I have noticed that most of the leading IPLs today (Sciton, Palomar, etc.) appear to be using only single pulses. Earlier versions of the original Lumenis models DID utilize pulse trains, but I do not know if the new model (i.e. Lum 1) does or not. Any opinions on this issue from the laser brainiacs out there? Does Brian Marshall know what he is talking about? How about the fact that Candela just started promoting pulse trains for their pulse dye laser (and claims it helps minimize purpura)??"


02.28.2008 | med spa guy

06.8 | Unregistered CommenterCHMD

This is pmdoc's observations about the article:

"medspaguy:
I carefully read the article on brianmarshall site. First of all, it was in 2005. Overall it was an impressive one with quite insightful information. Here are some problems thu:
1) Point #14:TRT of epidermis is 3-10ms range. "the PW should be kept LESS than this to prevent thermal damage". This is INCORRECT, PW should be kept MORE than this to prevent thermal damage.
2) Point #17: The example is proof of my point mentioned above. However the adverse rxns can be hyper and/or hypopigmentation. Obviously to treat a type V or VI to drive home only the hypopigmentation point is misleading at best
3) point 18: to imply that attempt to minimize AE's is by keep the PW down is wrong and contradictory to facts since the way to go would be to PROLONG PW to 20-40ms, especially in hair removal. Hair follicle TRT is 20-40ms anyway. The pulse train and variable pulse concept is INAPPROPRIATE one to even apply here. By the way, I am not sure of these terminologies anyway.
4) Point 22: 650nm or more: safe for darker skin: we know it is wrong now. The only one that is safe is 1064 Nd-YAG
5) Point 23: We now know air cooling in general is safest in reducing risks of PIH compared to compressed cryogen and contact cooling
6) Point 31: the first paragraph was accurate about bi-polar RF, but then on the second paragraph, he mentioned of burning (probably he meant it with the first generation 1.0cmsq thermage tips). Then he mentioned no peer reviews, probably correct about BF RF but INCORRECT about monopolar RF since it has lots of peer reviewed articles by 2005 already. They are still posted on thermage website.
SOOOOOOOO, what is Brian??? The chicken or the fox?????"

03.3.2008 | pmdoc

06.8 | Unregistered CommenterCHMD

Med Spa Guy,

I just looked at the report and I am printing it so I can read it in detail. It looks well done. We have the Dog and Lemon and now we have the Fox and Chicken. Let's read it and start the debate!!!

www.brianmarshall.com

Thanks for the tip!

I would be interested in LH, Charry's, SpaDocinCR and other's opinions on this report. pmdoc, thanks for your initial impressions.

06.8 | Unregistered CommenterCHMD

CHMD: Here is a re-post from the other thread...

MORE IPL INFORMATION: I believe the IPL "Dog and Lemon" document is somewhat helpful (I agree that it is a good start) but many of the comments need additional discussion. Although pulsed light devices seem rather simple, I have found through a lot of digging that they are far more complex than I first thought. The technology of the flashlamps, "free discharge" capacitators, dichroic vs. absorbative filters, "cut off" vs. pass through filters are all critical--and the list goes on and on. I have found a couple published articles that are much more in depth and will REALLY educate you about the key parameters for a first rate IPL system. Check out--

"Relevance of the Structure of Time-Resolved Spectral Output to Light Tissue Interaction Using Intense Pulsed Light" (C. Ash, G. Town and Peter Bjerring) Published in Lasers in Surgery and Medicine, 2008 Wiley-Liss, Inc.; and

"Measuring Key Parameters of Intense Pulsed Light Devices" (G. Town, C. Ash, E. Eadie and H. Moseley) Published in the Journal of Cosmetic and Laser Therapy, V. 9, Issue 3 2007.

In the latter article- which I have not yet been able to obtain in full (I have only the abstract right now)-- the authors identified the FIVE KEY PARAMETERS which they believe play the most important role in the way light interacts with skin and devised simple methods to measure these five parameters. Then they measured these parameters for 18 popular IPL devices and assessed variations in output. Their results show discrepancies between measured outputs and the values claimed by the manufacturers.

The first article ("Relevance of the Structure...") explains that there is a direct correlation between the ELECTRICAL discharge current profile and the output energy profile and suggests that IPL manufacturers should provide time-resolved spectroscopy graphs to users. BEFORE YOU CAN ASK FOR SOMETHING YOU NEED TO KNOW WHAT IT IS AND WHYIT IS IMPORTANT!!! Has anyone ever received these graphs from a manufacturer other than Cyden??

P.S.-- You need to know that these two studies were most likely paid for by Cyden, Ltd (the maker of the iPulse System). Nonetheless the information is excellent.

Thank you, Med Spa Guy! I will find and read. The Brian Marshall Report was a great find. It seems to be somewhat flawed like the Dog and Lemon, but it gives us a great nidus to start an important discussion about IPLs. Together hopefully we can find the truth.

This is what I want to post today to stimulate people to look back and then forward as we try to sort out fact from fiction:

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

I want to bring some of this old blog into our new blog. There was a lot of great information about IPLs and Hair Removal. Most was from May 2007.

Is this information still current? Do the key bloggers (LH, SpaDocinCR, Charry & Dexter) still have the same opinions one year later? See the original posts in the above blog for further details.

This is my summary of their setting recommendations and a series of questions that I have after rereading this great blog. I am currently looking into IPLs for my practice. BBL and Palomar are the leading contenders at this point.


Settings Discussion for Hair Removal (I will post more on other topics like Pigment Removal and Vascular Treatments with the IPL soon):

Hair Removal:

Palomar StarLux: 650 Lux R: Skin Type (ST) 1-3: 20-30 j/cm2; 20 ms
SpaDocinCR ST 4: 16-40 j/cm2 60 ms
ST 5 16-40 j/cm2 100 ms
ST 6 16-40 j/cm2 200 ms

Sciton BBL: ST: 1-3: 640 nm; 18-20 j/cm2; 15-25 ms
LH, Charry, Dexter: ST: 4: 695 nm; 18-19 j/cm2; > 20 ms

Lip and Chin are difficult areas to treat

Nice discussion of using double pass to treat difficult areas

One protocol is to do IPL first and then 1064
Other protocol is to use IPL twice. First pass at 20 ms and second pass at 100 ms.
See the other blog for details (May 2007).

Some practitioners are thinking that long pulses might work better on dark thick hairs!
(I will be posting Thermal Relaxation Times for Hair and Epidermis soon – www.geocities.com/doglemonipl/ )

Longer pulse durations and longer wavelengths are always safer on darker skin types. See Melanin Absorption Curve at www.geocities.com/doglemonipl/ . Do these longer pulse durations really work?

I will also be posting www.BrianMarshall.com on the www.geocities.com/doglemonipl/ site. This will be a place you can go to see full reports and reference material like the Melanin Absorption Curve and Thermal Relaxation Time Graphs. Hope you enjoy.

These are my questions:

1.How can BBL do the job with only half the fluence of StarLux? I don’t buy Charry’s explanation about better filters. It does not make sense unless Palomar filters block out light in the active wavelengths (are their filter “clogger rather than clean? - I am thinking of my air-conditoning filter when I clean it).

2.There is some talk about square pulses vs other type of pulses. What is a square pulse and why is it better than a series of short pulses which approximate a square (see The IPL Dog and Lemon Guide page 17. www.geocities.com/doglemonipl/ .) The Dog and Lemon Guide explanation makes sense to me. www.brainmarshall.com also covers this topic (I have not read it yet).

3.Is BBL underpowered for Hair Removal (max 30 j/cm2)?

4.LH, after one year with your BBL, how do you like it? How does it compare with the Cutera IPL?

06.9 | Unregistered CommenterCHMD

CHMD: Once you read the two articles I cited you will be able to answer most of your questions yourself. One thing that is very helpful is to find out from busy practitioners like LH and Charry what energy fluences they actually use to perform treatments. You will see that the various advertising claims about "high power" are largely irrelevant. The real determining factor is how high you can go using any given filter on the patient you are treating without causing a burn or pigmentary change. The reading on the control panel is just a means of keeping track of the energy levels you are using so you can record them in your charts -- the skin will tell you when you have gone too high. This is why test spots are so critical - with a 24 to 48 hour observation window. Per David Goldberg, the key is to use as much as much energy as you can short of causing a blister! Many practitioners use insufficient energy to give good efficacy. That is certainly a safe way to proceed-- but you will get poor results and have unhappy patients.

CHMD

1)The filters are the most important issue for an IPL.The relative output in comparison of the filter wavelengths for the BBL is very high for the wavelengths near the filter wavelength and is low for the other non-active (eg.for HR) wavelengths.
2)As ServiceTech posted "The BBL uses the second lamp behind and a parabolic reflector to "fill-in" the edges where the front lamp fades - this allows the device to offer a wide applicator (15mm x 45mm) with very homogenious energy delivery....Another key feature of the BBL is the square spectral output across the entire bandwidth - how exactly this is achieved I will not tell but you can prove it for yourself with a laser power meter...This output is maintained irrespective of the pulsewidth or the inserted filter"

These two main featurs give the BBL the title "Leader of the IPLs" and that's why is doing the job with only a half fluence of Starlux...It has equal and even better results from my Alex 755nm (a Photogenica LPIR by Cynosure).

06.9 | Unregistered CommenterCharry

CHMD,

1. I think a really important thing for people to understand is that the numbers on the screen aren't always reflective of what energy is actually being produced. why? 1. Lamps degrade over time. The energy you start with on a new lamp is not the same energy you get after you put pulses on it. You may start off using 20J/cm but end up using 40 J/cm after 10,000,20,000,40,000 have been put on the system. When we did a self calibration on our medilux it told us that we were only getting 50% of the energy the screen predicted. 2. This is because most IPL's (and lasers for that matter) do not calibrate the energy at the handpiece. It may predict on the screen that you are getting 20 J/cm but you might actually only be getting a fraction of it. Again, I think a case for BBL dual lamps because they don't put the same kind of stress that a single lamp does. The BBL dual lamps share the load. In other words, you are not "red lining" the lamp. Maybe this is Sciton hype but we have seen it to be true. We are using the same energies two years into our BBL handpiece and have not replaced it.
2. It's my opinion that the pulse train argument can be taken out of context. Pulse stacking is not necessarily bad if you can deliver the micropulses so that the second micropulse is delivered quickly enough after the first (and so on) that there is no temperature drop off. This is somewhat of a power issue. The context it was used in initially was with regards to Lumenis IPL which delivers triple pulsing because it doesn't have the power to deliver it in one.
3. I hope the first two tells the story about power. BBL is not underpowered. We only use 20J/cm and it is more than enough. The protocols actually call for lower energies.
4. defer to LH


06.9 | Unregistered Commenterdexter

I have had a TERRRIBLE experience with the Fotona- not the actual machine but the service and support system they have. I would NEVER recommend them to anyone- do not buy from them. They are all about selling you a $150,000 machibne an dthen do no follow-up or training and are completely understaffed and incapable of helping you once you have their laser.

That last post was very poorly written. I apologize. We purchased a Fotona 1064 in 2005- and were told it was the most advanced best laser on the market. We were new in the Medical Spa industry and did not do our homework. Three years later we are disgusted by Fotona- their lack of support, training options, assistance and professional ethics. Anyone considering purchasing one is free to e-mail me and I will tell you all about our experience and how terribly they have treated our practice. It is a great machine- but we have learned the hard way that even if you have all of the technology without the proper vendor support you are not getting your money's worth. There is only ONE customer service representative for the entire country- a nurse Robin Sult who also runs her own practice in addition to constantly traveling out of the country to sell the laser to anyone who will buy it. And her husband their new medical director Dr. Tom Sult is abrasive and rude and completely unhelpful.
Our practice's next step is investing in an IPL.
We are considering the Palomar StarLux 500.
Has anyone heard of the Quanta?
I love this forum and am so grateful there is a place to come together and exchange information! I wish we had known aout it before we purchased our Fotona.

Dear LH, CHMD, Dexter, MedSpaGuy, Charry, Dr. Fiala, MichiganMD:

I find these discussions very interesting. By the way, another MD and I have been trying to organize a meeting with some of you here in November. Please send me your email addresses so we can try to reach you with more information. My address is: pmhdoc@gmail.com. I will also respond to some of your postings here about IPL's later. Thanks

06.9 | Unregistered Commenterpmdoc

Glow MedSpa,

Check out the BBL by Sciton. We are also getting an IPL soon. We have it narrowed down to Sciton and Palomar. Sciton is currently in the lead because of cost of purchase, cost of use, and other reasons. Let's share opinions as we move along. Two brains are better than one!

06.9 | Unregistered CommenterJEE

My sales rep told me that the warranty on the BBLs is Three Years and Unlimited Pulses. He said that the BBLs can last up to 1 million pulses because of the Duel Flashlamps.

06.10 | Unregistered CommenterMDP

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