The State of Aesthetic IPLs & Lasers

In the last few years there's been an explosion of new IPLs and cosmetic lasers.

While that's generally good for clinics - inducing some competition and pricing/sales pressure - it can be a problem trying to find the right system to invest in.

READ: Cosmetic IPL & Laser Reviews & Comparisons Forums

In 2011, Dermatologist Dr. Goldman wrote a journal article about using what kind of laser should be used for the practice. In the present, there are devices that have multiple modalities and treatment options, you can have a single laser device instead of two or more. These devices are now made convenient for physicians and practitioners.

Lasers are steadily gaining traction in the aesthetic field. Many aesthetic devices have been launched, and various companies continue to upgrade their devices or create breakthroughs. Physicians are able to choose devices, which is suitable for their practice, as there are many ranging from skin rejuvenation to fat melting to even vaginal rejuvenation. At the same time, not everything has been met with praise, as lasers have its downsides for the patients or the physicians or practice itself. Thus, it is best that physicians and practitoners practice laser treatments with care.

Multiple treatments are common in many practices. More and more aesthetic companies are making more integrated systems with multiple modalities. Alma, Sciton, and Cutera are some of the aesthetic laser companies that have begun or launched a multiple modality device for one’s practice. No studies have been made about the efficacy of using multi-modality systems, but the technology is promising.

Having multiple modalities could mean multiple or combination treatment options. Effectiveness has been proven in several studies. Prior to multiple modality in a single device, physicians have been combining treatments.

Findings:

• In a dermatologic setting, treatment of non-melamona skin cancer with laser and photodynamic therapy was proven successful and effective. Er:YAG and ALA-PDT had the most efficacy rate with 98.97%
• Goldberg, 2012 suggests that IPL is better at removing hair considering it will be done with multiple sessions
• As for skin rejuvenation, an alternative to fillers would be repeated Erbium:YAG laser mini-peels (El-Domyati et al., 2013), leaving patients with an average of 88% satisfaction rate after the treatment.

Lasers remain to have some controversy over lawsuits filed by patients and complications brought about by its usage. One common issue faced by practices is negligence or mishandling by a non-physician administering the laser procedure. Several state laws allow non-physician practitioners, so long as the doctor is present in the practice. However, unhappy patients experieince some adverse side effects possibly due to poor handling and patient screening.

Training is important to avoid any of this concerns to rise and be the cause of lawsuits. According to E. Victor Ross, dermatologist, vigilance is key when administering laser treatment.

In 2016, a study was published by Dr. Gary Chuang, noting that fumes were present in a laser hair removal system. There are 13 carcinogenic compounds present in the laser hair removal plume. It is a cause for alarm as it could affect the respiratory systems of those performing the procedure and those receiving it. The researchers suggest that better ventilation systems and protection would help prevent any further issues.

Aside from this finding, Laser Service Solutions provides us with a list of common issues with laser devices. Technical issues like LCD screens and circuit boards should not be taken lightly. Other problems include: water issues, calibration, and handpieces.

It is expected that despite issues and problems, aesthetic laser procedures will still rise according to several market research reports.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376014/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632833/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100114/

http://dermatologytimes.modernmedicine.com/dermatology-times/news/laser-fundamentals?page=0%2C1

http://jamanetwork.com/journals/jamadermatology/article-abstract/2532614

https://www.laserservicesolutions.com/most-common-aesthetic-laser-issues/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376014/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632833/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100114/http://dermatologytimes.modernmedicine.com/dermatology-times/news/laser-fundamentals?page=0%2C1http://jamanetwork.com/journals/jamadermatology/article-abstract/2532614https://www.laserservicesolutions.com/most-common-aesthetic-laser-issues/

Cynosure SculpSure

SculpSure is a laser-based non-surgical treatment that apparently melts abdominal fat. The treatment is recently gaining more interest as it claims to be the first system to do such a procedure. It was only in late 2015 that the Food and Drug Administration (FDA) that the department approved the use of this treatment for patients.

During the procedure, four flat non-suction applicators and contouring frames are placed in the area where the adipose tissue cells will be burned. According to Cynosure, the company for SculpSure, the wavelength (1060 nm) has an affinity towards the adipose tissue. They use a Proprietary Energy Modulation method elevating subdermal temperature from 45 up to 47 degrees Celsius. Despite the heat, cooling is available making the patient comfortable. They claim that up to 24% of fat is reduced in a span of 25 minutes.

The company has had patients try their procedure before after one to two treatments, showing significant changes in their abdominal area. A weight change may or may not occur; even gain after 6 weeks is possible. No data regarding diet or behavioral habits are revealed which could explain the gain or loss.

Considering the effects after six weeks, a study referenced below investigated a low-laser light treatment (LLLT) done weekly in a span of six weeks. The study’s results proved to have high very satisfactory ratings (54%) for participants. Thus, the study may imply that prospective patients of laser-based fat destruction treatments may consider the effects based on the research’s findings.

Dr. Thornfeldt, Dr. Thaxton, and Dr. Hornfeldt find that:

"subjects undergoing LLLT experience no treatment-related discomfort or other post-treatment adverse effects. In addition, the six week protocol will allow[s] for a more convenient treatment plan, further increasing the likelihood of overall patient satisfaction."

Eventually, it is the patient’s decision whether to try the breakthrough SculpSure or find another one that may suit their needs (and possibly their budget). SculpSure ensures that the procedure is done quickly and after one to two treatments, with results showing after 6 weeks' time.

Study:

Thornfeldt et al., 2016

Medical Spa MD Podcast: Dr. Thomas Young & Smartlipo

In episode 8 of the Medical Spa MD Podcast, Dr. Thomas Young of Young Medical Spa discusses new Smartlipo techniques and training, choosing cosmetic lasers, and cosmetic stem cell treatments.

We discuss the latest trends and nonsurgical cosmetic technologies including Smartlipo, stem cell treatments, laser liposuction, technology choices and integrating new surgical techniques into your cosmetic practice.

Dr. Young began performing SmartLipo Laser Body Sculpting soon after it's FDA approval and was the first physician to introduce awake tumescent laser liposuction to the Lehigh Valley. He trains other physicians across the country in awake tumescent liposuction and liposculpture procedures and was the first physician to perform Vaser® Lipo, SlimLipo, Body-Jet®, Stem Cell Enriched Fat Transfer Natural Breast Augmentation, Brazilian Butt Lift, ZERONA, VelaShape, and the Soprano XL Pain-free Laser Hair Reduction procedures in the region.

Cosmetic Lasers, User Groups & Clinical Exchange Forums

Medical Spa MDs forums are getting some TCL.

With tens of thousands of comments, the navigation menu had pretty much outgrown the the previous navigation and was bursting at the seams. The only way to really drill down and find information was to search, and that's somewhat clumsy since you have to know what you're looking for.

We spend the last couple of days and nights attempting to create a better system that allowed physicians to brows by topic as well as have access to holistic search functions. It's still in need of a little tweaking but we're letting you see it now.

Medical Spa MDs new forums are divided into four broad categories:

• Medical spa business

  that includes legal and marketing and advertising forums.

• IPL & cosmetic lasers grouped by manufacturer 

  You'll find a special forum on cosmetic laser & IPL reviews and comparisons as well as forums for Palomar, Cutera, Sciton, Lumenis, Candela, Cynosure, Sineron, Alma, Solta and others. I've also put all of the IPL & cosmetic laser user groups in one place.

• Physician clinical exchange

• Used cometic laser classified listings

These changes to the forums combined with the new area for Medical Spa MD Select Parterns should allow you to navigate the site and find information that's relevant to your needs more easily... at least I hope so.

We'll try to manage the places that posts are found and move them to the appropriate location when we can. Of course there's a huge amount of overlap. I've included pretty much any fat removal treatment under the Bodyscupting & Liposuction forum for example. While it's not perfect, I think it's much better to have only a few forums that you can peruse.

If you haven't used the forums before, please do. We have a very active physician community who are very helpful. Many of the best threads on the site were started with physicians asking very specific questions around treatments, techniques, and other 'down in the trenches' queries.

If you would like to have a forum added or think we've missed something please let us know. If there's enough content or interest we'll add it.

Also, if you're a physician who has some great information or something to say on any topic, please submit it as a guest post and help everyone out.

Zerona Lasers

Thoughts on Zerona Lasers

LH (Dr. Lornell E. Hansen II MD) has this comment on the latest Zerona Lasers review discussion around the effacacy of Zerona for 'fat melting' and a study that was just released.

Here's the Zerona Body Sculpting Study

Low-Level Laser Therapy Effectiveness for Reducing Pain After Breast Augmentation American Journal of Cosmetic Surgery Vol. 26, No. 3, 2009
Robert F. Jackson, MD; Gregory Roche, DO; Todd Mangione, DO

LH's comments:

...I do have to apologize as I did not know that the article had been published. The last I had read was that it was waiting for review. I also want people to understand that I am not saying that the physicians involved in the study did anything wrong with my evaluation of the article. I just think that the company is over marketing the product and charging way too much.

My critique:

1. The first thing they teach you in medical school on how to evaluate research is who paid for the research. In this case the sponsor of the research and article was Erchonia the company that makes Zerona.
2. Who wrote the article? In this case the article appears to have been written by Ryan Maloney. Who is Ryan Maloney? He not only is the medical director of Erchonia he actually has ownership in the patent of the Zerona. Other than that you do not know his background. We know he is not a PhD or physician otherwise it would be behind his name under the authorship of the article. He has a direct financial benefit to write the article in a positive light.
3. 8 Individuals did not have final measurements. The first question is why? 4 were from the treated group and 4 were from the placebo group. At first that seems OK, but when you look further into they kept all of these test subjects included in the study. What they did is they took the last measurements for those subjects and carried them forward. Again seems Ok at first but when you start to look at the trend of circumferential loss at the 2 weeks post treatment the measurements are trending back toward baseline. So if you include these patients last measurement (which by the way is the best overall average circumferential loss during the treatments for the treated group) and carry them forward they will artificially lower the true values two weeks post treatment. All 8 of these subjects should have been eliminated from the study.
4. There is no assessment of cosmetic benefit. To have this be worth something you would need before and after pictures that are reviewed by a group of individuals that are blinded to which treatment the individual participant received. So in other words is a 3 inch loss aesthetically significant.
5. They do not state if participants are male or female. So the question is left, does it work as well on males as it does on females? This could be very important as males tend to have thicker skin so does the laser penetrate as deep in men?
6. the study was limited to patients with a BMI of 25 to 30. Now I think it is fine to have this limitation as you have to start your research somewhere. But the limitation is that the article is implying that it will work for all BMI's. What about the thinner female patient with a BMI of 20 but has a small lower abdominal pooch? Or what about the patient that has a BMI of 35? This should be stated in the conclusion but Mr. Maloney seems to forget this.
7. They also do not state if the patients received their treatments for free or if they were compensated for their time. This is only important for the portion of the study that talked about the patient satisfaction. We need to understand that patients will put a value on the treatment because if something is free their expectations are much lower. their expectations are much higher if they paid $2500 for the treatment. So if this was free to the patient and you have 30% of the treated group that are dissatisfied or neutral what would that mean to a clinic if the patients are paying for it. I would guess you will have a much higher dissatisfied group that either wants their money back or free treatments. I do not want something in my clinic that has a 30% failure rate.
8. They do not discuss if either group was asked to change their diets. This should be stated up front in the methods portion of the article. They also do not mention if there were any dietary supplements required such as niacin. Most clinics using Zerona are having the patients take niacin even Erchonia recommends it.
9. They set the standard for success to be an inch loss of 3 inches or greater. Only 62.86% of the treated group achieved success. So this translates in to a 37.14% failure rate. Again, not something that I would want to stake my reputation on.
10. Now what do the numbers mean? If you look at the numbers the patients baseline combined measurement average was 120.31 inches. At week 2 of treatment (the best measurements achieved) the average was 116.79 inches or an inch loss of 3.52 inches on average. This sounds pretty good until you look at the true numbers. Using the numbers from the study this equates to a 2.9% inch loss as measured over 4 areas. Is this clinically (visually) significant? I do not think that most individuals will be able to see a 2.9% change or if they can it will be meaningful.
11. Lets take a look at the 2 weeks post treatment measurements. Remember, these are not true numbers as 4 patients had their best numbers included in these measurements pulled forward and included here. (I think all of their measurements should have been puled out). At 2 weeks post treatment, you see a 0.31 inch increase from the circumferential measurements at the 2 week treatments. What this equates to is an 8.8% increase in inches in only 2 weeks. So what happens at 4 weeks? 6 Weeks? So if it were a perfectly linear increase it would only take about 20 weeks or so to be 100% back at baseline. That is if it were linear and I highly doubt it is a linear response and if i had to guess most patients will be back at baseline measurements within 6 to 10 weeks and this is why there are no long term studies. The company has had ample time to produce longer term studies they apparently do not want to.

So as you can see, there are a few issues with this article and how it was analyzed and written. The first and foremost problem is that the article was authored by an individual with direct financial interest in the product. The ASLMS journal never should have published this article due to the authors conflict of interest or it should have a disclaimer prior to the abstract. I have no vested interest in any of these non-invasive technologies and would love to see something like this work and have long term benefits for the patients. I think this technology may have better long term benefits on cholesterol etc. I have heard that there are some interesting studies coming. I just hope they are not written by Mr. Maloney. And for others reading this I assume that Chad works for Erchonia or the marketing company that is selling this thing to anyone they can including chiropractors.

Sincerely,
Lornell E. Hansen II, M.D. (LH)
www.LazaDerm.com

p.s. Sorry for being so long winded but I could not help myself. I want these companies to be held to higher standards. I think the ASLMS should have higher standards as well.

If you read the thread there's some interesting thoughts that spring to mind. If Chad is not with Zerona it would be the first time in my experience that a patient has been searching for peer-reviewed medical studies before deciding to have a treatment... I'm just saying.

Of course this qualifies as a guest post and a well deserved back link.

Any other physicians using Zerona have any thoughts?

Zeltiq vs. Zerona

Zerona and Zeltliq booth promise to freeze fat and shed pounds well enough that it would be a slam dunk to add these treatments to your medical spa or laser clinic. But do they work?

Here's some commentary from the NY Times Story

Doctors and patients alike are excited by the prospect of having new technologies that can attack fat without surgery. It is too early, however, for consumers to know how effectively either device works. That hasn’t stopped men and women unhappy with back fat and muffin tops from paying thousands for treatment in recent months...

...Zeltiq Aesthetics, based in Pleasanton, Calif., is a cautious wallflower that aims to get the data behind its device approved by the F.D.A. before it makes too rowdy an entrance to the party. Its slogan is “More Science. Less Fat.”

Meanwhile, Erchonia Medical, based in McKinney, Tex., has aggressively marketed its Zerona laser as “the first non-invasive body contouring procedure to effectively remove excess fat” even though it has yet to receive F.D.A. clearance to promote this use. (In general, the F.D.A. must sanction a medical device for a specific use before a company can market that use. But doctors are free to use devices off label. )

Nonetheless, a brochure for Zerona states patients can collectively “lose up to 9 inches without the pain or down time of surgery.” Nationwide, medical spas, chiropractors, cosmetic surgeons, plastic surgeons and dermatologists now offer Zerona for $1,700 to $3,800 for six sessions. Part of the reason the device has made inroads during these strapped times is that doctors don’t buy it outright, but pay per use.

So how is Zerona supposed to work? The low-level laser causes “fat to seep out of a cell, almost like a balloon being struck by a needle,” said Ryan Maloney, medical director for Erchonia Medical. The fat enters the lymphatic system, and is eventually used as energy, Dr. Maloney said.

Zeltiq uses controlled cooling to target and eliminate fat cells, a process called selective cryolipolysis. Skin isn’t damaged, but subcutaneous fat, which is more sensitive to targeted cold, begins a two-month death march soon after exposure to Zeltiq.

Doctors on the advisory board for Zeltiq Aesthetics have put the word out about it on television news segments. But at this stage, the company itself has been careful not to promote its device directly to consumers since its F.D.A. clearances for, say, pain reduction during dermatologic treatments don’t encompass fat reduction. Gordie Nye, the chief executive, sent an e-mail message declining to be interviewed for this article.

The company has clinical data that has been submitted to the F.D.A. for approval, according to a few doctors who were principal investigators. Data relayed at a meeting of the American Society of Dermatologic Surgery showed a 22 percent reduction of the fat layer as measured by ultrasound.

Erchonia Medical has published the results of its clinical trial in Lasers in Surgery and Medicine. Thirty-five patients in the treatment group lost an average of 3.5 inches total in hips, thighs and their midsection according to the company’s clinical trial. The company has promoted Zerona as “a new body-sculpting procedure designed to remove fat and contour the body without invasive surgery.” But the F.D.A. has not sanctioned marketing this use. It has cleared the Zerona laser for pain reduction 24 hours after breast augmentation or as a way to decrease the pain associated with recovering from liposuction.

In general, Karen Riley, a spokeswoman for the F.D.A., said “it is considered off-label promotion if you are marketing to the public a use that has not been cleared.” Steven Shanks, the president of Erchonia Medical, said, “Since we use the exact same power for liposuction and breast augmentation, we self-certified the device.” He said that in January 2009, the company had applied for a 510K clearance — which is based on the notion that an older device is substantially equivalent to a new one — and had yet to receive it. (Such a delay is atypical, Ms. Riley said, adding, “most 510Ks are cleared within six months.”)

Last month, Dr. Robert B. Seltzer, a dermatologist in Pasadena, Calif., ran an advertisement in The Los Angeles Times for an informational seminar that called Zerona “the holy grail.” In a phone interview, however, he said, “I’m not 100 percent convinced” and planned to return his Zerona if he didn’t continue seeing results in his patients. (So far 5 out of 6 have been pleased.)

After reviewing Erchonia Medical’s clinical study, Dr. Brian M. Kinney, a plastic surgeon in Los Angeles, said, “I can’t prove that it works.” His concerns are that the tape measure method of gauging circumferential changes “isn’t consistently reliable.” What’s more, study participants and the placebo group were assessed only two weeks after their last treatment, not long enough to measure adequately whether results last.

Dr. Kinney doesn’t have a Zerona or a Zeltiq cooling device, though in the case of the latter, he said, “it is well documented that freezing fat tissue aggressively enough can lead to fat necrosis,” or, fat dying, over a few months.

Patient selection for any body contouring procedure is crucial, said Dr. Jeffrey M. Kenkel, vice chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. Dr. Kenkel, who recently replicated results of Zerona’s clinical trial in 12 of his patients, doesn’t offer Zerona to obese patients, or to ones who have had surgery in the area they want treated. “It’s critical to be evaluated by a doctor,” he said.

Success is also dependent on diet and exercise, he said. If you’re sedentary and not eating healthy food, he said, then once fat is leaked after Zerona treatments, “your body will just store it again.”

How the body rids itself of fat, and how quickly, after any noninvasive body slimming procedure is unclear, said Dr. Lawrence S. Bass, a plastic surgeon in Manhattan who started using a Zeltiq device last July. That includes, he said, forthcoming devices like UltraShape and LipoSonix, which employ ultrasound waves to single out fat. It’s a “sticking point with the F.D.A. with all these things,” he said. Dr. Bass was not a clinical investigator for Zeltiq, but he said, “I’m convinced both on the science and clinical experience, it’s able to eliminate fat noninvasively.”

Nadine Tosk, a publicist for Zeltiq, explained that the rollout of the device was “very limited right now.” Dr. Jeffrey Dover, a dermatologist in Chestnut Hill, Mass., who advises Zeltiq and participated in its clinical trial, said a few board-certified plastic surgeons and dermatologists were “handpicked” because “we know they do good work.” Restraint is key, he said, because a doctor could apply Zeltiq to “the same spot” in the same day, which isn’t how it’s meant to be used. Hourlong treatments are best spaced out by two months, said Dr. Dover, who charges $700 per spot.

That said, a doctor with a Zeltiq device isn’t hard for patients to find. More than five dozen “Zeltiq specialists” can be found by ZIP code at body-contouring.com, which is a patient guide not sponsored by manufacturers of body-slimming devices. Dr. Jason N. Pozner, a plastic surgeon in Boca Raton, Fla., appears topless in a YouTube.com video that shows his left flank being suctioned and cooled as he reads his Kindle. (His partner, Dr. David J. Goldberg, was an investigator for Zeltiq.)

Ms. Bonvouloir hasn’t given up on Zerona. Recently, she paid $2,100 for six treatments at Parker Day Spa in Parker, Colo. This time, each session is followed by a massage that supposedly speeds the release of fat. “I still have three more sessions,” Ms. Bonvouloir wrote in an e-mail message. “Again, they are convinced I will lose some inches. I’d like to know when!!!”

Not exactly a raging endorsement but that shouldn't come as a surprise. Is anyone we know having success with Zerona treatments? Is Zeltiq or Zerona going to cause trouble for Thermage?

Laser Clinic Tatoo Removal

One of Medical Spa MDs eaders sent me this story on job hunters going to tatoo removal laser clinics in an effort to make them more employable.

The multi-billion dollar business of tattoo removal is enjoying some recession-proof growth — with one LA-based clinic even planning on going public next year to help fund a national expansion plan.

“More than 40 million people have tattoos and about seven million, or 17 percent, are in the process of figuring out how to get rid of them,” said John Keefe, the CEO of Dr. Tatoff, a California tattoo removal clinic, who hopes to use the proceeds from a 2010 initial public offering to grow to a 10-location chain.

“More than 66 percent of those tattooed are between the ages of 25 and 45 and what was cool to them at 18 is an eyesore now that they are a mother with kids,” says Keefe. The executive said revenue per client is about $1,600 — which comes out to $40 per square inch, per laser treatment  with an average of 10 treatments required. The average tattoo is four square inches, he said.

“It costs 10 times more to remove a tattoo than to put one on and it takes one year for safe and effective removal,” says Keefe.

The national market is currently fragmented, with dermatologists operating on a one-off basis and usually not dedicating their entire practice to tattoos removal.

The growing unemployment rate is also helping the company ink new business as job hunters feel the need to be competitive. Of course, many look to get rid of their tattoos because of personal taste — they may have simply fallen out of love with their tattoos or out of love with the name of the person indelibly inked on their arm.

I personaly never saw the attraction of getting into laser tatoo removal, but our patient population wasn't really inked-up either.

Is anyome meeting with real success with their tatoo laser removal services? Is tatoo removal cost effective? Is it dependant upon a certain inked demographic? What cosmetic lasers are being used to remove tatoos?

Do it yourself laser hair removal... Unhappy medical spas?

The're are a growing number of 'home laser hair removal' devices appearing on the market. This article on do it yourself laser hair removal supposes that medical spas and laser clinics are feeling the heat.

Want to get rid of some unsightly hair, but don’t want to spend the big bucks for electrolysis or a laser clinic? Now, you can buy your own laser and do it yourself.

And people are.

The growth of the at-home cosmetic-device market, which includes personal lasers, has some professionals buzzing. At an annual conference hosted by the American Society of Plastic Surgeons, Barry DiBernardo, a New Jersey surgeon, delivered a talk in Seattle about the pros and cons of the DIY market on the ASPS’s “Hot Topics” panel.

“We have to make sure that the patients are getting good, safe treatments. If they are getting good, safe treatments, then whether they are doing it at home or not, I’m not as worried,” DiBernardo told Wired.com by phone. “What I’m worried about is that they are seeing things in the Skymall on the airplane and spending hundreds of dollars, thousands of dollars on something that is not going to work or is unproven.”

New cosmetic medical devices including DIY lasers are expected to explode into a $1.3 billion market 2013, up from just $296 million in 2008, according to the analyst group Medical Insights. The growth in the market appears to be coming from light-based products that claim to either remove or grow hair on the human body. The Silk’n Hair was the first at-home laser device to be approved by the FDA, in 2006, although it didn’t come on the market until early 2008.

The laser hair removers damage the hair follicles that are in their growth phase, generally leading to some permanent reductions of body hair. DiBernardo questioned whether the lasers used in the home devices were powerful enough to get the kind of results that clinics achieve.

“In general, these devices are low-powered versions of the doctor versions. We’ve been doing hair removal since 1998, so we know that they work and how well they do,” he said. “I think these home devices have some effect, but they legally can’t have the power of what we fire at people.”

From nother nice post from Wired:

My own experience is that people looking to do it yourself home laser hair removal (or skin tightening or complexion light-based photo-therapies) are really looking to save money and are buying a device in the hope that it will work. Patients who are actually interested in laser hair removal or skin tightening are put off by these types of home remedies. I've never heard that a laser clinc or medical spa is suffering from this, but I may be wrong.

Does anyone running a medical spa or laser hair removal clinc feel differently? Is laser hair removal at a medspa moving to home laser hair remvoal that a do it yourself laser treatment?

Non-Invasive Fat Melting Devices: Sail or Sink?

There’s a lot of buzz about the new wave of non-invasive fat melting devices like Zerona™ (635nm low level laser), Lipo-Ex™ (radio frequency) and UltraShape® (selective focused ultrasound) who all lack the illustrious FDA clearance desperately needed to make a huge impact in the body sculpting arena.

Sure they possess FDA clearances for safety, but not yet efficacy in the key category of actual fat reduction. What’s the FDA’s hang up? Apparently it has to do with fat metabolism. Specifically, the FDA wants to know what happens to the fat that is expelled from the liposome after treatment, it’s ingestion by macrophages, the transportation to the lymphatic system, and the final excretion by the kidneys. The FDA wants to ensure no harm will come to a patient by this natural process of foreign body elimination. They also want to prove they work as a stand-alone therapy.

I’ve talked with many physicians at ASLMS and The Aesthetic Show and have read posted discussions by fellow MAPA members like, Dr. Lornell Hansen who is extremely proficient in the development of lasers in the U.S. and is highly regarded for his opinions. If I may quote Dr. Hansen, he states every time he asks physicians who have used, specifically the Zerona™ by Erchonia, over the last few clinical trial years if the device actually works, the answer he receives is they “think it does”. For many physicians that answer doesn’t quite cut the mustard when you're thinking of investing time, money and your reputation on a device. On the other hand, if the technology is proven to be clinically advantageous for your patients, and they finally do receive the FDA’s approval in the next few months as all companies are claiming, are you willing to “miss the boat” and sit idly by on the shore watching everyone else sail into a sea of opportunity? Or, will you get into the boat too early and risk having it sink? It’s a gamble and timing is everything.

Well, our medical spa has thought long and hard on this technology and we have come to the conclusion that if the device is positioned in the right practice and for the right patient, it can be advantageous for both our practice and the patient. Many patients we see during complimentary consultations don’t want to have a minimally invasive surgical procedures, or the multiple injections of lipodissolve. They diet and exercise regularly, but can’t seem to lose those pockets of fat that seem impenetrable by their current regimen. Our practice offers SmartLipo™, SlimLipo™, VASER® Lipo, lipodissolve and VelaShape™. Body contouring is 80% of what we do. We believe this device has a place in our practice either before or after laser lipo, or combined with the lymphatic drainage abilities of the VelaShape™. Of course, with all body contouring procedures, optimal patient selection is a must for success.

Our decision was influenced in the faith and belief in technology and also the fact that the Zerona™, unlike the UltraShape® and Lipo-Ex™, is at least FDA market cleared for laser assisted liposuction. And just think, a few years ago even laser lipolysis was scoffed at. And, who would’ve even dreamed that fractional technology would exists and prove to be beneficial? Technology will continue to advance. Sometimes it works they way you hoped it would, other times your dreams fall a little short.

So, we are very excited to take the leap of faith into the Zerona™ low level laser and look forward to only positive results for our patients. If it works like we trust it will, we all win and score one more for technology! If it falls short, the worst that could happen is that the technology will need a little more “tweaking” and we’ll sail out boat back to shore.

We’ll keep you all posted on our travels.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.

Lumenis Ultrapulse Treatments

Lumenis Ultrapulse Recommended Treatment Parameters PDF

Use the download link below to access a PDF that Lumenis just released on the recommeneded treatment parameters for the Lumenis Ultrapulse. Including:

Download

Lumenis Ultrapulse pre-treament guidelines

Physicians may want to consider a skin care regimen prior to treatment including broad spectrum sun block SPF 30+

Topical analgesic may be used according to manufacturer’s guidelines and should be removed prior to treatment
Skin surface shall be thoroughly clean and dry prior to and during treatment

Do not conduct FX treatment if active herpes simplex virus or facial bacterial infections are present
Prescription Medications which may be considered:

• Anti-viral
• Anti-anxiety
• Narcotic analgesic
• TotalFX treatments may consider:
• Antibiotic
• Antifungal
• Facial blocks

Eye Shields shall be wore by the patient

Metallic intraocular eye shields should always be used when treating within the orbital rim

Medications to avoid two weeks prior to FX treatment:

• Acetylsalicylic acid
• All anticoagulants, including nutritional supplements, such as vitamin C and E, flaxseed, fish oil and herbal tea.

Combination therapies considerations:

• Botulinum Toxin Type A may be used to suppress dynamic lines prior to FX treatment
• IPL Photofacial may be conducted prior to FX treatment
• Exfoliate with microdermabrasion may be performed prior to FX treatment to increase absorption of topical anesthetics
• Dermal filler can be injected prior to FX treatments

Lumenis Ultrapulse post-treament guidelines

Patients should apply a bland occlusive ointment to prevent direct contact between the treated tissue and the air during the healing process. The use of an occlusive ointment improves patient comfort, and reduces the sensation of pain and burning by preventing air from contacting the treated region. After healing is completed an intense moisturizer may be used.

• Patient may apply cool compresses immediately after treatment. Some patients report a “hot” feeling which lasts a few hours to a few days.
• They can gently wash area with tepid water and a gentle cleanser 3 times a day starting the morning after your treatment. Then immediately re-apply occlusive ointment for at least 4 days.
• Patient may shower, but avoid hot water/steam on treated area.
• Avoid “picking at” and aggressive scrubbing of the exfoliating skin—allow it to gently exfoliate with the washing process.
• Sleeping with head elevated on pillows (head above heart) the first few nights post treatment can help minimize swelling.
• Avoid direct sun exposure. Apply sun block SPF 30+, after the fourth or fifth day. Sunscreen with titanium oxide, zinc oxide provides broader protection.
• Wear a protective hat the first 2 weeks while outdoors.
• Avoid dirty, dusty environments, hairsprays, perfumes etc. while skin is healing
• May use mineral make-up usually 3 or 4 days after treatment, when skin is healed.

Laser Lipo ~ One Lump, or Two?

I like to regularly read through various self-help forums to understand the patient’s point of view on the types of procedures we perform. (Laser Lipo, SmartLipo) I believe in doing so, it can help fine tune our procedures, prepare us better for responses to patients with similar experiences, and help us perform overall better customer service.

One of the common complaints I have continually come across was lumps and bumps patients have experienced post laser lipolysis. Many seem somewhat traumatized by the bumps, others state their physicians have given them no explanation or even treatment for the lumps.

Let me first preface that this is in no way comparable to the lumps and tracts after traditional liposuction for reasons we’re all well aware of. In fact, many of our patients are coming in to have those lumps and tracts removed with laser lipo. Patients need to be well educated about the healing process of the lymphatic system, underlying tissue layers, the remaining layer of fat post laser lipolysis, and that lumps can be part of that process for some. How many lumps remain visible after the healing process has been completed (6 months or more) is dependent upon how much fat was left underneath the skin from the procedure, how aggressive the procedure was (amount of fat removed and severity of manipulation), and how the area was treated during the healing process. These lumps can be pockets of just fat, or consolidation of scar tissue and body fluid, even seromas that require regular draining until gone.

It doesn’t matter if the device used was a lipo lysing laser or the ultrasound Vaser, lumps can occur and tend to be more operator dependent than anything. No surprise to any of us, I noticed with many physicians I talked with experienced more lumps at the beginning of their training and had to bring many patients back for touch-ups. These physicians tell me that as their experience level increased they began to see fewer lumps and attributed the reduction to technique enhancements from training with more experienced physicians, choices of suction devices and cannulas, aggressiveness of suction post lysing, and post treatment regimens.

Because you can’t rush a physician’s level of experience, what you can do is offer your patients methods to help keep the lumpy bumpies away. These treatments can be started as early as 2 weeks post-procedure or as early as tolerated by your patient.

Here are some of the laser lipo remedies that we currently use or have been suggested to me by others.

• Proper garment fitting
• Placement of large foam surgical pad across abdomen under garment to disperse pressure evenly
• Lymphatic massage, or deep tissue massage, by an experienced massage therapist
• Use of a roller ball. We like the Omni roller ball suggested to us by our dear friend Dr. Richard Goldfarb (thanks Rich!)
• Ultrasound therapy
• VelaShape, or comparable device. We give our patients 2 free sessions with every laser lipo procedure. We like the blending of the infrared, radio frequency, roller motion and suction to help our patients smooth out and tighten the skin.
• Endermologie
• Use of a small cannula to excise the areas of fat (plastic surgeon suggested)

More theories and suggestions are welcome!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Stepping Your 'Smart Lipo' Laser Clinic Out Of The [Branding] Box

Let's say you needed a tissue and asked a friend for a Kleenex... would you be perturbed if they handed you a Puffs instead?

Silly point, but it seems to be somewhat of an ethical conundrum that I came across at ASLMS while talking with a group of physicians who are contemplating adding laser lipo to their already successful aesthetic practices and are unsure of how to market it.

Let’s face it, there have been quite a few technological advancements since the FDA approval of the first SmartLipo in November of 2006. There’s ProLipo, Vaser Lipo, SlimLipo,... let me take a breath here... Cool Lipo, LipoLite, Lipotherme (I know I have omitted some, but you get my point).

Since SmartLipo was first to market, it has now become a household name like Band-Aid or Clorox even though we know there are more brands of those products. In fact, the same situation is going to happen once Reloxin is released.

These physicians made a valid point when they stated patients are calling in asking for “SmartLipo”. So what if the physician decided they want a different laser lipo device? How would they market it since the public is primarily only aware of “SmartLipo” and are specifically asking for it?

Ethics suggest to me to market it as “laser lipo” and that use of the name “SmartLipo” would not only be misleading, but probably even illegal for false advertising. So what’s a physician to do if he wants different technology? What’s the best marketing strategy?

• Purchasing a used SmartLipo device on eBay, perhaps, just to say they own one?
• Advertising your device as a “SmartLipo-like” device?
• Co-purchasing a SmartLipo device with another practice?

It definitely proves the point that first-to-market has sustaining branding longevity.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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IPL Burns

The Independent newspaper in the UK has an article today in their Health & Wellbeing section from a reporter who was badly burned by an IPL treatment at a 'Top London Med Spa'.

The photos show the reporter with large uneven red welts on her chest and areas of redness on her face also. According to the story the correspondent was seduced by the promise of a `fast and effective way of removing the visible ravages of time without surgery’.

This is the second high profile newspaper report in recent times (see also News anchor gets burned by photo facial). I wish this were even less common than it is, but I've seen a number of IPL & laser burns before. These are often the result of rogue operations (Mesotherapy Lipodisolve Horror Stories) poorly trained staff AND physicians who intimidate their staff.

If your a plastic surgeon or dermatologist running a skin clinic, med spa, or laser clinic and your staffs first reaction is not to tell you somethings going wrong or they're not sure about an IPL or laser setting, you're just setting yourself up to have problems.

These types of IPL and laser burns are almost invaraibly the result of a physician who has medical estheticians or laser technicians who are afraid of confronting them with a problem or question. The doctor's defense? They were told what to do... but problems always arise and doctors who don't want to be hassled are the ones putting both their patitent and their laser clinic at risk. It's just a numbers game. If you treat 1000 patients at least some of them will have problems. Your staff should never be repremanded or belittled for ANY question.

The technician told me she would use a strong setting to get better results. As she passed the handpiece across my face the feeling grew hotter and hotter. By the time the device reached my neck, I could barely imagine continuing with the burning sensation. When she started on my chest the pain was intolerable and I had to ask her to stop repeatedly before continuing with what felt like torture. I'd thought of "no pain, no gain" and I soldiered on.

I got dressed, with a burning hot chest and a face that looked as if I'd been pulled out of a forest fire.

I was scheduled to return in two weeks for the next IPL treatment, in a course of six that costs £1,200. I went to a make-up shop and was dusted with a mineral powder, suggested by the spa, to camouflage the redness of my face.

A woman at the same counter asked me what the hell I'd had done. When I proudly informed her I'd had an IPL photo facial – she looked at me with total horror. "I don't mean to worry you, but I've had a course and it never looked like that." I largely shrugged off her words of warning. Why would I question the skill of a technician at the high end of the market? It's not as if I'd taken a chance and visited a high-street beauty parlour.

When I got home and looked in the mirror at my chest for the first time since the treatment - only an hour later – I was horrified. Angry red rectangular burns covered my chest in a random grid. Little did I know when I'd set off that morning that I would return after my first exciting treatment scorched and traumatised. What made no sense to me was that the treatment had not been done uniformly which was more obvious on my chest where I looked like I'd been branded with a hot iron.

The next day, on the advice of a friend, I called a top dermatologist – Dr Nick Lowe – known as the god of dermatology. He is also the man the rich and famous depend on when they need to be fixed, without resorting to the knife.

Dr Lowe saw me as a medical emergency the following morning. He works at the Cranley Clinic, off Harley Street, London, has a private practice in Santa Monica, California, and is clinical professor of dermatology at the UCLA School of Medicine, Los Angeles. He has his own skin care range and is the author of many books, including, most recently, The Wrinkle Revolution.

He was horrified by what he saw and concerned that no doctor was present at the IPL treatment – but it didn't surprise him. Along with other doctors, he is lobbying to get these types of treatments regulated in the UK. He believes treatments including Botox, line fillers, laser and light should only be conducted by doctors or administered under a doctor's supervision.

"The UK is one of the few countries in Europe that does not have sound legislation. It is much more regulated in France, Spain and Italy where only trained doctors can administer these treatments. The UK has failed totally to protect the public in this arena," says Dr Lowe.

Brazilian & Bikini Line Laser Hair Removal

Brazilian or bikini line laser hair removal can be classified in four types that has variable names depending on the med spa or laser clinic visited.

It has been claimed that Brazilian laser hair removal, the most renowned form, was named after a pair of Brazilian sisters who delivered the service  as a waxing treatment in New York.

• The American: bikini line laser hair removal is removal of hair at the top of the thighs and under the navel when wearing a bikini. It is also known as a basic bikini line.
• French bikini line: leaves a vertical strip in front (a landing strip), two to three finger-widths in length just above the vulva. It is also known as a partial Brazilian laser hair removal. Hair of the peri-anal area and labia may be removed. Removal of hair from these areas is also known as the 'Playboy' or 'G-waxing'.
• Brazilian refers to a removal of everything, front to back, while sometimes leaving a thin strip of hair on the pubis. An extreme form of bikini line laser hair removal, it involves complete removal of hair from the buttocks and adjacent to the anus, perineum and vulva (labia majora and mons pubis). Laser hari removal reatments that remove all of the pubic hair are known as a full Brazilian, full Bikini line, Hollywood wax or the Sphinx.

Further subgroups has been proposed by Anthropologist Desmond Morris, while referring to inconsistency in nomenclature:

• The Bikini Line: This is the least extreme form. All (most) pubic hair covered by the bikini is left in place. Only straggling hairs on either side are removed, so that none are visible when a bikini with high-cut sides is being worn.
• The Full Bikini: Only a small amount of hair is left, on the Mount of Venus (the mons pubis)
• The European: All pubic hair is removed 'except for a small patch on the mound'.
• The Triangle: All pubic hair is removed except for a sharply trimmed triangle.
• The Moustache: Everything is removed except for a wide, rectangular patch. This is sometimes called 'The Hitler's Moustache', sometimes 'Chaplin's Moustache'.
• The Heart: The main pubic tuft is shaped into a heart symbol.
• The Landing Strip: The central hair is trimmed into a narrow vertical strip and all other pubic hair is removed. This has become popular with models who must wear garments of an extreme narrowness in the crotch.
• The Playboy Strip: Everything is removed except for a long, narrow rectangle of hair.
• The Brazilian: This is the most famous of the bikini line laser hair removal styles but there is some confusion about its excact form. To some it is the same as the Landing Strip, leaving only a 'vertical stripe of hair'. To still others it signifies the complete removal of all pubic hair.
• The Sphynx: This is unambiguously the 'everything off' style, leaving a completely hairless pubic region. The name is derived from that of a naked breed of cat from Canada. Some laser clinics and med spas refer to 'the Sphynx' as 'the Hollywood'.

Fractional CO2 Chat Transcript: Lumenis UltraPulse, Reliant Fraxel, Sciton ProFractional, Cutera Pearl Fractional...

The Fractional CO2 Laser chat transcript: The various Fractional Technologies. Lumenis UltraPulse, Reliant Fraxel, Juvia, Sciton ProFractional, Lutronics, Cutera Pearl Fractional, and others. Depth of Penetration, Energy Levels, Length and Width of Ablation and Coagulation, % Surface Area Covered etc.