LimeLight Facial (520nm visible light - 1100nm infrared technology)

FDA Clearance: LimeLight is cleared for a variety of indications including benign pigmented lesions and vascular lesions.

Novel 3-in-1 Wavelength Light Source for Photorejuvenation

LimeLight - Reds & Browns Begone


*Although this device has not been optimized for hair removal, hair removal may occur as a result of a LimeLight treatment.

Acutip may be combined with a LimeLight facial for the treatment of small facial veins and pigmented lesions.

Use of a Novel Small-Tip IPL Handpiece for

Treatment of Discrete Pigmented and Vascular

Lesions

Treatment of Facial Telangiectasia with a Small Spot Broadband Pulsed Light Source

Combining Obagi with Cutera Procedures

Obagi products combined with Cutera procedures may help to reduce melanin formation of pigmented lesions. Advanced skin care with products is a very important part of a skin care treatment plan.

Infrared, Laser based technology may be used to treat leg veins and facial veins.

Variable Long-Pulse Nd:YAG Laser: A New Way To Treat Difficult Vascular Lesions

Make Veins Disappear

Dermatosis papulosa nigra (pigmented lesions) may be treated with a 1064nm Nd:YAG Laser (infrared technology).

Treatment of dermatosis papulosa nigra with a 1064 nm Nd:YAG laser: Report of two cases

Tradition, with a twist: Combination approach works well for treating pigmentary problems

Advanced Facial Sculpting: Beyond Filling Lines

Advanced skin care treatment often includes Laser based technology for skin tightening, pigmented lesions and Laser vein treatment. Dermal fillers are often part of the skin care treatment plan to to sculpt the face and hands.

Creating an Office ‘Oasis’

Offices that treat pigmented lesions, provide Laser hair reduction or leg vein treatment have a different environment that traditional medical offices. Customers come in for skin care treatment but also look forward to the relaxing atmosphere. Turn your medical office into an "Oasis" for skin tightening, laser hair removal and vascular treatments.

Developing a Web Site for Your Practice

Pigmentation Revisited

By: Peter T. Pugliese, MD

Skin-lightening Challenges

By: Zoe Diana Draelos, MD

The reason for selecting YSGG over CO₂ is only strengthened when comparing YSGG to low power CO₂ lasers. Low Power CO₂ lasers (typically 30 watts and below) exaggerate the problems of CO₂ and have several independent problems as well. Histology obtained from data sheets for Deka’s SmartXide DOT and Alma’s Pixel CO₂ are included to illustrate the problems with devices that do not have sufficient power and energy density in each spot. 

Many people believe wavelength determines depth. For ablative lasers, this is not true. Wavelength determines the thermal characteristics of the laser, but depth of ablation is determined by power and energy density. With the right amount of power, all ablative wavelengths can ablate equally deep. Their thermal damage zones, however, vary significantly across devices.

A first typical problem of lower power CO₂ lasers is ablation depth. To ablate deep, lasers must have high energy densities delivered in short time periods. This requires high power. Depth of ablation is directly proportional to treatment results up to about 400-800 µm deep. Beyond this depth, there are two schools of thought. One thought is that greater depth is better, the other is that greater density is better. There is likely some truth to both. Either way, however, device should be able to treat at least 400-800 microns deep. 

In the histology image below, the image on the left shows a lesion from a single laser pulse. The ablation depth in this image is ~200µm (based on epidermal thickness of ~70µm). The histology image on the right shows a deeper treatment, but as can be seen, this required stacking 3 pulses (i.e. firing three pulses in the same location). Stacking pulses is challenging as even minor movements by the patient or practitioner can misalign the treatment holes as each spot is only several hundred microns in diameter. Further, it takes 3X longer to perform a treatment if stacked pulses are required. This means the patient experiences 3X as many shots per pass, which can reduce the tolerability of the treatment.

The second problem with low powered CO₂ devices is pulse duration. The primary problem with any CO₂ laser is excessive thermal damage. This thermal damage leads to increased potential for pigmentary complications and slows wound healing time. This is the reason all low power CO2 units were long ago abandoned for full resurfacing. This thermal damage is also a limiting factor or fractional CO₂ devices and can lead to the same complications as observed with full resurfacing CO₂ lasers if greater depth or density treatments are attempted. To properly perform a resurfacing procedure with a CO₂ laser total exposure time should be less than ~600µs to confine thermal damage. 

·        This is documented in the text “Cutaneous Laser Surgery” Chapter 6, Carbon Dioxide Laser Surgery.  In this text, it states that the thermal relaxation time for the volume of ablated tissue during CO₂ resurfacing is about 695 us and pulse durations of less than 950 us (0.95 ms) are sufficient to prevent clinically significant thermal damage

Because the laser is low powered, long pulse durations must be used to deliver sufficient energy to ablate tissue. In fact, many pulse durations as much as 100X longer than was experimentally and clinically proven optimal for CO₂ lasers.

The long pulse durations used with low power CO₂ lasers can be seen histologically in the two images above. In both cases, the coagulation / thermally damaged tissue zone is ~250-300 microns wide and deep. This means the treatment diameter of the laser is not just the spot size, but the spot size plus ~250 µm on each side of thermally damaged tissue, meaning the spot size is ~500µm wider than stated – leading to greater downtimes if treatments are performed to equivalent depths for equivalent treatment results.

The end result of minimized ablation depth, excessive thermal damage, and large effective spot sizes is that treatments are predominately thermal (not ablative), and are not very deep. Fractional non-ablative devices were completely thermal, and deeper, but required 4-6 treatments. Low powered CO₂ lasers do have maximized ablation (the only difference between ablative and non-ablative fractional lasers) meaning these treatments and results are closer to fractional non-ablative devices. Further, it is often necessary to perform multiple treatments to provide equivalent end results as highly ablative fractional devices (like Pearl Fractional). Many before and after pictures actually show results pre and post 3 treatments each spaced roughly 1 month apart.

Pearl Fractional was designed to reproducibly deliver deep fractional ablation with variable density to provide single-treatment results with maximum results and consistency. Accomplishing this and limiting downtime and complication risks required a wavelength capable of providing controlled thermal coagulation in a pulse-duration that is thermally confined. Pearl fractional was designed with sufficient power to ablate to necessary depths (typically 600-800 microns, which is ½ of maximum power). See comparison histology images below – image sizes are scaled to maintain approximately equal magnification. Histology images for the SmartXide DOT and the Alma Pixel CO₂ were obtained from product brochures from each company.

In a simple answer, Cutera selected YSGG (Pearl and Pearl Fractional) for thermal control with the desire to maximize ablation and control, but not eliminate coagulation (thermal damage). A little thermal damage during ablative procedures is a benefit, but too much can be a liability. Laser wavelength is the primary determinant of thermal damage. Power determines how deep an ablative laser vaporizes – and necessary power is determined by water absorption. At the edges of the ablation column though (sides and bottom) there is not sufficient power to continue ablating tissue. From this point outward, the zone of thermal damage is determined by how far sub-ablative intensity light penetrates through tissue – creating a coagulation zone. Cutera selected YSGG because this zone is 40-60 microns thick. Conversely, Er:YAG is about 10-20 microns and CO₂ is about 75-150 microns.

The coagulation zone (thermally denatured tissue) with YSGG is thick enough to coagulate normal microvasculature in dermal tissue, thus preventing significant operative bleeding. It is small enough though to be able to maximize ablation area without unduly increasing the size of the lesion. Note: thermally denatured tissue is dead / necrotic tissue that the body must also clear for the wound to heal. Additionally, excess thermal damage is associated with increased risks of pigmentary complications. With the thermal control of YSGG, Pearl fractional can maximize treated area and tissue vaporization beyond that of CO₂, yet still provide coagulation and thermal stimulation that is lacking with Er:YAG.

Having a simple protocol for patient photography is essential. This means taking steps to standardize not only the method of taking representative photographs, but also of storing/cataloging them for efficient retrieval for presentations and patient use.

The key to this is to simplify the process and make the number of photos required for each patient uniform.


Source: Skin & Aging
 

Laser Based Technology

“I’m not looking for the fountain of youth,” said Jeannie Wright, 60, of Memphis. “I don’t want magic, but just to look the best I can at my age.”

Wright tried Pearl, one of the city’s newest technologies to treat multiple brown spots on her face. Pearl uses a controlled thermal effect to vaporize part of the epidermis. It treats sun damage, hyperpigmentation, uneven textures and fine wrinkles and stimulates collagen production.

Wallace found the results of his surgery could be enhanced by lasers, so two years ago he joined with Mona Sappenfield in a new medi-spa, Mona Spa & Laser Center-Germantown, where Wright was treated with Pearl.

“Combination is where it’s at,” said Sappenfield. One of her most popular treatments is a laser double-punch: Laser Genesis for pores and redness and to jump-start collagen production, and Titan, which goes deeper into the skin and actually tightens it.

Pearl is a more aggressive treatment and may come as a surprise to laser users accustomed to just a few stings and no down-time. To get Pearl, your skin must be numbed with ointment. You’ll spend the next three days with your face slathered in Vaseline to keep it from hurting, and after that come two or three days of peeling.

It was well worth it for Wright, who saw, to her astonishment, nearly all of her spots literally drop off her face. Improvements have continued.

“My skin has gotten smoother and my pores tighter. … I don’t have a wrinkle on my face,” said Wright.

Source: www.aestheticmedicinenews.com

Pearl may be combined with Titan for skin tightening; Limelight for treatment of pigmented lesions; Laser Genesis for tone, texture, pore size.