Thank you for the very interesting & informative day I spent with you and your lasers last week. You obviously have great rapport with your clients, and I was very impressed with the results you are getting with the Fotona NdYAG, both for hair and spider vein removal.
I have been doing cosmetic LASER procedures for hair, vein, blemish, & wrinkle reduction regularly for more than two years, using a variety of LASERs with wave-lengths from 532 to 1450 nm, and from 3 other LASER manufacturers. This was my first exposure to the Fotona NdYAG, and I was very impressed, having had experience with 3 other NdYAG machines to compare it with. I believe the Fotona, along with its unique skin-cooling system, is the most elegant and effective treatment system of all, and is, in fact, remarkably superior to the others for the resolution of spider veins.
The Fotona NdYAG system is also less expensive to operate, I noted, because it does not require either a consumable Cryogen cooling spray or a topical anesthetic cream. Your patients obviously tolerated the procedures well without these. Having experienced the “feel” of the Fotona myself last week, I can confirm that there is a remarkable comfort difference in favor of the Fotona. It has been a very rare patient in my office (male or female) who could tolerate the other NdYAGs without triple anesthetic cream, which has to be specially compounded and applied at least one hour in advance of each treatment. (By the way, we first tried EMLA topical, but it didn’t help anyone at all.)
I have not personally used IPL for hair removal. We have not used it in our office because we are convinced it is not as effective as LASER. It will burn hair on top of the skin, giving the initial appearance of effectiveness, but it does not reach the roots well, which is required to “kill” the hair, as you know. We have seen multiple patients requesting LASER treatment after they had IPL elsewhere without lasting benefit.
To my knowledge, we have never had anyone “burned” by any of the NdYAG LASERs. The 1064 nm NdYAG is probably the least likely of all superficial skin LASERs to cause a burn.
As you know, it is approved for all 6 skin types, which is quite unusual and, by itself, is
indicative of its remarkable safety. By the way, the term “laser burn” is, in my experience, most often used incorrectly. While it is possible to cause a superficial skin burn (in the sun-burn sense), this does not happen if the operator is using the proper prescribed settings for a particular skin type. I cannot recall seeing any true burn with an NdYAG, primarily, I suspect, because it does not target melanin.
More commonly, when someone discusses a “laser burn”, they mean only that there was some (temporary) hypo or hyper-pigmentation following LASER treatment. This also would be caused by inappropriate machine settings for the patient’s skin type. In my experience, both of these conditions resolve spontaneously, although it can take some time. Most of the time, we have found this to happen when someone has used a shorter wave-length LASER on someone with a skin type of type 3 or darker. For example, our office commonly uses a 755 nm Alexandrite LASER for hair removal on skin types 1-3, and a 1064 nm NdYAG for skin types 4-6. We could have gotten along with one machine for all, and with less chance of pigmentation problems, namely yours!
Thanks again for your time and for teaching this old dog a new trick.
R. A., M.D.