Medical Laser Blog - Fotona Straight Talk for the Physician

Collagen Stimulation Decreases Snoring!

Snoring is generally caused by vibration of the posterior soft pallet – resulting in a whole bunch of noise!  I can tell you that I know something about snoring because my mother snored like a freight train when I was growing up and it could literally wake you up on another floor of the house!  

Snoring can be a gigantic deal for couples because the snoring issue will actually lead to them sleeping in separate rooms.  Snoring is also associated with sleep apnea and sleep apnea is associated with other significant health problems, including an excess risk for heart disease, etc.  

The Fotona Laser has been used, in several studies around the world, to reduce snoring.  Accomplished with a fractional hand piece, this erbium treatment is designed to tighten the tissue of the posterior soft pallet resulting in better airflow across the soft pallet, less vibration and less snoring.  It’s simple, non-invasive and almost painless.  It’s an easy treatment to provide and dramatically improves the quality of life, if not for the snorer, then certainly for the snorer’s spouse.  

Fotona continues to research and find ways to improve the lives of its patients…and this time the snorer is helped through the application of collagen stimulation/production, which results in a tightening of the soft pallet and an improvement in snoring.

Erase Years With Full or Fractional Laser Skin Resurfacing

“Doc – how long is this skin resurfacing going to last??”  I’m certain it’s a question you’ve heard. I know it’s a question I get a lot and the answer lies in how well you treat your skin.

With the full or fractional laser resurfacing of your skin, we have literally taken age off of your skin and the moment we’re done and you start to heal, you start to age all over again.  Yet – there are certainly many things that you can do to slow down the aging process or at least the appearance of aging on the skin. 

Probably the most important is sun protection.  Not only do you want to provide your patients with excellent cosmeceutical grade, high SPF sun blocks, you also want to provide good sun protection clothing.  One of things we do in our medical laser spa/clinic is to provide a line of sun protection clothing for sale:  wide brimmed hats, sun-protective shirts and so on.  

Another item of great importance is moisturizer, which is critical to reducing the signs of aging.  Often, the sun blocks can be combined with the moisturizing component.  If you want to know what we use in our office, get a hold of us and we’ll connect you with the company we recommend.

The other really important thing is nutrition.  You want your body to have all of the building blocks necessary for repairing and building.  If your patients are eating the standard American diet (which is abbreviated SAD) this is not a good thing.  They need to be eating a minimum of 5 servings of vegetables and 3 servings of fruit per day and healthy choices of proteins – proteins that are low in fat, or in other words, lean meats, poultry and fish and not the typical high fat foods.  

Next they ought to consider some sort of multi-vitamin with extra anti-oxidants in it.  And there are yet more nutritional things we do for our patients with the full line of nutritional elements in our clinic.  

On top of all this there are laser maintenance therapies.   Now, the very therapies that other companies position as their primary therapies such as “non-invasive or fractional skin tightening” and stuff like that, we position as maintenance therapies.  It’s true that if you get a Fotona FRAC 3® or T3 therapies with an Nd:YAG over the course of a year you’ll really get some good results.  The problem is that very few people are patient enough for that, so we like to position the “wow therapies” in front - but we fall back to the less invasive treatments for those who don’t want to have the downtime.  Non-invasive therapies will help to keep their skin looking younger, longer.  It will help prevent the pigments from coming back and so on.  

There’s a whole list of things we do, ranging from moisturizers, sun blocks, protective clothing and nutritional supplements and additional laser therapies for keeping skin looking younger.  How long will your skin stay looking good?  It depends on how you treat it –but what I tell patients is that we set the clock back 10 years and then you’re going to start aging again.  Take note that when you’re older, you don’t repair as well.  So if you don’t treat your skin better, it’s only going to take 5 years to gain that 10 years we just took off your skin. 

Non-Invasive, Breast Enhancement Therapy

Another interesting “trick” that we’re able to pull off with our Erbium:YAG laser is breast firming.   It turns out that using a pixilated smooth-mode (in other words, fractional smooth-mode) with our erbium laser, we can treat the chest wall from the clavicle to the costal margin with emphasis on circumferentially treating the breast.  This skin tightening gives a lift to the breast and a firming to the breast that is quite noticeable to patients. 

This laser treatment is typically done at the highest tolerated setting with the smallest pixel size reasonable for the size of area (we usually use the PS02 – our fractional handpiece) and it’s usually done in a series of treatments.  After the first treatment, we have a certain amount of result.  But if we wait 12 weeks and repeat the treatment (we usually do 4 in a year) we find very satisfying results for women who might have that post-baby sag where the upper pole of the breast is a little deflated and the supportive structures of the skin have lost their elastic strength and they have, perhaps, mild ptosis (meaning that the breast is drooping).  We have documented several millimeters of improvement of ptosis – so clearly it’s not going to be a one or two centimeter improvement, like you might experience with a breast pexi or a surgical breast lift, but nonetheless, it’s a significant improvement and women say they now fill out their bra cup better and now have better aesthetic lines in their clothes.

This is a procedure that we do commonly and we find the results to be very pleasing.  It’s also another thing you can add to your laser treatment listing for procedures getting outcomes just shy of surgical results.  So how do we position this?

When I examine a woman who comes in for breast issues, I will give her the entire spectrum of treatment options.  I will tell her what I see as the issue. If it is ptosis and the need for some kind of lift, I try to explain how much lift can be expected from each type of therapy.  Many women will respond that they understand that they likely need a surgical procedure to lift things fully, but that they’re not quite ready for that yet.  They’ll often opt to try laser therapy first to see what kind of result they can get.  And I always remind them that having good elastic, strong tissue for the surgeon to work with is always a benefit.  It’s like giving the artist a good canvas to paint on.  So even if, in the end, the woman decides that “gee, this procedure did help, but it just wasn’t enough” – we have only helped the surgeon’s cause by improving the strength of the tissues he/she will have to work with.  

There you have it: Erbium YAG, Smooth-Mode, Fractional Treatment for Breast Lift.

Fractional, Skin Tightening and More: The Fotona Way.

Fractional treatments are all the rage.  You’ve got inexpensive CO2 lasers with fractional attachments. You even have people doing fractional non-ablative therapies such as fractional Nd:YAG skin tightening.  That’s something that is, to me, completely ridiculous.  But they’re doing it…and they’re doing it because they’re jumping on the bandwagon of “fractional.”  

Well Fotona has fractional too.  We have a specific handpiece that allows fractional treatments on our Erbium YAG platform.  The unique and interesting thing about our Erbium YAG platform is its ability to change the pulse duration.  Extremely short pulse duration will give you very cold ablation.  Longer pulse duration will give you progressively hotter ablation.  We also have a mode called “smooth mode.”  

Smooth mode is a way of laying down the erbium YAG laser energy in a non-ablative way to simply heat and coagulate tissue.  This is a very unique mode and is associated with remarkable skin tightening and collagen stimulation.  

So a therapy that is completely unique to Fotona and has been shown to have really great results by multiple physicians around the world is to use our smooth mode through our fractional handpiece to do treatments.  It’s been used for the face and it gets great tightening results.  It has been used also on the breast.  Tightening the skin circumferentially around the breast gives a non-invasive breast lift.  The results are far better than I ever would have imagined they could be, thpough they’re certainly not going to be the same as a surgical result.  If a woman has a loss of volume post breast feeding or post menopause, and has that loss of volume of the upper pole, the only thing that’s really going to fix that is an implant or a fat transfer.  But, she can get significant tightening of the skin surrounding the breast with this fractional erbium treatment.  And this can give a significant lift to the breast.  So while it won’t give you the same results as volume replacement from fat transfer or an implant, it will certainly give better skin tightness and tone, and that in turn will give the appearance of a fuller breast.  

You can also do circumferential treatments of the upper arm to tighten that loose appearance of the upper arm and to get better skin tightening and tone around the muscles of the upper arm - resulting in a more sleek appearance to that area as well.

Multiple options for treating the head and neck, face and neck tightening – the sort of turkey gobble neck – are treatable with this procedure. When we’re doing facial treatments, we’ll treat with the erbium yag by parting the hair and going well up into the scalp because remember, erbium will not affect the hair follicle, and so we can track well up into the hairline to get a longer pull of the skin of the face and then treating the chest for the wrinkle and laxity that’s often seen in the décolletage and also circumferential treatments of the breast for breast tightness – so many therapies available uniquely from Fotona for tightening of the skin in many areas of the body.

Fractional Laser Treatment is Just One Trick

So where does fractional resurfacing fit into your cosmetic laser treatment line-up?  Fractional resurfacing is just one trick in your bag.  Fractional treatments are used for decreasing downtime.  If you injure 10-20% of the skin with a tiny injury, it will tighten the skin and stimulate new collagen growth. Over time, with more and more fractional resurfacing, you’ll get more and more tightening and more and more improvements to the surface of the skin.  

So fractional resurfacing should really be positioned for that patient that does not have the luxury of significant downtime.  Maybe they’re interested in having their fractional treatment on Friday after work, with the intention that by Monday morning the redness is gone and they’re ready to go back to work.  On the other hand, if they’re looking for that wow treatment…that 10 years younger look in 10 days… then what they really need is full resurfacing. 

So rather than owning a one trick pony machine that only does one type of therapy, it’s better to have the treatment options at your disposal - to have a machine that is versatile enough to do fractional resurfacing when minimizing downtime is important to the patient, and to do full-on resurfacing when the wow factor in the shortest possible recovery time is required.  

When you think about it, if there are 3 days of downtime per fractional resurfacing treatment (which is probably conservative as there is likely a longer recovery in some cases), and you have to do 5 resurfacings, then 3x5 = 15 days of downtime.  If I do a papillary dermis peel with the erbium yag laser, using warm settings, or even fairly hot settings to achieve good collagen stimulation, the vast majority of the time patients can be in camouflage makeup and be back to work in 5 days.  In 7-10 days they are, in most cases, back to their baseline - of course with the exception of the improved tone, texture and tightness of their skin!

When is a Fractional Laser Treatment NOT Fractional?

As you probably know, fractional resurfacing is all the rage.  The idea behind a fractional laser treatment is that you make small, discreet and non-confluent injuries to the skin.  The uninjured skin around the sight of injury then accelerates the healing process, providing for a faster recovery time.  Typically, a fractional resurfacing will cover somewhere between 5 and 25% of the skin’s surface, per pass.  The original idea was that you would do one pass, allow things to heal, and then come back and do further treatments at a later time - generally at 4-6 wk intervals in order to give the initial treatment time to heal.

More and more we’re hearing about “multiple pass” fractional resurfacing.  As an easy example, if you’re covering 20% of the skin on a single pass, when you do three to five passes you are now covering 60-100% of the skin, making it no longer a fractional resurfacing.

So, many physicians are being fooled into believing that they’re giving a fractional resurfacing when they’re actually doing multiple, multiple passes.  Are they getting good results?  They are. But are they also getting the long down times?  They are indeed.

So be careful about the claims surrounding fractional and understand the concepts behind it.  One or two passes is probably still fractional, but three, four, five, six passes is no longer fractional – it’s just resurfacing.

Fractional Laser - Tailor Resurfacing Treatments to the Patient.

“If you only have a hammer, you tend to see every problem as a nail.”
Abraham Maslow

If you only have a dedicated fractional system, you see every problem as needing fractional therapy.  This is the problem with a dedicated fractional system.  A case in point is a patient I recently consulted in my office.  

She had undergone a fractional resurfacing of her hands some time ago.  The doctor who did the resurfacing is a nationally known figure in laser medicine.  She was being treated for “age spots” on the back of the hand.  He used a rather high setting and 5 passes.  Rather than a fractional resurfacing, he ended up doing a deep full resurfacing due to the multiple passes.  Unfortunately for the patient this resulted in thick, cord-like scars to the hands.  Why did this happen?  Because the patient was force-fit into the treatment instead of the treatment being tailored to the patient.

Tailoring the care to the patient is what is needed in every case.  Sometimes a fractional treatment is exactly what is needed, other times not.  In this case a standard “cold ablation” with Er:YAG, in my opinion, would have carried far less risk than the treatment employed.  So it comes back to the issue of “one-trick ponies”.  Generally they will lead you to a bad decision.  On the other hand, you are not interested in a “jack of all trades” either.  Between the do-it-all poorly, underpowered machines and the hyper-focused marketing driven machines is Fotona.  Fotona uses the scientific literature then creates machines that can achieve published laser parameters shown to work.

Skin Resurfacing Laser. And The Winner Is..….

There are three main lasers used in laser skin resurfacing.  They are CO2, YAGG and Er:YAG.  Each has advantages and disadvantages, but I believe the Fotona Er:YAG is the clear winner.  Why? The reason has to do with the basic issues of resurfacing to control ablation depth, coagulation thickness and heat deposition.  

Depth of ablation is controlled by energy delivery so all lasers are essentially equivalent.  The depth of ablation is chosen based on the lesion being treated and the degree of surface irregularity.

Coagulation is controlled by the native absorption coefficient (AC) of the wavelength into water and the pulse duration.  Because Er:YAG laser equipment has the highest AC, it is capable of the least coagulation.  Because the Fotona Er:YAG has a wide pulse duration, it is able to increase its coagulation thickness.   More or less, coagulation is chosen based on the need for homeostasis and for skin tightening purposes. Coagulation is related to heat deposition and is associated with a greater degree of pigmentation changes.  In individuals at risk for pigmentation changes, cold ablation is desirable.  On a practical level, cold ablation is only achievable with an Er:YAG.

Heat deposition is accomplished with coagulation or with stacked, sub-ablative long pulses.  The Fotona Er:YAG has the ability to separate the coagulation from the heat with its proprietary “Smooth Mode”.  Smooth mode is often used with a fractional handpiece (any of the modes can be) to achieve a minimal down-time skin, tightening effect.

Fotona is about versatility without compromise.  The Fotona Er:YAG can be used to give treatments like a micro-dermabration or a chemical peel, or to perform papillary dermis peels or a plasma treatments.  This can be done with or without fractionation, with independent control of depth, coagulation and heat.

Fractional Laser System - Not a One Trick Pony

Our aesthetic laser practice is in a small town 90 west of the Twin Cities (that’s Minneapolis and St Paul, MN).  You need to understand, for 80 of those miles you will see nothing but farmland.  To give you a better picture, this is how small our town is.  One day at the local dinner the special was a Philly sandwich.  I ordered it and ask if they could bring some Au jus. The answer was "yes."  Great, we are up town, I thought.  When lunch arrived I got a Philly and a glass of orange juice!  That’s a small town!
 
Despite the 80 miles of farmlands and the lack of culinary acumen, we routinely get people from the Twin Cities at our clinic.  You can find lots of those fractional systems in the cities, so why are they coming to our clinic?  We don’t have a one trick pony. 

We have a Fotona Er:YAG laser.  With our laser we can do everything from laser microdermabration to papillary dermis peels with or without fractionation.  We can also do Smooth mode, a more precise plasma like treatment, also with or without fractionation… and everything in between.  So rather than fitting the patient to the treatment we have, we fit the treatment to the needs of the  patient.
 
When a new patient comes to our office they get a complete consult for free.  They will understand the option and the various levels of outcome.  If they need a no down time treatment, we can arrange it.  If they want the 10 years younger in 10 days we can do that also.  Most importantly, we fit the treatment to the patient not the other way around.
 
 
“If the only tool you have is a hammer, you tend to see every problem as a nail.”
Abraham Maslow