Medical Laser Blog - Fotona Straight Talk for the Physician

Fotona’s New XS Dynamis

Soon to be released, the Fotona XS Dynamis is the most comprehensive skin resurfacing workstation available on the planet  - period.  The XS Dynamis takes everything that the previous XS Dualis had and puts it on steroids!

This laser can do cold ablation, warm ablation, hot ablation and heat only treatments in both full-resurfacing mode and fractional mode.  In addition, it has something called Turbo Mode.  Turbo Mode allows for stacking pulses, both in the standard and fractional modes.  It will also be available with two scanners.  One will be a full resurfacing scanner and the other a fractional scanner.  

One of the interesting things about the fractional scanner is a mode called “random mode.”   The combination of using turbo mode in cold ablation plus random mode on the scanner allows you to do very interesting things.  If you happen to be a hair transplant surgeon, you can drill holes in the scalp for placing the harvested hair follicles.  Now the nice thing is that because it’s not a perfect pattern, but random, it looks much more natural.  The other noteworthy item is that while a hair follicle is round, a typical hair transplantation will use a needle to make these holes, which actually becomes a slit in the skin.  With the laser drilling a hole, the hair follicle fits better.  And because you use cold ablation you actually get bleeding, which is important for the graft to “take.”  Add this to the list as another unique, interesting advantage of the Fotona technology.  

In addition, you will be able to do variable smooth mode.  In other words, you can choose the depth of penetration of heat by the number of stacked pulses.  So – you can use long pulses, which are hot pulses, at sub-ablative settings and stack them in order to cause deep penetrating heat – resulting in phenomenal skin tightening.

Now, according to the FDA, there is no such thing as skin tightening, but our Fotona photographs are unbelievable.  People who you would swear had a tummy tuck, but instead just had a non-invasive laser treatment, have great before/after photos of the abdomen.  People have as much as a centimeter lift in their breast by doing full upper-chest skin tightening procedures.  

There are so many things that this machine can do.  And the great thing is that it uses the Fotona interface, which is intuitive, user-friendly and easy.  You don’t have to become a computer programmer to figure out how to use this thing…you just have to know what you want to do and then tell the machine to do it.  

Easy to learn.  Easy to set up.  Unbelievable results.  That’s Fotona.

Laser Skin Resurfacing or Chemical Peel. Precision vs Guess.

It would be reasonable to ask “why do laser peels when you can do chemical peels for so cheap?” A big part of this is the tried and true answer of “you get what you pay for.” I tell patients a chemical peel is a little like using prunes as a laxitive. There’s an old commercial for kids and it goes something like this: “Is two enough? Is three too many? We just don’t know.” Well, it’s a bit like that with chemical peels. When you put the chemicals on the face there’s a timing element and the correct timing depends on the degree of hydration and the overall health of your skin.

With a laser, you take things down layer by layer, in a controlled fashion, to landmarks that you have pre-determined. If you want to stay within the curatenous layer, you simply ablate to a white color on the skin. If you want to get down into the living tissue (the upper papillary layer), you ablate until there’s a yellow color. And if you want to take it down to the papillary dermis, you ablate until you can see a fine, reticular mesh of capillaries and start to see some very fine punctate bleeding. If you want to go deeper than that, you start to see more and more bleeding. For every level, there are very definitive endpoints.

With a chemical peel, you place the chemical on the face and you wait. But how long do you wait? Do you wait 2 minutes, 5 minutes, 30 minutes? It depends on the preparation, it depends on the operator and so many other variables. There are fewer variables with a laser skin resurfacing. In my mind, a laser skin resurfacing is safer, and because you are getting to your pre-determined endpoint in terms of depth of the skin layers, it is more efficacious as well.

So the difference between a chemical peel and a laser skin resurfacing is a guess versus precision. It’s as simple as that.

Enhance Your Income With An Aesthetic Laser Practice

My team and I have been very successful in all aspects of Aesthetic Medicine and we would like to show you how.  Allow me to "talk at you" with this short video and check out this web page that will also show you some conservative aesthetic laser practice financials.

If you're interested in doing laser hair removal, collagen and skin rejuvenation, laser vein treatments, treating cystic acne, warts and more - you have the patients already.

To get started, download our free papers and then contact us.  We're here to help you jump start this new and lucrative piece of your medical practice.

 

Skin Rejuvenation After Sun Damage

Golfing season is upon us in Minnesota.  For those of you who live in the more southern latitudes, you’re already deep into summer, but for us, we’re just now starting to see some consistently warm temperatures!  

One of the best ways to manage sun-damaged skin is with an erbium laser.  Studies have shown that an erbium laser results in fewer re-occurrences than other therapies and one of the places to find people with a lot of sun damage is at the golf course.

Men with receding hairlines often have a lot of AK’s on the top of their head.  What you might think about doing is going out to the golf course and talking to the manager there about giving away some gift certificates as prizes in their golfing events.  Don’t just make them for the women…make them for the men too.  The men have got lots of sun damage from being outside.  A lot of people take care to wear a long sleeved shirt to protect their arms from burning, yet the backs of their hands are often very aged looking, from age spots, AK’s and the like.  The Fotona erbium laser does a fantastic job of resurfacing the back of the hand.

Don’t forget that it’s very easy to use some Restalyn or some other filler substance, or even harvested fat, and injecting it into the back of the hand to take away that really aged look of skin on skeleton that comes with age.

You can do a really wonderful job of skin rejuvenation of the hands and the skin on the face and the top of the head with a full or fractional treatment with the erbium laser.  So go where the people are – tennis clubs, golf clubs, boating marinas (sailors & boaters are in the sun all the time).  These are people who are interested in being fit and healthy and active and they also want to look as good as they feel.

You can target these groups pretty easily just by offering some gift certificates as prizes.  These kinds of promotions will increase traffic to your clinic, produce happy patients and in turn, give word-of-mouth advertising.  All in all, a good deal for everyone.

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. 

What's Fractional Laser Skin Resurfacing Got to Do With Driveway Cracks?

Father’s Day is right around the corner and while many of us may not think about it, men want aesthetic services just as women do.  We see a lot of men in our medical laser practice, particularly men in the sales professions, wanting to look young, healthy and vital.  They do this with Botox, by getting a Fotona full or fractional laser skin resurfacing, re-volumizing injections…basically all the same procedures that women are interested in (just applied slightly differently).  

With Father’s Day coming up you might think about coming up with a promotion that reminds men that they fix the cracks in their driveways, kill the weeds in their lawns, repair the paint chips on their car and why aren’t they fixing the imperfections in their face?

When you present an issue to your audience, you need to use their own language.  Men understand maintenance and men understand health.  To promote your medical laser spa services to men, you really need to present from the perspective of a man’s point of view.  While he’s thinking about the chips on his car and the cracks in his driveway, etc., he may not be thinking about beauty and aesthetics and could use a friendly reminder!   You should also promote wellness.  Men work hard and workout hard, but wanting to look good includes healthy looking skin.  In addition to toning muscles, you can help him look healthy by taking the furrows out of his face.  

Promote your services to men…especially now around Father’s Day.  Speak the right language using the concepts of “maintenance” and “wellness.”

Q-Switched Laser for Skin Rejuvenation & Collagen Stimulation

Q-Switched lasers are all the rage in Asia and that interest is now trickling into the United States.  Asia represents roughly 70% of the world’s demand for Q-Switched Lasers and they use it almost exclusively for skin rejuvenation.  The tattoo removal capability is not a big piece of the drive for this laser in Asia.  

In the United States, Q-Switched lasers are seen primarily as tattoo removal tools.  And they’re great tattoo removal tools, but there are several things about the Fotona Q-Switched laser – specifically the Fotona QX Max – that are really lost on the US public.

It’s a 4-wavelength machine so it’s competitive with the best machines out there.  Actually, it’s better because it has the highest single pulse energy available.  Other companies talk about similar energies, but when you read their literature, you find they’re doing a stacked pulse.  Data generated by the R&D Dept. at Fotona shows that after a Q-Switched pulse of any significant energy (300-500mj),  the skin is damaged in a way that creates a collagen cap.  That collagen cap acts as a barrier to a second pulse. That second pulse then has very little clinical efficacy, so you really need a large energy, single pulse and that’s what the QX Max can deliver!
Having this single, large-energy pulse means the QX Max is excellent for skin rejuvenation. Using Nd:YAG or KTP you can do a beautiful job of improving the skin's texture, tone and color.  

In addition, the Fotona QX Max has something called Accelera Mode.  Accelera Mode provides a longer pulse duration so it gives you the opportunity to do things no other Q-Switched laser can do.  If your primary interest is in skin rejuvenation but people come to you with little spider veins along the nose or mouth or what have you,  the QX Max can treat those very effectively.  It also has the capability to do hair removal .  Now it’s not primarily a hair and vein machine – it doesn’t have the capacity to do large areas.  If you’re going to do large body areas of hair removal, you’re going to want a machine with the power to do that such as the
Fotona XP Max or an SP Dynamis.  But for the focused practitioner who’s interested in excellent non-invasive, non-ablative skin rejuvenation types of therapies, the QX Max is truly a great choice because it’s a complete workstation that also manages the telangectasias, the hair, the texture, tone & color issues of the skin.

We’ve seen excellent results using this technology and we have our Asian partners who would say that it is by far the best platform on the market for the skin rejuvenation application. So if that’s your niche, take a look – it’s pretty interesting!

Microsoft Word and the Fotona Nd:YAG laser

At ALSMS this year there was a newly FDA cleared ultrasound device for brow lifts.  What they basically do is what ultrasound sonographers have desperately been trying to avoid for years, which is causing thermal injury to the deep tissues with ultrasound.

So, they have now created an ultrasound device that is able to create micro-thermal injuries to the dermal and sub-dermal tissue (but sub-epidermal) creating injury that requires a healing response that results in more collagen production and greater elasticity of the skin – resulting in a brow lift.

Now unfortunately, not only I but also a prominent dermatologist (a friend of mine that I was speaking with at the conference) looked at their before and after pictures and his comment was “…if you dropped them on the floor and picked them up, you would be very hard pressed to find the before vs. the after photograph.”  The company's statistical analysis claimed that they get about 1.9 millimeter lift of the brow.  And as this prominent dermatologist stated (and I certainly agree), you could easily achieve that same result with botox if you know the facial muscular anatomy and you know how to place the botox.

This ultrasound device is really just another case of radio frequency  - and in this case it’s ultrasound energy – but it’s the same idea as radio frequency causing these micro-thermal injuries.   And unfortunately, it looks like this ultrasound device has very similar results as radio frequency energy has.  Multiple studies have already shown that Nd:YAG skin tightening does as good or better a job than radio frequency.  

So in your hands right now, if you are a Fotona owner of an Nd:YAG, you have a device that works better than this recently FDA approved device (in my opinion).    And the nice thing is that you have a couple of options of how to do therapies – and I’m going to recommend that you combine them.  

There’s a Fotona procedure called T3 – meaning Tightening, Toning & Texture.  T3 is a bulk heating modality.  Basically it’s using around 50 joules per centimeter squared and around 50 milliseconds or so of pulse duration and scanning (using our computerized scanner) with a 6 mm spot and scanning the entire face.  

We also have FRAC3®.  Now FRAC3® is a 3 dimensional, self-fractionating therapy.  It is a very special zone of energy; high energy and very short pulse durations usually done with our 3mm spot size. Basically it selects imperfections at about the level of the papillary dermis, resulting in micro-thermal injuries, healing response and new collagen laydown.  By combining the T3 and FRAC3®,  we find we get even better results.  So rather than spending $60,000-100,000 dollars for a new gizmo in your office, remember that you can do a lot of things with the laser that you already own. 

You have to think of the laser you already own kind of like Microsoft Word.  Most people buy Microsoft Word and they just type on it.  And if they want to make business cards or banners they buy special programs just for that.    The truth is, Microsoft Word will do it all.  Your Nd:YAG laser is very much like that.  It is Microsoft Word – and if you know how to use it, you can get a lot out of it – including skin tightening (with your Fotona Nd:YAG laser)!

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!