Medical Laser Blog - Fotona Straight Talk for the Physician

Hair Removal Laser Treatment System. You Get What You Pay For.

Why on earth would anyone in their right mind pay 100K or more for a hair removal laser treatment system?

From my own experience in our aesthetic laser practice, let me tell you why.  We have been in the practice of laser medicine for about 9 years now. About 5 years ago the local ENT clinic decided to get into Aesthetic Medicine.  They rent space from the eye group in town.  One of they eye guys is a friend of mine.  He let me know of the plans.  Their plan was to purchase an inexpensive IPL. Robin and I invited our eye doc friend over to our clinic to show him why the choice of an IPL would not likely work. Our friend “got it” and asked the ENT to come over and see how we could collaborate rather than compete. The ENT was having nothing of it. He was going to put us out of business.
 
No need to worry. We are doing fine.  In fact, we are back on the growth track after a bit of a flat, during the worst of the economic down turn.  The treatments at the ENT were painful, sometimes burned people and had marginal results.  Many come to us for a second opinion.  Once they are treated by our superior technology they are ours.  From there we consult them on all we have to offer… and they stay, and buy.
 
In the end you get what you pay for.  An inexpensive IPL, vs. a real laser with full authority over beam quality and delivery -  it's no contest.  The ENTs?... They don’t do much in the way of hair removal anymore.  But hey, thanks for the referrals!

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.

Telangiectasia by any other name would still look as unsightly.

Spider veins are a common cosmetic and physiologic problem for both men and women.  Veins on the face, legs and elsewhere are commonplace resulting in social anxiety.  Leg veins often cause people to stop wearing shorts or swimsuits.  Facial veins are felt by the bearers to make them look like a “drunk” or just look older than they are.  In our youth obsessed and competitive job market, that is a real issue for many.  

About 25% of the business in our clinic is for spider veins.  Here in the US, I have been treating spider veins since 1987.  I started out with sclerotherapy and as lasers got better and better, changed over to all laser in about 2001.  Now I would not think of doing veins without a laser.  The results are better, it is less painful and we see fewer side effects.  We use the Fotona Nd:YAG laser system.  The great thing about Fotona lasers is that the various models do not compromise outcomes or safety.  The main difference between models is speed.  So if your only interest is in spider veins you could do quite well with a lower end, lower power model.  On the other hand if you are interested in a multifunction machine you will need all the power you can afford.

Many companies still say they cannot do a good job on certain veins.  But for laser spider vein removal, I will tell you we routinely treat veins on any and all body parts with great results. 

Real Laser Machines Vs. IPL

On the surface of it an IPL looks like a great deal.  It has so many things it can do.  The problem with an IPL is that it is a‘jack-of-all-trades’ and master of NONE.

 

What is an IPL? IPL stands for Intense Pulsed Light.  It is basically a really bright light.  In fact, the light is created by a flash lamp like the ones used to “pump” or stimulate real lasers.  This bright light is put through a “cutoff filter” to give you only a part of the spectrum of light.  The problem is the spectrum is still too broad to have any real specificity. Clinically, that means you are not focused on any one target. Instead you are bulk heating the tissue. For some applications this will work, unfortunately the risks are greater.  

 

It is much like medication.  Some have a wide therapeutic index, while others have a narrow therapeutic index….the difference between therapeutic and toxic.  An IPL has a narrow margin between therapeutic treatment and burns to the skin.

 

With a real laser you have more control.  It is not just about the wavelength (although that is important), it is about much more.  The wavelength is just one factor.  Different wavelengths are absorbed by different targets in the skin (called chromophores).  So selecting a wavelength is important. But control of the delivery of the laser is of equal or greater importance.  In our white paper on the Fotona Nd:YAG lasers we go through the many variables that are important in control of the laser.  They include the pulse duration, spot size, the attach-and-decay of the beam discharge and other parameters.  While all of this seems complicated, it really is not.  We have a sophisticated computer controlled interface… it’s so sophisticated it is simple, and isn’t making it simple exactly the point? Fotona has a bunch of proprietary and patented technologies - all designed to give you better outcomes with less effort.

 

While the IPL will have perform “fair to good,” our lasers will perform no less than outstanding to excellent.  With an IPL you have a Swiss army knife, an excellent tool for emergencies.  With a Fotona laser you have a master craftsman’s shop!

 

Medical Laser Systems for the Most Requested Aesthetic Procedures

Remember that the top 15 procedures are:
    1.    Botox
    2.    Soft Tissue Fillers
    3.    Laser Hair Removal
    4.    Microdermabrasion
    5.    Facial Rejuvenation - IPL
    6.    Chemical Peel
    7.    Laser Facial Peels
    8.    Sclerotherapy
    9.    Facial Rejuvenation – Non-Invasive Tightening
    10.   Laser Leg Veins
    11.   Facial Rejuvenation - Fractional
    12.   Soft Tissue Filler - Radiance/Radiesse
    13.   Soft Tissue Filler - Collagen
    14.   Soft Tissue Filler - Autologous Fat
    15.   Soft Tissue Filler - Sculptra
 
Numbers 2, 12, 13, 14, 15 are really the same thing.  And regrouping the others you get…
 
    1.    Botox
    2.    Soft Tissue Fillers
    3.    Laser Hair Removal
    4.    Microdermabration  (better done with a laser)
    5.    Facial Rejuvenation-IPL  (better done with a laser, see post “why you need a laser”)
    6.    Chemical Peel  (better done with a laser – more control, better outcomes)
    7.    Laser Facial Peels  (see I told you laser is better… Chemical peels are cheap but you get what you pay for)
    8.    Sclerotherapy  (see my original post on “Top 15 Aesthetic procedures”)
    9.    Facial Rejuvenation – non-invasive tightening   (Fotona’s T3 and Frac3 treatments are GREAT)
    10.    Laser Leg Veins (see prior post on “spider veins”)
    11.    Facial Rejuvenation – Fractional (this is really just number 9 again… with a fractional hand piece).
 
So this list is really 10, not 15. And of the 10, 8 are best accomplished with a Fotona Medical Laser System with VSP, Energy Feedback Control and Auto-Calibration with each pulse.  The two that remain are just lost leaders to get people in the door.  But don’t underestimate that… they are a great way to do just that.  You cannot watch TV without seeing something about Botox. You should advertise “YES, WE HAVE BOTOX.”  When they are in the door, do a real consult and let them know what they really need to get the outcomes they are after… It may be botox, it may not.

Wart Treatments: Not Exactly Glamorous But a Reality of Life.

Warts – they’re not exactly glamorous, but a reality of life.  Most treatments for warts are only marginally better than having the wart.  Freezing is painful during and for days after the treatment.  Chemicals are inconvenient and take weeks to months to treat and immunotherapy can be quite inflammatory and uncomfortable.  In our office, and with our Fotona wart removal laser treatment, we treat warts in 1 or 2 sessions with some discomfort during the treatment but minimal after treatment.  In fact many of our teenage patients will go back to basketball practice (or whatever) immediately after treatment.

Unlike most wart treatments, ours are non-ablative using the Nd:YAG laser.  We use a relatively high fluence to heat the blood supply and kill the virus.  The treatment shows results within 24 to 48 hours and generally requires only one treatment.  On the occasional patient that needs a second, the discomfort is considerably less due to the partial effect of the first treatment.  We have treated many resistant cases.  It is hard for a virus to become resistant to heat, so we see few failures.

Our community is known for its women’s high school basketball team.  Several years back, one of the star players had a large cluster of plantar warts that would not go away with conventional therapies.  She came to our office only days before the state tournament, limping.  We were able to treat her with great success, no down time and a state title!

Fast, efficient and no down time…that is laser treatment of warts with the Fotona Nd:YAG laser.

THE TOP 15 AESTHETIC PROCEDURES

Recent surveys have shown the following to be the 15 most popular aesthetic procedures:

 

1. Botox
2. Soft Tissue Fillers
3. Laser Hair Removal
4. Microdermabrasion
5. Facial Rejuvenation - IPL
6. Chemical Peel
7. Laser Facial Peels
8. Sclerotherapy
9. Facial Rejuvenation – Non-Invasive Tightening
10. Laser Leg Veins
11. Facial Rejuvenation - Fractional
12. Soft Tissue Filler - Radiance/Radiesse
13. Soft Tissue Filler - Collagen
14. Soft Tissue Filler - Autologous Fat
15. Soft Tissue Filler - Sculptra

 

Now, several of these are really the same thing.  Numbers 2, 12,13,14,15 are all really just fillers of one sort or another.  Fillers are great for the pharmaceutical company that makes them, but there is not much margin in them. The same is true for number 1, Botox.   Now, I am not saying don’t do them.  I am just saying they are more of a “lost leader.”  You need to provide them to fill out your services menu, but they are not going to be your bread and butter.

 

That leaves 3, 4, 5, 6, 7, 8, 9, 10 and 11. The Fotona platforms can accomplish these procedures with excellent results.  Take a look at number 8 - sclerotherapy.  I know you have heard that lasers are not as good as sclerotherapy, but I am here to tell you differently. 

 

I have been doing sclerotherapy since 1989, and I can tell you I am good at it.  But in a head to head competition between my wife (RN and Laser operator) and me (MD and sclerotherapist extraordinaire)… She won!  The Fotona XP Max can do spider veins from the smallest to 4 or even 8 mm, on any body part with less pain, less bruising, faster healing. That’s my experience.  So now I rarely do sclerotherapy, as the Fotona laser is just that good.

 

As for the other procedures on the list, let me just say… Fotona hands down!

Laser Hair Removal Equipment: The Ideal vs. The Rest

Hair removal is the most common non-injectable aesthetic procedure today.  There are many ways to remove hair.  Non-permanent methods include shaving, sanding and various forms of mechanical epilation.  More permanent forms include electrolysis - the heating of the hair follicle with a thin wire.  Each follicle must be treated individually, making it the most tedious job on earth.  Some companies sell product that supposedly retard hair growth.  While these products often have endorsements, they do not seem to have true scientific support.

The ideal hair removal equipment would treat large areas rapidly with few side effects.  Over the years many methods have been tried, including radio frequency and various forms of light.  One company has combined radio frequency and light and claims they can achieve hair removal with white and gray hair (something that is quite challenging).  But if you read the fine print they claim a 10% reduction.  This type of reduction is achieved by any system and is not clinically significant.  So be aware of extreme claims.

IPL (Intense Pulsed Light) is basically a very bright light that is filtered to varying degrees.  It goes by a number of names - each company trying to position itself in better light (pun intended).  The problem with IPL is that it has no specific target in the skin and so is more prone to side effects.

Lasers hair removal equipment has been used for some time.  There are vast differences between systems.  Some systems are melanin driven.  This means that their primary chromophore is melanin, the pigment in your skin and hair.  At first this seems like a good idea, but in reality it is not.  An example of a melanin driven device is a KTP laser.  It was first thought to be good for hair.  The problem is that it is so powerfully absorbed in melanin that it has almost no penetration into the skin and cannot reach the base of the follicle. Other wavelengths are now used with varying degrees of melanin affinity.  They include pulsed dye, ruby, alexandrite and others.

Fotona laser hair removal equipment is different.  Fotona uses Nd:YAG.  While Nd:YAG is not new, the way Fotona uses it IS.  Fotona has developed VSP technology to deliver the pulse of laser light in a precise way.  The primary chromophore of Nd:YAG is blood, not melanin.  The laser light easily penetrates to the base of the follicle heating the blood supply as it enters from the base.  This heats the follicle and kills the stem cells within the follicle.  With Fotona’s hair removal system, the laser is applied with a computer-controlled scanner to ensure even coverage and eliminating technician error.