Medical Laser Blog - Fotona Straight Talk for the Physician

Why Nd:YAG for Laser Lipolysis?

The 1064 nm Nd:YAG lasers are the most widely used lasers for lipolysis, with the longest clinical record of safety and efficacy. The clinically observed minimal discomfort, exceptional long-term success and short recovery are attributed to this lasers ability to optimally target laser energy into fatty tissue, thereby limiting undesirable side effects.

In addition, the Nd:YAG 1064 nm laser systems have developed significantly since their introduction for laser lipolysis. For example, the latest Fotona XP-2 Focus has a 30W QCW mode power generating capacity, reaching higher procedure speeds and efficiency while operating at a fraction of its maximum capacity. This ensures system durability, essentially lowering running costs. In conjunction with the VSP (Variable Square Pulse) technology, a wide range of selectable pulse durations are now available in Nd:YAG lasers. This provides better procedure control and extreme versatility. The latest Nd:YAG laser devices can be used not only for laser lipolysis but also for endo and exo vascular procedures, FRAC3 skin rejuvenation, acne treatments, hair removal, and other procedures. The high performance and versatility of the latest technology solid crystal Nd:YAG 1064 nm laser systems, combined with their optimal efficacy and safety, make these lasers the medical devices of choice when compared with other wavelength devices for laser lipolysis.  Take a look at our white paper on laser lipolysis for more information.

Acne Laser Treatment...My Solution for Stubborn Acne

Why use laser for acne treatments?  The Nd:YAG laser has been the way to heat the tissue and sterilized the follicular unit.  In addition it has been shown to reduce sebum production and reduce inflammation.  This is a safe and effective treatment that targets at least three of the known cause/promoter issues in acne.  In addition, the laser is safe and does not show sign of treatment.  A patient may be treated and return to work without any sign of a therapy being done. Often patients will call the next day and tell us that they see a great difference in the acne.  Many report complete resolution within 2 to 7 days.  We find that in a high percentage of patients we see the start of improvement in the acne with in 12 to 48 hours.  If they do not, we will re-treat at 2 weeks.  If no improvement at that time we will look more carefully at the diet and hormone piece. 

Erbium Laser Treatment for Stretch Marks

Stretch marks are actually deep wounds in the skin.  People have tried to treat them with creams and lotions - with little success.  They have been treated with superficial treatments like microdermabration - also with minimal results.  Some have tried more aggressive therapies, like CO2 lasers, but that will often scar in areas other than the face. So what is one to do?

We use a VSP Er:YAG laser.  With it we are able to address all of the issues inherent in stretch marks.  First, we can do a light-to-moderate resurfacing that will help with the pigment and contour issues.  Next, we use fractional SmoothMode - a heat only mode that simulates collagen growth and repair deep in the skin.  Rather than be aggressive, we consult the patient about the physiology and how the stretch marks did not appear overnight and they will not go away overnight.  We do a series of treatments.  We will typically do 3 to 8 treatments spaced at 4 to 8 weeks.  We have seen good results with this (better than we have seen elsewhere).  When at conferences I always walk around looking at the many before and after pictures displayed.  Have you noticed, like I have, that it is not always easy to tell the before from the after?  Our Fotona pictures are clear and remarkable. However, it is important to be very clear when consulting a person with stretch marks.

Stretch marks are a lot like acne scars in that they carry a lot of emotional energy.  If you make the stretch marks 75% better they are still 25% there.  This may not be what the patient was after.  They may have been dreaming of their former bikini days.  So, as with all of Aesthetic medicine, a great consult is imperative.  I often tell women that we can get their stretch marks to a place they can wear a short, untucked shirt for a little skin to show - but not to their prior flawless state. 

Laser Hair Removal Seen On TV Talk Shows: Marketing Vs. Science

So what is it better to have? The best science or the best marketing? Depends. If you are selling a "thing", it’s marketing.  If you are selling a service, it’s science!  In marketing the theme is “don’t sell the stack, sell the sizzle”.  Well that is all well and good, but when you as a doctor are selling a service, it is results that matter.  Results are achieved by science.  Results make your patients happy.  Results bring in new patients.  

The laser hair removal market is filled with wild claims that, while marginally true, are deceiving and lead to disappointment from both doctors and their patients.  One company claims to be able to treat white and gray hair.  Even its own literature shows that it will reduce white and gray hair by about 10%.  This is a clinically insignificant number and can be achieved by most any system.  But they market white and gray hair.  Guess what… you buy such a claim and the result will be your patients (and then you) will be very unhappy.

If you take a look at most companies web sites, you will find they are marketing driven.  It is hard in many instances to find out what wavelength they are using and in some cases if it is a laser or something else.  They sell application specific devices.  They have one for this and one for that.  This is great for the company - they sell lots of boxes - but not so great for you.  You need a high quality, science-based, versatile device to accomplish your services.

That is why I have Fotona Lasers - they are science driven.  Look at the web site.  Look at the White Papers.  For instance “Scientific Evaluation of VSP Nd:YAG Lasers for Hair Removal” written by myself and others.  While “they” talk about gray hair, Fotona delivers the goods!  Under promise and over deliver - that is what you get from Fotona.

Collagen Stimulation Laser...Like Taking Your Skin to the Gym

As we age, the skin becomes lax and the result is the primary sign of aging.  This laxity and the other signs of aging, such as variations in skin color, can be treated non-invasively and without downtime.  Due to the high power and extreme flexibility of the Fotona Nd:YAG platform, Fotona has been able to develop the FRAC3®.  It operates at very high peak powers between the so-called Q-Switch range and the Long Pulse range.  These conditions are only achievable with the sophisticated energy feedback control system of a Fotona unit.  Basically what happens is that very small imperfections within the skin are heated.  These imperfections are pigments, injured skin cells and other imperfections.  The result is stimulation of collagen remodeling and improved elasticity of the skin and improved color of the skin.  It is subsurface, auto-selective and non-ablative.  There is no downtime and patients will tell you that they feel the difference in only one treatment.  Pigments will require a series of treatments.  I think of this treatment like going to the gym for your skin.  You would not expect optimal results from a single trip to the gym.  In that same way, you can expect excellent results from FRAC3® as an ongoing maintenance therapy.

The Worst Possible Way To Choose a Laser Hair Removal System

There are a lot of laser hair removal systems out there… how do you choose?  The worst possible way is actually the most commonly used.  The typical person looking for a laser makes a list of the highest fluence, largest spot size, fastest reputation rate… etc.  What this creates is a list of clinically meaningless parameters.  Companies are great at this game and promote it to their advantage. As an example -  fluence = Joules per centimeter squared.  In order to create a big fluence number simply place the machine on the smallest spot size and the highest power, two things you would never do in the clinic.

So how should you choose a laser hair removal system? 

First look at wavelengths.  You would like to choose a wavelength that is safe on all skin types.  That means it will need to be above 1000 nm.  

Next is the quality of the laser discharge and the optics.  In other words, is the discharge on/off or is it like a dimmer switch…slow on/slow off?  The former is desired.  With the optics, is the beam flat or with hot spots?  Flat is desired.

Comfort is next.  Many companies solve the quest for speed with a large spot size, yet large spots hurt more.  Smaller spots are better - to a point (see below).

Speed is a tricky issue.  You can only go as fast as your patient can tolerate.  As noted above, larger spots hurt more, but too small a spot may not have adequate penetration.  The ideal spot has clinically relevant penetration.  A smaller spot is hard to successfully place by hand, side by side.  So a scanner is needed… a computer-controlled scanner is a must for fast, safe and comfortable hair removal.  Speed is also related to power.  So a more powerful machine can go faster.  Be careful about power - it is not fluence.  Even the sales guy often is not sure of the power.  So ask how fast it can go at a clinically useful setting.

By design, the Fotona XP MAX has a wavelength of 1064 nm, has on/off, VSP (variable square pulsing) power control, has Flat top optics, a computer controlled scanner and is the most powerful Nd:Yag laser on the market.  The Fotona XP MAX is the ideal laser hair removal system period.

I have been using Fotona lasers in my clinic for 8 years now.  I had the first XP MAX in the country and have used it on a daily basis since that time.  We get great results, safely, on all skin types.  We also see many refugees from competing clinics (due to poor outcomes or pain)… also with great results.

Skin Resurfacing Laser System - Look 10 Yrs Younger in 10 Days

That is what patients are asking for and you can provide it.  Fotona Er:YAG resurfacing is in a class by itself.  I have talked extensively in the past about how the Er:YAG is the most versatile resurfacing wavelength.  This is due to its ability to give cold ablative, warm or hot ablative treatments and heat only treatments for resurfacing and skin tightening.  With warm to hot settings and a papillary dermis peel, we are told by our patients and by their friends that they look 10 years younger.  The recovery time for this is generally less than 10 days.  For most of our patients, they are back to work in 3 to 4 days with cover up makeup. 

The process is quite simple.  After a consult to be sure they are a good candidate (no skin problems, healing issues, no bleeding issues, no psychological issues, etc), have them start a good skin hydration protocol with pigment control about 2 to 4 weeks prior to the treatment.  On treatment day we do a light peel to open the dermis and then apply BTL (lidocaine) cream for 20 min.  At 20 min we are ready to start the procedure.  The patients will be quite comfortable, but for those who are worry-warts or 'nervous Nellies', we suggest Valium and/or Vicodin prior to treatment.

The treatment is given with the Er:YAG laser. I generally use a 5 mm spot, 15 hz and about 3 - 5 Flu.  At these settings, you will see the capillary flush or punctate bleeding in about 2 or 3 passes.  I use orthogonal passes to be sure a more even ablation is given.

After the treatment is complete we place aquaphor or a similar topical on the skin and we are done.  We keep in touch by phone and follow up at 3 to 7 days.

Total time for MD about 20 min. Total time of procedure including prep about 1 hour.  The charge is going to be between $1,700 and $ 3,500 or so… You do the math.  Is it worth your time?