BB&T Contributing Editor

SAN FRANCISCO — The annual meeting of the American Academy of Dermatology (AAD; Schaumburg, Illinois) drew a record crowd of 18,824 attendees from 90 countries here in early March, an impressive accomplishment given the weak economy.

In addition to many drugs promoted for a wide range of dermatological conditions, a full spectrum of laser and non-laser light-based systems and thermal methods were featured for aesthetic and clinical applications, including body sculpting, skin rejuvenation, skin tightening, reduction of cellulite and fat, scar reduction, as well as for the treatment for acne, ros-acea and psoriasis.

A symposium on "Advanced Lasers" was held for a standing-room-only crowd. Kenneth Arndt, MD, clinical professor of dermatology at Yale University School of Medicine (New Haven, Connecticut), noted that pulsed dye lasers are being challenged by newer technologies such as the KTP 532 nm laser for the treatment of superficial vascular skin lesions.

Jeffrey Dover, MD, also at Yale, observed that laser treatments of acne are effective with longer wavelengths penetrating deeper, but the treatment is painful and new technologies and devices promise to change the treatment of acne.

A vast array of commercial medical and aesthetic lasers and intense pulsed light (IPL) systems were on display. These devices typically have multiple indications, presenting a challenge for each supplier to differentiate its offerings.

Hair-removal devices. The hair-removal market is currently the leading skin treatment worldwide and is estimated to be $9 billion – $6 billion from the low-end market (shaving, waxing and depilatories) and $3 billion from the high-end market (lasers and other light forms). Ruby, alexandrite and diode lasers and IPL systems have FDA clearance for use in hair reduction. They send concentrated beams of light through the skin that are absorbed by the melanin (dark) pigment present in the hair follicle shafts. The market for light-based hair removal is comprised of 80% women and 20% men.

Ronald Wheeland, M.D., professor and chief of dermatologic surgery at the University of Missouri (Columbia, Missouri), noted that medical office-based hair removal will likely decline and that a growing number of over–the-counter hair removal devices are coming to market.

Home-use hair-removal devices. Tina Alster, MD, director of the Washington Institute of Dermatologic Laser Surgery and clinical professor of dermatology at Georgetown University (Washington), reviewed the two FDA-cleared home-use hair removal devices, from SpectraGenics (Pleasanton, California) and Home Skinovations (Yokneam, Israel and Richmond Hill, Ontario).

The Tria device from SpectraGenics uses an 808 nm diode laser and a battery with a three-hour charge. It is not approved for facial use and is sold to consumers for about $900.

Home Skinovations sells Silk'n to the professional hair removal market. The device uses 475 nm-1200 nm intense pulsed light and operates on household current. It sells for about $800 and has a headpiece that delivers 750 flashes and costs $50 to replace.

It was found in a clinical trial to yield a 40% reduction in hair after three treatments. Hair removal with Silk'n is faster than the Tria device because it has a larger tip (footprint). Home Skinovations plans to soon introduce SensEpil, its home-use hair removal device, for sale to consumers at a price of $399.

Lasers and IPL are most effective in removing hair from light skin with dark hair. Creative Technologies (Chesapeake, Virginia) supplies Meladine (melanin encased in liposomes) which is pushed into the skin using ultrasound as an aid for laser removal of light colored hair.

The use of ultrasound alone for hair removal has the advantages over lasers and IPL of being safer with minimal risk of side effects.

Applisonix (Rehovot, Israel) sells its Selectif ultrasonic hair removal device for professional use in Europe and Asia and plans a future entry into the consumer market.

Lasers for treating acne. Macrene Alexiades-Armenakas, MD, PhD, assistant professor of dermatology at Yale University School of Medicine, presented data illustrating how photodynamic therapy combined with a long-pulse from a pulsed dye laser and topical 5-aminolevulinic acid (ALA) provide long-lasting clearance of mild to severe acne lesions.

The patients received one to six treatments, depending on the severity of their acne. Side effects were limited to mild redness that lasted 48 hours. Another variation of photodynamic therapy that is being investigated uses methyl-aminolevulinic acid (MAL) as a topical photosensitizer. MAL may have better absorption than ALA into acne cysts.

A new therapy approved by the FDA for treating acne is photopneumatic technology using broadband light between 400 nm and 1200 nm combined with a vacuum device that suctions the skin to remove oil for clearing acne. Aesthera (Pleasanton, California) featured its isolaz photopneumatics therapy for treating acne, skin rejuvenation and hair removal.

Alexiades-Amenakas believes that more long-term clinical trials need to be conducted on photopneumatic therapy.

Another device cleared by the FDA for treating acne is the 1550 nm fractionated laser, which thermally burns tiny columns of tissue. However, this treatment does not target oil glands or address the underlying cause of acne, resulting in its recurrence.

Home-use acne treatment devices. Hand-held devices for the home-use treatment of acne are ThermaClear from Therative (Livermore, California) and a line of Zeno-branded products from Zeno Corp. (Houston). These battery-operated devices employ heat, but differ in their length of treatment time.

Heat shock response is a reaction that bacteria have to heat and which activates heat-shock proteins that cause bacteria to self-destruct. Revitalight from Skincare Technology (Chicago) uses a photo-pulsating LED-based device with a detachable handpiece that emits blue light (420 nm) for treating acne.

Liposuction and fat reduction for body contouring. Liposuction is performed using lasers or RF energy devices. It is the leading surgical cosmetic procedure performed in the U.S. Lasers enhance liposuction by heating the fat and liquefying it to facilitate removal. RF devices induce fibrosis, which tightens skin and makes cellulite deposits less noticeable. Newer techniques, such as focused ultrasound, laser lipolysis and cryolipolysis also show some improvement in fat deposits, but have not yet been cleared by the FDA

Robert Weiss, MD, associate professor of dermatology at Johns Hopkins University School of Medicine (Baltimore), reviewed the benefits of laser-assisted liposuction which include more efficient removal of fat than standard liposuction, less bruising, faster healing and less need for tumescent fluid.

Alma Lasers (Caesarea, Israel/Buffalo Grove, Illinois) markets lasers for aesthetic applications for treating skin texture, loose skin, wrinkles, pigmented lesions, acne, hair, vascular lesions and fat. The company recently received FDA clearance for its UniForm handpiece which delivers RF heat for the non-invasive temporary reduction in appearance of cellulite. It is accompanied with a mechanical applicator that increases circulation in the subcutaneous tissue, thereby producing superior results. Alma's Accent 980 nm diode laser is approved for tissue ablation and is awaiting FDA clearance for liposuction.

Osyris Medical (Lille, France/Dallas) made its debut at the ADA conference. It also markets medical lasers for aesthetic applications including skin tightening, body contouring and vein removal procedures. Its Lipotherme 980 nm continuous wave diode laser targets localized fat deposits.

The company previewed LipoControl which is awaiting FDA clearance. It is a laser-assisted lipolysis system that allows for visual placement of the cannula as it enters the patient. It features automatic adjustment of laser power to compensate for cannula movement to avoid hot spots.

Solta Medical (Hayward, California) is the new name of the company formed from the acquisition by Thermage (Hayward) in December 2008 of Reliant Technologies (Mountain View, California).

The company markets the Thermage and Fraxel aesthetic energy devices. Thermage uses capacitive coupling in a non-invasive monopolar RF procedure for skin tightening and contouring. Fraxel uses fractional laser technology in a minimally invasive procedure for resurfacing aging and sun damaged skin.

Solta Medical is promoting the combined use of the Thermage and Fraxel systems. Since 2002, roughly 1 million Thermage and Fraxel procedures have been performed by 4,500 physicians in nearly 80 countries.

Viora (Jersey City, New Jersey) has developed medical aesthetic systems for use in a range of applications. Its line of Reaction brand devices are used for cellulite reduction, skin tightening and body contouring. They employ the company's CORE (Channeled Optimal RF Energy) technology. Viora's Trios IPL phototherapy system is used for hair removal, skin rejuvenation and treating acne. These products are marketed in Europe and Latin America and FDA clearance is pending.

Elemé Medical (Merrimack, New Hampshire) markets the SmoothShapes system for cellulite reduction. It uses proprietary technology, called Photomology, and treats the causes of cellulite by restoring adipose cells and improving the fibrotic fibrous septae.

Its mechanism of action combines dynamic laser and light energy with manual manipulation and vacuum to specifically affect the tissue responsible for the appearance of cellulite, resulting in tighter and smoother skin. The SmoothLipo employs a 980 nm continuous wave diode laser for the thermal breakdown of fat cells, and is used for body contouring and skin tightening.

EndyMed (Caesarea, Israel) markets outside the U.S. its EndyMed 1000 system for non-ablative face and body skin tightening, body contouring and cellulite reduction. It utilizes 3DEEP technology to control the power and depth of RF energy delivered to the skin. 3DEEP is a proprietary multisource phase-controlled technology that uses an array of electrodes to manipulate the interaction between the multiple RF fields to achieve the desired 3-D thermal pattern in the target area.

Zeltiq Aesthetics (Pleasanton, California) utilizes cryolipolysis that is highly selective for fat cells and does not harm skin. The patented technology is based on the natural biologic vulnerability of fat cells to controlled energy extraction (cold). It was licensed from R. Rox Anderson, MDand Dieter Manstein, MD, of the Wellman Center for Photomedicine at Massachusetts General Hospital (Boston) and has been evaluated in three clinical trials. The company has recently received the CE mark and has submitted a 510(k) to the FDA for clearance to market.

Lasers and IPL systems for treating psoriasis, vitiligo, vascular and pigmented lesions. PhotoMedex (Montgomeryville, Pennsylvania) displayed its new Xtrac Velocity 308 nm excimer laser with touch control handpiece. It is 300 times faster than the Xrtrac Ultra. PhotoMedex recently announced its acquisition of Photo Therapeutics (Cheshire, England and Carlsbad, California), marketer of the Omnilux line of LEDs for treating a range of clinical and aesthetic dermatological conditions including wrinkles, acne, photodamaged skin, vitiligo, and non-melanoma skin cancers.

Iridex (Mountain View, California) markets the Gemini 532 KTP/1064 nm Nd:YAG laser for the treatment of vascular and pigmented lesions including telangiectasia, rosacaea, hemangiomas, port wine stains, cherry and spider angiomas. The laser can also be used for treating leg and blue facial veins, skin tightening and rejuvenation, and hair removal. Its portable Venus-I 2940 nm erbium laser delivers a series of superficial peels for variable depth skin resurfacing. The entire face can be treating in seven to 10 minutes.

Aerolase (Tarrytown, New York) markets compact medical aesthetic lasers including the LightPod Neo, a 1064 nm Nd:YAG laser for vascular applications, removal of age and sun spots, skin tightening and hair removal. Its LightPod Era 2940 erbium laser is used for skin resurfacing. Such as laser peels, acne scar reduction, and cutaneous lesion removal.

Focus Medical (Bethel, Connecticut) sells the NaturaLight IPL system with exchangeable light guides for use in treating vascular lesions (510 nm to 1200 nm), hair removal (640 nm to 1200 nm), and skin rejuvenation (530 nm to 1200 nm). It is awaiting FDA clearance for use of this system for acne reduction (420 nm to 1200 nm) and skin tightening (800 nm to 1200 nm).

The company's leading product is its NaturaLase Q-switched Nd:YAG laser with 1064 nm, 532 nm, 585 nm and 650 nm wavelengths in one system. It is claimed to be the most powerful Q-switched Nd:YAG laser on the market and can be used for hair removal, tattoo removal, skin rejuvenation, and treatment of pigmented lesions.

Ellipse (Atlanta) featured its MultiFlex I²PL system that combines intense pulsed light with a Nd:YAG laser in a single platform. It is used for the treatment of facial telangiectasias, vascular and pigmented lesions, port wine stains, acne and hair removal.

Fractional RF for skin resurfacing. Primaeva Medical (Pleasanton, California) featured its new Miratone bipolar fractional system which it plans to begin selling later this year. It uses microneedles and claims to be the first minimally invasive RF aesthetic device for the treatment of aging skin. It provides precision control of energy for producing new collagen, elastin and hyaluronic acid and is seeking to make claims for use in treating wrinkles and skin laxity.

Syneron (Yokneam, Israel and Irvine, California) introduced its new eMatrix table-top unit with the claim of being the world's first RF-only technology for fractional ablation and skin resurfacing which delivers results similar to the more bulky ablative systems. It is equipped with three settings to enable customization of the depth of ablation and degree of skin resurfacing.

Aesthetic apps using saline. TavTech (Yehud, Israel) markets the JetPeel-3, a skin rejuvenation device based on jet aviation principles. It uses a saline solution and air or oxygen to exfoliate desired skin layers while it oxygenates and hydrates the skin. It allows for the transdermal delivery of nutrient supplements, vitamins and minerals to enhance skin beauty.

Human Med (Schwerin, Germany) displayed its body-jet for water-assisted lipoplasty and body contouring. It provides a gentle fan-shaped saline spray to release fat cells from connective tissue, sparing vital structures like lymph and blood vessels.