BBI Contributing Editor
Mark Taylor, MD, medical director at Gateway Aesthetic Institute and Laser Center (Salt Lake City, Utah), is excited about the OmniLux Blue from Alderm (Irvine, California). Taylor uses this light emitting diode (LED) device in various configurations. "We offer blue light alone for acne. We also offer the combination of red and blue light in the same session for acne," he said. An activated light facial with the Levulan Kerastick from DUSA Pharmaceuticals (Toronto, Ontario) is a third option. "The two most common conditions I treat are severe acne and extensive actinic keratoses," Taylor said. "We also are doing some photorejuvenation treatments with the OmniLux."
For light treatments alone, Taylor encourages a total of 12 sessions (two to three a week). Typically, one session with a single lamp costs about $99; red and blue together is $150. "Patients who pay for a package of 12 treatments up front are given a 20% discount," he said. In contrast, most patients require only one session with Levulan. "For full-fledged photodynamic therapy (PDT), the price is $1,050, which includes the Kerastick. There is enhanced therapeutic activity if the Kerastick is left on overnight. However, for any regimen, "patients look like they've had a sunburn for one week. Fair-skinned patients may stay red for an additional few weeks," Taylor added.
He said the OmniLux has allowed him to treat some patients with severe acne without systemic drugs like Accutane. "There is a lot of negative opinion these days about taking Accutane," he said. "I package the OmniLux as an Accutane alternative for severe acne. But we're still struggling with the best postoperative care."
The ClearLight from Lumenis (Santa Clara, California) uses a high-intensity, enhanced, narrow-band light source (405 nm to 420 nm) to clear moderate inflammatory acne. "I believe this is the slickest device on the market in this category," said Michael Gold, MD, a dermatologist in private practice in Nashville, Tennessee. "It actually is one of the most advanced light systems for any light source. There are picture and graph capabilities built into the ClearLight. When you tell high school students that you have technology for acne, it's a pretty easy sell because kids today know a lot about technology through their computers and cellphones." Adults can also be easily swayed to embrace the technology after having failed so many other options over the years.
Gold rarely uses the ClearLight as monotherapy. "This is a synergistic treatment, not a solo treatment," he said. Topical agents or topicals and orals are often prescribed. He prefers twice-weekly sessions with the ClearLight, each lasting 18 minutes, for a total of four weeks average. "If the patient commits only to weekly sessions, they last up to 25 minutes each, for six weeks average. Regardless of the plan, maintenance also is required. I bring the patient back anywhere from two to four weeks after completion. Some patients may need to undergo another cycle."
Gold charges $40 a session or $250 for a series of eight treatments with the ClearLight. "Patients are tired of seeing a doctor and just being given a medicine," he said. "By combining medicines and technology, we are at the forefront of what people want."
According to Greg Chernoff, MD, a clinical assistant professor of facial plastic surgery at Indiana University School of Medicine (Indianapolis, Indiana), emerging technologies need to be safe, predictable, reliable and reproducible.
The ThermaCool TC System from Thermage (Hayward, California) "is a promising piece of equipment that offers patients a viable addition to the armamentarium that we can offer them for skin tone," Chernoff said. "At this point, though, the device falls short in terms of predictability. Eventually, though, it will achieve the necessary predictability." He markets the ThermaCool as part of a patient's general skincare maintenance. "I explain to my patients that in many ways it is like taking their face to the gym."
Quarterly treatments are recommended, at $1,200 each, consisting of two to three passes. "The incidence of complications runs 2% to 3%. Thinner skin has a higher propensity for scarring, such as the neck," Chernoff said. Overall, the ThermaCool "has helped bridge the gap between what the patient can achieve at the salon and on the operating room table. But it is important not to overpromise the results."
Chernoff also is excited about soft tissue augmentation from Isolagen (Houston, Texas). "As far as injectables go, Isolagen and Restylane are the two shining stars," he said. "Once Isolagen is re-released in the U.S., I believe it will sweep the injectable markets because it offers the patient such a refreshing story of reinjecting their own tissue in more of a tissue-repair fashion than a filling fashion. Isolagen offers more of a semblance of permanence."
A series of three monthly injections is expected to be priced from $5,000 to $6,000. "This is one of the lowest-complication procedures we have seen in a long time," Chernoff said. Prior to the process being taken off the market by the FDA several years ago, he had injected more than 100 patients. "We had no complications directly attributed to the substance itself. We have also followed some patients for seven years now. They don't look much different from when we originally injected them. But we should not overpromise what an injectable can do for a patient who would benefit from surgery instead."
Plasmakinetic resurfacing from Gyrus Medical (Maple Grove, Minnesota) is a way to rejuvenate the skin without relying on a conventional laser or other light-based device. "Ablation is performed through a non-contact technique," said Roy Geronemus, MD, director of the Laser & Skin Surgery Center of New York (New York). "Ionized plasma delivers energy to the target tissues. The plasma readily gives up energy upon tissue contact. This creates some superficial ablation of the skin, but does not have the persistent redness normally associated with CO2 or erbium laser in the healing phase. Plasmakinetic resurfacing is still a wounding procedure. However, there is not as much pain as conventional resurfacing procedures. This is investigational therapy that appears very promising." Initial studies consist of one treatment session. "We are treating for winkles and very mild skin laxity," Geronemus said. "We're seeing improvement of some superficial wrinkles and lines that generally do not respond to nonablative technologies. The effect is immediate and there is continued improvement over time."
Ron Moy, MD, an associate clinical professor of dermasurgery at UCLA Medical School (Los Angeles, California), also commented on plasmakinetic resurfacing. "This is another way of resurfacing that seems to cause less redness than CO2 lasers. It has a faster healing process of about five days, compared to 10 days," he said. "And it is a gentler type of resurfacing. This technology is a new energy source that uses a plasma to precisely peel off layers of the skin." Moy uses the technique to ablatively resurface the skin and as a "weekend" peel (mild peeling over 48 hours). He said there have been no complications observed with plasmakinetic resurfacing, unlike prolonged redness, hypopigmentation and scarring that may occur with CO2. "Potentially, this could be another exciting way to resurface the skin," Moy said.
The VASER body sculpting system from Sound Surgical Technologies (Louisville, Colorado) selectively emulsifies fatty tissue via unique grooved probes that direct the pulsed energy. "This gives a lot more finesse to the liposuction procedure," said Greg Washington, president and chief executive officer at Patients Unlimited Marketing Consultants (Los Angeles, California). "Facial procedures also can be performed in a more refined way. The procedure removes fat without tearing unnecessary elements of the tissue. This is an appealing approach during a patient consultation."
With any new technology or new approach, "it is important that it be presented as an additional aspect of existing procedures. The VASER is a new twist to an older procedure," Washington said. Moreover, "the price of a service, particularly if it is new technology, is not an issue, as long as your price is reasonable. And if you err, you want to err on the high side, not the low side particularly on the front end of new technology. The surgeon should present new technology as a way to achieve a more refined result. The service needs to be a cut above what a competitor can offer who may not have adopted the technology or cannot afford to buy the technology."
The GentleWaves LED Photomodulation system from Light BioScience (Virginia Beach, Virginia) is an appealing modality for skin rejuvenation. "It requires so little consumption of time. There is no waiting period in the office because it is being administered by the medical assistants," said Patricia Wexler, MD, a cosmetic dermatologic surgeon in private practice in New York. "There also is no risk involved or downtime." Eight sessions are scheduled (twice a week for four weeks). "Each session only takes 35 seconds," she said. "However, GentleWaves often is bundled with other procedures, such as CoolTouch, ThermaCool and intense pulsed light (IPL). I've included GentleWaves with many other modalities, even without additional charge, because of the increasing benefits." Wexler has yet to encounter a patient who has not been pleased with the results. "There is improved skin quality and tone, and improved pigmentation and decreased redness to the skin," she said. "Many patients refer their friends because these friends have noticed a difference."
The TriStar Aesthetic Workstation from Cynosure (Chelmsford, Massachusetts) features three lasers in the same platform: a 595 nm pulsed dye, a long-pulsed 1064 nm and a 1320 nm Nd:YAG. "The pulsed dye laser, which is called the V Star, is probably the most powerful dye laser I've used," said Bruce Katz, MD, director of the JUVA Skin and Laser Center (New York). "We find that it works extremely well with the company's cold-air technology, SmartCool. Patients find it less uncomfortable than the cryogen sprays. And I think it is probably more powerful in terms of the fluences for the spot sizes of the handpiece." The V Star component has a 12-mm spot size. "This is the largest spot size of any pulse dye laser I've had experience with," Katz said. "So you can treat entire faces very quickly and very efficiently."
The 1064 wavelength of the TriStar "is the most effective laser for treating leg veins," said Katz, also director of the Cosmetic Surgery and Laser Clinic at Mount Sinai Medical Center. "There is increasing interest in the laser community in using multiple lasers for photorejuvenation." Katz typically treats patients first with the 595 nm laser, then immediately after with the 1320 nm setting. "After a total of four to six sessions at two-week intervals, patients can expect a 50% to 60% improvement. These are better results than using single lasers alone."