Register / Log In

Nonablative fractional lasers afford results, minimize downtime

Dr. Kaufman
Laser resurfacing revolutionized the management of cutaneous photodamage ever since its introduction in the early 1980s. Initially, options were limited to fully ablative carbon dioxide (CO2) devices. Although results were impressive, the lengthy post-procedure downtime and substantial risks for infection, scarring and depigmentation drove the development of alternatives.

Dr. Green
Though nonablative options demonstrated consistent safety, clinical efficacy was less than impressive. It is the fractional ablative and fractional nonablative options that have equipped dermatologists with the ability to offer outstanding results with far shorter downtime and excellent safety profiles.

Dr. Anolik
Fractional lasers work by delivering microscopic treatment zones in a pixilated pattern, allowing a fraction of intermixed untreated skin to rapidly heal the treated tissue. Until recently, fractional lasers resulted in at least a few days of social downtime. In the past year, however, newer fractional nonablative lasers have been introduced that deliver cosmetic benefit with only hours of minimal downtime. These include the Clear + Brilliant (Solta Medical) and Emerge (Palomar Medical Technologies).

System specifications

The Clear + Brilliant was first introduced in 2011 as a diode-based fractional laser delivering 1,440 nm wavelengths at 140 m spot sizes. In this model, factory-preset levels of low, medium and high correlate with penetration depths of 280 m, 340 m and 390 m and pulse energies of 4 mJ, 7 mJ and 9 mJ, respectively. Company guidance is four passes at 50 percent overlap (eight passes) resulting in 4, 7 or 9 percent skin coverage depending on selected level. The device utilizes single-use disposable tips that expire after 30 minutes.

A new version of the Clear + Brilliant was just cleared by the Food and Drug Administration and is known as the Clear + Brilliant Perma. This system includes both diode and thulium media, allowing dermatologists to use either the original 1,440 nm wavelength or a 1,927 nm wavelength. Factory presets are still low, medium, and high, but the 1,927 nm wavelength is delivered at a fixed spot size of 140 m, fixed penetration depth of 170 m, and a fixed pulse energy of 5 mJ.

Though these parameters are fixed, the low, medium and high presets for the 1,927 nm wavelength correlate with 2.5, 3.25 and 5 percent coverage, respectively. The 1,440 nm component remains the same as the original Clear + Brilliant. This Perma system will be promoted both for rejuvenation but also as a means of enhancing skin penetration to be used in combination with topical cosmeceuticals.

Studies using the Clear + Brilliant systems are just emerging. Nazanin Saedi, M.D., and colleagues presented findings with the 1,440 nm Clear + Brilliant system on pore size and skin texture at the April 2012 American Society for Lasers in Medicine and Surgery meeting. Twenty patients (Fitzpatrick I-VI) received six full-face treatments spaced two weeks apart using the company-recommended eight passes at different preset levels. Using the VISIA-CR Imaging System, a pore score was quantitatively evaluated, and a significant reduction was observed. On average, it was a 17 percent reduction in size.

Despite the number of currently available options for the treatment of actinic keratoses (AKs), dermatologists are still challenged by the occasional patient with widespread lesions refractory to multiple modalities.

The use of ultraviolet (UV) rays to dry nail polish can spell potential danger for patrons of nail salons, according to Joel Schlessinger, M.D., F.A.A.D., F.A.A.C.S., a board-certified dermatologist and cosmetic surgeon in Omaha, Neb.

Dose optimization, including appropriate use of a loading dose regimen, weight-based dosing and adherence to routine maintenance treatment, will maximize the benefits of biologic therapy for chronic plaque psoriasis. But if disease improvement seems less than optimal despite proper dosing, dermatologists should not to give up too soon.

The use of newer and more targeted chemotherapeutic agents can lead to atypical side effects affecting the skin, hair and nails of oncology patients, and these side effects can be different from those typically seen with longer-standing agents, says Beth N. McLellan, M.D., Ronald O. Perelman Department of Dermatology, New York University, New York.

With the presidential election behind us and myriad changes about to hit healthcare, dermatologists need to anticipate cuts in reimbursement by not only government, but also private, insurers. And if dermatologists are to combat the impact these declining reimbursements may have on their practices, they need to start implementing more aggressive patient education and retention efforts now.