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Next-generation fractional devices tackle difficult pigment indications

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Since its inception in 1997, Lutronic Global (Boston, Massachusetts, U.S.), has been striving to facilitate the goals of its physician partners who labor to deliver exceptional outcomes to their patients. Lutronic’s focus on developing smarter energy-based medical technologies that benefit physicians and patients worldwide has been unwavering.

Beginning with FDA approval for its Spectra-VRM device in 2000, and now featuring frontline technologies such as PicoPlus, eCO2 and LaseMD, among others, Lutronic has become a global leader in the aesthetic space.

The latest addition to Lutronic’s family of intelligent energy-based skin treatment devices is PicoPlus, the cutting-edge picosecond/nanosecond laser known for its dual pulse duration and high power. PicoPlus offers wide-ranging, but precise fluence control, making it versatile enough to blast deep tattoo pigment, gently dissolve low-contrast pigmentation, such as melasma with minimal risk of post-inflammatory hyperpigmentation (PIH), and yield excellent skin rejuvenation results with extremely low discomfort or downtime. This robust and ergonomically-designed platform is also reliable and easy to use.

“For me, it is about high power and dramatically reduced thermal impact,” said Laurence Imhof, M.D., of the department of dermatology and director of the laser unit at University Hospital Zurich (Zurich, Switzerland).

“This is safer and more ethical to use because it is less injurious – with a better side effect profile – and more comfortable for the patient during and after treatment,” Dr. Imhof continued. “Compared to fractional CO2 lasers and other non-ablative lasers, such as IPL for skin rejuvenation, downtime is significantly lower. Increased power also means that you can treat using larger spot sizes for faster treatments.”

According to Zena Gabriel, M.D., dermatologist and founder of Zena Medical in Newport Beach, California, U.S., “When you think lasers, you think in terms of three parameters: wavelength, pulse width and fluence. By shortening the pulse duration to the picosecond level, you achieve a paradigm shift from the principal of selective photothermolysis, which aesthetic skin revision has been based on for decades. The concept is to harness the photoacoustic effect for more efficacious treatments on difficult-to-clear pigment.”

Laser energy, used in this way, creates what has been termed Laser-Induced Optical Breakdown (LIOB), a purely photomechanical trauma that occurs beneath the surface and does not disrupt barrier function.

As laser energy passes through the skin, it causes acoustic stress as a microburst of plasma is created. There is explosive expansion as the resultant plasma absorbs any remaining laser energy, creating a cavitation bubble beneath the surface, as well as a shockwave that provides additional localized acoustic trauma. This initiates a wound response with resultant inflammation and activation of fibroblasts.

“This causes stimulation of collagen production and shatters pigment particles, which are removed by the body over time,” Dr. Imhof explained. At lower energies, a more diffuse effect without LIOB formation is induced, which may be more effective for skin rejuvenation.

Dr. Gabriel agreed. “Picosecond lasers completely destroy pigment in low-contrast lesions such as light brown spots and difficult-to-resolve small particle tattoos – which long-pulse lasers have trouble with. And in darker skin, because you’re not going for a photothermal effect, you have a significantly reduced chance of PIH,” she stated.

“In other words, if you are treating something like melasma, you are careful not to make it worse, which can happen if you are not using the right tool for the job,” Dr. Gabriel continued. “PicoPlus , at low energies, is the safest option for dabbling in what otherwise seems like dangerous territory, because it is gentle and non-thermal, but also causes a significant effect on pigment and collagen.”

In Dr. Imhof’s opinion, what separates PicoPlus from other picosecond laser platforms are the shorter pulse widths, sufficient power with multiple available wavelengths and precision of parameter adjustment. “There is a great deal of control when you use PicoPlus,” she said.

“High power means more energy delivered in shorter pulses, which is important because at this pulse duration the beam tends to be less stable. Thus, power is very important, especially considering spot size,” Dr. Gabriel elaborated.

“For any given spot size the energy delivered by PicoPlus will be greater than that of another device because of the high peak power. And it will be more stable, so you have a greater effective range of fluences. Where one device may have a minimum effective fluence of 1.0 J/cm2, PicoPlus could go as low as 0.2 J/cm2 because the beam is more stable,” said Dr. Gabriel.

“This is incredibly important when dealing with diffuse low-contrast lesions, something like melasma, where you want to start conservatively,” she added. “If you are dealing with solar lentigines on the face of an Asian patient, you need high performance at the lower end of the fluence spectrum.”

PicoPlus comes with five handpieces. The Zoom and Pico Toning Collimated handpieces can be used with its 1064 nm and 532 nm wavelengths, and three specialty handpieces, which include Gold Toning (595 nm), RuVY Touch (660 nm) and the new Dual Focused Dots (1064 and 532 nm).

“The new dual focused dots handpiece is optimized specifically for creating LIOBs, with three-step adjustable microbeam focus depth and scan size adjustable between 4 mm and 10 mm, in 1 mm steps,” Dr. Gabriel shared. This is just another way Lutronic innovation improves on existing modalities and therapies.

Dr. Imhof most commonly uses PicoPlus for tattoos and pigmentary issues such as melasma, as well as for skin rejuvenation when patients present with mild-to-moderate pigmentation and wrinkling.
“I use PicoPlus when the rejuvenation patient has some age spots and small wrinkles,” she expressed. “Treatment provides a refreshing effect for skin as well. This device is especially helpful for treating darker-skinned patients because the mechanism of action is non-thermal, so you have less concern about the higher concentrations of melanin versus using a traditional nanosecond laser.”

PicoPlus is ideal for rejuvenation patients who want minimal downtime, Dr. Imhof added. “For rejuvenation we suggest three to five sessions at intervals of about two to four weeks, with maintenance treatments approximately every six months.”

According to Dr. Gabriel, the character of the PicoPlus rejuvenation result starts to become apparent after a few sessions.

“As collagen remodeling – due to the photoacoustic effect – takes shape, you see a softening of texture, and you look brighter and dewy,” she explained. “With repeat treatments you can further improve textural changes and smooth out skin overall. It is not as powerful of a result as with ablative laser resurfacing, but there’s no downtime.”

A Varity of Solutions to Expand Treatment Options

Lutronic’s eCO2 incorporates the standard features that physicians have come to expect in a fractional CO2 laser system, along with a few innovative and unique advances. The result is improved fractional resurfacing, treatment of fine lines and wrinkles, applications for pigment or dyschromia, scar revision, or general revitalization of skin’s youthful appearance.

“I use this device primarily for scar treatment, skin rejuvenation or to treat photoaging in fairer skin types,” said Dr. Imhof. She also treats discrete pigmented lesions such as moles and skin tags with eCO2.

For Dr. Gabriel, eCO2 is her, “go-to ablative laser for acne scars or significant rhytides in fairer-skinned patients,” she stated. “I love it for deep full-face resurfacing and texture improvement. I also use it to tighten lower eyelids because the ablation and coagulation does this very well.”

Controlled Chaos Technology (CCT) is an algorithm that drives pseudo-random delivery to place maximum distance between sequentially-fired fractional microbeams. This eliminates unwanted thermal build-up between Micro-Ablative Columns (MACs) for the most rapid heat dissipation, leading to an improved safety profile, reduced discomfort during recovery, better healing time and excellent outcomes.

Fractional energy delivery in Dynamic Mode allows users to ‘air brush,’ which eliminates the checkerboard appearance seen with traditional fractional treatments. This is beneficial for treatment of large areas, or to feather, or blend, potential lines of demarcation.

Static Mode provides a more traditional stamping of spots up to 18 x 18 mm with adjustable density of MACs to maximize single-pass treatment. Each series of MACs can be placed randomly or in a pre-programmed regular pattern, with distribution carefully controlled via CCT.

In addition to being extremely robust and reliable, design of the device is intuitive. “This system is very easy to handle and use,” said Dr. Imhof.

“Parameter adjustment is easy to understand and perform, and the articulating arm is comfortable and ergonomic,” she added.

Also, eCO2 automatically recognizes which of the treatment tips is attached – the 120 μm for deep dermal penetration and lower coverage, or the 300 μm tip for mid-dermal penetration and higher coverage.

Users can choose scanning spots from 1 x 1 mm to 18 x 18 mm in several different shapes, and easily alter MAC density. eCO2 also features continuous wave and super-pulse modes for more traditional aesthetic and surgical laser applications, according to Dr. Imhof.

On the lighter end of the spectrum proudly stands LaseMD, a non-ablative fractional Thulium laser providing fast, safe and comfortable treatment for all skin types on the face, neck or décolleté to fade freckles or target actinic keratoses and other benign pigmented lesions, as well as restore a healthy glow.

“This is the most commonly used laser in my practice,” said Dr. Gabriel. “I use it for what I call ‘buff and shine,’ a basic refreshing treatment that improves tone, texture and pigment for that dewy, soft look with no downtime except slightly pink skin for one day. It is a great one-session pick-me-up, or you can stack three treatments for a better result. LaseMD has also virtually replaced chemical peels in my office because nobody wants five days of a sloughing face, they are too busy.”

The gentle, but profound, LaseMD experience is also ideal for younger patients, those otherwise needing minimal intervention or the new-to-laser patient who may be hesitant to undergo more aggressive therapies.

“I use LaseMD for patients who want fresher-looking skin, or for younger patients exhibiting the first signs of skin aging, because anything more aggressive is usually not necessary,” said Dr. Imhof.

“When someone is new to your practice you don’t want to throw them into the deep end of the pool,” Dr. Gabriel noted.

“A treatment with substantial downtime may scare them off, but you also want a noticeable result, so this makes LaseMD a great gateway treatment, similar to the way many of us used IPL in the past,” she added. “It is also safe and gentle enough to use with other therapies to enhance the result.”

The fiber-based laser of LaseMD produces a stable beam profile, and the intelligent magnetic tracking system adds safety and ensures even, consistent delivery of the ideal micro-beam density in every pass.

Each session is fast, lasting between 6 to 20 minutes depending on the aggressiveness of the treatment. There are four modes (dynamic, static, random and continuous wave), as well as various tips for specific applications.

LaseMD is also a Cosmeceutical Delivery System. Its minimal beam diameter creates patterns of microwounds that are exceptionally small, through which topicals may readily penetrate more deeply for an improved effect.

“It is excellent for melasma patients because it not only provides a gentle laser treatment, it improves delivery of cosmeceuticals in order to help treat melasma as gently as possible,” Dr. Imhof shared.
Proprietary LaseMD ampoules are specifically formulated for use with the device. They feature topicals designed with minimal ingredients and no preservatives. The particle size is optimized for the microwound channels created by LaseMD. The Ampoule Series includes tranexamic acid (TA), retinol (VA), ascorbic acid (VC), resveratrol (RS), stem cell conditioned media (SC) and stem cell conditioned media plus keratinocyte growth factors (CK).

When considering which device on the continuum to employ, Dr. Imhof takes into account the skin type, age, pigmentation profile and the downtime the patient is willing to accept. “I have the widest range of options for fairer skin types using PicoPlus, eCO2 or LaseMD. For darker skin types I would choose PicoPlus or LaseMD over eCO2.”

To Dr. Gabriel, comparing something like eCO2 to PicoPlus is likening apples-to-oranges. “If the patient needs significant resurfacing results (wrinkles and texture), is willing to deal with the recovery and downtime, and is of fair skin, eCO2 is the device. For darker skin, diffuse pigment, light textural improvement, or anyone who wants the lowest downtime, you want to go with the PicoPlus.”

“These treatments have their own niches. They are complementary rather than competing,” Dr. Gabriel noted.

“A laser like PicoPlus is finding more and more usefulness because of that long-standing trend toward low downtime – the busier we get, the lower our tolerance becomes for downtime,” she continued.

“We will definitely find more ways to use PicoPlus, but more than that, any good physician wants the right tool for the right job, with the full range of tools at their disposal. That’s why I have all three of these devices and use them often,” said Dr. Gabriel.

In Dr. Gabriel’s opinion, “Lutronic is unequalled in offering top-of-class devices that are easy-to-use and safely treat the range of pigmentary disorders, scarring and aging skin.”

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