Sponsored by Wontech
Since the 2000s, fractional lasers have been used in aesthetic and medical practices for a wide range of applications, including pigmented lesions, scars, skin rejuvenation and many others. Various wavelengths with a high absorption coefficient in water have been utilized, including 10,600 nm CO2, 2940 nm Er:YAG, 1550 nm Er:Glass, 1927 nm thulium and 2790 nm Er:YSGG.
While carbon dioxide fractional lasers are widely known for achieving dramatic results in the treatment of many indications, especially skin rejuvenation and scars, a number of studies report that side effects are frequent with prolonged erythema, edema, thermal damage and post-inflammatory hyperpigmentation (PIH). Er:Glass is frequently used as well, but its efficacy is not as dramatic as CO2 lasers.
I have been using Lavieen, a ground- breaking 1927 nm thulium fractional laser developed by Wontech, Co., Ltd., for over three years, and its benefits have had a tremendous impact on my clinical practice.
Similar to Er:Glass, 1927 nm thulium is classified as a non-ablative laser, which does not disrupt the stratum corneum, but shows tissue denaturation in the skin. Contrary to Er:Glass, though, the penetration depth of thulium is superficial because the absorption coefficient to water is higher. However, thulium can be specifically classified as sub-ablative because partial disruption of the stratum corneum and tissue denaturation in the upper dermis are histologically observed when applying commonly used parameters.
Since 1927 nm thulium represents an intermediate state between non- ablation and complete ablation, it can be a compromise between the two.
In addition to this feature, Lavieen can actually create all degrees of ablation, from non-ablation to ablation, depending on the parameter settings and stacking pulses. It allows practitioners to set and use various degrees of ablation for deli- cate treatments, taking into account the lesion and skin conditions. Since the degree of treatment can be adjusted from mild to aggressive, the period of downtime can also be controlled, which is of great benefit to patients returning to their daily activities after treatment.
Moreover, you can control the pulse duration and power separately with Lavieen. This is a unique feature among the thulium fractional lasers available in the market.
Multiplying pulse duration (μs) by power (Watts) yields energy (mJ) per pulse, which affects the degree of ablation. The value of the two parameter settings – 1,000 μs with 10Wand2,000μswith5W– are calculated to be equal to 10 mJ, and the sub-ablation is histologically indicated with both parameter settings.
However, the degree of disruption of the stratum corneum and denaturation of the upper dermis vary; more disruption of the stratum corneum occurs with 1,000 μs and 10 W, while more denaturation of the upper dermis occurs with 2,000 μs and 5 W.
By utilizing this exceptional characteristic, physicians can provide a more delicate and customized treatment to achieve superior results.
For these reasons, Lavieen can effectively treat a variety of indications, especially pigmentary disorders such as lentigines, age spots, PIH, melasma and various scar cases, including burn or traumatic scars.
There are many patients who complain about PIH caused by a carbon dioxide fractional laser treatment. For these patients, Lavieen treatment was very satisfactory. Downtime is not too severe or long compared to other fractional laser treatments, and the results are dramatic even with a single treatment.
The penetration depth of the 1927 nm thulium is the stratum basale layer of the epidermis, where melanin resides. Treatment with Lavieen is therefore effective in treating superficial pigmented lesions and/ or brightening the overall skin tone.
Melasma can be treated with Lavieen as well. I use moderate power to remove pigmentation, and a longer pulse duration to induce collagen remodeling to improve the dermal environment.
By combining Lavieen treatment with a picosecond laser and a fractional handpiece and/or cosmeceutical application, multiple layers of the skin can be targeted with different mechanisms to treat the inherent complexity of melasma and ultimately achieve great clinical results with no unwanted side effects.
Patients with severe scars, such as burn or traumatic scars that present an unfavorable impression, often visit my clinic for treatment. Scars with deformed skin tissues and colors are typically challenging to treat, but Lavieen therapy plays a role in normalizing abnormal skin tissues.
The laser energy damages deformed scar tissues and colors, and induces a natural wound healing process to generate new skin, which can improve dented or uneven volume, as well as hypo- or hyperpigmentation. I use a higher power, longer pulse duration and stack pulses on scarring. The results are remarkable. Now, I use Lavieen on newly formed scars as well, which has been shown to be more effective.
With Lavieen, the size and shape of the scanner can be adjusted according to the targeted lesion, and both stamping and moving techniques can be used. These features allow practitioners to perform procedures that are quick, easy and convenient. Also, the tip is not a consumable item, so it is not a financial burden on the practitioner or patient.
In conclusion, I have been using Lavieen for a long time and have found that the 1927 thulium fractional laser is more effective than Er:Glass, and safer than CO2 lasers in the treatment of numerous indications. I also appreciate the fine- tuning that can be performed by adjusting pulse duration, power, size and shape of the scanning, stamp or moving technique according to the lesion, which helps me achieve superior results.
The easy, fast and convenient procedures make Lavieen a satisfying modality for physicians, delivering the benefits of dramatic results, few treatment sessions, short downtime and no unpleasant side effects for patients.
About the author
Ibrahim Devrim Gursoy, MD, PhD
Dr. Gursoy began his medical faculty education in 1994 at Uludag University School of Medicine and graduated in 2000. He graduated from Gazi University Medical Pharmacology in 2006 and completed his PhD. He attends numerous international and domestic conferences, and participates in trainings and seminars. He is fluent in English and German.