Sponsored by Fotona
For long-term melasma results, the photomechanical, rather than photothermal, effects of laser energy are essential because thermal injury can exacerbate the condition. Furthermore, melasma requires a delicate balance of approaches to prevent flare-up.
The StarWalker® laser platform from Fotona (based in the U.S. and Europe) is designed to rank among the most versatile platforms available. With four wavelengths (1064 nm Nd:YAG, 532 nm KTP, 585 nm dye converter and 650 nm dye converter), 14 energy delivery modes and a wide spectrum of parameter modulation, physicians can treat aggressively or gently enough to handle both challenging and common conditions.
In the case of melasma, results persistent to 18 months have been seen from treatment with StarWalker.
StarWalker’s Transverse Mode Discrimination (TMD) oscillator modality is combined with Adaptive Structured Pulse (ASP) technology to deliver Q-switched pulses at 5 nanoseconds (ns), interacting with the skin in 580 picosecond (ps) peaks to create a photomechanical effect, combining high energy with ultra-short pulses.
“The StarWalker can achieve a similar photoacoustic effect with this hybrid pico/nano pulse structure, minimizing thermal effect and reducing the chance of a flare-up,” said Julio César Vélez Ocampo, MD, a dermatologist in Colombia, who developed the protocol with his brother, Sebastian Vélez Ocampo, MD, who is also a dermatologist.
“It could be described as a burst of pico-second peaks in a nanosecond pulse,” he continued. “With the tissue interaction of a picosecond laser and the higher energy of a nanosecond laser we can go deeper into the skin, with homogeneous treatment using larger spots.”
Drs. Vélez start with the 1064 nm Nd:YAG between 1.2 and 2 J/cm2 using this hybrid pulse (MaQX mode) with the 8 mm spot size. “We then use FRAC3 mode in very low fluences (10 J/cm2) to treat inflammation, which is fundamental in melasma physiopathology, with the 4 mm spot size to treat to the depths required.”
StarWalker’s focal fractional handpiece is used for the third step of the treatment, fractional controlled non-thermal rejuvenation of the skin. “Here we use fluences between 6 and 11 mJ per microspot,” Dr. Vélez noted. “Once the pigment has been cleared (after approximately three sessions) we treat the vascular component of the melasma with VERSA 3 mode at fluences between 180 and 220 mJ, pulse width 1 to 15 ms, using the 2 mm spot size, with minimal heat. Our approach has yielded outcomes persistent to 18 months after the final treatment.” A typical course of therapy is six sessions at 15-day intervals.
Melasma is fairly common but not well understood despite extensive study. According to Dr. Vélez the multifactorial nature of melasma makes it very difficult to treat and prevent relapses.
“With any treatment for melasma, especially energy-based modalities, you are likely to see relapses within a few months if not treated carefully, which is why the longevity of these results is so important,” he said. “With any protocol, the patient must have good skincare at home to limit sun exposure and provide the best conditions for healthy skin.”
Known for treatment comfort and patient satisfaction, the StarWalker platform is indicated for tattoo removal, vascular and pigmented lesions, hair reduction, acne and acne scar revision, skin rejuvenation and more.
“No device has this kind of versatility and functionality in one system,” Dr. Vélez expressed. “You can perform this treatment using other devices, but you will need two or three different platforms. StarWalker does this in a single system, which is simpler and more cost effective.”