The Harmony laser (Alma Lasers, which resulted from the merger of Orion Lasers and MSQ) equipped with Orion's ST handpiece is unique because it joins two modalities — broadband and intense pulsed light (IPL) — in one machine, while also fitting in well with other treatments, according to Dr. Bosniak, an attending surgeon at the Manhattan Eye, Ear and Throat Hospital and a Manhattan-based ophthalmic plastic surgeon in private practice.
"Our patients now want it all, and their expectations are exceedingly high," he says.In New York, Dr. Bosniak observes, "Even a 5-year-old can recognize a bad Botox (botulinum toxin, Allergan) treatment." When this treatment first became available, he says, "It was like magic, and not everyone knew about it. Now, everyone knows. And it can't be overdone — it must be perfect."
Newer noninvasive modalities
Similar expectations apply to newer noninvasive modalities for face tightening and lifting, Dr. Bosniak says.
"We must not only tighten and lift," he says, "we must treat skin texture, pigmentation and broken capillaries at the same time." Therefore, he says that if there's a modality that tightens and lifts, "We have to introduce a second modality to help with the pigmentation and telangiectasias" to meet patient demands.
In his practice, he says he frequently combines the Harmony laser with nonsurgical treatments including botulinum toxin injections, fillers, radiofrequency (RF) skin tightening and photodynamic therapy.
"They all have their place when used together," Dr. Bosniak says.
He adds that he finds the Harmony laser particularly useful in combination with the ThermaCool device™ (Thermage® ) because broadband works on a more superficial level than does RF tightening.
"For example, after we've done a monopolar RF skin tightening treatment with Thermage® , which is going to give some subcutaneous supportive tightening, then we can enhance the effects by going back and using the broadband technology of the Orion ST handpiece. The combination works well," Dr. Bosniak says.
He always uses the ST handpiece in combination with Alma's 570 nm intense pulsed light (IPL) handpiece. Together, he says, these technologies improve dyspigmentation, telangiectasias and superficial skin texture.
Specifically, Dr. Bosniak recommends performing one pass (over the face, neck and, perhaps, hands) with the 570 nm handpiece, followed by four passes with the ST broadband handpiece.
"Then we repeat the procedure in three to four weeks. Usually we tell patients they're going to need at least three or four treatments, and particularly with the ST handpiece, they probably need five or six to see the tightening effect."
With the 570 nm handpiece, he adds, he starts with 10 J/cm2 , and he may go up as high as 15 or 16 J/cm2 during subsequent sessions, increasing by increments of two J/cm2 . With the ST handpiece, he says he uses 35 J/cm2 — the highest setting available.
"We don't stack the pulses," says Dr. Bosniak, who has treated approximately 50 patients with the IPL/broadband combination, "but I don't do a pass on an entire side of the face and then start again."