Given the number of conditions to treat as well as the ever-increasing variety of devices with which to treat them, even seasoned practitioners might need a refresher course on what device does what. That's according to E. Victor Ross, M.D., of Scripps Clinic, San Diego, who presented “Energy Devices A to Z: What Does What,” at the inaugural Aesthetic + Medical Dermatology Symposia, held in Coeur d’Alene, Idaho, in May.
During his presentation Dr. Ross reviewed what devices worked best for specific conditions, including facial rejuvenation (especially acne scars), red and brown spots, tattoo removal and skin tightening. This is what he shared:
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Energy for Acne Scars
For ease of use by the practitioner and little downtime involved for the patient, Dr. Ross gives his highest grade to non-ablative fractional lasers.
“Ablative lasers offer better results, but there’s more downtime involved,” he says. “Conventional resurfacing is still widely used, but if I were to grade the three, I’d give non-ablative lasers an A-plus, ablative lasers an A and conventional resurfacing a B, due mainly to the relatively long downtime for the patient.”
A new technology for treating acne scars is radio frequency (RF) needling, which uses a combination of radio frequency and needling to induce collagen production in the deeper skin layers. Dr. Ross mentioned Infini, Fractora and Intensif as examples of RF needling devices.
For vascular lesions, he specified pulsed dye, potassium titanyl phosphate (KTP) and intense pulsed light (IPL) lasers.
There’s new technology for removing tattoos,” Dr. Ross says. “The hottest new thing is the picosecond laser, which is a step up from the nanosecond laser in that it’s capable of removing tattoos with fewer treatment sessions. Still, some tattoos just don’t respond — to any device we use — but it looks like picosecond lasers are trending for the future.”
Fractional lasers remain a choice for removing some resistant tattoos.
Brown Spots, Scars & Skin Tightening
For brown spots, “There’s a collage of different things you can do,” Dr. Ross says, citing fractional (especially thulium), Q-switched lasers, IPL and KTP lasers as the preferred tools for these indications.
When it comes to scars, fractional, Q-switched and vascular lasers remain the devices of choice, according to Dr. Ross.
“In this area, you basically find the particular characteristic of the scar that differentiates it from normal surrounding skin, and then choose the most appropriate device to treat it with,” Dr. Ross says.
The idea of replacing surgical procedures with energy devices for skin tightening is appealing for patients who want to want to turn back the clock without the expense of significant downtime.
“In reality, though, non-surgical ‘facelifts’ using energy devices only help temporarily or can defer a facelift until later,” Dr. Ross explains.
Cosmetic vs Medical
In keeping with the title of the meeting — Aesthetic + Medical Symposia — Dr. Ross made sure to differentiate.
“When we think of cosmetic versus medical application for RF, ultra-sound and laser devices, there are areas that can be classified as medical, such as port wine stains, severe scars and birthmarks,” he says. “With these and other such conditions, we are often treating psychological as well as medical issues.”
Dr. Ross notes two areas where energy-device technology has made few strides.
“Laser hair-reduction systems have improved a bit along the way, mostly by using larger spots and therefore covering larger areas, but there’s been nothing revolutionary in the past few years,” he says. “The same is true for melasma, which is still a big challenge to treat.”
As for the future of energy devices, Dr. Ross had this prediction: “They will be smaller, easier to use and more ergonomically friendly, and feature more sophisticated ‘navigational’ features to help in their use. They will provide more feedback to the practitioner regarding proper settings by scanning — or even photographing — the area being treated.”