Laser, light treatments expanding, combining modalities

Key developments from the recent American Society for Laser Medicine and Surgery (ASLMS) meeting include broader applications for existing devices and the growing availability of treatments that combine modalities.



Dr. Alster
"While fractional laser surfacing (Fraxel, Reliant Technologies) is nothing new to those physicians who have been using it over the last couple of years, it's still novel to the majority of attendees, including many experienced laser specialists," says Tina S. Alster, M.D., director, Washington Institute of Dermatologic Laser Surgery and clinical professor of dermatology, Georgetown University Medical Center.

According to a study Dr. Alster presented, clinical results obtained after three Fraxel treatments remained evident for 12 months thereafter (Tanzi EL, Alster TS. Lasers Surg Med. 2006; suppl.18:25).

"What is happening is that longer follow-up studies are being performed on rejuvenation patients, including those treated in nonfacial sites," Dr. Alster says.

As with other technologies, she adds, physicians are beginning to use Fraxel for additional indications, including acne scars and stretch marks.


Dr. Zachary
"Fractionated delivery of laser energy is a major advance in laser surgery, and we're already seeing other companies developing devices which deliver intense amounts of energy to a fraction of the skin's surface," says Christopher Zachary, M.D., professor and chairman of dermatology at the University of California, Irvine, and program chair of the meeting.

Ultimately, he predicts these developments will be as important to laser surgery as are cooling technologies.


PLASMA SKIN RESURFACING

The meeting also represented many attendees' first in-depth exposure to plasma skin resurfacing (Portrait PSR3, Rhytec), Dr. Alster says.

In addition to extended reporting on facial rejuvenation results, presenters revealed new research into the device's safety and efficacy on the neck, chest and hands.

"Plasma skin resurfacing packs a bit more punch than does Fraxel, but it does require some postoperative recovery by patients," reports Dr. Alster, who co-authored a study which found 40 percent to 60 percent long-standing improvement in 30 sites on the neck, chest and hand after a single treatment at low energy settings of either 1, 1.5 or 1.8 joules (Alster TS, Tanzi EL. Lasers Surg Med. 2006;suppl. 18;20).

"This is just the beginning of using plasma skin resurfacing off-face," Dr. Alster says, "but we clearly showed that it was safe using the technique and relatively low fluences applied. Further research is necessary to determine the effect of multiple treatment sessions, as well as optimal device parameters, treatment intervals and longevity of results."


CELLULITE

"Cellulite is a pervasive problem among post-pubertal women," Dr. Alster says, "and we still don't have a great treatment for it."

Based on a review of studies done to date, she says the VelaSmooth (Syneron) device, with a combination of radiofrequency, infrared light and mechanical negative pressure massage, appears to be more effective than TriActive (Cynosure), which combines a diode laser, suction and rollers, though other technologies could emerge.

"There's little doubt that cellulite treatment remains imperfect, and that some sort of combination treatment — whether it's radiofrequency, light and massage or another combination, including perhaps ultrasound or mesotherapy — represents the wave of the future," Dr. Alster explains.


HAIR REMOVAL

As for hair removal, Kathleen Gilmore, M.D., presented a review of more than 1,600 such treatments (1,092 with LightSheer diode laser, Lumenis; 545 with Aurora IPL and radiofrequency system, Polaris) occurring over three months in a high-volume laser hair removal center.

Researchers noted only two adverse events in the LightSheer group and none in the Aurora group, according to Dr. Gilmore, who is corporate medical director for American Laser Centers.

Laser epilation is a very safe procedure, "as long as one has a good, safe protocol," she says.

To that end, she attributes American Laser Centers' low adverse event rate to factors including fine-tuned skin typing, which considers elements such as heredity and hair color, and careful pre-treatment testing that focuses on the body's left side, which suffers more sun exposure when Americans drive.

Biostimulation through light-emitting diodes (LEDs; GentleWaves, Light BioScience) also continues to progress, Dr. Alster says. "When this technology was first introduced stateside," she observes, "there didn't seem to be a lot of clinical or basic science there."

But with increasing use, physicians are noticing subtle changes, which the research of David H. McDaniel, M.D., of Virginia Beach, Va., is beginning to quantify, she says.

Along with providing noninvasive rejuvenation, Dr. Alster says the technology appears especially helpful for minimizing erythema after laser procedures and sunburns. Its anti-inflammatory effect also makes it effective against dermatitis, she adds.

Dr. Zachary says, "There's a huge amount of interest in LEDs," and much more information available about the way in which these nonthermal lasers can affect fibroblast, vascular and other elements of the skin. "It would appear that these devices reduce erythema and can stimulate all sorts of cytokines with the goal of promoting collagen remodeling or rejuvenation," he adds.

Regarding other technologies, Dr. Zachary says, "The monopolar radiofrequency device (ThermaCool™, Thermage®) over the last several years has changed dramatically the way in which energy is delivered."

Specifically, he says its manufacturer now offers faster and smaller tips that create the potential for eyelid treatments.

Drs. Alster and Zachary say the Cynergy laser (Cynosure), which delivers two wavelengths (595 nm and 1,064 nm) in sequential pulses for vascular treatments, also merits mention.

"With the first pulse, one can change, within microseconds, the absorption characteristics of the blood to prepare for the second pulse, which will then cause a profound, deeper benefit to the vascular malformation," Dr. Zachary explains.

Thanks to increasingly sophisticated engineering, either through combining laser beams or refining intense pulsed light (IPL) devices through filtering and pulsing systems, Dr. Zachary says, "These are exciting times for laser surgeons."

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Disclosures:
Dr. Zachary is an unpaid consultant for Reliant Technologies.
Dr. Alster is an unpaid member of Syneron's medical advisory board.