Update On Permanent Hair Reduction

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28 May/June 2007 | Medesthetics Photo: Image Source/Image Source/Getty Images By Stacey A. Burns According to the January 2007 Medical Laser Report 4rom Laser Focus World, medical laser systems grew 15% worldwide in 2006 and are expected to grow an additional 14% in 2007. One o4 the 4astest growing segments o4 that market is lasers 4or hair removal.

The number o4 hair removal procedures was projected to increase 4rom 14 million to 45.4 million by 2009, according to a report 4rom Medical Insights released in 2005. Over the past couple o4 years the competition among device manu4acturers has led to continued re nements and incre- mental improvements that have made these procedures easier, 4aster and more e44ective. As public demand 4or hair removal continues, manu4acturers are making a dynamic shi4t toward multiuse laser and light-based devices that do more than just reduce the amount o4 hair.

Update On Permanent Hair Reduction May/June 2007 | Medesthetics cT he Lumenis LightSheer diode laser has been the most popular hair removal device in the U.S. mar- ket, d says Michael H. Gold, MD, who helped develop the original Epilight, licensed by the FDA in 1997.

cAnd currently there are a number o4 4ast, e4 cient ... more. less.

de- vices 4or hair removal, including Lumenis One, Sciton BBL, Alma Lasers and the Aesthera PPx. d The consensus among the dozen or so experts we consulted 4or this article is that the next step in hair reduction technology is a move toward more e4 ciency, us- ing devices that work on a wider range o4 skin types, allow 4or 4ast- er treatments, and keep patients sa4er and more com4ortable. According to E. Victor Ross, MD, Division o4 Dermatology (Skin and Cosmetic Center) at Scripps Clinic, La Jolla, Cali4or- nia, cThere have not been a lot o4 signi cant changes in the eld o4 hair reduction in the past year. Changes have been incremental rather than dramatic, with compa- nies ne-tuning existing technolo- gies and de ning and re ning the capabilities o4 lasers and intense pulsed light (IPL) devices. I expect this to continue through 2007. d The most critical and limit- ing 4actor is still the patient 9s skin type and hair color, notes Mitchell Chasin, MD, Refec- tions Center 4or Skin and Body, Livingston and Bridgewater, New Jersey. When he speaks to groups about the di44erent devices avail- able and their appropriate use, he inevitably hears the question, cSo, which one should I buy 4or my o4 ce? d His advice is to as- sess your practice and choose the device that will allow you to best serve the patient population. Dr. Chasin has several di44erent hair removal devices in each o4 his 4acilities and nds that they all have merit, depending on the pa- tient he is treating. cFor a patient population with lighter skin types, I usually choose an Alexandrite laser, speci cally the GentleLASE. For patients with darker skin types, I pre4er the GentleYAG, an Nd:YAG laser. I4 you must choose only one device, choose the one that will allow you to serve the most patients. When you do have a patient whose optimal treatment requires a device other than the one you own, be wary o4 attempt- ing to treat the patient, d he says. Chasin reports instances where doctors have tried treat- ing skin type VI patients with a short wavelength laser by sim- ply lowering the power. cThis is not an acceptable protocol, d he states. cIt is not only ine44ec- tive at removing the hair but it may possibly worsen the situa- tion. Using a short wavelength at lower power on dark skin can cause hair regrowth that is ner and subsequently more di4 cult to treat. Plus, the patient may experience pigmentation changes or even additional hair growth stimulation in the area. d Experts unanimously advise against 4alling into the trap o4 getting so com4ortable using one device that you decide it is the best 4or all o4 your patients. Multipurpose Trend The current industry trend toward systems that combine energies and wavelengths, allowing physi- cians to buy one plat4orm that can be used 4or all skin types, as well as other procedures, may make it easier 4or physicians with limited resources to o44er a 4ull menu o4 noninvasive cosmetic treatments. The Lumenis One led this trend in 2004 with one plat- 4orm that included the LightSheer 4or hair removal, Multi-Spot Nd: YAG laser technology and an IPL. The newest o4 these plat4orms is the GentleMAX Integrated Aes- thetic Workstation 4rom Candela, which combines its GentleLASE Alexandrite and GentleYAG lasers with either cryogen or air cooling options. Use e4 ciency is 4urther improved with a spot size o4 1.5 mm to 18.0 mm. cIt used to be that when two lasers were combined in the same device, many o4 the operating parameters, including power, were compromised, d says Dr. Chasin. cWhen I tested the GentleMAX, I was excited to nd no reduction o4 available power or other de ciencies. The lasers were the same as when the two were individual units. d Dr. Jason Lupton, MD, says the Candela GentleMAX makes it easy to treat vascular and pigmented Update On Permanent Hair Reduction May/June 2007 | Medesthetics x The GentleMAX integrated Aesthetic Workstation allows physicians to treat leg veins and do skin tightening as well as hair removal in the same appointment. x Lumenis was one o4 the rst companies to o44er a plat4orm that allowed physicians to per4orm hair removal 4or di44erent skin types and additional procedures with one system. lesions, leg and 4acial veins, skin tightening and wrinkle reduction during the same appointment as the hair reduction. One appoint- ment makes patients happy and use o4 the laser more e4 cient. Cynosure o44ers a dual system with its Elite Aesthetic Workstation combining 755 nm and 1064 nm wavelengths within one versatile, compact unit. Shino Bay Aguilera, DO, a dermatologist in private practice in Florida, says that he likes the Elite because he gets repeatable, predictable outcomes and can opti- mize treatments. cThe combination o4 8real laser 9 wavelengths is a 8must have 9 4or our practice. The Elite has opened the door to a huge market 4or me, d he says. In early 2006 Syneron intro- duced emax, a versatile system that combines radio4requency and an 810 nm diode laser 4or 4ast hair removal. An article in the April 2006 Journal of the ASLMS concluded that the clong pulse 810 nm laser coupled with bipolar radio4requency energy achieved cosmetically acceptable hair reduction with a high degree o4 patient satis4action. d A second article in the June 2006 issue o4 the Journal of Cosmetic and Laser Therapy concluded that elos technology can be e44ectively used 4or permanent hair reduc- tion even in patients with blonde hair. The emax system also o44ers ReFirme skin tightening, skin rejuvenation and treatments 4or leg veins and acne. In early 2007 Palomar intro- duced the LuxYs pulsed light handpiece 4or its StarLux Laser and IPL Plat4orm. The LuxYs al- lows practitioners to treat patients with light, ne hair, including vellus hair. The StarLux system already included the LuxRs 4or permanent hair reduction on all skin types, including tanned skin. Evan Parker, vice president o4 sales 4or Creative Technologies, which makes products used in conjunction with light-based hair removal devices (creativeinc.biz), works with nearly 2,000 laser cen- ters across the U.S. cMany o4 these multi-plat4orm devices are very good at o44ering both hair removal and other treatments, but make sure you evaluate the hair removal component individually, d he ad- vises. cAre the fuences su4 cient? Can you adjust the energy level and pulse rate? Does the company o44er good training? No matter which device you choose, you 9ll nd that e4 cacy and sa4ety are di- rectly correlated to the technician 9s knowledge and pro ciency. d Newest IPL Devices Aesthera introduced Painless PPx therapy in August 2005. The PPx System combines IPL and proprietary photopneumatic (PPx) technology. cIt 9s really quite simple, d states Bob Anderson, CTO / co-4ounder o4 Aesthera Corporation, who holds multiple patents associated with laser technology and has more than May/June 2007 | Medesthetics Update On Permanent Hair Reduction cNo matter which device you choose, you 9ll fnd that e\xefcacy and sa\xeety are directly correlated to the technician 9s knowledge and profciency. d OTC Hair Removal In December 2006, Palomar Medical Technologies an- nounced that it received the frst-ever 510(k) over-the- counter clearance #rom the U.S. Food and Drug Ad- ministration #or a light-based hair removal device. OTC clearance means the product can be marketed directly to consumers #or home use without a prescription. cThis is a signifcant milestone #or Palomar, d says CEO Joseph P. Caruso. cThe market opportunity #or an OTC product is bigger than any market we have addressed to date. We have demonstrated again that we are the clear leader in this technology, just as we did in 1997 when we received the frst FDA clearance #or a high powered, light-based hair removal device #or the pro#essional mar- ket. We envision a strong potential market #or an OTC product and an increase in consumer awareness to help drive growth in our pro#essional business. d Palomar has signed an agreement with The Gil- lette Company to #urther develop the device #or the consumer market. This development period will extend throughout 2007. x The new Palomar Starlux 500 plat4orm can include both the Lux Ys and the Lux Rs 4or hair removal. 25 years o4 experience in the laser industry. cDuring a PPx treatment, a handpiece is gently placed on the skin. In a 4raction o4 a second, a vacuum gently draws the skin into the treat- ment tip, bringing the targets such as hair 4ollicles closer to the skin 9s sur4ace. A painless light is applied which sends highly e4 cient photons to the target at 4 to 5 times the standard rate. Because the hair 4ollicles are closer to the light, a lower energy can be used, providing an overall sa4er, painless procedure that 9s extremely 4ast and e44ective. d Results o4 one study in which patients were given ve to six treatments with the Aesthera PPx showed average hair reduction o4 88% at 9 months 4ollowing the last treatment. Newer cost-e44ective multi-application IPL devices include the Mistral 4rom Radiancy and the Chromolite 4rom Genesis BioSystems, both introduced in 2006. The Chromo- lite with its proprietary Smartlite technology allows the device to target blonde and red hair as well as darker hair. The device is also FDA cleared 4or skin rejuvenation and active acne. This broad-spec- trum light energy attacks hair in two ways. The red spectrum light targets melanin in the hair, while the yellow spec- trum light reaches subsur4ace skin layers to target the blood that 4eeds the hair 4ollicle cgerm d cells. This precise targeting means no cooling gel is needed. According to Jim La44erty, president o4 Genesis Biosystems, the broad- spectrum light combined with Chromolite 9s large 15 mm by 50 mm fash lamp and lightning-quick two-second repetition rate make treatments highly cost e44ective. Hair reduction on a man 9s back can be completed in 10 minutes and, 4or ladies, both legs can be treated in about 45 minutes. May/June 2007 | Medesthetics Update On Permanent Hair Reduction Ê The Radiancy Mistral makes it possible to treat all skin types with one e4 cient device. The Radiancy Mistral is a light heat energy (LHE) plat4orm, which can also be used 4or skin rejuve- nation and even acne and psoria- sis treatments. Mistral introduces Optimized Pulse Protocol, which creates a protected environment 4or the sa4e delivery o4 energy. The LHE hair removal system uses a 35-msec light pulse and a large spot size (22 mm by 55 mm), which heats the hair 4ollicle without heating the sur4ace skin. This allows physicians to achieve better than 50% hair reduction six to nine months a4ter treatment with 4our to nine treatments, while eliminating the need 4or any cooling method. A second handpiece allows physicians to sa4ely treat skin types V and VI. New and Improved Patient com4ort is another area o4 emphasis. There has been continued re nement in the man- ner in which lasers cool the skin during hair removal. Dr. Chasin believes cooling devices need to be more operator-proo4 to o44er sa4er and more consistent results. cWhen the treatment depends on the operator spreading a cold gel on the skin to protect the epi- dermis, or pressing a handpiece against the skin at the right angle and 4or the right amount o4 time, there can be a lot o4 variability, d he notes. cBoth overcooling and undercooling o4 the skin can have signi cant adverse e44ects. Today 9s cooling systems are 4ar more exacting than they used to be. Devices with cryogen cooling o44er the sa4est and most predict- able results, e44ectively reducing the chance o4 tissue damage. d Dr. Aguilera is a proponent o4 air cooling. cAir cooling allows us to destroy the target e44ective- ly without the damage. The risk o4 hyperpigmentation is signi - cantly decreased, compared to contact and cryogenic cooling, which must be per4ormed with exact precision and timing. Plus, air cooling eliminates messy gels and creams, d he says. Alma Lasers has taken a di44er- ent approach to patient com4ort with its brand-new Soprano XL system. This virtually painless hair removal system is made possible by the combination o4 low fuence, rapid pulsing diode technology with an in-motion treatment technique. Accord- ing to David J. Friedman, MD, o4 Jerusalem, Israel and New www.medestheticsmagazine.com | May/June 2007 York, one o4 the principal investiga- tors 4or this new product, cThe SHR mode o4 the Soprano XL, which is the in-motion mode, is remarkable. My patients love it. I don 9t nd any o4 the resistance to treatment due to patient discom4ort that I have in the past. In addition, I have 4ound the SHR mode a44ords patients with darker skin an increased sa4ety margin without a compromise in e4 cacy. d Another interesting re nement comes 4rom HOYA ConBio with the introduction o4 its PurpuraLite 4or use with the MedLite laser system. This handpiece allows the ne blood vessels to be temporarily cemptied d in the treatment area so that there is no purpuric response in the skin. Tim Shanahan, director o4 U.S. medical sales 4or HOYA ConBio, says that there has been 4eedback showing increased patient satis4action because there is less pain, which translates into more patients completing treatments. Looking Ahead Dr. Gold, who uses a variety o4 IPL and laser devices in his Nashville, Tennessee, laser center, believes that today 9s hair removal devices are gener- ally comparable in e4 cacy but he continues to research more e44ective approaches. At the annual meeting o4 the American Academy o4 Dermatology held in Washington, DC, last February, he presented results 4rom a recently completed comparative study done in conjunction with Sciton looking at advanced hair removal protocols. Study patients 9 backs were divided into 4our sections. One section was le4t untreated; one was treated only with the Sciton BBL; one was treated only with the Sciton 1064 Nd:YAG; and one was treated with both the BBL and the Nd:YAG. All three treated sections showed e44ective hair removal, but the section treated with both the BBL and the Nd:YAG showed signi cantly better results than either single method. Andrea Pezzano, director o4 mar- keting at Sciton, says, cThe PROFILE is the aesthetic system available that o44ers the advantage o4 both high-speed robotic scanning o4 the 1064 Nd:YAG and a BBL with unlimited pulses all in the same plat4orm. And with the con- gurable plat4orm, any PROFILE system can be easily upgraded with the BBL. d During 2007 our experts predict we 9ll see the trend toward multi-plat- 4orm devices continue and researchers will endeavor to re ne how each o4 these devices works individually and in combination. Finally, Quest Pharmatech, a Canadian -based company, recently reported the results o4 an initial study with a topi- cal compound called SL-017 designed to be used in conjunction with laser or broad-spectrum light to remove hair. The company is now beginning a trial to determine the appropriate light dose 4or optimal results. Quest reports that adding SL-017 to light-based hair removal will accomplish permanent hair reduction in 4ewer sessions 4potentially in a single treatment. Stay tuned 4or more. Stacey A. Burns is a Cedar City, Utah-based freelance writer. Update On Permanent Hair Reduction May/June 2007 | Medesthetics x Using both the Sciton BBL and 1064 Nd:YAG produced more e44ective hair removal than using either device alone in a recent study. x HOYA ConBio 9s Med Lite C6 now includes the PurpuraLite.

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