There are hundreds of lasers and lights used in the field of dermatology, none of which are inexpensive, so it is important to carefully select those that will best fit your specific practice. Making this decision can be particular ly daunting for a new provider interested in embarking upon this sizeable purchase decision within a young practice. Matching your practice style and geography is critical to the right move. For example, the pulsed dye laser – ideal for hemangiomas and port-wine stains – was our practice’s first laser when we saw mostly children. A fractional CO2 ablative laser would not have made sense then. Likewise, in New York City or Los Angeles, age-defying lasers may be more relevant than in a remote area where an ultraviolet B box may prove a serious workhorse and greater revenue generator for the practice.
No matter which laser or light device you choose for your first, pick one that you have some experience with, either through residency training or a colleague. The learning curve for any new laser is a steep one, so might as well start with something you have some familiarity with. Laser vendors can augment that training to be sure, but their perspective is usually somewhat different than a clinician’s perspective.
I polled the providers in our practice and asked, “of all our non-surgical (light, laser, etc.) which is your favorite and why?” The answers gave me some insight on why we as care providers gravitate toward certain therapies over others. Here is what they had to say:
Dr. Libby Rhee: Ultherapy
Ultherapy is a noninvasive, non-surgical device that uses ultrasound technology and the body’s inherent rejuvenation mechanisms to tone and tighten skin. It is FDA approved to help lift eyebrows and address laxity in the face, neck and chin areas. The procedure is done in the office and takes approximately one hour. There is mild-to-moderate discomfort associated with the procedure but it is generally considered very tolerable. Unlike conventional laser therapy, Ultherapy bypasses the surface of the skin and delivers targeted ultrasound energy to the deepest levels of the dermis. The energy, in the form of heat, induces microscopic damage in the thermal treatment zones, thereby promoting new collagen production. The collagen neogenesis continues to work under the surface of the skin over the months following treatment. The result is a subtle yet gradual improvement in skin laxity and tone that continues to improve with time. With a series of treatments the results can be more significant. 1,2
An important advantage of the Ultherapy device is that it can be used safely on any skin type regardless of ethnicity. With all of the work occurring under the surface of the skin, there is virtually zero potential for epidermal dyspigmentation or scarring. It is an ideal choice for someone who is not ready for a surgical facelift but desires results with minimal downtime.
Dr. Rebecca Marcus: Clear + Brilliant
Clear + Brilliant is a non-ablative fractional laser ideal for patients who wish to improve their appearance as they begin to show early signs of aging. This laser is an affordable and minimally invasive solution for dyspigmentation, fine lines and textural changes. Patients are treated in 3 to 6 sessions spaced as few as 2 weeks apart, and we have found that pre-application of topical anesthetic cream renders treatments pain free. Results are immediate and cumulative, with post-procedure redness lasting a few hours.
Patients often notice a brighter, glowing complexion after their first treatment, and additional treatments result in achievement of more even pigmentation, improved appearance of pore size and stimulation of collagen with subsequent improvement of fine lines.
Clear + Brilliant may be used with 2 different handpieces with wavelengths of 1440 nm and 1927 nm, each targeting slightly different levels of the superficial dermis. Water is the chromophore for both, which eliminates the risks associated with targeting pigment and translates to versatility across a broad spectrum of skin types. In addition, both handpieces leave the stratum corneum intact, which accounts for nearly non-existent social downtime. Patients may apply makeup immediately following the procedure.
The 1440 nm handpiece targets a depth of 200-300 µm, which corresponds to the level of the dermis where uneven pigmentation and fine lines appear. The 1927 nm handpiece reaches a depth of 170 µm, the level at which melanin resides, and creates broader, more superficial defects to increase skin permeability and enhance the efficacy of topical brightening serum applied immediately post-procedure.
When used with either handpiece, Clear + Brilliant is an exciting option for patients who wish to freshen and brighten their skin without committing to the cost and recovery time associated with other laser resurfacing options.
Christopher Busapavanij, PA-C: Clear + Brilliant
The Clear + Brilliant laser also is my favorite cosmetic laser to use in our practice. This is due to its ease of use and effectiveness. The laser is gently rolled over the skin, while emitting a beeping sound that ensures the practitioner is correctly using the laser. The laser will immediately let someone know if they are rolling the laser tip too quickly, and therefore adjustments can be made instantly.
With only 3 possible settings to choose from, the Clear + Brilliant laser is the easiest to use of the ones in our practice, and the least intimidating. It is also a good laser to use for patients with mild acne scaring where a stronger laser would have significantly more “down time” associated with it. Patients usually see a significant improvement after a single treatment as well.
Dr. Amy Spizuoco: Nb-Uvb
Narrow band UVB (NB-UVB) therapy is a safe and effective treatment for several dermatologic conditions. Most commonly used to treat patients with psoriasis, it also has been shown to repigment vitiligo, and alter the itch-scratch cycle in patients with atopic dermatitis and pruritus, and safely treat cutaneous T-cell lymphoma.3-12
Sunlight has been shown to decrease lesions in patients with psoriasis. Studies have shown that the broadband UVB spectrum of 290-320 nm is what is inducing these positive effects: more specifically, the narrow band spectrum of 308-311nm.
Patients are to reach the minimal erythema dose (MED) for optimal treatment response. MED is defined as the lowest dose that causes a minimally perceptible “sunburn” reaction at 24 hours after treatment. Treatments are given 2 to 5 times weekly. Each treatment builds on the previous.
NB-UVB therapy allows patients with psoriasis to avoid using systemic medications (typically immunosuppressants) to treat their psoriasis. Patients can expect a treatment regimen that lasts approximately 3 to 4 months and when it comes to psoriasis, patients may be lesion free for 4 to 6 months.
Dr. Aanand Geria: Nd-Yag
The Q-switched Nd:YAG laser is an extremely valuable device in our office. Its longer wavelength compared to other Q-switched lasers makes it ideal for targeting pigment deep in the dermis. We most commonly use this laser for the removal of blue or black tattoos but it can also be used for a variety of lesions with a deep dermal component such as Nevus of Ota or Ito, minocycline-induced pigmentation and even graphite tattoos.
For more superficial lesions, the Q-switched Nd-YAG is effective for lentigines and café au lait macules but less so for nevus spilus. From a safety perspective, the 1064 nm wavelength is considered ideal for treating skin of color patients.
Dr. Morgan Rabach: Pulsed Dye Laser
The Pulsed Dye Laser, or PDL, uses a concentrated beam of light that targets blood vessels in the skin. The versatile laser easily treats skin conditions such as rosacea, angiomas and telangiectasias. Patients express their satisfaction when the PDL laser is used and they see improvements in scars, red stretch marks and even their warts. The PDL laser also has an important role in treating pediatric birthmarks such as hemangiomas and port wine stains. Because of the versatility and ease of this laser, the PDL is my favorite.
Bobby Buka, MD, JD: CO2 Matrix
The CO2 Matrix by Sandstone is my favorite laser for high-powered resurfacing. Among ablative therapies the CO2 has taken a pole position in efficacy. Patients with Fitzpatrick skin types I-IV are ideally suited for this modality. Patient selection must be performed with care because the healing time for this laser can be daunting. Wound care instructions and management of complications must be on-point, so your medical assistants should be well trained on counseling. But there is no better option for “one-and-done” procedures that more and more of my cosmetic patients are gravitating toward.
In addition, the CO2 at lower settings is my secret weapon for melasma and dermatoheliosis. Because we can adjust wattage, duration and depth with this laser, I can satisfy expectations ranging from a mild glycolic acid peel to a 3 mm depth heavy rejuvenation with neocollageneis and dermal remodeling.
I use this laser chiefly for rolled, ice-pick and boxcar scarring formations. It is wonderfully gratifying for me to begin treating a patient for severe nodulocystic acne and scarring at age 15, head hung low with a palpable lack of self-confidence, only to watch this same teenager transform into a clear complected, pre-med collegiate full of self-esteem. n
Dr. Buka is in private practice in New York, NY. He serves as section chief for the Mount Sinai School of Medicine, Department of Dermatology.
Disclosure: Dr. Buka has no disclosures related to this article.
References
1. Ultherapy website. https://www.ultherapy.com
Accessed October 31, 2013.
2. The Dermatology Review website. https://www.thedermreview.com/ultherapy/. Accessed October 31, 2013.
3. Resnik KS, Vonderheid EC: Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients. J Am Acad Dermatol. 1993;29(1):73-77.
4. Ramsay DL, Lish KM, Yalowitz CB, Soter NA: Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma. Arch Dermatol. 1992;128(7):931-933.
5. Boztepe G, Sahin S, Ayhan M, Erkin G, Kilemen F. Narrowband ultraviolet B phototherapy to clear and maintain clearance in patients with mycosis fungoides. J Am Acad Dermatol. 2005;53:(2)242-246.
6. Volc-Platzer B, Hönigsmann H: Photoimmunology of PUVA and UVB therapy. In: Krutmann J, Elmets CA, ed. Photoimmunology, Oxford, United Kingdom: Blackwell Science; 1995:265-273.
7. Ozawa M, Ferenczi K, Kikuchi T, et al. 312-nanometer ultraviolet B light (narrow-band UVB) induces apoptosis of T cells within psoriatic lesions. J Exp Med.1999;189(4)711-718.
8. Westerhof W, Nieuweboer-Krobotova L: Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997:133(12):1525-1528.
9. Yones SS, Palmer RA, Garibaldinos TM, Hawk JLM: .andomized double-blind trial of treatment of vitiligo. Arch Dermatol. 2007;143(5):578-584.
10. Jekler J, Larkö O: Phototherapy for atopic dermatitis with ultraviolet A (UVA), low-dose UVB and combined UVA and UVB: two paired comparison studies. Photodermatol Photoimmunol Photomed 1991;8(4):151-156.
11. George SA, Bilsland DJ, Johnson BE, Ferguson J. Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis. Br J Dermatol. 1993; 128(1):49-56.
12. Reynolds NJ, Franklin V, Gray JC, et al: Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 2001;357(927):2012-2016.
To read more news, trends and case studies about lasers and light therapies, visit.the-dermatologist.com/laser-light-therapies.
There are hundreds of lasers and lights used in the field of dermatology, none of which are inexpensive, so it is important to carefully select those that will best fit your specific practice. Making this decision can be particular ly daunting for a new provider interested in embarking upon this sizeable purchase decision within a young practice. Matching your practice style and geography is critical to the right move. For example, the pulsed dye laser – ideal for hemangiomas and port-wine stains – was our practice’s first laser when we saw mostly children. A fractional CO2 ablative laser would not have made sense then. Likewise, in New York City or Los Angeles, age-defying lasers may be more relevant than in a remote area where an ultraviolet B box may prove a serious workhorse and greater revenue generator for the practice.
No matter which laser or light device you choose for your first, pick one that you have some experience with, either through residency training or a colleague. The learning curve for any new laser is a steep one, so might as well start with something you have some familiarity with. Laser vendors can augment that training to be sure, but their perspective is usually somewhat different than a clinician’s perspective.
I polled the providers in our practice and asked, “of all our non-surgical (light, laser, etc.) which is your favorite and why?” The answers gave me some insight on why we as care providers gravitate toward certain therapies over others. Here is what they had to say:
Dr. Libby Rhee: Ultherapy
Ultherapy is a noninvasive, non-surgical device that uses ultrasound technology and the body’s inherent rejuvenation mechanisms to tone and tighten skin. It is FDA approved to help lift eyebrows and address laxity in the face, neck and chin areas. The procedure is done in the office and takes approximately one hour. There is mild-to-moderate discomfort associated with the procedure but it is generally considered very tolerable. Unlike conventional laser therapy, Ultherapy bypasses the surface of the skin and delivers targeted ultrasound energy to the deepest levels of the dermis. The energy, in the form of heat, induces microscopic damage in the thermal treatment zones, thereby promoting new collagen production. The collagen neogenesis continues to work under the surface of the skin over the months following treatment. The result is a subtle yet gradual improvement in skin laxity and tone that continues to improve with time. With a series of treatments the results can be more significant. 1,2
An important advantage of the Ultherapy device is that it can be used safely on any skin type regardless of ethnicity. With all of the work occurring under the surface of the skin, there is virtually zero potential for epidermal dyspigmentation or scarring. It is an ideal choice for someone who is not ready for a surgical facelift but desires results with minimal downtime.
Dr. Rebecca Marcus: Clear + Brilliant
Clear + Brilliant is a non-ablative fractional laser ideal for patients who wish to improve their appearance as they begin to show early signs of aging. This laser is an affordable and minimally invasive solution for dyspigmentation, fine lines and textural changes. Patients are treated in 3 to 6 sessions spaced as few as 2 weeks apart, and we have found that pre-application of topical anesthetic cream renders treatments pain free. Results are immediate and cumulative, with post-procedure redness lasting a few hours.
Patients often notice a brighter, glowing complexion after their first treatment, and additional treatments result in achievement of more even pigmentation, improved appearance of pore size and stimulation of collagen with subsequent improvement of fine lines.
Clear + Brilliant may be used with 2 different handpieces with wavelengths of 1440 nm and 1927 nm, each targeting slightly different levels of the superficial dermis. Water is the chromophore for both, which eliminates the risks associated with targeting pigment and translates to versatility across a broad spectrum of skin types. In addition, both handpieces leave the stratum corneum intact, which accounts for nearly non-existent social downtime. Patients may apply makeup immediately following the procedure.
The 1440 nm handpiece targets a depth of 200-300 µm, which corresponds to the level of the dermis where uneven pigmentation and fine lines appear. The 1927 nm handpiece reaches a depth of 170 µm, the level at which melanin resides, and creates broader, more superficial defects to increase skin permeability and enhance the efficacy of topical brightening serum applied immediately post-procedure.
When used with either handpiece, Clear + Brilliant is an exciting option for patients who wish to freshen and brighten their skin without committing to the cost and recovery time associated with other laser resurfacing options.
Christopher Busapavanij, PA-C: Clear + Brilliant
The Clear + Brilliant laser also is my favorite cosmetic laser to use in our practice. This is due to its ease of use and effectiveness. The laser is gently rolled over the skin, while emitting a beeping sound that ensures the practitioner is correctly using the laser. The laser will immediately let someone know if they are rolling the laser tip too quickly, and therefore adjustments can be made instantly.
With only 3 possible settings to choose from, the Clear + Brilliant laser is the easiest to use of the ones in our practice, and the least intimidating. It is also a good laser to use for patients with mild acne scaring where a stronger laser would have significantly more “down time” associated with it. Patients usually see a significant improvement after a single treatment as well.
Dr. Amy Spizuoco: Nb-Uvb
Narrow band UVB (NB-UVB) therapy is a safe and effective treatment for several dermatologic conditions. Most commonly used to treat patients with psoriasis, it also has been shown to repigment vitiligo, and alter the itch-scratch cycle in patients with atopic dermatitis and pruritus, and safely treat cutaneous T-cell lymphoma.3-12
Sunlight has been shown to decrease lesions in patients with psoriasis. Studies have shown that the broadband UVB spectrum of 290-320 nm is what is inducing these positive effects: more specifically, the narrow band spectrum of 308-311nm.
Patients are to reach the minimal erythema dose (MED) for optimal treatment response. MED is defined as the lowest dose that causes a minimally perceptible “sunburn” reaction at 24 hours after treatment. Treatments are given 2 to 5 times weekly. Each treatment builds on the previous.
NB-UVB therapy allows patients with psoriasis to avoid using systemic medications (typically immunosuppressants) to treat their psoriasis. Patients can expect a treatment regimen that lasts approximately 3 to 4 months and when it comes to psoriasis, patients may be lesion free for 4 to 6 months.
Dr. Aanand Geria: Nd-Yag
The Q-switched Nd:YAG laser is an extremely valuable device in our office. Its longer wavelength compared to other Q-switched lasers makes it ideal for targeting pigment deep in the dermis. We most commonly use this laser for the removal of blue or black tattoos but it can also be used for a variety of lesions with a deep dermal component such as Nevus of Ota or Ito, minocycline-induced pigmentation and even graphite tattoos.
For more superficial lesions, the Q-switched Nd-YAG is effective for lentigines and café au lait macules but less so for nevus spilus. From a safety perspective, the 1064 nm wavelength is considered ideal for treating skin of color patients.
Dr. Morgan Rabach: Pulsed Dye Laser
The Pulsed Dye Laser, or PDL, uses a concentrated beam of light that targets blood vessels in the skin. The versatile laser easily treats skin conditions such as rosacea, angiomas and telangiectasias. Patients express their satisfaction when the PDL laser is used and they see improvements in scars, red stretch marks and even their warts. The PDL laser also has an important role in treating pediatric birthmarks such as hemangiomas and port wine stains. Because of the versatility and ease of this laser, the PDL is my favorite.
Bobby Buka, MD, JD: CO2 Matrix
The CO2 Matrix by Sandstone is my favorite laser for high-powered resurfacing. Among ablative therapies the CO2 has taken a pole position in efficacy. Patients with Fitzpatrick skin types I-IV are ideally suited for this modality. Patient selection must be performed with care because the healing time for this laser can be daunting. Wound care instructions and management of complications must be on-point, so your medical assistants should be well trained on counseling. But there is no better option for “one-and-done” procedures that more and more of my cosmetic patients are gravitating toward.
In addition, the CO2 at lower settings is my secret weapon for melasma and dermatoheliosis. Because we can adjust wattage, duration and depth with this laser, I can satisfy expectations ranging from a mild glycolic acid peel to a 3 mm depth heavy rejuvenation with neocollageneis and dermal remodeling.
I use this laser chiefly for rolled, ice-pick and boxcar scarring formations. It is wonderfully gratifying for me to begin treating a patient for severe nodulocystic acne and scarring at age 15, head hung low with a palpable lack of self-confidence, only to watch this same teenager transform into a clear complected, pre-med collegiate full of self-esteem. n
Dr. Buka is in private practice in New York, NY. He serves as section chief for the Mount Sinai School of Medicine, Department of Dermatology.
Disclosure: Dr. Buka has no disclosures related to this article.
References
1. Ultherapy website. https://www.ultherapy.com
Accessed October 31, 2013.
2. The Dermatology Review website. https://www.thedermreview.com/ultherapy/. Accessed October 31, 2013.
3. Resnik KS, Vonderheid EC: Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients. J Am Acad Dermatol. 1993;29(1):73-77.
4. Ramsay DL, Lish KM, Yalowitz CB, Soter NA: Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma. Arch Dermatol. 1992;128(7):931-933.
5. Boztepe G, Sahin S, Ayhan M, Erkin G, Kilemen F. Narrowband ultraviolet B phototherapy to clear and maintain clearance in patients with mycosis fungoides. J Am Acad Dermatol. 2005;53:(2)242-246.
6. Volc-Platzer B, Hönigsmann H: Photoimmunology of PUVA and UVB therapy. In: Krutmann J, Elmets CA, ed. Photoimmunology, Oxford, United Kingdom: Blackwell Science; 1995:265-273.
7. Ozawa M, Ferenczi K, Kikuchi T, et al. 312-nanometer ultraviolet B light (narrow-band UVB) induces apoptosis of T cells within psoriatic lesions. J Exp Med.1999;189(4)711-718.
8. Westerhof W, Nieuweboer-Krobotova L: Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997:133(12):1525-1528.
9. Yones SS, Palmer RA, Garibaldinos TM, Hawk JLM: .andomized double-blind trial of treatment of vitiligo. Arch Dermatol. 2007;143(5):578-584.
10. Jekler J, Larkö O: Phototherapy for atopic dermatitis with ultraviolet A (UVA), low-dose UVB and combined UVA and UVB: two paired comparison studies. Photodermatol Photoimmunol Photomed 1991;8(4):151-156.
11. George SA, Bilsland DJ, Johnson BE, Ferguson J. Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis. Br J Dermatol. 1993; 128(1):49-56.
12. Reynolds NJ, Franklin V, Gray JC, et al: Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 2001;357(927):2012-2016.
To read more news, trends and case studies about lasers and light therapies, visit.the-dermatologist.com/laser-light-therapies.
There are hundreds of lasers and lights used in the field of dermatology, none of which are inexpensive, so it is important to carefully select those that will best fit your specific practice. Making this decision can be particular ly daunting for a new provider interested in embarking upon this sizeable purchase decision within a young practice. Matching your practice style and geography is critical to the right move. For example, the pulsed dye laser – ideal for hemangiomas and port-wine stains – was our practice’s first laser when we saw mostly children. A fractional CO2 ablative laser would not have made sense then. Likewise, in New York City or Los Angeles, age-defying lasers may be more relevant than in a remote area where an ultraviolet B box may prove a serious workhorse and greater revenue generator for the practice.
No matter which laser or light device you choose for your first, pick one that you have some experience with, either through residency training or a colleague. The learning curve for any new laser is a steep one, so might as well start with something you have some familiarity with. Laser vendors can augment that training to be sure, but their perspective is usually somewhat different than a clinician’s perspective.
I polled the providers in our practice and asked, “of all our non-surgical (light, laser, etc.) which is your favorite and why?” The answers gave me some insight on why we as care providers gravitate toward certain therapies over others. Here is what they had to say:
Dr. Libby Rhee: Ultherapy
Ultherapy is a noninvasive, non-surgical device that uses ultrasound technology and the body’s inherent rejuvenation mechanisms to tone and tighten skin. It is FDA approved to help lift eyebrows and address laxity in the face, neck and chin areas. The procedure is done in the office and takes approximately one hour. There is mild-to-moderate discomfort associated with the procedure but it is generally considered very tolerable. Unlike conventional laser therapy, Ultherapy bypasses the surface of the skin and delivers targeted ultrasound energy to the deepest levels of the dermis. The energy, in the form of heat, induces microscopic damage in the thermal treatment zones, thereby promoting new collagen production. The collagen neogenesis continues to work under the surface of the skin over the months following treatment. The result is a subtle yet gradual improvement in skin laxity and tone that continues to improve with time. With a series of treatments the results can be more significant. 1,2
An important advantage of the Ultherapy device is that it can be used safely on any skin type regardless of ethnicity. With all of the work occurring under the surface of the skin, there is virtually zero potential for epidermal dyspigmentation or scarring. It is an ideal choice for someone who is not ready for a surgical facelift but desires results with minimal downtime.
Dr. Rebecca Marcus: Clear + Brilliant
Clear + Brilliant is a non-ablative fractional laser ideal for patients who wish to improve their appearance as they begin to show early signs of aging. This laser is an affordable and minimally invasive solution for dyspigmentation, fine lines and textural changes. Patients are treated in 3 to 6 sessions spaced as few as 2 weeks apart, and we have found that pre-application of topical anesthetic cream renders treatments pain free. Results are immediate and cumulative, with post-procedure redness lasting a few hours.
Patients often notice a brighter, glowing complexion after their first treatment, and additional treatments result in achievement of more even pigmentation, improved appearance of pore size and stimulation of collagen with subsequent improvement of fine lines.
Clear + Brilliant may be used with 2 different handpieces with wavelengths of 1440 nm and 1927 nm, each targeting slightly different levels of the superficial dermis. Water is the chromophore for both, which eliminates the risks associated with targeting pigment and translates to versatility across a broad spectrum of skin types. In addition, both handpieces leave the stratum corneum intact, which accounts for nearly non-existent social downtime. Patients may apply makeup immediately following the procedure.
The 1440 nm handpiece targets a depth of 200-300 µm, which corresponds to the level of the dermis where uneven pigmentation and fine lines appear. The 1927 nm handpiece reaches a depth of 170 µm, the level at which melanin resides, and creates broader, more superficial defects to increase skin permeability and enhance the efficacy of topical brightening serum applied immediately post-procedure.
When used with either handpiece, Clear + Brilliant is an exciting option for patients who wish to freshen and brighten their skin without committing to the cost and recovery time associated with other laser resurfacing options.
Christopher Busapavanij, PA-C: Clear + Brilliant
The Clear + Brilliant laser also is my favorite cosmetic laser to use in our practice. This is due to its ease of use and effectiveness. The laser is gently rolled over the skin, while emitting a beeping sound that ensures the practitioner is correctly using the laser. The laser will immediately let someone know if they are rolling the laser tip too quickly, and therefore adjustments can be made instantly.
With only 3 possible settings to choose from, the Clear + Brilliant laser is the easiest to use of the ones in our practice, and the least intimidating. It is also a good laser to use for patients with mild acne scaring where a stronger laser would have significantly more “down time” associated with it. Patients usually see a significant improvement after a single treatment as well.
Dr. Amy Spizuoco: Nb-Uvb
Narrow band UVB (NB-UVB) therapy is a safe and effective treatment for several dermatologic conditions. Most commonly used to treat patients with psoriasis, it also has been shown to repigment vitiligo, and alter the itch-scratch cycle in patients with atopic dermatitis and pruritus, and safely treat cutaneous T-cell lymphoma.3-12
Sunlight has been shown to decrease lesions in patients with psoriasis. Studies have shown that the broadband UVB spectrum of 290-320 nm is what is inducing these positive effects: more specifically, the narrow band spectrum of 308-311nm.
Patients are to reach the minimal erythema dose (MED) for optimal treatment response. MED is defined as the lowest dose that causes a minimally perceptible “sunburn” reaction at 24 hours after treatment. Treatments are given 2 to 5 times weekly. Each treatment builds on the previous.
NB-UVB therapy allows patients with psoriasis to avoid using systemic medications (typically immunosuppressants) to treat their psoriasis. Patients can expect a treatment regimen that lasts approximately 3 to 4 months and when it comes to psoriasis, patients may be lesion free for 4 to 6 months.
Dr. Aanand Geria: Nd-Yag
The Q-switched Nd:YAG laser is an extremely valuable device in our office. Its longer wavelength compared to other Q-switched lasers makes it ideal for targeting pigment deep in the dermis. We most commonly use this laser for the removal of blue or black tattoos but it can also be used for a variety of lesions with a deep dermal component such as Nevus of Ota or Ito, minocycline-induced pigmentation and even graphite tattoos.
For more superficial lesions, the Q-switched Nd-YAG is effective for lentigines and café au lait macules but less so for nevus spilus. From a safety perspective, the 1064 nm wavelength is considered ideal for treating skin of color patients.
Dr. Morgan Rabach: Pulsed Dye Laser
The Pulsed Dye Laser, or PDL, uses a concentrated beam of light that targets blood vessels in the skin. The versatile laser easily treats skin conditions such as rosacea, angiomas and telangiectasias. Patients express their satisfaction when the PDL laser is used and they see improvements in scars, red stretch marks and even their warts. The PDL laser also has an important role in treating pediatric birthmarks such as hemangiomas and port wine stains. Because of the versatility and ease of this laser, the PDL is my favorite.
Bobby Buka, MD, JD: CO2 Matrix
The CO2 Matrix by Sandstone is my favorite laser for high-powered resurfacing. Among ablative therapies the CO2 has taken a pole position in efficacy. Patients with Fitzpatrick skin types I-IV are ideally suited for this modality. Patient selection must be performed with care because the healing time for this laser can be daunting. Wound care instructions and management of complications must be on-point, so your medical assistants should be well trained on counseling. But there is no better option for “one-and-done” procedures that more and more of my cosmetic patients are gravitating toward.
In addition, the CO2 at lower settings is my secret weapon for melasma and dermatoheliosis. Because we can adjust wattage, duration and depth with this laser, I can satisfy expectations ranging from a mild glycolic acid peel to a 3 mm depth heavy rejuvenation with neocollageneis and dermal remodeling.
I use this laser chiefly for rolled, ice-pick and boxcar scarring formations. It is wonderfully gratifying for me to begin treating a patient for severe nodulocystic acne and scarring at age 15, head hung low with a palpable lack of self-confidence, only to watch this same teenager transform into a clear complected, pre-med collegiate full of self-esteem. n
Dr. Buka is in private practice in New York, NY. He serves as section chief for the Mount Sinai School of Medicine, Department of Dermatology.
Disclosure: Dr. Buka has no disclosures related to this article.
References
1. Ultherapy website. https://www.ultherapy.com
Accessed October 31, 2013.
2. The Dermatology Review website. https://www.thedermreview.com/ultherapy/. Accessed October 31, 2013.
3. Resnik KS, Vonderheid EC: Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients. J Am Acad Dermatol. 1993;29(1):73-77.
4. Ramsay DL, Lish KM, Yalowitz CB, Soter NA: Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma. Arch Dermatol. 1992;128(7):931-933.
5. Boztepe G, Sahin S, Ayhan M, Erkin G, Kilemen F. Narrowband ultraviolet B phototherapy to clear and maintain clearance in patients with mycosis fungoides. J Am Acad Dermatol. 2005;53:(2)242-246.
6. Volc-Platzer B, Hönigsmann H: Photoimmunology of PUVA and UVB therapy. In: Krutmann J, Elmets CA, ed. Photoimmunology, Oxford, United Kingdom: Blackwell Science; 1995:265-273.
7. Ozawa M, Ferenczi K, Kikuchi T, et al. 312-nanometer ultraviolet B light (narrow-band UVB) induces apoptosis of T cells within psoriatic lesions. J Exp Med.1999;189(4)711-718.
8. Westerhof W, Nieuweboer-Krobotova L: Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997:133(12):1525-1528.
9. Yones SS, Palmer RA, Garibaldinos TM, Hawk JLM: .andomized double-blind trial of treatment of vitiligo. Arch Dermatol. 2007;143(5):578-584.
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