Joel L. Cohen, MD, is Director at AboutSkin Dermatology and DermSurgery, Greenwood Village, Colorado.
“I had a great opportunity to put my own series of before and after pictures together, and to really think about the lasers that I use every day,” said Joel L. Cohen, MD, who presented “IPL to Resurfacing: Laser and Light Innovations” at the 2021 Fall Clinical Conference®.
“When you’re asked to cover something with this broad a spectrum… [it gives] you the opportunity is to think about what you have done in your practice historically, what you do now, and what are potential unmet needs.”
Case in point, dermatologists have historically used a stamping approach with pulsed light technology that can leave tell-tale “patterning,” said Dr. Cohen. Not only is there a risk of burning the skin, but also of leaving an area where the treated skin is visibly distinct from that which is untreated.
“We apply the handpiece to an area… and then we pulse, and then we move to the next area and place the handpiece down again. And there’s an inherent shape to all those tips of the handpiece where that light is being delivered…Sometimes even when you are being very careful to connect the rectangle or square, yet meticulously try to avoid overlap—you can still end-up with an area where you can actually see the shape of the handpiece, and so I think the biggest innovation, really for me and my practice lately, has been BBL HERO, which is Sciton’s in-motion device.”
The broadband light device has a large spot size and high repetition rate. Dr. Cohen commonly uses 4 Hertz, which is 4 pulses/s, to efficiently cover large treatment areas—and not only is patterning less likely, but treatment is likely safer as it avoids overlap, he said.
“I haven’t seen anybody really that I’ve treated since I got this technology almost a year ago that ended up getting any patterning to the skin from the actual handpiece of the light-base device–as it is ‘in-motion’ the entire time.”
According to Dr. Cohen, another noteworthy innovation is Sciton’s new BAREit laser hair removal device, which launched in September 2021, which also incorporates handpiece “in motion” technology.
“BAREIt is an 810 diode laser on the traditional handpiece, but the spot size is very large. You can cover a lot of ground with that spot size. And for darker skin types, there is a BLEND handpiece that is 50% 810 diode, and 25% 940 nm + 25% 1060 nm—enhancing safety and efficacy for higher Fitzpatrick skin types. In addition, there is a comfort mode and a speed mode. Similar to what I was referring to with BBL HERO, you can do this ‘in motion’ as well. So, it’s speedy and it is something that’s relatively painless … plus, we’re seeing a lot more efficacy per treatment session than any other laser hair removal device that I have seen. This is a high-energy 4,800 watt device that is capable of very short pulse durations”
Next, Dr. Cohen calls the fractionated 1927 nm thulium laser the “Goldilocks of wavelengths,” and though it’s not a new technology, it is “just right” for many patients.
MOXI (Sciton), LaseUltra (Lutronic), Clear + Brilliant as well as Fraxel Dual (both from Solta Medical), are among the available fractionated 1927 nm thulium laser devices that can be used safely on all skin types to treat pigment and overall sun damage.
“With thulium 1927 nm lasers, they are superficial and you’re seeing improvement in pigment and sun damage. You’re seeing improvement in roughness as well as luminosity to the skin. It’s also FDA cleared for… actinic keratosis… and, at low energy settings, thulium is also a great treatment for melasma.”
Dr. Cohen said the thulium 1927 is top of his treatment algorithm for melasma (with low energy and less passes to keep the heat down), following a frank discussion with patients on the importance of absolute diligence with sun protection with hats and zinc, plus topical regimens.
“Thulium is something that I’m often asked about. ‘How do we help clean up some of the summer sun damage?’ It’s thulium 1927.”
In terms of innovations in resurfacing technologies, Dr. Cohen said the HALO (Sciton) hybrid 1470 nm/2940 nm offers the best of both worlds.
“…you’re able to see coagulation and deeper heating and improvement of the underlying deeper dermis with the 1470 and then…with the mild ablative settings that you use as part of the halo of 2940, you’re able to see improvement in smoothness and discoloration and sun damage on the surface of the skin.”
For deeper lines and wrinkles, Dr. Cohen said he uses fractional ablative erbium or fractional ablative CO2. “If someone’s darker skinned, I tend to use fractional ablative erbium especially for acne scars because I’m worried about post-inflammatory hyperpigmentation.”
Full-field 2940 nm erbium like the Sciton Contour also has a place, said Dr. Cohen. “The pendulum is swinging back for many of us wanting to see big improvement in often just one session in heavily etched-in, deep lines around the mouth … because in one treatment you can give them really significant improvement that’s unparalleled even with three treatments of fractional.”
With full-field erbium, however, it can take 2 weeks for the treatment area to re-epithelialize, and patients may have post-inflammatory redness for 8 to 10 weeks. The key here is patient communication and showing patients your own patient pictures of what to expect with this whole process, said Dr. Cohen.
“They need to know, as my buddy Dr. Jay Burns always says, that redness for weeks after heavy erbium is expected, and is actually ‘the highway to get to the desination’ of improvement.”
