Demanding more for less

Ranella Hirsch, M.D., is a Boston-based dermatologist who specializes in laser procedures, lectures and writes frequently on the topic, serves as vice president of the American Society of Cosmetic Dermatology & Aesthetic Surgery, and serves on Dermatology Times' Editorial Council. She says patients want treatments that will allow them to get on with their daily lives as quickly as possible - no more extended healing periods, even at the expense of somewhat pared-down results.

"There is a definite trend toward less and less downtime - patients come in with that in mind as a priority," Dr. Hirsch tells Dermatology Times.

Meeting the need

Fractional resurfacing techniques are one way dermasurgeons fulfill this patient need.

"Ablative resurfacing is still the gold standard for this kind of procedure as far as efficacy goes, but the downtime is relatively significant," Dr. Hirsch says. "Fractional and Fraxel laser technology have been around for a couple of years now. We've been able to modify substantially the amount of downtime and efficacy is acceptable enough that patients are willing to make the trade-off."

In laser procedures to correct vascular lesions, however, there isn't much of a trade-off to make, Dr. Hirsch says.

"Today we can aim for similar results as five years ago with markedly reduced downtime," she explains. "Device manufacturers have tweaked their machines so that we can successfully treat vascular lesions without the profound bruising that used to occur and that lasted for up to 10 days."

Dr. Hirsch, who is also involved in the clinical testing of laser devices for various companies, says she sees a number of these devices being developed that will reduce downtime even more and even increase efficacy.

"I'm currently a clinical investigator for a device called the Multiplex from Cynergy," she says. "It's a combination pulsed-dye (PDL) and YAG laser with a feature that allows better penetration for the device, with increased safety and less downtime, by sequencing the pulses. The product is Food and Drug Administration (FDA) approved to be used as single wavelength PDL or YAG with the option to combine the two, which is termed 'multiplex.' "

Dr. Hirsch says there are several studies on this device that are either completed or in the final stages on facial vascular, skin rejuvenation (which encompasses redness, pigment and skin texture), leg veins and port wine stains (PWS).

Low-down on lasers

"Some of the thoughts when the device was on the drawing board was not to compromise the settings of the stand-alone systems, and they were not - they are both fully powered stand-alone YAG and PDL," she says.

"Also in designing the laser we had two objectives in mind, one being patient safety - lower energies by using the two together - and second, better outcomes with fewer treatments by creating a better chromophore for the YAG to attack."

Dr. Hirsch says another consideration was to design and build a vascular laser that could treat the widest range of vascular conditions, something that could only be done with multiple wavelengths.

"The product has all the FDA approvals that YAG and PDL have," she says. "This device and others like it that are being clinically tested are extremely exciting developments in the realm of treating vascular lesions more effectively with less downtime."