Paul Friedman, MD: An In-Depth Review of UltraClear Laser-Coring

UltraClear Laser-Coring is a “first-of-its-kind" advanced technique that targets deep wrinkles and scars to help smooth patients’ skin. With less bleeding and downtime, UltraClear Laser-Coring is convenient for both the dermatology clinician and the patient.¹

Paul Friedman, MD

Paul Friedman, MD, a board-certified dermatologist, Mohs surgeon, and director of the Dermatology & Laser Surgery Center in Houston, Texas, recently spoke to Dermatology Times to review in-depth UltraClear Laser-Coring, its main benefits, patient downtime, advice for clinicians starting their aesthetic device journey, and how to decide what devices to have in each clinic.

Dermatology Times: Can you please provide a brief overview of UltraClear Laser-Coring and its main benefits?

Paul Friedman, MD: UltraClear is an innovative and versatile MID IR 2910 nm Fiber Laser that emits energy at peak water absorption. It creates very small ablation channels with minimal thermal dispersion of energy to surrounding tissue. The various modes allow for ease of use offering highly customized treatments ranging from fractionated low fluence, superficial ablation to high fluence, deep ablation to fully ablative treatments to laser-enabled tissue coring. The degree of tissue coagulation is also customizable on a sliding scale. This wide range of options have allowed us to safely treat various conditions including fine lines and wrinkles, photoaging/dyschromia, acne scars, traumatic scars, and rhinophyma/nasal contouring with the fully ablative mode.

Historically, tissue coring technologies have involved the mechanical removal of skin with the goal of achieving the largest possible injury without scar formation by 1) not exceeding 400-500 µm in diameter, 2) incorporating proper treatment technique, and 3) avoiding overlap. UltraClear Laser-enabled tissue coring offers the ability to remove tissue at various depths and tissue densities, while also delivering controlled coagulation. At our office, each patient receives a customized treatment that allows us to address various cosmetic concerns in a single treatment by combining multiple UltraClear modes. We have predominantly utilized laser coring to treat along the jawline, jowls, upper neck, and submentum to achieve tissue tightening.

The UltraClear Laser-Coring mode, or laser-enabled tissue coring, is unique because of how the energy is delivered. The 2910 nm Fiber Laser operates at 5000 Hz. Pulses are laid down in a flower pattern with six 170 µm drill points in a circular fashion to create uniform and larger ablative microchannels with an estimated diameter of 360 µm. The device allows us to select depth ranging from 1-3 mm, with coverage ranging from 1-3%. In our clinic, we typically treat patients using 1-2 mm with a coverage of 2% depending on the treatment area. The thermal relaxation time between micro-pulses allows pressure and steam time to escape the channel, resulting in a more comfortable patient experience. We have found that doing a second pass with the superficial mode expedites the healing process through superficial exfoliation.

We have been able to perform treatments with only topical anesthesia and optional nitrous oxide, obviating the need for more advanced analgesia measures as compared to traditional ablative fractional resurfacing technologies or mechanical tissue coring devices.

Dermatology Times: How does UltraClear Laser-Coring compare to other available laser treatments in terms of patient discomfort and downtime?

Friedman: Laser-Coring delivers quick laser pulses to remove micro-channels of skin and may be combined with laser resurfacing to address a wide variety of photoaging concerns. The micro-pulse technology delivers thermal injury and ablation simultaneously in the same location within the microchannel to promote collagen contraction and tissue tightening. In my experience, patients treated with UltraClear Laser-Coring have experienced less downtime, reduced discomfort, and minimal bleeding as compared to mechanical tissue coring. Patients have reported improvement in redundant skin alongside the beneficial results of laser rejuvenation.

Based on the findings from our histologic analysis following laser-coring, soon to be submitted for publication, we are seeing coagulation along the ablation channel which explains the tissue tightening observed and controlled hemostasis post-procedure.

Dermatology Times: In your experience, what are a few main highlights of UltraClear Laser-Coring?

Friedman: The main highlights of UltraClear Laser-Coring are its ability to:

1. Deliver a high ratio of efficacy to downtime for tissue tightening
2. Quickly incorporates laser-enabled tissue coring into a customized resurfacing treatment plan.
3. Consistent and reproducible cores
4. Leverages key advantages of advanced fiber optics – namely, ultra-fast speed (5000 Hz), precision and stability

Dermatology Times: For physicians wanting to delve more into the aesthetic device industry, what advice do you have for those just starting their journey?

Friedman: Become a member of the American Society for Laser Surgery in Medicine and attend their Annual Conference. Attending conferences, reading journals, and speaking with colleagues will assist in learning about the aesthetic device market. The purchase of a laser involves large investments, so careful consideration of laser specifications, training, ongoing costs, warranty, and reliability of service are important prerequisites. Physicians looking to purchase an aesthetic device should also identify and evaluate:

1. Practice mission and brand
2. Patient profile – demographics, lifestyle, attitudes, budget, and motivation, etc.
3. Common aesthetic needs seen in the practice
4. Nearby competitive services, opportunity to differentiate your practice
   

Dermatology Times: With so many devices in the aesthetic space, what is your advice to other physicians on how to select the best devices to fit their clinic’s needs?

Friedman: Before purchasing a new device, physicians should decide what energy-based devices are best suited for their practice and patient population. Think about what procedure you are most often referring your patients to another practice. Before making a decision, I recommend they:

1. Discuss new technology and systems with peers
2. Research evidence of efficacy and safety (adverse effects) of device
3. Identify gaps in their device “toolbox”
4. Schedule a demonstration of the machine
5. Decide a stand-alone vs platform system
6. Check the reputation and credibility of the manufacturer
7. Find out about educational and marketing support provided by the manufacturer

Reference

1. Key benefits of UltraClear Laser-Coring. UltraClear. Accessed January 3, 2023. https://ultraclearlaser.com/solution/laser-dermal-coring/