As with any type of new technology, there are a number of systems to choose from, ranging from $40,000-$130,000, depending on the technology. Palomar Medical Technologies, Inc.’s Lux 1,540 nm erbium:glass laser and the Reliant 1,550 nm erbium “doped” diode fiber Fraxel systems are currently the two top systems in the market, both for the materials used in their construction, and the large amount of clinical and technical research that went into their development.
The Palomar system is based on lasing light from an erbium rod through a glass fiber, creating the desired 1,540 nm wavelength necessary to coagulate the tissue at an efficient rate with enough depth for some clinical effect to take place. Using stamping technique, the Palomar system creates its coagulation columns uniformly, and with very little exposure (10 ms) to the light. This creates minimal discomfort, and a quick treatment for smaller areas, such as acne scarring on the cheek (Fig. 4.13), or skin rejuvenation (Fig. 4.14). Topical anesthetic is not typically used with this fractional nonablative system in a majority of treatments, as any discomfort is managed with posttreatment ice application alone. Density and depth are the two keys to the successful treatment of most of these conditions, so energy per microbeam is usually in the 40-70 mJ range, and multiple passes are performed
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Before After Figure 4.13 Acne scarring treated with Palomar Lux 1540 hand piece. |
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Before After Figure 4.14 Skin resurfacing 8 weeks after treatment with the Palomar Lux 1540 hand piece. Photos courtesy of Dwight Scarborough, MD. |
to a specific area before moving on to others. This system uses a stamping technique and this, in part, helps control discomfort.
The Reliant Fraxel system utilizes an erbium doped diode fiber to achieve the desired 1,550 nm wavelength. It uses a scanning device to paint the pulses of energy onto the skin. This process creates more heat in the skin, ultimately creating pain. This creates an increase in epidermal temperature relative to that of a device that uses a stamping technique, and consequently, topical anesthetics are needed for all treatments with devices that use scanners. This also may lead to an increased occurrence of postinflammatory hyper pigmentation (PIH), which is realistically the one potential side effect that can occur with these types of treatments. This creates an added expense of a disposable, as well as added time and space taken up by the patient in the office. Regardless of the pain with the Fraxel system, it has shown very good and consistent results, and along with the Palomar, continues to be one of the most successful systems in offices worldwide.