It is important to keep abreast with the latest trends in procedures and devices used in the fast-changing field of aesthetic medicine. D&PS met with Dr. Jong-gu Kim of Cheonan Oracle Dermatology Clinic and Dr. Sam-shik Shin of Gwangju Clear-Skin Dermatology Clinic, two of the early adapters in the field, to gain insights on medical devices expected to win over the market in 2017.
Dr. Jong-gu Kim of Cheonan Oracle Dermatology Clinic
Dr. Kim not only is one of the first dermatologists to purchase and try new devices as they are released in the market but he also conducts clinical research using several devices of the same model. We asked him which devices he thought would lead the market in 2017.
Will the picosecond laser lead the market in 2017?
At the moment, it is still difficult to tell if the picosecond laser has definite superiority to the traditional choice of Q-switched Nd:YAG laser, in terms of pigment removal. Installing a new lens and other new technologies would be needed to make the picosecond laser more competitive.
The picosecond laser is particularly effective in removing tattoos or dermal pigments but is not deemed to be more effective than other lasers when it comes to epidermal pigments and surface blemishes. The 532nm wavelength of the picosecond laser is also too high to be used in non-Caucasian patients and may need to be lowered in the Korean population.
The picosecond laser produces anywhere between 0.05 and 0.3J of energy even when the parameter is set at 0.1J. This means poor reliability. Improvements in terms of consistent energy output and detection technology are needed to improve reliability.
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What types of lesions can be treated with the picosecond laser?
In theory, the picosecond laser does not cause PIH as it uses acoustic effects, not thermal. However, this can be a disadvantage in clinical practice as it would be ineffective on wrinkles which respond to thermal energy. One mystery with the picosecond laser is that it is surprisingly effective in pore reduction, despite the absence of thermal energy. Pores are thought to be enlarged due to over-developed sebaceous glands. There are various theories on how large pores develop. From where I stand, the picosecond laser improves small, shallow pores because they do not require deep delivery of thermal energy.
In my personal experience, I have not had much satisfaction with the picosecond laser in melasma. Recently, the ruby laser is becoming very popular in melasma but more clinical data is needed to make any conclusion regarding its superiority.
On the other hand, the use of Q-siwtched Nd:YAG laser grew exponentially in the past decade due to the widespread popularity of laser toning. In comparison, I use the ruby laser less frequently. Whereas the Q-switched Nd:YAG laser allows rapid coverage of extensive areas with 10Hz, the ruby laser only uses 2-3Hz, making the treatment more time-consuming and less practical. If the speed of the ruby laser improves, it would be more widely used and produce more positive clinical data.
Does the medium play any role in the picosecond laser?
I don’t think the medium has much impact on the performance. The wavelength (1064nm, 755nm, or 532nm) is more important. For the picosecond laser to be a major trend, it needs to lower the energy level and allow accurate calibration.
I have used all the picosecond lasers that were released but did not see much difference in terms of performance among them. However, I do think the Korean products need to improve output consistency.
Do small differences such as 0.03J/cm2 have impact on the treatment outcome?
Edema is caused at 0.13J/cm2 but not at 0.1J/cm2. At 532nm, laser is generally absorbed in blood vessels and pigments and also in the blood vessels on the upper dermal layer. This may be causing the edema. Edema leads to release of histamine which promotes formation of pigments and hyperpigmentation. However, at 0.1J/cm2, the laser energy is somewhat absorbed in the pigments but is not strong enough to cause edema and pigmentation. Even smaller differences such as 0.15, 0.16, or 0.19J/cm2 should be examined to find the most effective and safest energy level. This would help set the picosecond laser apart from the Q-switched Nd:YAG laser.
-To be continued-
