Dr. Sam-shik Shin of Gwangju Clear-Skin Dermatology Clinic
Dr. Sam-shik Shin of Gwangju Clear-Skin Dermatology Clinic is Korea’s leading laser surgeon who is known for being the first to purchase the newest devices. He shared with us his thoughts on the prospects of energy-based treatments in 2017.
Devices that will lead the trends in 2017
I expect fat-removal procedures using Sculpsure will be popular in the new year. Energy-based fat removal procedures used to take 50 minutes to an hour per treatment. Moreover, patients often complained of post-treatment bruising, pain and edema. On the other hand, Sculpsure, a diode laser indicated for lipolysis, uses four points of delivery (a drastic increase from only one in previous devices) which reduces the treatment duration to 25 minutes and causes less downtime, pain, bruising and edema.
Thermi RF is another device with infinite potential. It uses thermal action of radiofrequency for correcting the jawline, cheeks as well as hyperhidrosis and osmidrosis axillae. In the United States, it is also commonly used in vaginal tightening and urinal incontinence. Viveve is another RF device with similar actions. The two devices are different only in that Thermi RF uses rubbing and Viveve uses contact methods. They are highly competitive due to their various indications ranging from facial skin tightening to vaginal tightening.
Outlooks for the picosecond laser
The advent of the picosecond laser has increased the interest in pigmented lesion and tattoo removal. Recently introduced picosecond lasers such as Picoway (Nd:YAG The picosecond laser), Discovery Pico, and Enlighten, etc. allow use of sufficient energy. Korean devices such Picocare have also entered the market.
As we already know, unlike the Q-switched Nd:YAG and other lasers, the picosecond laser can destroy smaller pigment particles and is effective in removing green, blue and red colors. The future for the picosecond laser is bright as there is an increasing number of patients seeking tattoo removal. However, its effect in other pigmented lesions such as melasma is unclear. In my personal experience, the picosecond laser had outcomes similar to laser toning in melanin removal, however, at a higher output, it destroyed melanocytes and caused hypopigmentation. More clinical research is needed to establish its efficacy in melasma and various pigments, however, I think it can be effective in melasma when used at lower energy levels.
Various indications of the picosecond laser
Installing the MicroLens Array fractional tip to the picosecond laser basically allows fractional laser therapy without the downtime. Depending on the type of laser, this increases the energy by 10-20 times and promotes collagenesis as well as improves pores, scars and fine wrinkles. For example, Enlighten, the picosecond laser with MLA fractional tip has output that is 10 times higher. This device is my personal favorite.
There are limitations to the picosecond laser as well. Despite the option of various pulse durations, clinical outcome does not vary greatly. New devices with various media are being released but adding a fractional tip or a wavelength adjusting feature to the nano- or the picosecond laser will widen its clinical application.
HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)
How to reduce PIH after the picosecond laser treatment
A key benefit of the picosecond laser is that it uses a low energy level to bring results comparable to traditional lasers. This does not mean that the picosecond laser is free from the risk of PIH. PIH is pretty uncommon at 1064nm, 750ps but the risk goes up drastically at 532nm. This high energy level is particularly prone to PIH and caution is needed. Unlike the Caucasians, Korean patients are more susceptible to PIH due to vascular and melanocyte responses. I think Korean picosecond devices have great potential. There are many new picosecond Nd:YAG lasers that are being released. I think this is due to the convenience of manufacturing.
Do you need the picosecond laser at your practice?
When the picosecond laser was first released, it had a prohibitive price of over 300 million KRW (approximately USD 250,000). However, the price has dropped to the level of nanosecond lasers. And when the prices are similar, there is no reason not to have it at your practice.
-To be continued
