• Dr. Lee’s Best Laser: GreenXel, New MIDAS, MIXEL

    Lee Myungjong Nametag


    As a plastic surgeon, I used to think that laser devices are useful only in dermatology. However, my patients would often ask me to recommend a dermatologist after receiving plastic surgeries for their body contour. Now I endeavor to provide beautiful skin as well as body line to my patients, with more attention to skin lasers. Since my focus is on surgery, I seem to have slightly different criteria for selecting a laser device. I tend to prefer devices that provide immediate effect and strong output, in addition to safety. Of course, the unit price and other charges for consumables are important factors as well. The lasers described below were selected according to these criteria, and I’m still quite satisfied with them.




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    GreenXel: treating pigmented or vascular lesion without the need for consumables

    GreenXel Laser (HIRONIC) provides long-pulse 532nm wavelength, with focus and fractional handpieces, to treat pigmented or vascular lesion. A rejuvenation effect may also be expected from the long-pulse. The principle of this laser is that 808nm wavelength from the diode source becomes 1064nm by crystal pumping and then 532nm by frequency doubler. The charges for consumables, as well as the effect of a laser, are an important factor among practitioners. As mentioned above, GreenXel uses diode as a medium, which means that it does not require consumables since electrical energy is converted to light energy.





    A number of lasers lack 2 things: one is that pigmentation is not treatable by IPL and Q-switched Nd:YAG and that it requires repeated therapies. The other is in regard to the treatment of a vascular lesion. It is my understanding that vascular laser is a low priority among devices to be purchased even by dermatologists. High unit price of the device itself and the cost for dye replacement (about 10 million won a year) make purchasing it too burdensome. GreenXel thankfully satisfies both of these aspects.


    GreenXel has many other advantages. For pigmented lesions, it provides potent therapeutic effect with just single procedure for dark epidermal lesions. Chloasmata had been treated with Q-switched Nd:YAG alone, but since combining it with GreenXel, patients have been expressing better satisfaction then for monotherapy. Recurrent chloasmata had been difficult to treat without vascular treatment, but when vascular treatment was followed by the procedure for chloasmata, the recurrence rate was markedly decreased, although complete recovery is still hard to achieve. High unit price of GreenXel also gives slightly more financial burden to patients.


    For vascular lesions, both types of handpieces are used, mainly for redness from acnes and telangiectasia. Among the two types of handpieces, fractional one is mostly used when applying even energy across a broad area. The area of beam irradiation can be controlled, but I use it by safely controlling the fluence and the number of beams not the area, such as increasing the fluence while reducing the number of beams or increasing the number of beams while reducing the fluence. I also prefer to use slightly higher fluence than the parameter offered by the manufacture, which tend to be weak considering safety issue.


    Focus handpiece is used when applying more elaborate treatment in parts. There are 3 modes including pulsed mode, but pulsed mode is used in most cases. The number of irradiated beams, pulse duration and delay time can be modified, depending on the darkness and depth of a lesion, for safe and effective treatment.

    Since most lesions of redness from acnes are widely distributed, fractional handpiece is used first, followed by focus handpiece for more intensive treatment. During the latter, the duration of treatment can be shortened by irradiating multiple beams and by reducing off time. Unlike other existing therapies, long pulse protects from bruise and allows the control of erythema or edema that may develop after the procedure, giving less interruption to the patient’s daily life.


    GreenXel is satisfactory to patients with telangiectasia since it can provide an immediate effect by instantaneous coagulation upon irradiation. The effect can be enhanced when the fluence is slightly increased at the start and end of the procedure. As anyone knows, overlap should be avoided and post-procedural cooling is most important.


    New MIDAS: face lifting and body shaping simultaneously without pain

    Radio frequency (RF) energy has been used for medical purposes for about 70 years now. One of representative is Vovie, which is used for various procedures. RF energy has developed to protect the epidermis while delivering energy selectively to deep dermis or subdermal layer. Despite deep energy penetration using high frequency, previous RF devices were limited by strong pain and high prices of consumables.



    New MIDAS


    New MIDAS (HIRONIC) was designed to overcome various limitations of light and RF devices and enables simultaneous irradiation of strong contact cooling, large output of infrared (IR) and RF energy, heating the dermis and stimulating collagen regeneration. One of the most remarkable aspects of New MIDAS is the strong cooling effect. Larger energy output for superior therapeutic effect accompanies more pain and side effects, such as burns. To overcome such issues, New MIDAS is equipped with strong contact cooling to as low as -5℃ for painless treatment.


    New MIDAS uses two handpieces, bipolar and monopolar. The bipolar handpiece irradiates both RF energy and infrared simultaneously and is used primarily for wrinkles, elasticity, pores and lifting. The strong cooling enables painless, comfortable treatment, 2Hz shot speed shortens overall procedure time on face by 15-20 minutes, and the procedure is very simple. Monopolar handpiece provides continuous irradiation of energy with a 45-㎜ spherical probe and is used for lipolysis around the body. This body shaping function does not cause pain, bruising or hemorrhage, and the tip size and further enhanced power as well as the variability of frequency (0.5-10Mhz) is useful when delivering proper energy depending on the area of procedure; such a focused energy delivery to the target area allows superior effect. The monopolar handpiece actually provides relatively satisfactory results immediately after liposuction by lipolysis of remaining fats and by inducing collagen activity inside the dermis to enhance elasticity of sagging skin. Such a painless heating of the dermis lifts the skin immediately after the procedure by collagen contraction, a previous step of collagen regeneration, occasionally making patients amazed. From what I’ve seen from prognoses of quite many patients after the procedure (although very subjective, of course), the effect seems quite positive. Some patients even snored during the procedure, showing how comfortable the procedure is. Furthermore, patients with nasolabial folds due to saggy cheeks, double chin and neck wrinkles may benefit from bipolar procedure followed by as short as 5-10 minutes of monopolar face mode, even more supporting its positivity.


    Moreover, New MIDAS does not require additional consumables and can be applied for body shaping as well as face lifting. The possibility of utilizing it for obesity treatment is also helpful in terms of business management. Above all, considering the advantages such as no interruption of daily life and painless procedure, New MIDAS is a very effective device highly recommendable for office workers or women who are particularly sensitive to pain.


    MIXEL: ease of use and high beam quality

    MIXEL (HIRONIC) is a CO2 fractional laser. Fraxel repair is being used in one of the two clinics that I run. When opening another branch, I invested so much effort when selecting a fractional laser. In conclusion, it was an excellent choice. Despite my initial thoughts that domestic devices would still have lower quality than world renowned devices, the recent purchase totally changed my prejudice on Korean devices. One of the reasons is in the quality of the beam. MIXEL produces a very small beam despite using CO2 as a medium. By using a metal tube and lens, post-procedural crust is also very different from that of Korean devices in the past. Tube itself is made in the USA.


    Second reason is in overlap function, which enables 10 repeated irradiations on one spot. I haven’t used up to 10 but only up to 3 for patients with severe acne scars. This overlap function seems to overcome the limitation of not very deep penetration due to the nature of CO2, compared to Er:Glass. CO2 fractional laser with overlap function would be particularly appropriate for acne scars or burn scars.





    The third reason is in the ease of use. As a frequent user of laser, the ease of use is not something to be ignored. MIXEL is well designed in this aspect as well. Easy configuration of frequently used menus and memory function are often overlooked in many devices, but MIXEL automatically calculates the number of dots and treatment area once the power, density, repetition rate, area and pattern are set up in one screen. Several lasers make operators excited even before starting a procedure. What makes such a mood for operators is patient outcome after the procedure and comfort during the procedure. In this sense, MIXEL is a laser which makes procedures a pleasant experience.


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