Conducting an evaluation in the marketplace and looking to independent sources of information are steps that need to be taken before buying any energy-based device to be used in cosmetic dermatology.
Performing a market analysis is key to making wise decisions about which medical devices to buy for aesthetic medicine procedures, according to Professor and Chair, Department of Dermatology, University of California, Irvine, CA.
"You have to know if you have the business to support it," says Christopher Zachary M.B.B.S., F.R.C.P., in an interview with Dermatology Times. "Do a market analysis of what it will cost you, what the consumables and maintenance costs will be, whether there’s a market for this procedure, whether your office can accommodate this device, and whether this is really something you enjoy doing. You will end up being very disappointed if it will not make good business sense."
Speaking at the annual meeting of the Canadian Association of Aesthetic Medicine, Toronto, about which devices for aesthetic medicine applications clinicians should buy and why, Dr. Zachary notes devices can "cost you a lot of money unless you use them on a regular basis."
Picosecond technology is very impressive but has a high price tag, and may not be a worthwhile investment if a clinician is not routinely removing tattoos or other pigmented lesions, Dr. Zachary notes. “Your older device with nanosecond technology might be just as good, depending on the size of the particles in the tattoos."
Particularly for those starting out in practice, you don’t necessarily have to put down six figure investments in new devices when chemical peels might do the trick for your patients with photodamage and textural changes, Dr. Zachary says.
He suggests that clinicians contemplating purchasing a new device educate themselves by attending various meetings such as the American Society for Laser Medicine & Surgery Controversies or Summit meetings.
"Know the facts and speak to your colleagues," he advises. "Do your research before you put your money down."
Marketing material from manufacturers of laser technologies should be met with wariness; it is important to request the science and evidence to support the efficacy and safety of the technologies, Dr. Zachary says.
He suggests visiting the website Zalea.com, the ‘Consumer Reports’ of branded procedures, to aid those considering purchasing a new device. The website provides unbiased assessments of technologies for aesthetic medicine, separately assessing the veracity of marketing, the science, consistent results, the comfort level, and overall patient satisfaction. The website provides scores out of 10, explains Dr. Zachary, who is one of the editors of the website. "Zalea does not accept any money from industry," he notes. "The information that is being presented is fair, balanced, and transparent."
For instance, Ultherapy, which uses ultrasound to lift and tighten the skin on the neck, chin, and chest, has an overall score of 5.8 out of 10, “probably less than most would expect,” he says.
Gentlelase, a laser for removing unwanted hair, has been assigned an overall score of 9 out of 10 on the website. "It works, it is comfortable, and it has science to support it," he adds.
The cryolipolysis bulk cooling technology, known by the brand name CoolSculpting, has been given the thumbs-up with a score of 8.5 out of 10. "This technology has real science behind it; there is very good evidence in terms of histology and ultrasound that it works," he says.
In addressing submental fat, the CoolMini is clearly effective as an alternative to Kybella, he adds. "They are both very good technologies and the two are complementary," he says.
Cynosure's 1060 nm diode laser is also effective in reducing fat, he notes. “It probably doesn’t matter whether you bulk cool or bulk heat, both appear to induce an apoptotic reaction.”
In contrast, technology such as Liposonix for non-invasive body sculpting causes focal injury but is quite painful and less effective. “The role of ultrasound for this indication has been disappointing despite years of research and development,” Dr. Zachary says.
Fractional ablative lasers are highly effective and have represented a major advance in skin rejuvenation as well as in wound repair, says Dr. Zachary. "They are one of the mainstays for patients with skin contractures," says Dr. Zachary. "They have been particularly useful in helping our troops injured in Afghanistan and Iraq."
An emerging technology called Halo, developed by Sciton, is a hybrid fractional laser that delivers coincident ablative and non-ablative wavelengths to improve tone and texture of the skin; the clinical evidence points to efficacy and safety with its use, Dr. Zachary says.
Home devices, such as those developed by Tria, will probably become increasingly popular in the coming years and represent an untapped market in aesthetic medicine, according to Dr. Zachary.
"We should be able to miniaturize the devices we have in the office and safely place them in the hands of the public," Dr. Zachary says.
"If you create repeated small injuries in the skin on a regular basis, then over the long term, you should be able to induce significant benefits,” says Dr. Zachary. “You just need to start the process early, before the aging process has set in!”
Disclosure: Dr. Zachary has received honoraria or has been a consultant to Candela, Solta, Zeltiq, Sciton, and Amway.