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New Orleans — A striking array of new, non-invasive cosmetic laser treatments and devices has been developed recently to help dermatologists rejuvenate skin and improve appearance. From class 2 products that treat cellulite to a variety of radiofrequency devices, the many options may leave physicians wondering which one to choose.
Melanie Grossman, M.D., a New York dermatologist in private practice, helped dermatologists learn more about some of these new options at the 63rd Annual Meeting of the American Academy of Dermatology (AAD) here.
"I always want to know what's available to offer my patients and know what works well," she says. "It's good to try new things, because we all want to approach the cutting edge. But we also want to do it with a healthy respect for the fact that it is new technology, and we can't always predict exactly how something is going to behave."
Cutting-edge technologies The Thermage® (ThermaCool™) procedure delivers monopolar radiofrequency energy in combination with cooling. The theory is that one possible approach to tightening skin is to deeply heat the collagen. When the collagen heats and uncoils, it shortens.
Thermage® allows for deep heating by generating radiofrequency energy and allows the delivery of energy deep into the skin without allowing any superficial changes. While the device has been on the market for more than a year, recent improvements in technology have made the procedure less painful, and it appears to be efficacious and safe. In addition, studies have shown the skin-tightening effects of Thermage® appear to be long-lasting. While the up-front cost of the machine is minimal, the downside is high-priced consumables.
An even newer product is the Titan (Cutera), a light-based device that deeply heats the skin. The theory is that by deeply heating the skin, the collagen molecules come apart and shorten. This particular machine is a broadband light source, with cooling before and after. Early results of treatments performed on the face and several body parts showed that the procedure works better on the abdomen than on the face, but when used on the face, best results were seen on the jowl area. Also, like the Thermage®, the procedure is not painful when treatments are delivered using low energy. Because the machine is so new, it's unclear how long results will last.
Dr. Grossman cautions that when using deep-heating devices like the Thermage® or Titan, it's important to find out if the patient has injectables or other products in their skin.
"You need to be careful because these products may change the behavior of the technology on the skin. If you're delivering heat deep into the skin and they've had substances injected at the same depth, the treatment might be altering the process in some ways."
Another new technology - Electro-Optical Synergy (Syneron) - tightens skin by combining radiofrequency and light. Introduced in early 2002, the device uses a combination of light and bipolar radiofrequency to increase the temperature of skin, which, in turn, provides a better medium for the current. The result is highly selective targeting with minimal impact on surrounding tissue. Dr. Grossman has seen some photos showing "interesting" results.
Other devices new to the market include Vela Smooth cellulite treatment (Syneron), a laser-like medical device that combines radiofrequency energy suction and light. Like all cellulite treatments, the procedure requires repeated applications. Vela Smooth has not yet been cleared by the U.S. Food and Drug Administration.
Another treatment for cellulite is TriActive (Cynosure Inc.), a diode laser with contact cooling and suction. The class 2 device is simple to use, but the downside is that it appears to require repeated treatments and maintenance.