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Sciton Profile Laser System
The Clinical Benefits of Coagulation with Sciton’s ProFractional-XC™ Jason N Pozner MD Unless otherwise specified, all photos provided are courtesy of Dr. Jason Pozner Sciton JOULE laser and light platform The Sciton JOULE provides the widest array of aesthetic and surgical procedures available from a single expandable system on the market today. What can JOULE do? Laser-Assisted Lipolysis Fractional Resurfacing Deep or MicroLaser Peels Skin Firming Permanent Hair Reduction Phototherapy Endovenous Ablation Scar Revision and more… JOULE – 9 Sciton Modules 9 Modules ProFractional ProFractional-XC Contour TRL ThermaScan ClearScan 3 Delivery Modes Arm Modular Platform ProLipo PLUS Pro-V Fiber BBL SkinTyte Broadband Light JOULE The Sciton JOULE is the world’s first laser and light platform to accommodate three distinct delivery modes: arm, fiber, and BBL. Skin Thickness SC 10 microns Epidermis 60-100 microns Papillary Dermis 60-100 microns Reticular Dermis Up to 1000 microns Traditional Ablative Laser Resurfacing Laser Islands of new epithelium Dermis No zones of spared epidermal tissue remain SubQ Deep Laser Resurfacing Papillary Dermis 60-80 microns Top of Reticular Dermis Deep Laser Resurfacing • Ablation – Epidermis – Dermis • Thermal damage – Collagen contracture – Inflammation • New extracellular matrix TRL Er:YAG Combination Therapy Short pulse width and high fluence for ablation – heat is ejected along with ablated tissue Fluence Sub-ablative fluence in long pulse train envelope for coagulation – heat remains in tissue Ablation threshold Time Mechanisms of Skin Improvement Following Laser Resurfacing • Collagen shrinkage – Thermal desiccation – True shrinkage? – Temporary but may provide initial matrix for collagen production Mechanisms of Skin Improvement Following Laser Resurfacing • Fibroblast migration – Immunofactors – Mast cells • Vasoactive substances – Macrophages • angiogenesis Prior to Laser Resurfacing •Thin grenz zone •Solar elastosis After Laser Resurfacing • Thickened epidermis • Thickened grenz zone • Neocollagenesis – Parallel collagen fiber orientation – Reduced solar elastosis Eyelid Resurfacing 80 ablation/50 coagulation 2 passes Pretreatment Laser Resurfacing (age 39) Before 3 years post Eyelid Healing Pre Day 2 Day 3 Day 4 Day 8 50 Microns face – 70 ablation/50 coag eyes X 2 6 Months Skin Resurfacing - Fractional • Non-Ablative Fractional Lasers – 1319nm – 1440nm – 1540nm • Ablative Fractional Lasers – YSGG (2780nm) – Erbium (2940nm) – Carbon Dioxide (10,600nm) Non-Ablative Fractional Lasers Laser ~100 µm Healing occurs from viable tissue Zones of spared tissue contain clusters of epidermal stem cells and Transit Amplifying (TA) cells Dermis SubQ Non-Ablative Fractional Laser Histology Column of desiccated tissue Non-Ablative Fractional Results • Multiple treatments for result • Need to go deep 5 Non-Ablative Fractional Treatments ProFractional™ Laser Treatment Healing occurs from viable tissue Zones of spared tissue contain clusters of epidermal stem cells and Transit Amplifying (TA) cells Dermis SubQ Histology Comparison Fraxel ProFractional ProFractional 300 microns - 3 weeks after 2 treatments Photos courtesy of R. James Koch, M.D., Palo Alto, CA ProFractional Before After Four weeks post 3tx, 450µm, 6.5% Photos courtesy of G. Todd Bessinger, M.D. PhD ProFractional before 2 months post 2 treatments 20 micron peel then 75u/10% MicroLaserPeel® Combined with ProFractional First pass – MicroLaserPeel Result: new surface and fractional deep ablation zones free from necrotic tissue Depth range: 0 – 200 um Second pass – ProFractional sc Depth Range: 20 – 1500 um epidermis Area coverage: 5 – 20% dermis Sequential Arcticpeel/MLP + ProFractional • Best of both worlds • Quicker results • More textural improvement compared to fractional alone • No increased healing time ProFractional + Arcticpeel before 2 weeks post 1 treatments 10 micron peel + PF 75 microns/5% ProFractional-XC™ + MLP before 8 weeks post 1 treatments 20 micron peel + PF 75 microns/11% ProFractional + MLP before Photos courtesy of R. James Koch, M.D., Palo Alto, CA 5 weeks post MLP: 20 microns x 2 with 30% overlap; no coag. PF: 100 microns ProFractional pre 6 months 10u MLP @ 30%/100u 4% PF X 3 Courtesy Jason Michaels, MD Las Vegas, NV 7 months ProFractional + MLP before 1 year post ProFractional + MLP 200u 200u/20% 60/25 150u 200u/20% 200u before 1 year post ProFractional + MLP before 7 months post ProFractional + MLP 25u 100u/5% 100u/20% before 7 months post ProFractional + MLP before 6 months post 20 u MLP and 200u 20% ProFractional + MLP before 6 months post ProFractional + MLP 50u 200u/25% 80/50 X 2 50u 100u/25% 200u 300u before 6 months post ProFractional + MLP Before 2 months post Photo courtesy Catherine Fisher MD 20u MLP + PF 150u ProFractional-XC with Coagulation • • • • • Wavelength: 2940nm Er:YAG Spot size: 430 µm Coag Levels 0, 1, 2, 3 (0 to 150 um) Depth: 25 – 1500 µm Density: 5% and 11% – two most frequently used densities with ProFractional • Scanned area: 6x6 – 20x20 mm • Fast treatment speed – 2 to 3 times faster than first generation ProFractional Parameters • Spot Size • Coag Level – Degree of thermal damage • Depth of ablated column • Density • Depth of MLP Spot Size • 430u vs 250u – Is spot size clinically relevant? Spot Size Study 430u vs. 250u Right 250 u spot Left 430u spot 200u/10% 200u/11% Before and 3 weeks Spot Size Study 430u vs. 250u Right 250 u spot 200u/10% Before and 3 weeks Spot Size Study 430u vs. 250u Left 430u spot 200u/11% Before and 3 weeks Spot Size Conclusions • 430u vs 250u – No difference in healing times – Slight increase in patterning by 1-2 days if examined by magnification – Larger size had slightly better result ProFractional-XC with Coag Ablation volume and heataffected zone remain. Depth of each treatment zone is physician-selectable Fluence Laser Pulse Profile Ablation threshold Time stratum corneum epidermis 1. Initial ablation pulse 2. Subsequent coag pulses (add heat) dermis ProFractional-XC – Tunable Coag Optional and User-Controlled Coagulation • Control the amount of heat delivered independent of ablation depth • YSGG and CO2 lasers can only deliver ablation in conjunction with thermal injury • Optimize the ratio of ablation and thermal zone • Increase coagulation for more collagen production ProFractional-XC – Tunable Coag Ablation Depth 1000 µm Coag Level 0 Coag Level 2 Coag Level 1 Coag Level 3 ProFractional-XC – Histology ProFractional-XC without coagulation ProFractional-XC with coagulation CO2 ProFractional-XC – Emulation Three Different Technology Capabilities in One System • Replicate outcomes of YAG, YSGG, and CO2 with thermal injury control Emulation with Heat Control • Avoid the risks of too much thermal injury, which can cause: • prolonged erythema • hypopigmentation CO2 Laser Treatment Coag Conclusions • Increasing levels of coag give increasing amounts of thermal damage • Level 3 coag is similar in histology to carbon dioxide fractional histology Ablation Depth • 25u-1500u • Assumption – deeper depths leads to better results • Assumption – deeper depths leads to longer healing times • What role does MLP play in results and healing times ProFractional Therapy–Tunable Ablation Penetration Depth • Erbium’s efficient absorption instantly eliminates tissue, creating clean columns and leaving behind no necrotic debris • Drills columns as deep as 1500 µ and as superficial as 25 µ • Select depth appropriate to the indication being treated Coverage Density • PF > 1.5 – 60% (250 µ spot) • PF-XC > 5.5 or 11% (430 µ spot) 54 PF-XC Healing Study 100 level 2 coag immed Day 4 Day 14 300 level 2 coag immed Day 4 Day 14 1000 level 2 coag immed Day 4 Day 14 ProFractional-XC Healing pre immed Day 1 Day 2 20u MLP/150 11% Level 1 coag PFXC 1 week ProFractional-XC Healing pre immed Day 1 Day 2 Day 3 20u MLP/250 11% Level 1 coag PFXC 1 week ProFractional-XC Healing pre immed Day 1 Day 2 Day 3 20u MLP/350 11% Level 1 coag PFXC 1 week ProFractional-XC Healing pre immed Day 1 Day 2 20u MLP/550 11% Level 1 coag PFXC Day 3 ProFractional-XC Healing pre immed Day 1 Day 2 BBL 560 10j 15 msec 15 deg 515 10j 15 msec 15 deg 20u MLP/150 11% Level 1 coag PFXC Day 4 ® MicroLaserPeel Results (20 microns) Pre 1 Day 2 Days 1 Week MicroLaserPeel Results (30 microns) Pre 1 Day 2 Days 4 Days MicroLaserPeel Results (60 microns) PRE 2 DAYS 4 DAYS 3 MONTHS ProFractional-XC + MLP before 6 months post 50u then 200 PF/11% ProFractional-XC + MLP before 5 months post 30u MLP and 200 11% ProFractional + MLP ProFractional-XC + MLP before 6 months post 20u MLP and 200 11% ProFractional-XC + MLP before 1 year post 50uMLP and PFXC 200u/11% ProFractional-XC + MLP before 8 months post 20 u MLP and 200u 11% ProFractional-XC + MLP before 8 months post 20 u MLP and 200u 11% ProFractional-XC Before Immediately post 100u level 2 11% ProFractional-XC Day 1 Day 3 ProFractional-XC Day 8 5 weeks ProFractional-XC Before 100u Level 1 11% 5 weeks ProFractional-XC Before Day 1 Day 3 3 weeks ProFractional-XC Before 3 weeks ProFractional-XC Before 3 weeks ProFractional-XC Before 7 months ProFractional-XC before 3 months post 250u level 3 coag ProFractional-XC ProFractional-XC ProFractional-XC ProFractional-XC + MLP Before and 10 months post ProFractional-XC + MLP 60u 200/11%/1 80/50X 2 60 200/11%/1 200 Before and 10 months post ProFractional-XC + MLP Before and 10 months post ProFractional-XC + MLP Before and 10 months post ProFractional-XC + MLP before 4 months post ProFractional-XC + MLP before 4 months post 50u MLP/200 level1/11% PF XC ProFractional-XC + MLP before 4 months post 20u MLP/100 level 1/11% PF XC ProFractional-XC + MLP before 4 months post 20u MLP/100 level 1/11% PF XC ProFractional-XC + MLP before 12 months post 2 Treatments 20u MLP/150 level 1/11% PF XC ProFractional-XC + MLP+ BBL™ before 3 months post BBL 515/12j/15msec/15 degrees MLP 20u/PFXT 100/Level1/11% ProFractional-XC + BBL ProFractional-XC + MLP before 11 months post ProFractional-XC + MLP 200u 100/11% 80/50 X 2 200u 300/11% 300u before 11 months post ProFractional-XC PFXC 250u level 3 coag @11% 40u ablation 40ablate/25 Coag 2nd pass ProFractional-XC PFXC 250u level 3 coag @11% Facelift, TC Bleph, Laser (age 60) before 5 months post Facelift, TC Bleph, Laser (age 60) 50 400/2/11% 80/50 X 2 300 200/3/11% before 5 months post Facelift, TC Bleph, Laser (age 60) before 5 months post Deep Resurfacing/ProFractional Multiple Treatments Deep Resurfacing/ProFractional Multiple Treatments Deep Resurfacing/ProFractional Multiple Treatments before 1 year post Multiple treatments MLP + PF Deep Resurfacing/ProFractional Multiple Treatments JOULE – Combination Advantage JOULE Readily Enables Combination Treatments • Add any Sciton module to the JOULE platform • Conveniently offer combination treatments in the same treatment room Popular Combination Treatments (in the same treatment session): ProFractional Therapy (PF) [ProFractional™ or ProFractional-XC™] ® + MicroLaserPeel (MLP) + Broadband Light™ (BBL) MLP – 100% ablation to remove superficial irregularities PF – fractional ablation for collagen remodeling BBL – phototherapy to remove pigmented and vascular lesions PF – fractional ablation for collagen remodeling + SkinTyte™ (ST) PF – fractional ablation for collagen remodeling ST – light energy to improve skin firmness MicroLaserPeel + Broadband Light MLP – 100% ablation to remove superficial irregularities BBL – phototherapy to remove pigmented and vascular lesions ProLipo PLUS™ + SkinTyte PLP – laser-assisted lipolysis to melt unwanted fat ST – light energy to improve skin firmness (PLP) Broadband Light © 2009 Sciton, Inc.BBL All rights reserved. – phototherapy + SkinTyte 108 to remove pigmented and vascular lesions ST – to improve skin laxity
