Hey, Am looking to decide between the Cutera Vantage and the Candela Gentle Yag. I've got a great offer on the Candela, around 30% cheaper than the Vantage. My main application would be skin rejuvination along with a backup and using it for my hair removal Laser ( I have a Lumenis LightSheer ET ). I mainly treat dark colored skin ( Type IV and V ). The Laser Genesis procedure interests me a lot, albeit the Gentle YAG has the same specifications which the Cutera offers, hence am wondering whether to spend the extra on the Cutera.

My Cutera rep claims that the Cutera offers better results due to a flatter and more uniform beam profile on their 1064nm. Also, they are claiming that for the hair removal using a spot size of above 12mm will not target the hair effectively, as it would miss the target of the hair follicles.

Looking for some recommendations from Physicians using the Candela and the Cutera for their feedback on the rejuvination and hair removal results. Thanks a lot.

I have had a GentleYag for over 2 years. Overall we have been very pleased with the hair reduction patients. Some patients we have had were previously treated by a Cutera at another clinic and for whatever reason did not respond well. They did well with the GentleYag. As far as I know the reverse never happened...but can't say for certain. As far as skin rejuvenation goes, we usually use our other laser as it works on pigment/redness/laxity and doesn't require anesthesia. The GentleYag treatment requires topical anethesia and usually oral pain meds to make it bearable. Most of our patients prefer to stick to our other laser when it comes to rejuvenation procedures so can't make a good comment on outcomes using the Yag only. Hope this helps.

I have the Cutera Xeo platform with the 1064 YAG and the Prowave. I have not yet had a single complaint. My customers have all been very satisfied and the service from Cutera has been excellent.

Robert,
Seriously, You are the first person,that I am aware of, that has been pleased with Cutera service. I'll bet you are still under a service contract for a new machine. Enjoy it while you can, because once the contract expires and your unit breaks down you are so screwed. Good luck when that happens because Michael (Cutera HDQ service) is a real piece of work.

Used to work selling candela lasers. Laser is good. Liked the cryogen cooling. Paying for replacement cryogen can get costly! Service terrible! Won't return calls! Even worse in canada! Currently work with cutera! No replaceables! Small compact machine! Also have a Cynosure acclaim 7000. Stay far away from cynosure. Nothin but trouble!

Tracey,

Cutera has replaceables. They just do a good job of hiding it. Look at replacement heads for the Titan or the IPL. Then look at the cost of the yearly service contract, it is the worst in the business. Also, they will not let anyone work on their lasers unless they work for Cutera. They will no sell parts to anyone except a Cutera service person.

It seems good upfront but will burn you in the long haul. I should know I own a Cutera.

Cutera,
I believe is good device but yeah, these guys are right. NO ONE ELSE replaces or repairs these devices, you will have to buy the warrenty quite heaftey forever. Titan refills are a complete JOKE. Pearl sucks better to go with another ablative device.

i have been reading everyones comment, but the more i read the more confused i get of which laser is the best. i am currently looking to purchase a new laser, i have worked with cutera lasers for a while but it does not have the best result on thin hair. can anyone tell me if getleyag is better than coolglide or not. help im so confused of what to buy.

Sara:
It is quite confusing for you to decipher among the postings. They were speaking from their own experiences with Candela and Cutera. It is true that replacement costs and customer services from the manufacturers can be very daunting, financially and time consuming wise.
1) Make sure you have backup laser repair company that can service you independently. At least in my experience with Candela machines, they usually can be handled by independent repairers
2) For hair removal, it is possible to do a very good hair removal job on Candela GentleYag in Fitz III, IV. My patient profile is III and IV, so I know this very well. Please see my postings under "Treatment progression for brown spots" and "Port Wine Stain Therapy"
3) For skin rejuvenation with GentleYag,there are TWO procedures you can do with. One is what the company told you which is the "skin tightening protocol". It is true that it is painful but it is possible to do it with local anesthesia. I have done it to myself without even cream, :-). I have done it using the 18 mm spot size protocol and the 10mm spot size protocol. THis is the same thing you can apply in any long pulse Nd-YAG machines (also from Cynosure Elite and I guess Cutera). Another procedure is LASER PEEL using carbon powder. THis is mostly for pore size reduction, skin rejuvenation (lightening of skin color and improvement of texture) The beauty about this is patients can see results in one week post treatment. This procedure can also be used in the new Nd-YAG machine from Lutronic (SpectraVRM)
4) When choosing a machine, it is PARAMOUNT to find out the device specifications. For Hair Removal, you must make sure it has pulse duration from 20ms to .3 ms. Find out at these PW, what kind of fluency it can deliver under the respective spot sizes. It is the only way to make sure you can remove hair "permanently"
5) It is incorrect for the Cutera agent to say that spot size larger than 12 mm can not do effective hair removal.However anything larger than 15 mm would be quite painful without extra cryogen air cooling such as the Zimmer. Effective hair removal has A LOT to do with the understanding of laser physics: Pulse Width vs THermal Relaxation Time of the hair follicles. When you master this concept you can do effective hair removal job.
6) 1064 NdYAG is also very effective in treating small vascular lesions such as spider veins and blue veins (telengectasia)
Good Luck

Sara: PMDOC provided you with some excellent comments. I would like to add a couple--

1. Check the specs of the various lasers on the market and be sure to purchase the right laser for your unique needs. I recently spoke with a doctor who bought a huge (200+ pound) Candela laser for her mobile laser business. She was not aware that there are comparably powerful lasers on the market today that way less than 100 pounds and can be easily moved in the back of your SUV!

2. Make sure that your own repair person can buy replacement parts (such as flashlamps, laser rods, etc.). If you can only get service through the one company they really have you by the _alls. I can get my Chevrolet service by almost any reputable mechanic.... Should be the same for lasers.

3. Remember that every sales rep will tell you THEIR laser is the best. It is up to you to do some comparison shopping.

For mobile laser operation, the Candela machines would not be ideal due to its weights, LOL. One drawback with these big and powerful machines is soemtimes they requires 220Voltage power supply. Also, they suck up much electricity if being ON for too long. However, I must say if you want an effective workhorse you have to go with the powerful machine thu. Am I confusing you more now??? :-). Good luck though. Honestly, in Laser Hair Removal, the gold standards are
755nm wavelength for Fitz I-III
1064 Nd-Yag for Fitz III-VI

thank you for replying to me. I am currently looking to purchase a used laser either xeo to gentleyag. i called cutera they want 35000 dollars to warranty this machine!!!!!!!!!! how do you get warranty on used lasers? another question i have is that i am planning to have two different locations is th gentleyag imposibble to move. i had the coolglide for couple of years and i did move it between offices, not the easiest thing to do but no impossible. is the gentleyag much heavier than the coolglide?thanks.

Sara,

The $35,000 is the biggest reason you have seen me complain about Cutera on this site. That is an absolute rip-off. If you are looking at mobility, make sure to look at the Palomar system. You can find them used and I believe you can get aftermarket parts. Also, look to see if you have someone in your area that can work on lasers and see which systems they can work on.

I would also look at the Sciton equipment. It really depends on all of what you are going to do for procedures.

It is possible to have a Cutera machine, and not buy the service plan. You do pay through the nose to Cutera for repairs - but it comes out cheaper than with their over-priced service contract. That's what we do.

just going back to comparing the result between coolglide and gentle yag. When i owned my cutera laser, i was able to treat all skin type with that, am i going to be able to do that with the gentleyag and have as good as a result?

I just bought a gentleyag laser, does anyone know any repair guy in new york area, i am having problem buying warranty from candela.

MH:
Did you buy it brand new?? I have used the GentleYAG for 2 years now. It has not had a single problem. Make sure you clean the round glasses on the spot sizes frequently, especially after hair removal or carbon powder laser peel procedures. I am in CA so I don't know anyone in NY but in general, most independent laser service companies know how to handle Candela machines. Good Luck.

Thank You pmdoc
no, the laser that I bought is not brand new, it's a 2005 laser with a very few pulses on it. how can I find a independent laser service company that I could trust, and do you think it's better to buy warranty from them or just pay for repairs as needed?

I also need some training on using this equipment what do you recommend for me to do? I worked with the cutera coolglide for five years, but i just did hair removal with that. Since I bought a used laser obviousley candela is not going to help me with this I was hoping you would have a recommendation.

Cutera has the WORST

you almost have to buy new because you CANT repair the unit if you buy used.... WORST and MOST EXPENSIVE WARRENTY service; you MUST go through them to repair the unit because the laptop they carry around covers the microboard for the XEO.

1/2008 --------- CEO Kevin Conners selling 60,000 of his OWN stock.. THE PEARL IS A "MY FIRST ABLATIVE DEVICE TOY" that gives you a IPL result. Pure crap in my opinion. If you are going to ablative skin and be down for 3-5 days why would you want to do it again and again ???? Do it once and be down with it ! ActiveFX/DeepFX or Reliants' RE:PAIR or MIxTO -- fractional CO2. This company is going down, down , down..... check it out yourself: msn.com ; CUTR

MH:
For repair, try www.medproonline.com
www.telsar.com
I assume you used the CandelaGentleYag for hair removal??? I can help you in this regard since I used it before

I have a Gentle Yag and I have been very pleased with it. I have worked with several different machines over the years. The Yag is great because it treats unwanted hair, spider veins and wrinkles. I love the cryogen cooling! I can get through hair reduction treatments quickly by using the 18mm spot size. It's a great machine!

Angela:
Personally, I would not use the 18 mm spot size for hair removal since it tends to penetrate a bit deeper than you would like in order to get rid of the hair and hair bulbs on the epidermal level. I use up to the 15 mm spot size. Save the 18mm for skin tightening option since here you want to go deep into the dermal and subdermal levels. Remember the larger the spot size the deeper the laser penetration.

pmdoc:

Can you please elaborate on the carbon peel? I have a gentleyag and have had one training session and they never mentioned the carbon peel. I use it mainly for spider vein removal and skin tightening using the protocols printed up by candela. I use it also for HR on African Americans very cautiously. I'd love to hear about new protocols to try.

jmd

pmdoc,

I am interested in the carbon peel too. 6J/cm2 is the lowest fluence we can get on the gentleYag at 6mm spot size. Is that the energy that you use?

Cutera has the best Nd:Yag laser available period. Only upgradeable product and all competitiors are still trying to duplicate what Cutera launched back in 2000. If you bought a Cutera Yag in 2000 you would still be utilizing the same gold standard technology but if you bought the first version Candela Yag you would have started with a huge machine with fixed 3ms pulse duration...then they launched the mini Gentle Yag...and now they are selling the Gentle Max. Three product launches that basically do the same thing and each model quickly became obsolete. Not a good business model which is reflected in the large retraction in Candela sales.

Dr Koons:
Cutera Xeo 1064 is a very good platform. Maybe it is the first 1064 platform according to you but to say that it is the best 1064 on the market is probably inaccurate. Its advantages are: 110V and more light weight. I used the Candela Gentle YAG since mid-2006. The pulse duration is down to 0.40ms. Its spot sizes are up to 18mm which Cutera Xeo can hardly match with its largest one at 10mm. LHR can be performed without any gel to the skin with the Candela Gentle-YAG. Anyway, in general, they are both great products as well as Cynosure Elite.

JMD and CanMD:
Thanks to Dr. Koons' post I was able to see your posts from 3 weeks ago. Sorry I never saw them before. For the carbon peel which can also be done with the Cutera Xeo and Cynosure 1064 you need to purchase carbon powder from someone such as SOFTLIGHT at www.telsar.com. Make sure you tell them to show you how to have it apply to the face if not let me know.
Here is the setting:

10mm spot size, 9-10 Joules, 1Hz, 0.45 ms pulse duration, cooling off

Instruction: Treat whole face once with about 20% overlapse. Then using the 5x diopter magnifying glass to look for the still-remaining carbon powder inside the pores, treat over again once more.

PRECAUTION: Carbon is flammable. If there is too much carbon powder all over the face, instead of mostly inside pores, then when you treat with 1064 it might be not only too strong but also in areas with dense fine hair to catch fire. It happened to me before so I KNOW (grin)

Three treatments q 4 weeks. Tell them to expect no-downtime subtle skin peeling over a week. Almost universally they will come back telling you that after a week, their skin becomes brighter, smoother and pores smaller. This is one of a few procedures with a high satisfaction rate. Good Luck.

pmdoc
Thanks. Have you tried this in the darker skin type?

YES, it is safe since it is 1064 which has very low affinity to melanin. For Fitz V and VI, you can start at 8 Joules and have patients put on some steroid cream such as betamethasone right after treatment. This has been shown to reduce PIH risks. By the way, after going thru the face once you will see many untreated spaces left, make sure you treat those once. For the pores, make sure you treat over (once, twice or thrice) until the carbon powder is gone from the inside. The theory of this treatment is by inserting something like carbon powder inside pores, you get an "enhanced" deep thermal heating causing the pores to shrink down but light enough on the skin surface just to cause it to peel off without downtime nor damages. Remember the setting called for the Cooling to be OFF-MODE. On a 3 times rx regimen, you can charge about $800. It is SAFE, QUICK with HIGH SATISFACTION rates. Make sure to clean the spot size often since the black powder got stucked on it.

Thanks

Does anyone have experience treating Laser Hair Removal with only Cutera XEO 1064 Yag? I am considering purchasing, I have many paitients with high Fitz skin type, however also a handfull of I and II.

Yag 1064 is only good for skin type 5 & 6 (African American). Thick black hair.
Not good for thin hair.

Do not purchase as your only laser.

I would get the Lumenis Lightsheer with the 30 - 400 ms pulse width (if you want the least expensive option).

Consider the Candela Alexandrite plus Candela 1064 Yag (great combination). A little more expensive.

Don't script on the lasers, you will have upset patients when you don't get the results.

AVK,

You Cutera Rep is stupid or a liar (probably both).

12 mm spot size is better than smaller spot sizes (Lumenis has a study to prove this (check with your Lumenis rep)).

There is so much bullshit that the reps tell you. Be very careful and be very skeptical.

Ask for references, ask for articles. Tell every rep what the other rep says to see what the response is (the truth usually falls out somewhere when you get the reps "point-counter pointing".

Good luck.

Does your Lumenis has the 100 ms and 400 ms pulse duration???

Robert,

I have the same machines you have. My experience has not been the same. We are buying another hair removal laser because results are not that good.

For more on Cutera, see the Cutera Blog on this site.

"Bulls & ?"

Cutera has lots of work to do if they want to stay in business. Support sucks, their lasers are not that good (outcomes not good enough) and they have this facade that they are the best. They may even believe it.

They are all "smoke and mirrors". Be very careful with them (and all other laser manufactures for that matter).

Dear All:
When you decide to purchase a device for LHR, it is very important to know your patient demographics and to make sure the device has the sufficient specifications. When you have these in place then you should be able to get the best possible device for YOUR practice. In general, the GOLD standards for LHR are:
755nm Alexandrite for Fitz I-III and 1064ND-YAG for III-VI. Make sure the machine is powerful enough to deliver down to pulse width of 3ms or shorter (pulse width of 20ms or longer will NOT be able to get rid of hair on a long term basis). Make sure the device can get down to 3ms on a 12mm or larger spot size AND fluency of 20 J or higher. If not, the device's output is weak. It is better to keep ourselves from being stuck with name brands and confused by manufacturer's biased claims

Yag

getting to love this site, should have visited far more often. I bought the GentleYag new back in mid 2006 as well as a 2nd hand GentleLase at the same time. Though I knew, as pmdoc said, 755 for Fitz 1-3 and 1064 for Fitz 3-6, somehow I just get stuck to use the 755 most of the time. Both great machines, just little hiccups treated by the local agent here in HK.

The main reason to duplicate the purchase was that I wanted to use the 1064 for Blood vessels and tightening, which cannot be done by the 755. Now I am not too satisfied with the results though I follow the protocols from Candela. For telangiectasia I would say the satisfaction is around 60-70 for the face and just 50 for the legs, and I find the procedure very tedious in tracing the blood vessels, yet the 6mm does not seem to work well. A typical for me is 3mm, 60ms, 220-260J. Comment would be much appreciated.

Then for the tightening,it is very painful with only modest result. I am now totally abandaning it, and swob to the Fractional CO2. Could I have used it wiser?

dr stephen

Dr. Stephen:
With the Gentle YAG, here are 2 popular things you can do there in HK, both NOT based on Candela protocols. I do this tightening protocol to myself without numbing cream thus I know it WORKS (18mm spot size penetrates to the dermal collagen MUCH deeper than a 8,10 or 12mm spot size). Precautions: blisters on thinner skin people.

Skin Tightening (numbing cream for 30 mins if needed): 18mm spot size, 30J, 30ms PW, 40/20 cryo setting (lower face=below cheeks) 2 passes qmonth. No overlaps
18mm, 20J, 20ms PW, 40/20 (forehead, under eyes, temporal and neck)
2 passes, q month. No overlaps
Laser Peel (pioneered in Japan and Korea): 10mm spot size, 0.45ms PW, 9-11J, NO cryo coolant with CARBON POWDER applied on face. 2-3 passes q3 weeks. This is for reduction of pore sizes, skin lightening and rejuvenation.

great and thanks a lot, will try to do, perhaps also as a comparision to the Fractional CO2. Will let u know the results once I get them.

PM Doc: Where do you purchase the carbon powder for this treatment?

medspaguy:

www.telsar.com Please refer to my post on 2-28-2008 above. Good luck

Personally, I have used all of the aforementioned equipment and it all has it's place. With respect to LHR, I personally think the gold standard for fitz I-III was the light sheer not the Alexandrite. The Alex wavelength works well but it does not offer the versatility and efficacy of the diode wavelength that lumenis pioneered some years back. Candela does in fact offer a good LHR platform.It can treat all skin types however, the cryo spray can become costly. However, I am firmly convinced the Cutera laser is a better LHR platform.

Looking at wavelengths for skin types, they offer four. An alex, a doide, a wavelength around 900nm and of course the 1064 yag. As with the light sheer to the alexandrite, I would say that this offer superior versatility. The efficacy is unquestionable in my mind.

Skin tightening is another issue in itself. Frankly, I have seen only mild results,at best, with skin tightening using a yag. To say that it's painful would also be accurate. I have tried this procedure as well with Cuteras laser genesis. Turned up the fluence to 20j/cm2 and the HZ to 10. Achieved the same result with respect to skin tightening and that is why I say that a YAG is not the ideal skin tightening device in my mind.

IMO, both are good laser but I believe head to head the Cutera laser is again much more versatile and offers a higher value than that of Candelas.

Thank you to everyone for posts clarifying many questions. In the interest of transparency for all on this board, I am a Cutera employee with a background in biomedical and electrical engineering. I designed lasers for ~10 years in both ophthalmology and dermatology, including a diode hair removal laser.

I agree with most of the statements posted related to spot sizes and pulse durations, but differ on a few points. The first point is spot size. To the initial post stating that 12mm decreased efficacy, this is not accurate. It however, is also not accurate that the larger spot size is more effective.

Depth of penetration is limited by 2 factors--absorption and scatter. Scatter is only significant when sufficient energy exists to scatter. For example, a green light will not reach the hair bulb regardless of the spot size. Scatter is not the limiting factor, absorption is.

Secondly, wavelength affects scatter. Short wavelengths scatter more readily than long wavelengths (reason the sunset is red). This means that almost regardless of the spot size, a YAG (1064nm) laser will always penetrate deeper than a large spot green laser.

If the wavelength penetrates deeply enough and the spot size sufficiently large to reach the target depth (vein, hair bulb and bulge, etc.), spot size is no longer a differentiating factor for efficacy. YAG lasers using spot sizes of ~7mm or larger penetrate to hair blub depths with comparable efficacy. For smaller spot sizes, greater fluence is required to reach deeper (increasing epidermal heating).

Cutera's spot size of 10mm is not dictated by laser limitations. The laser uses lenses internal to the handpiece to adjust spot size on the fly significantly increasing efficacy and ease treating vascular lesions where spot size selection and fluence selection can change frequently. 10mm comes from this option.

The second point is pulse duration. A YAG device should be able to provide fluence and pulse durations from hundreds of microseconds (0.3ms to 100+ms) to treat the full range of applications available to YAG lasers. Cutera's meets all these specifications.

The ideal pulse duration should be greater than the thermal relaxation time of the epidermis and shorter than the thermal relaxation time of the target hair or vein (ideally about 1/2 the TRT, but still larger than the epidermis, if possible, to maximize epidermal protection). The time constant of the epidermis is between 5 and 10ms. Typical "fine" hairs have pulse durations of 10-20ms. Medium hairs tend to be in the 20-40 ms range and coarse hairs range from 40-100ms. This means ideal LHR pulses durations are typically between 10-30ms.

One thing that separates Cutera from competitors is the real pulse duration. Most YAG lasers do not use a single pulse (necessary to maximize epidermal protection). Instead, they use a series of short pulses with off time in-between each. The string of sub pulses continues for the selected pulse duration meaning that typically 5-10 actual pulses are delivered with a large amount of off time instead of 1 constant pulse. To deliver the same average fluence, each sub pulse must be many times the requested power to account for the off time between each mini pulse.

The problem is that the epidermis is most frequently the smallest target meaning it reacts to energy fastest. Using these short sub pulses effectively selectively heats the epidermis creating spikes of temperature while the larger hair or vein slowly heats through the accumulation of multiple pulses. These spikes decrease the degree of safety to the epidermis, decrease heating efficiency, and increase the average fluence necessary for smaller targets. This becomes significant when attempting to treat finer hair or telangiectasia without damaging the epidermis.

Dr. Stephan,

One problem you likely have with your efficacy for treatment of telangiectasia is the pulse duration. 60ms is extremely long meaning heat is able to "leak" out of the vein almost as fast as you're putting heat in with the laser. Many small telangiectasia need to be treated in the 5-20ms range. You will likely find you're able to treat these at significantly lower fluences when the correct pulse duration is employeed. Ideally, your laser will deliver a single pulse to optimize epidermal safety at these settings and maximize efficacy. Multiple pulsed systems will lose some thermal efficicency due to the off time between pulses meaning higher fluences will be required. This can become significant with smaller targets that require shorter pulse durations.

I hope this helps. Adjusting your parameters increases efficacy and efficiency. The correct pulse duration provides the greatest efficacy with the lowest fluence. Lowest effective fluences equates to greatest patient safety.

Hello, I am interested in having the Laser Genesis procedure for pore size, pore texture and for small blood vessels on the nose. Can someone with experience using this machine please tell me what exact specifications the laser technician would need to use to help improve the pore size and texture (i.e. spot size? Pulse Width? Joules?)
Thankyou.

Laina,

I posted two descriptions specific to Laser Genesis, both it's mechanism of action and how to perform the procedure to achieve best results. To ensure transparency, I am a Cutera employee and the site is a link to a Cutera site. Please take a look at the following link for this description.

http://blog.cutera.com/blog/laser-technical-discussion

I hope this helps answer your question. Please feel free to post either here or there if you have follow-up questions.

Thank you

Stuart,

Thanks for being honest and upfront about who you are.

Laina,

Don't waste your time or money. There are better options. I am a physician that has offered "Laser Genesis" in the past. I never charge for it as it is not worth the time or money.

If your compairing Candela and Cutera on a service level there is no comparison, Candela is far an away the least expensive with the least downtime company. There are many third party companies that offer service and accessories for all candela laser systems. Cutera offers no service for any customer unless they are under pricey contracts. As a service technician I have never had any luck with ordering even the most minor parts such as a footswitch.