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Cosmetic IPL Laser Reviews & Comparisons > Lumenis Active FX VS Reliant Fraxel SR1500 VS Cutera Pearl

Local sales rep has arranged for demo of the Lumenis Active FX fractionated CO2 laser. I have done a few freebie case using this laser for the following conditions; melasma, atrophic scar, and hyperpigmented nevus. Our clinic will be demoing the Reliant Fraxel SR1500 in two weeks, and the Cutera Peal in early March. What are fellow docs opinion on the above 3 ablative lasers?

I have done Fraxel SR1500. I am going to the Cutera Pearl workshop soon for more info. Lumines Active FX is CO2. Reliant also just came out with their new CO2 called Re:Pair. In general, you must not decide on the technology based on the sale rep. It is a NO-NO. Here are the few basics:
1) Fraxel is in the 1500's nm range, mostly water-philic, not too ethnic dependent but still with Fitz IV-VI, be conservativer early on. Its depth of penetration is pretty good
2) Cutera Pearl is 2790 nm.It is more "ablative" from what I understand. I am not sure how good it is thu. It does not seem to have much "thermal coagulative ability", thus no skin tightening effects. I'm going to its clinical workshop to find out directly from the lecturing MD rather than from the sales rep.
3) CO2: has been the gold standard of skin resurfacing with the BEST skin tightening effect of all due to its high thermal coagulative nature. Its usage has been hampered by its long downtime, pain and risks of adverse side effects. The Active FX and Re:Pair aim to reduce the downtime and side effects. The Re:Pair appears to be close to "ablative" in its effect, needing only 1-2 treatments. But its clinical protocol appears still evolving at present. FX has been out longer, probably with better protocol. However, I don't pay much attention personally to it so this is just my guess.
When it comes to making the decision best for YOUR practice, this is another problem to itself based on your practice profile:
1) ethnic profile
2) age profile
3) Market's existing technology and level of competition
4) Patient's acceptance of downtime vs risk of PIH vs prices

1) Where is your practice??
2) What other services do you offer? Be careful of overlapping services
3) How long have u been doing laser/cosmetics?

01.24 | Unregistered Commenterpmdoc


Pearl is truly a minimally ablative device. Depth of ablative is pretty superficial, thus NO tightening. Results I would compare to IPL/Levulan. TRUE exciting technologies would be: fractional CO2 is BEST and will beat any Erbium or Erbium like (YSGG) hands down.

DEEP FX .12 mm spot size; ablation depth > 700um !!
You can change spot size with Active FX handpiece to 1.2 mm. True surgical applications in ENT, OB/gyn colposcopy, derm. (Why is this important? Hospitals like and will rent this device.) Beyond aesthetics ; made by the Godfathers of CO2 -- lumenis/coherent.
continuous ultrapulsed co2

Relient RE:Pair : disposalbles here that you have to continuously buy and difficult hand roller hand piece,
NO true surgical applications; .20 mm spot size; low power at 40 watts; You cannot change shape , size or density.
pulsed co2 -- weak.

MIXTO: probably better than Reliants RePair but spot size is
.300 mm; lowest power at 30 watts; You cannot change shape , size or density. continuous wave co2 w/ peak power; ablation depth 500 um

but when all is said and done.....
what is better ? deeper? density? continuous wave ultra pulsed? or simply pulsed? gausian pulsed based? we are completing some clinical trials and hopefully will be answered soon. welcome to the next generation... real tightening, real rejuvenation, real results......

01.24 | Unregistered CommenterPEARL?

Dear Kenneth Wang,
There is a great article on microablative fractional technologies in Aesthetic Trends and Technologies this current issue. check it out.

In my opinion most technologies last about 5 years and then go out. Fraxel had its day and I personally think they are on the way out. Re:pair will get you way better results in ONE treatment.

In our office most patients would rather have one treatment with incredible results than minimal results after 5-10 treatments.

01.24 | Unregistered CommenterPEARL?

Thanks so much pmdoc for the detailed reply. I am still demoing the above mentioned equipments and will be doing so thil end of February / early March.
I already have the following equipment to my arsenal: Sciton 1064 ND YAG, Sciton 2940 Erbium YAG, Sciton BBL with all filters including the ST (Skin tyte), Fotona QX 1064 Q switched laser, Fotona KTP532 Q switched laser, Cutera Titan,Thermacool Thermage, and the Syneron Velasmooth. I also perform Botox, Restylane (perlane, restylane, touch, Sub Q), and Aquamid filler(not available in the U.S.) I am able to perform great ablative procedure with my Sciton 2940 erbium (single point for nevus / spot treatment and scanner for the micro laser peel and deep resurfacing).

I treat mostly Fitz patrick type 3-4 skins in my practice and Melasma is a huge problem in this area. The Erbium resurfacing results in too much downtime especially when I am ablating away 60-80 micons of epidermis. However the Micro Laser Peel is truely amazing (ablating 4-8 microns) and is the real money maker at my practice. I need a reliable resurfacing laser to take care of my Melasma patients

This is my fifth year in the cosmetic derm business. I am trained and board certified in family practice and did additional training with LA area dermatologists during my residency training. I also worked at a laser derm department in a hospital in the Alhambra,CA area for a few years. Although I trained and practiced in the U.S. (Los Angeles area). I left the country 2 years ago to start a cosmetic derm / medspa in Taipei, Taiwan China in 2006. My partners and I are planning on opening a similar practice in Shang Hai China in 2009 if 2008 continues to be a successful year.

Thanks to PMDOC and LH for your expert advice. My colleagues and I from China, Taiwan, Hong Kong, Singapore, Japan, and Korea have all been raving about this wonderful forum.

Here's my office website.

I attend my CME seminars in LA, and Boston each year. I had a wonderful experience from the Harvard Course "What's the Truth in cosmetic dermatology" taught by Rox Anderson and Matt Avrum last September and will be stopping by Harvard each year to learn the latest from the field of cosmetic derm.

I checked your website but was not able to understand much, LOL. You know why!!!!! Please give me your email address so I can discuss more with you about your business venture and share some of my ideas with you. Thanks

01.24 | Unregistered Commenterpmdoc

You are a wealth of information. Thanks. In general, I am not that impressed with anything from Cutera. I kind of suspected that Cutera Pearl was Erbium-like as you alluded to. Honestly I don't know why anyone would take Erbium over CO2 at this time. I would love to hear from you in regards to deep CO2 (dermal ablation) on Fitz III and higher. This issue has been the most elusive to me personally.

01.24 | Unregistered Commenterpmdoc

hi pmdoc:
here's my personal email.
thanks for the great advice. I treated 3 patients with the Active FX this morning. Hope to hear great feed back from these volunteers who allowed me to do test spots on them. Settings were from 80 mJ to 120 mJ, Spotsize 3, Shape Pyramidal, Density 3.
I returned the Lumenis Aluma yesterday after trying it out on 5 patients and a few office staffs.

I really want to have one great machine to treat my Melasma Type 3-4 patients. But as you said earlier, I have over lapped my equipments. I should consider selling the Thermage and perhaps the Cutera Titan and sharpen up my technique on Erbium laser resurfacing. The market price for the Lumenis Ultra Pulse (Active FX) is around US$160,000. There are 5 Reliant Fraxel SR1500 in my vicinity (10 Km radius). It is hard to justify spending so much money on an equipment only few patients will utilize.

01.24 | Unregistered CommenterKenneth

Lumenis DEEP FX impressive. I am waiting to see more from the MIXto from Italy and Reliant;s comeback Re:pair.

01.26 | Unregistered Commenterwhoa!

Returning the Lumenis Ultapulse (active fx CO2 laser) back to the sales rep today. I have done 5 fractional ablation cases with this equipment and a few more single point nevus ablation. I am still more comfortble with my sciton erbium laser for ablation. I tried the parameters provided by Dr Goldman (per sales re). The result and down time is no less than what I see with the Reliant Fraxel SR1500. The down time is similar to the erbium laser I currently own. Although I am not amazed by the Active FX, I think it is a worthwhile investment for someone starting a laser derm practice. I may have gotten the Lumenis Active FX if I did not already own the Sciton 2940 erbium yag

01.30 | Unregistered CommenterKenneth

I have tried a Fractional CO2 laser on about 20 patients since 2 months ago and I have achieved remarkable results in tightening facial skin, tightening upper and lower eyelids, and improving acne scars, and in ONE treatment. So the technique of Fractional CO2 laser does work far better than Fraxel, which I agree with Pearls that it is on its way out. Some doctors I know here actually regretted a great deal about having bought this.

This Fractional CO2 laser I bought is actually from Korea. This is great.The beam is about 0.12mm. You can change shapes, change sizes continuously from 1 to 20mm., have 10 different densities levels, and very powerful with 500-1000 microns penetration. Guess what, the price is only about half of the Lumenis Active / Deep Fx, which is a rip-off. It is one of my best buys in the last few years.

01.31 | Unregistered Commenterdr stephen

dr stephan,

Are you talking about the Mixto? What kind of warranty does it have.

01.31 | Unregistered CommenterLH

He is talking about the machine from Lutronic, the Spectra SP. I do know the company that represents them here in the US.

01.31 | Unregistered Commenterpmdoc

Have you heard anything about the mixto? I have heard it is much cheaper.

01.31 | Unregistered CommenterLH

Sorry guys, it is a Korean machine called CoLaGen by a company called DanilSMC. They are selling it in Asia only I think, although they plan to expand to Europe and the US, it will take a while though. I am based in Hong Kong.

I have compared this with the Lumenis Active Fx and decided it is far more worth for the money @ about 70k US.

As Pearl pointed out above, the Mixto cannot change density, shape or size and to me this sort of spec is not really useful.

Is it medico-legally a problem in the US if a doctor uses a machine that is not FDA cleared?

dr stephen,
welcome aboard. deep fx/ active fx is really an incredible device . i am currently working on some clincal studies for possible publication w/ lumenis re: stretch marks. not to increase the hype but this is truly remarkable. between the spot sizes 1.3 and .2 which is the largest and the smallest of all the fractional CO2 and the most power not to mention density changes and shape is truly an advantage. i have the fraxel and it is now never used. acne scarring --- deep fx amazing. single treatment results that 20 fraxel could really not achieve or be it minimal.
surgical for me has been great --- viral warts, skin tags, and complete scar revision and of course blephorplasty, etc. surgical. i think you really set yourself apart . in our state texas , this can only be physician performed . so offices that carry this technology is limited.

02.1 | Unregistered Commenterhmmm

correction deep fx spot is .12 not .200 -- which is reliant's re:pair

02.1 | Unregistered Commenterhmmm

Dr Stephen:
Do you have any problems with PIH from treating CO2 on your population Fitz III and IV??? How do you "prep" them before and/or after procedures??

02.1 | Unregistered Commenterpmdoc

skin and aging article re: fractional CO2 resurfacing over 2000 clincal cases without any true cases of PIH; we treat with hydroquinone prior to procedure . never have had a case of PIH. real data conflicting reports re: whether pretreating may or may not make any difference. true PIH last on average at least 3 months from clinical cases mainly from korea s/p punch biopsies.

02.1 | Unregistered Commenterhmmm

Pliaglis numbing cream ..... whooooooo......nice.

02.1 | Unregistered Commenterhmmm

Has anyone tried Sciton's new pro-fractional erbium?

We have done over fifty Profractionals. We are doing quite a bit of microlaserpeel and profractional combinations and getting great results. With Profractional we do anywhere from 100 microns and 1.5% coverage out to 450 microns and 10% coverage. We like the flexibility to be able to change both depth and coverage based on the clients needs. We are also doing BBL 515 and 560 combinations as well. The Sciton users here should start a forum on combination treatments.

02.19 | Unregistered Commenterdexter

please share your sciton experience with us. I am interested in learning combination of BBL with the profractional /MLP experiences.

hi everyone,

what are your thoughts of treating moderate rolling acne scars with SR1500 on treatment level 5, 30mj, 12-14 passes? Will the patient have a 50% improvement? I've a patient that have PIH if the settings are turned higher. Thanks.

02.27 | Unregistered Commenterlammd

I have seen incredible results with Pearl (YSGG) compared to Erbium. It is easy to use, safe, effective, and zero consumables compared to Fraxel. Cutera has an exclusive relationship with the only YSGG supplier so other companies are trying to discredit the technology because they can't offer this unique wavelength that hits the sweet spot between CO2 and Erbium.

02.28 | Unregistered CommenterDr. Koons

The Pearl just does not go deep enough. I will put my erbium with coagulation up against the Pearl any day. I also own Cutera. I have talked to people with the Pearl and just about everyone has not been happy with the results. The results do not have the staying power.

02.28 | Unregistered CommenterLH

You sound like the Sciton rep in my area. IF you own both technologies please post your phone number so people can verify your identity.

Pearl is the only product that can provide full epidermal turnover (100 microns) in a week with zero clinical downtime. Check out Cutera owner and patient surveys that show the best satisfaction rates in the industry. The spin stops here.

02.28 | Unregistered CommenterDr. Koons

Just look at the stocks. Cutera Pearl Poops.

02.28 | Unregistered Commentercutera?

Dr. Koons or JK,

You are embarrassing yourself. Please try and be informed if you are going to try and pass yourself off as an expert. There are a number of very educated laser users on this site. I'm glad you are excited about the Pearl and I wish you the best of luck, but you have to be careful calling out members of this blog who have earned respect over a long period of time.

02.28 | Unregistered Commenterdexter

Dr Koons:
You obviously are not a very well seasoned laser physician but rather someone who feels "empowered" by simply espousing the oft-quotes from sales people without making sure that YOU, yourself, fully understand the technology and its clinical potentials. Tell me:
1) What is so sweet about 2790nm compared to 2490 and 10000?? Give me 2 possible reasons why it is SO UNIQUE from 2490 and the GOLD STANDARD 10,000nm.
2) Whatever the hell YSGG is, who cares since it is just a glorified version of a fractional concept that is ALREADY 3 years behind the curve??
3) Please explain to us all what you meant "full epidermal turnover in a week time with zero clinical downtime"

02.28 | Unregistered Commenterpmdoc

Dr. Koons,

Did I mention Sciton? I have talked to physicians with the Pearl and they are not that happy with it. To have real correction that is long lasting you need to be deeper. So if you want baby technology then the Pearl is a good choice for you. I want more from my lasers. Personally, it looks like one more time that Cutera has over promised and under delivered. As the others know I also own the Titan which has become a $40,000 coat rack.

Zero clinical downtime? Having your epidermis peel off is the equivalent of no downtime. That is an absolutely incorrect statement. I can do the same as the Pearl by using a TCA 20% peel and save $39,995. The Pearl in the long haul is no different than me doing a light to medium depth TCA peel. The results will be similar and the epidermal sloughing will be similar.

I did not think my comments would cause such a significant uproar. Thanks for the backup Dexter and pmdoc. I hope to get to LA sometime this year pmdoc so I can meet you and look at your place. I have not been to active on this site as i am currently opening my second facility and not having much time.

02.29 | Unregistered CommenterLH

The Pearl treatment will give you the same results similar to an IPL/Levulan. Come on folks. MIXTO vs. Repair vs Deep FX ablation depth 500 - 1000 microns into the skin. Still in question: How deep is enough? How close to the spots (density) need to be without overlapping? We will see you in Whistler Canada. Conversations and Controversies Conference this year. Lets bang it out !.

02.29 | Unregistered Commentercutera?


Those are the exact questions we want to continue to ask each other. Another question to ask about the fractionated CO2's is how long does the tightening last? One recent publication made the statement that you only see skin tightening last about 18 months with full face CO2 resurfacing. So what happens with fractionated CO2?

02.29 | Unregistered CommenterLH

If skin tightening only lasts 18 months,does that mean laser treatment results are only temporary?I have mostly moderate boxcar and rolling scars.Should I even go for laser?If so,which machine is suitable.....laser industry has become overwhelmingly confusing.Has anyone of you heard of dermal grafting for scarring?Thanks

Skin tightening and acne scar smoothing are 2 different concerns. I have used ActiveFx laser for severe facial acne scars for more than 70 cases since April ’07.
I did my initial cases, like my prior Sharplan CO2 experience and textbook taught, put focus on vaporizing the shoulder to a more gentle slope. The result of mod. to
deep acne scars was poor. Why? The bottom of scar is fibrotic tissue. The pebble is always a stone. Eradiate or vaporize it may be the only right way. Targeted laser dermablation is done for each scar. Since changing my Tx procedure, till now, the follow-up PO features are exciting. An alterative thinking to all of you.

03.5 | Unregistered Commentersmiling

The length of time that you see tightening with CO2 is also going to depend on the mode of operation of the CO2 laser (continuous wave vs superpulse vs ultrapulse). There are studies out showing results 2 years after full face co2 resurfacing with a Continuous Wave co2 and Ultrapulsed CO2...tightening affect is fading at 2 years more so with the Ultrapulse than the CW CO2.

03.10 | Unregistered Commenterlaserguysd

Sorry folks, been missing out on the valuable comments here for a while.

To pmdoc:

I have now done a lot more with the Korean Fractional CO2 laser, so far on Fitz Type 3 - 4 Chinese skin, there had been no PIH up to 40mJ, very mild PIH up to 60mJ. Of course things may vary if we use higher density. I am using mostly ~1.5mm between spots. Also we provide cooling for 10-15 mins after the procedures, I believe it helps. By the way, too painful to do 60mJ on the face even with emla, while 80mJ on the tummy is still ok. What is your usual for the face?

Love to learn more about the Mixto / Repair and perhaps you guys can help by putting the gradings into actual figures, e.g. actual distance when one talks about ActiveFx density 5.

It is said that applying Red LED light will hasten the healing process a lot, and I do that for patients getting 30mJ or higher.

The results so far are indeed very impressive, and referrals through patients are forthcoming. I am probably the first one in HK here to own a Fractiona CO2, just because I abandoned very fast the idea of spending $120,000us on the US models, and jumped on an Korean "equivalence" for only ~$63,000us.

dr stephen

03.22 | Unregistered Commenterdr stephen

dr stephen,
is the korean model superpulsed or ultrapulsed co2 ? and what is the spot size ? just wondering... thanks.

03.22 | Unregistered Commenter.

I believe it is ust a simple CW beam being scanner into a pattern (not exactly sure, will find out). The beam size is just the natural straight out CO2 beam, and I measure it to be ~ 0.1 -0.15mm.

There is a choice of dimemsions from 1mm-20mm x 1mm-20mm, square or round / oval.

10 Choices of density from 0 - 3.3mm

there is also choice of "degree" : no of repetitions ( 1-10) of each beam, ie for a degree 3 , it punches 3 times before moving on to next beam. Not sure this is very helpful, and may complicate things a little too. They talk about TRT there, while not knowing the time interval between each beam, so a bit of a woffle there.

03.23 | Unregistered Commenterdr stephen

forget to say, energy is from 10mJ to 160mJ.

03.23 | Unregistered Commenterdr stephen

Hi Dr Stephen,
Have you been treating acne scars with the Korean laser?Would like to learn about the laser if its effective against scarring.I am from HK and am looking to do fractional CO2 but I couldnt anyone that has it.

03.26 | Unregistered Commenterscarface

Hi scarface,

I have been doing fractional CO2 laser for about 6 months and I have used it on about 50 people for various indications, the first of all is acne scar patients because I already had a pool of these people doing chem peel and micro-dermabrasion before.

I certain feel very excited about the result I get from fractional co2 laser, so are the people who have tried it, the results are very impressive. Apart from a doctor who has an active fx for research purpose (free from Lumenis of course), I think I am probably the only one who has it so far, no wonder you can't find anyone who has it.

If you would like to discuss it with my assistant, feel free to talk to my assistant on 2890-8020.

03.28 | Unregistered Commenterdr stephen

Hi Dr Stephen,

Thanks,I will definitely call you.Of which system did you get impressive results from?I have heard the total FX yielding very good results,is that a newer version of the active FX?Also,what's your opinion on fraxel re:pair and will you offer that in your practice,thanks again.

03.30 | Unregistered Commenterscarface

Hi,I was told that since some of these lasers go so deep that it hits the subcutaneous fat, and one might end up watching their face slowly cave in after a period of a year or so from subcutaneous fat loss just like the patients who had suffered from Thermage.Is this true??

03.30 | Unregistered Commenterlucy

The total Fx is just a combination of DeepFx and Active Fx.Fraxel re:pair is yet another fractional CO2 laser models. I have to say I am using a model from Korea for all my cases for the past 6 months.

Non of any of them are FDA cleared for acne scar, although the Fraxel re:pair is probably going to get this done soon. As I put up above, apart from a doctor who has an active Fx for research here , I am probably the first one to jump on this technology, although 3 other doctors have also bought my models and will get this delivered soon.

As far as I know, no one offers Fraxel re:pair yet here in Hong Kong.

03.31 | Unregistered Commenterdr stephen

Just wondering, what fractional C02 laser would be best for enlarged/scarred pores?

2 years ago, I had a Mico Laser Peel with no results, so last summer I had 3 Fraxel re:storeTM treatments on my nose and inner cheeks with no change at all. Not 1 pore changed and the enlarged/scarred ones remained the same...I hate spending so much money without getting any results! If anyone lives in Toronto, Ontario, Canada or can recommend a fractional CO2 laser, what would work...please message me. Thanks.

03.31 | Unregistered CommenterTorontoguy

Keep in mind that even when something worked on your pores, it would not be permanent. I would not pay for the cost of CO2 laser for this purpose. One cheaper way is to do the Carbon Powder Laser Peel with 1064Nd-YAG. If you do it 3 times, it porbably would last you about 1-2 years.

03.31 | Unregistered Commenterpmdoc

Thanks for your reply. I'm just looking for something that would work to both fix the enlarged and scarred pores and shrink them if that is possible. I currently use Retin A micro, it speeds up skin renewal, but I don't feel it makes much of a difference, since it irritates my skin and I still get noticable blackheads since the pores are big and deep...and when the blackhead is gone I'm once again left with deep's a continual process.

That's why I want to find something whether it's a type of laser, light, or cream that will actually shrink the pores. If anyone knows something that has worked for them or their patients please let me know. Thanks.

03.31 | Unregistered CommenterTorontoguy

Just a quick question...when you recommended the Carbon Powder Laser Peel with 1064Nd-YAG for large pores is that the same as Laser Genesis 1064 Nd:YAG?

I believe so. Actually it would be with the Cutera XEO 1064 Nd:YAG. As long as it can do these settings: 10mm spot size, 0.45ms pulse width, 8-11Joules, post cooling OFF position.

04.1 | Unregistered Commenterpmdoc

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