AVK209,

ActiveFx co2 Laser can cause PIH and should not be used in skin type 5 and 6.
The DeepFx may be different because it has a spot size of 120 micons (0.12 mm) and you only do 15% of the skin in a treatment. With the ActiveFx, you have a spot size of 1400 microns (1.4 mm) and you treat 85% of the skin in each treatment!

JEE,

I have the Lightsheet ET, infact was the first laser I bought, I never even looked at the ND Yag. However, I can today after 3 years say that a ND Yag is better for Indian skin from a patient view point. The pain factor is considerably less as well as the burn marks are minimal. I bought the Cutera last year and since then my hair removal practice has increased very nicely by patient referral. So far the results have been quite good too with the Cutera.

The Cutera Genesis procedure actually gives me nice results , but the company suggested protocol is not that good.I feel, the key to genesis is to actually concentrate the pulses and the treatment very specifically on the problematic areas like scars and pigmentation. For Indian patients it gives me good results and very safe. Im not saying its the best procedure but the satisfaction rate in my patients is quite good. Earlier I also thought Genesis wasnt upto the mark, but underwent a training with a Doctor in the US in April and she showed me some good tricks for the Genesis to increase patient satisfaction. I spoke to Dr.Battle as well, and he also mentioned the same tricks for Genesis. I am aware that lot of people in this forum are not so fond of Genesis, but my experience has been good. Hence I was wondering due the scanner function of the SCITON, are parameters like the ones suggested for the Genesis, available on the system.

MDR

Yeah you are perfectly right. I wont use the active fx in Indian patients, though there are a couple of Doc using it here. Deep FX might be a good option, I shall have a look at it. I feel though im not so much into surgical work, and am just little vary of the CO2 on darker skin. Hence, was looking at the 1540 or 2940 wavelengths.

AVK209,

I would love to know those "tricks". I would love to be able to use my Laser Genesis more. Especially for pigment problems in African-Americans and patients of color. Could you share those tricks with me here or off line? My email is Jeff4459@aol.com. Thanks.

Try this out.. Use the following parameters 18J / 8Hz / 0.3 msec... concentrate on the problematic areas very slowly, do'nt do just the painting like the cutera guidance video shows.If you are doing it on a surgical scar, use around 2500 shots on that scar....for acne scars I tend to give around 2500 pulses on one cheek and then on the other ....For freckles and similiar small marks concentrate the pulses on the pigmented area, when the patient just starts becoming a bit uncomfortable move to the the area and then come back to the pigment, you should get slight erythema and perhaps a slight swelling in the pigmented spot. Its important to be slow, Genesis is not about painting, its about delibrately giving more pulses on problematic areas which we want to improve.Ideally schedule 6 treatments at a gap of 1 week each, though I also do it at gaps of 3 weeks.... I think Cutera promotes Genesis as saying that the patient can sleep through the procedure, in ideal the patient should be a tad uncomfortable :) It should be sustained volumetric heating ! Let me know if you see any difference by this method.....

avk209,

If you are treating a freckle or a small area of hyperpigmentation, the skin heats up very rapidly when you use 18j / 8hz /0.3 ms. I would guess that you will only be able to do a few hundred pulses in any one treatment. Does this sound correct? Would you do the treatment using a slower rep rate (4-5 hz?)

Do you use the Laser Genesis for treating PIH in type 5 and 6 skin? For example, PIH from acne scars?

When you say it is "important to be slow", what do you mean by this?

The take away message for me is that you need to treat to "tissue response" at each treatment and in this case it is slight swellling and slight redness. Is this correct?

Thanks.

Yes , very right for the take away message.....you would look for tissue response at the problematic areas while covering the entire area to be treated...For a small area of PIH on the cheek, you would basically do the whole cheek with say 2500-3000 pulses, but give extra targeted pulses on the areas of PIH.I do the treatments at 8hz personally, I dont think it would matter if you do it at 4-5 hz,but then it takes too much time the treatment...You need to give at least 2500 pulses to each area of the face, e.g. one cheek...

By slow I mean, well if you see the Cutera video for Genesis, they just paint the area randomly as if there is no specific purpose for the treatment, that I dont think is correct, you do need to paint the area but at a slower speed while concentrating during the treatment on the specific problematic area's e.g. PIH,scars, I hope im conveying my stream of thought :) ?

We dont have Type VI skin here, but all of the patienst are Type IV and V mainly.

AVK209,

I think when you say "slow", you mean the speed of your hand. Rather than waving the handpiece at a rapid rate in a random manner, you want to move it slowly across the face and concentrate your pulses in the areas of interest. You may even lay the pulses down side by side rather than the pulses being centimeters apart.

Do I have it correct?

I'm fitz skin type 3 (half mediterranian/half irish) and am interested in erbium resurfacing down the road. Would anything deeper than a MLP be safe for my skin type?

Thanks TC

Yes you have it perfectly right. I had actually posted this reply before ,not sure why it wasnt posted...Anyways reposting it.....

Profractional XC users,

I finally got the proFrax XC last week. I had my periorbital area done with 150microns/ coag level 2 and 3. I had two small bruises and pinpoint bleeding. Today is P/O day 5 and I' m completely healed with some dryness. I have Fitz type 2 skin. An office staff had full lower face 200 microns/ coag2 and was healed with slight redness P/O day 4. She (fitz 2) had pinpoint bleeding that lasted~ 1 day. Results are very good. I did get the upgraded screen. Very nice. I now have 70 microns coag with contour. Other users, tell us what parameters you are using. I have been doing CO2 since '94 so I may be a little more aggressive.

RAY

RAY

What was the density that you used? 5,5 or 11%?What was the time for the full face resurfacing? (single module)?
70 microns coag with contour(You mean the level 1 coag of Profractional-XC)?

Charry,
We used 11% density, 150 microns coag level 2 and 3. It did sting a bit. Time for lower face (form lateral brow down) was about 35 minutes including eyelids. I did have coag level 2. Without coag the time would be half that or less. Sorry about the confusion with the coag. With the color screen updating there are some software changes. I have a single head Erbium. Previously, with the resurfacing mode scanner I had 50 microns of coag per pass. Now with the software upgrade I have up to 70microns coag with the resurfacing mode.

RAY

Thanks RAY

I would like to do a profractional combined withy MLP treatment for myself but it is very frustrating because I live in a small town and one guy here has the Sciton profractional with no MLP and the other guy here has a Sciton MLP with no profractional. Can I do them both on the same day? If so which one should I do first? Or should I just do them in between eachother? I want the most bang for my buck for one combination of treatments.

if the proceedures are done on the same day, the microlaser peel would be done first at a level of 10 -20 microns. the profractional leaves tiny dots of bleeding and the energy from the mlp is absorbed by the blood and does not reach the skin. which treatment is best for you depends on the problem you are treating. the mlp might be best for more superficial problems like epidermal pigment and roughness. the profract better for wrinkles, scars and skin tightening. if your providers are knowledgeable and ethical they would recomend the best rx for you whether they provide the service or not. many providers offer free or low cost initial consults and this is the place to start. congratulations on taking steps to improve the health and quality of your skin.

I've been doing the combo MLP and ProFx w/ good results. But the patients still have several days of downtime. I've been recently doing BBL w/ ProFX with nice results and short weekend of down time. Patients seem to like this combo. Still playing with the density vs depth settings. I tend to run 8-10% w/ around 150-200 mircon profx. Anyone else doing this combo? If so, what settings have you been most pleased with. Any thoughts on treating perioral and/or periorbital rhytids w/ just the ProFx? Note: above is with original ProFx and not the XC.

flightdoc,

i have also been doing the profractional+ bbl with good results. the bbl seems to increase the efficacy without prolonging the downtime. i had been using less pitch area and greater depths than you have with pretty good results. lately, as a result of my experience treating acne and burn scars(which have greatly varying depths- up to 1000-1500 microns in some areas and 200-250 in others even in the same scar) i have also been using variable depths for skin rejuvenation, wrinkles and skin tightening. this approach, called SOFT for selected objective fractional technique, the depth of each area is selected by determining the minimum depth required to reach the papillary dermis (onset of pinpoint bleeding) and using coverage area of 5.5 to 11 % depending on the length of downtime the patient will allow. of course, each patient responds differently, but even at the higher end the social downtime is usually in the range of 2-4 days, shorter with mineral makeup as soon as the "crusts"fall off (24 hrs). this approach has yielded very happy patients especially after 2 treatments. i am currently pursuing a grant to compare traditonal resurfacing with the xc for perorbital rhytids and laxity. my hypothesis is that the results will be comparable but with shorter downtime for the xc. my current approach is profractional (using SOFT) over the entire face then come back with 50 ablation on the first pass and 50 ablation with 25 coag on the lower lids. redness lasts about 5 days under the eyes.

Dear Sirs,

I have posted a letter before about lasers.
I had 2 sessions of MLP 2 and a half years ago, and a few Cynosure pulsed dye treatments and a few BBL later on.
My skin looks nice , but I have some lines under my eyes. My Doctor has just purchased a Sciton Profractional, can I have the treatment with that just under my eyes? I have Bio-Alcamid in my nasolabial folds and I read many reports about Bio Alcamid causing problems at a later stage when second surgery is performed, or if any kind of infection arises on the skin.
Do you think its safe to have a profactional for me? Does it carry the risk of infection?

Nora

nora,
bioalcamid is injected in the subcutaneous tissue under the skin. the profractional should not penetrate that deep. infection is very unlikely with careful skin care post op 24-48 hrs and NO PICKING at the microscabs. as i alluded to above, no studies have been published (to my knowledge) asessing the effect of profractional on lower eyelids. but, i have had good results and heard encouraging anecdotal reports especially with the xc handpiece or combining with full resurfacing just for this area. you probably would want to do the procceedure all over your face or maybe just a mlp so that your face wont have two colors or textures. at least feather around that area on your cheeks. does that help? enjoy your new skin!

Positiveagingdoctor,

Thanks for the feedback. I take it you have the XC. I have the original ProFx unit. So for better results with periorbital resurfacing treatment, you are coming back with the full ablative scanner doing 50 ablate, then 50/25 ablate/coag around the eyes? Is one treatment generally enough? And for ones doing just profractional, how many treatments are you generally doing. I seem to average about 3, done around 6 or so weeks apart.

What's the highest skin type you have done?

Finally, have you done ProFx on anyone that has had a previous h/o full CO2 laser, even if remote?

don

unfortunately, i don't have the xc. i would be using the grant to buy it for the research project. with the full resurfacing around the eyes one treatment gives a very good result but i like to do it twice if the patient will agree and they have the downtime available. i always qoute the patient for three treaments, but half the time they stop at two at least for wrinkles and skin rejuvenation. acne and burn scars need at least three and usually more. the highest skin type i have done is 3, but i have heard of and seen pictures of 4-5. i think if i tried this i would use lower pitches and emphasize the importance of careful skin care post. i personally have not done any resurfacing on a patient with previous resufacing. lets us know about your experience and results.

My dearest Doctors

I'm half italian / half irish and olive skinned, do you think I need to be pretreated with hydroquinone for a 20 micron mlp combined with 150 microns of profractional?

dear amelia,
hyperpigmentation is unlikely with those settings, at least when not using coag. that being said it is still always a good idea to have postop skin care perhaps with a product with bilberry, kojik acid, azealic acid, etc. if you want to avoid hydroquinone. good skin care improves your results over just the proceedure by itself and protects your investment. your doctor or his/her aesthetician can make reccommendations on what might be best for you.

Flightdoc,
I have the Profrax XC. When doing Profx with MLP or resurfacing do the MLP/ablation first. otherwise you are ablating your profractional MTZ's, and the blood will cause trouble with the MLP/ablation. If you are doing 100+microns of ablation with coag you will get better results with adding more coag and no profx. If you want little down time, on the lids 2 passes of 20 microns and then Profx works well. I use 125 to 150 microns 11% coverage with coag of 2-3 no MLP and get good contraction. Down time is two to four days. It's not unusual to get bruising in the lids since the obicularis is right under the skin. If the patient is injected first with lido w/epi there will be much less bleeding. I have done Profx on previous CO2 patients. Treated them regularly, no healing problems.

I'm wondering if anyone has had any luck with treating melasma with BBL?