Alright so I am looking into different resurfacing lasers for my practice and I am primariy treating type 3-4 europeans. Looking for the best results possible. What's going to get me there?

Fractional CO2 ?
pros = power and results
cons = too much for olive skin?

Fractional Erbium ?
pros = safe
cons = results

Sction Contour -
pros = mlps and the ability to combine with pfx no consumables...
cons = cant really ablate much more than 40 microns or use coagulation

Pearl =
pros (?)
cons= Cutera
(don't laugh, I am treating type 3-4 afterall)

Plasma = I'm reaching on this one but I'll include for the sake of discussion of its use on type 3-4 skin

I am going to tell you to go with the erbium. You are less likely to have pigmentation problems even with full resurfacing as it is the coagulation that causes most of the problems. With the CO2, you do not have the option to eliminate the coagulation. You then have the option to fractionate the laser. I would choose the Sciton as it will give you the most options.

With the Sciton you can do full face resurfacing from 4 microns to hundreds of microns. You can then add coagulation if you would like as this works very well around the eyes. You then can fractionate the laser to decrease risks and downtime and now you can add coagulation to the fractionated erbium as well. You can even add varying degrees of coagulation.

The only option you have with the CO2 is to fractionate and depth. The coagulation is automatic and you can not change the amount of coagulation without changing the depth.

Mikel,

I have done alot of research on erbium and co2 lasers and decided on the scition profractional/profractional-xc. Firstly, I have used the mixto, smarxide, deep and active fx, palomar erbium and Sciton. The profractional / profractional - xc combo laser offed me all of the pros and almost no cons. The Sciton lets me program exactly how deep the laser will penetrate and then program the amount of coag from 50-150 microns. Prior to these procedures I am usually performing a 10-30micron microlaser peel.

Patients tell me how much downtime, the Sciton can be programed for strictly ablative to ablative with co2 coagulation (100-150 microns of coagulation). Which has translated into 1-6 days of social downtime depending on patient preference. Lastly, the erbium is much safer on darker skin types (without coag)

In summary

Pro's - Programable penetration (downtime)
Programable coagulation 0,50,100,150 microns
No consumables
Safer for all skin types (I-VI)
Can ablate up to 1500 microns
Programable from 3 - 60 % coverage and 5.5/11% coverage (prof/prof-xc)
Very easy to use
Upgradeable platform

Con's - Should get the dual erbium if perfoming alot of coaguation. (tends to slow down treatment time)

I hope this helps.

Been awhile since I checked in but I thought I would help offer some advice. I don't have a lot more to add than LH and Sciton Owner but I did want to comment on something you posted. You mentioned that you can't go more than 40 microns of ablation and can't coagulate with Sciton. This isn't the case. You can ablate up to 200 microns per pass in the resurfacing screen. This would get you well into the dermis. We commonly resurface (100% ablation) to a total depth of 300-500 microns utilizing 2 or 3 passes. Additonally you have the ability to add coagulation to this ablation to a depth of 120 microns using the new software. I see you are looking at at Pearl so let me give you an example. According to their own histology they claim around 20-30 microns ablation and 40-60 coagulation. With our scitons we can mimic that YSSG wavelength histology by yet we can also use it like co2 by adding more coagulation. You have the ability to independently control any amount of ablation or coagulation. You don't get this with the other modalities you mentioned.

Hope this helps.

I appreciate the feedback guys. I have to admit that I was leaning towards the Sciton platform before I even posted as I feel that it offers me the most options - it's just been pretty hard not to be swept up by all of the fractional CO2 hype but it seems you can duplicate those results with erbium + pfx + coagulation and do a whole lot more.

Dexter

Sorry for the confusion, I meant that you couldn't really ablate more than 40 microns or use coagulation on type 3-4 european olive skin. At least I would be hesitant to, not sure if any of you are having success doing deeper ablative peels on olive skin. That would be my one problem with the Contour, its a bit overkill as I don't think I'd be doing much deep resurfacing with it due to my patient population.

Mikel,

You can do resurfacing deeper on the Fitz 3 and 4. I have seen some pictures of 1000 micron ablation to cheeks on a Fitz 4. It was done for acne scarring. Results look very good. It is probably a little more aggressive than I would do but it can be done.

1 mm? Whew! That makes my 40 microns look pretty tame. When doing deeper peels on type IV, do you think it's a good idea to start off with lighter peels to see how the patient reacts? Anyways I'm currently looking into the Contour along with pfx and bbl. I really think Sciton's got all of their bases covered here and this trio is tops.

1 mm? Whew! That makes my 40 microns look pretty tame. When doing deeper peels on type IV, do you think it's a good idea to start off with lighter peels to see how the patient reacts? Anyways I'm currently looking into the Contour along with pfx and bbl. I really think Sciton's got all of their bases covered here and this trio is tops.

1 mm? Whew! That makes my 40 microns look pretty tame. When doing deeper peels on type IV, do you think it's a good idea to start off with lighter peels to see how the patient reacts? Anyways I'm currently looking into the Contour along with pfx and bbl. I really think Sciton's got all of their bases covered here and this trio is tops.

1 mm? Whew! That makes my 40 microns look pretty tame. When doing deeper peels on type IV, do you think it's a good idea to start off with lighter peels to see how the patient reacts? Anyways I'm currently looking into the Contour along with pfx and bbl. I really think Sciton's got all of their bases covered here and this trio is tops.

1 mm? Whew! That makes my 40 microns look pretty tame. When doing deeper peels on type IV, do you think it's a good idea to start off with lighter peels to see how the patient reacts? Anyways I'm currently looking into the Contour along with pfx and bbl. I really think Sciton's got all of their bases covered here and this trio is tops.

1 mm? Whew! That makes my 40 microns look pretty tame. When doing deeper peels on type IV, do you think it's a good idea to start off with lighter peels to see how the patient reacts? Anyways I'm currently looking into the Contour along with pfx and bbl. I really think Sciton's got all of their bases covered here and this trio is tops.