Does this IR device work? does it work as well as Thermage?

Does ND-yag work as well or better than the above.

Hi M.D.
I've been pitched on the Titan and here are my (current) opinions.

The Titan is an attempt by Cutera to enter the "tissue tightening" market using an IR source as opposed to the RF source of Thermage. Thermage seems to have some formidible patents in this area and it's left the other technology manufacturers scrambling to catch up.(Palomar supposedly has a new IR head for the StarLux almost ready for lunch as well.)

My understanding from a number of physicians who are very familiar with Thermage and have looked at the Titan device, feel that Thermage is still the obvious choice between the two.

At the last medical conference I attended in which Cutera had a booth, I never saw a single sales rep.

The ND-Yag has different properties and is not really compete directly with Thermage.

That's odd. What I've read so far indicates Titan may be as effective or more (similar results) as Thermage but less painful. ???

I would look into Syneron and their Polaris device for Wrinkle Reduction - it is FDA approved and has been providing very good results from what I have heard - the combo of Bi-polar RF and optical energy provides optimum collagen stimulation and deeper penetration.

I have not used thermage in my clinic, but do use the Titan. In a short amount of time my clients have been happy with the results.

However, I wouldn't use anything by Syneron. I used the Aurora for hair removal and believe the IPL's can't compete with the Yag Lasers. I was one of the first office to use the Polaris. It is extremely painful! I will tell you that in the 7 months that I worked with it about 75% of my clients grew more hair, including myself. Not impressed at all!

Can anyone tell me about their exprerience with the Gentlelase, by Candela. I'm looking into it

Thanks for the info, NYlaserGirl

I have been using a Candela Gentlelaser for the laser 3 years and have outstanding results. The cryogen (DCD) that cools the skin before the laser hits is a great way to reduce discomfort. I now have the YAG too!

I have been very pleased with Candela Gentlase. Clients find it very gentle, tolerable. Good results so far. Clients relate stories of trying other lasers. Lesser results, more pain.
So far I am very happy with Product. If it breaks tomorrow, I will be back here complaining:)

I have a Titan and am getting good results in most patients with 2-3 treatment sessions. Many of my patients have had Thermage in the past and either didn't get any results or found it too painful. I need no pain medicine with Titan treatments and although there is a transient hot sensation, it is not painful.

Can anyone give me any insight on Medsurge Advances? They seem well organized and their lasers seem very advanced...What is a reasonable price for an IPL with 530-580 filters and decent cooling? Can anyone tell me if there is any good evidence that an 810 diode is equally as safe and effective as an alex for 1-3's and a yag for 4-6's? What are reasonable prices for these lasers (new lease)? Collagen remodelling??? Aramis 1540 vs cool touch vs thermage vs titan vs other 1540's and what are reasonable prices for these? Information as far as head to heads aren't easy to come by. I absolutely want consultant help..is medsurge the best in the business?- Thanks Dr. E

Hello Dr E,
I would offer the following free advice. Take it for what you paid for it.

The questions you're asking suggest that you're not comfortable with your current knowledge base. I would suggest that you start making phone calls or sending emails to physicians who are respected. There are more than enough salesmen/consultants who will be willing to tell you what will make them money. Often not the best choice. Contact someone who's willing to help you out a little without charge or contract. Then, after you have some outside points of reference and feel comfortable on at least a few points, think about spending money on a consultant. I would suggest you use these forums to querry those of us 'lurkers' who might be able to point you in a direction you want to go.

To QueenSheb,
The Medspa I work @ has been in much debate about the effectiveness of the Titan By Cutera. I haven't had a client ever verbalized seeing results. What Joules are you using for a face?
I perfer the Harmony with that Supertitan wand by Astera. The Harmonyrmony has other wands: IPL with filters 570 &540 and a Yag wand.

For those of you who are interested in skin tightening, there is an article coming out in the next Aesthetic Trends and Technologies magazine www.aesthetictrends.com (May/June) featuring skin tightening, specifically, Thermage vs. Titan. The objective of all skin tightening devices, is to 1) heat the collagen fibers so that they denature (for an immediate and visible tightening effect) and 2) create a wound in the dermis, which will result in the would healing response that includes collagen stimulation.

Main points: Thermage is FDA approved or wrinkle reduction , is the first to market, requires generally 1 session, and has the most research and extant users

Titan is FDA approved (but not for skin tightening, specifically), reportedly less painful, requires 2-3 sessions, but has less scientific evidence/research to support its claims. One would also think that they would be more vigilant about getting FDA approval for the skin tightening indication if that is what is is primarily marketed for.

Advice: reach out to the community and talk to actual users - doctors and their nurses - to gather their experiences. Do a search on the internet and you will also find some interesting user forums dedicated to Thermage/Titan, with actual consumer reports on their respective experiences.

After attending the last American Academy of Dermatology meeing in Atlanta I came away with the following feeing that Thermage is still the biggest gun. I took the opportunity to speak to a few of the presenters it felt to me as though they all felt that Thermage was still the best bet. )They all felt that Thermage was a bit shady with their pricing for tips though.)

Disclosure: I have a Thermage device and a Cutera Xeo without the Titan head. Not fraxel experience yet.

I have a Lumenis One with a 1064 Yag. I use it for veins but have read that some people use the 1064 for wrinkle reduction. My Lumenis rep will not share any information about this because he wants me to buy the new Aluma head for tightening. Does anyone use their 1064 for tightening/wrinkle reduction?

Has anyone used the Aluma by Lumenis for skin tightening? It is a new RF attachment and I am trying to compare the Titan and the Aluma. Thanks!

all these whimpy nonablative procedures.... come to the real "wow" side.... co2 ablative.... physicians only please.
(downtime of course.)

I am a nurse that has used both Thermage and Titan in the 6 years I've been practicing with non-ablative lasers. Thermage is extremely painful and required in my practice, ativan, percocet, ibprofen and a topical anesthetic cream to manage the procedure. Even with all that on board, clients were still uncomfortable and needed a ride home from the procedure and a day to recover from their medications. Results were variable dependant on the clients tolerance and more than one treatment was generally needed.

Titan is managed with Tylenol or Ibprofen 30 mins ac the procedure and the client has no down time. Occasionally, a client may develop a blister which can also occur with Thermage. 2-3 treatments may be needed, we complete 2 treatments a month apart and conduct a 3 month and 6 month followup. After 6 mths the client may wish a third treatment. I've seen some convincing results with Titan and as both a technician and a client of both procedures; I prefer the Titan. My understanding is there currently is a study underway comparing both procedures. Thermage may have FDA clearnace and been available longer but, I am not convinced it is a better technology.

I see a previous reference to Polaris by Syneron, but what about the new Refirm procedure for skin tightening? Does anyone have/recommend it? It seems like a very inexpensive upgrade to an Aurora, and they claim it is painless. Pain seems to be a very big issue in this market.

all these whimpy nonablative procedures. CO2 all the way. Ill send the thermage,titans,1064s to the nail spa down the street.

I have been using the Titan for about 9 months in my aesthetics practice and I have been consistently amazed by one thing, and it is not the results. Every consultant, trainer, user, tech, etc that has ever had their hands on a Titan has developed their own technique, and every one is different. I have repeatedly asked Cutera for some objective evidence about their specific technique included in their guidelines but it is evident that protocol is designed to avoid being sued for injury. I have been a Titan patient as well as user and the results are horrendously inconsistent using the same protocol on similar skin even taking into account subtle differences in age, genetics, sun exposure, medical co-morbidities, etc. I think my personal results were great, but unfortunately it is my patients that are paying the rent. Over time I have begun to see improvement in the results, but not before I have given away quite a few 'extra' treatments for the sake of patient satisfction. The evidence that the collagen continues to develop for 6-12 months is exciting and I hope to be able to use that to placate some patients who would otherwise be standing in line for refunds. I also hope the technology firms up soon, then maybe the sagging skin we are treating will also!

IndyDoc,

Welcome to the world of nonablative. It doesn't matter what modality you use you will always have the drawback of unpredictability. Whether it's Nlite, Cooltouch, Thermage, Syneron, Titan it doesn't matter. None of them yield results which can be counted on from one patient to the next. If you are not telling your patients that they have to refrain from judgement for months then you are setting yourself up for disappointment. Any "tightening"results they get immediately is mostly attributed to swelling. The swelling will go down and so will their satisfaction if they are not forewarned of this. If you do not set up proper expectations in the beginning it will kill your business in the long run. Who wouldn't want a facelift without surgery (Thermage)? It's a great story that you can sell to patients, but you will regret it in the end. Trust me. I could go on forever about this topic but I'll wait and see if anyone else is interested in taking part in this discussion.

We have been using the Thermage for over a year now, but have since added the Refirme ST by Syneron. The ST has a huge advantage over the Thermage and Titan in that there are no additional consumable costs. We sell a lot of the Thermage packages becuase of the name recognition alone, but we've been giving those people that call in the Syneron treatment becuase there is no pain, we make more money from the treatment, it can be combined with our Foto Facials and the results are just as consistent as Thermage.

We also own a YAG which we can get tightening from, but I wouldn't even consider using it as a top 3 option.

HI I am 45 and have had the titan procedure. My skin is ok
to begin with. I tried the titan 3 times and I did not get
really any noticible results. I wasted 3500.00
my friend tried it on her neck and had zero results.
so go figure why everyone is raving about it. ???

do you know the settings that were used on you? i have had the titan for 2 years now and still consistently get rave reviews from patients.

Truth,

I would like to know your settings. I have also had the Titan for 2 years and have not had rave reviews. I think everyone shows some improvement with it but there have been no "wow" experiences. I am thinking about putting mine in a corner and using it for a coat rack. If you have insight into a great protocol please post it and I will try it if I have not already done it. We have tried just about everything including doing up to 4 passes. The problem with doing that many passes is the cost. By the time I am done it is just about as bad as paying for thermage tips.

I tried titan and photographed before and after. although therapist was adamant could see result I saw none. 2 months later no lifting but skin looks slightly better. Didnt go for second appointment as didnt think it worth it and a few facials would do as good a job

Swann,

The thing you need to remember is that the Titan is multiple treatments anywhere from 3 to 5. I space them 2 to 4 weeks apart. Results are slow and take 3 to 6 months after the last treatment. So my feeling is that you did not give it a chance but I also think there are better options out there for you.

What about accent by lumenis and skin tightening??

DrD,

I do not have experience with it but it would not be on the top of my list. I was just at a conference and they tried to market the crap out of it. Some pictures were good for the face. They had some pictures of the body treatments and I was not impressed.

You better look at the rest of their system. I would not buy it just because of the Accent.

LH: have you demo'd the Accent, just curious as Alma has been by and seen to have high hopes for it for tightening and their "Harmony" platform for surface rejuvenation. Many post here seem to think it (the Harmony) is underpowered..wonder if the same for the Accent

I had them coming to my office for a demo. I had already looked at Palomar Syneron, Cutera and Sciton. I talked to quite a few people about the Harmony and they were not real high on it. So I cancelled the Alma demo. I knew I was going with the Palomar or the Sciton so it was a waiste of the Alma reps time. No direct contact but personally, I think it is somewhat of a "me too" product. I also do think the whole system is underpowered. You need to but the entire box just to have the Accent. I think there are definitely better IPL systems on the market.

We've used the Alma Harmony for about 10 months now. We haven't had any "underpowered" issues. We use the Pixel laser resurfacing, the Skin tightening, and 540 AFT IPL heads. I would agree that it is somewhat of a "me too" product, it's definitely a nice idea to have a base unit with many different application heads vs. the single function machines.

As for the Accent and Accent XL (ver. 2 with more power), we're looking at it and trying to get more opinions about it. Some people rave about it and others say the results are inconsistent.

Richard,

How is it doing for hair removal? This is where I have heard it was underpowered. I also can push things a little more for an IPL as most of my pts are Fitz 1 to 3. I ran out of power with my Cutera IPL. I bought it before the Limelight was available.

I think the Accent may be OK if you own the system and use it as an add on but I would not buy the Harmony just for the Accent.

Personally, I do not want everything on one system. I need to be able to use one system while my nurse uses another. I want as many rooms busy as possible.

I hear that the ActiveFX by Luminus does skin tightening. It is a fractionated CO2 Laser with about 3-5 days of downtime.

Fractional CO2 does have some tightening but definite downtime. It is new in the ballgame and not sure yet if will need more than 1 treatment. Lumenis does show some nice results in their marketing.

There will be 2 or 3 more on the market very soon. Reliant has one coming. I talked to a friend and he may buy one out of Italy. So I am waiting to see about long term benefits before I jump on that bandwagon.

It still comes down to the downtime and this should be physician only.

LH-
We actually only use the Harmony for Pixel Laser Resurfacing, Skin Tightening, and 540 AFT IPL. We find these are most useful for dedicated "Skin Rejuvenation" Room.
We have a dedicated room for Laser Hair Removal in which we use the Soprano after replacing our Cutera Vantage. Since we don't use the Harmony for LHR you're probably right that it would not be powerful enough for us for LHR either.
I thought the Accent was a stand alone product not an add-on to Harmony?

Richard,

You are right. I thought it was an add on but it is a stand alone unit. Sorry about my confusion.

LH,

No worries, it's hard for me to keep straight who's offering what these days. It seems there are new releases every week.

I just sat through a webinar by Dr. Mayoral in FL who has been using the Accent for about a year. She is a speaker for Alma, so I'm taking it with a grain of salt. She said it works well for about 85% of her patients and most see a difference after 2-3 tx. It does sound promising, just $120,000 is a lot to ask. I wish it were more like $60,000. She wasn't able to answer my questions comparing it to Velasmooth or using it in combination with mesotherapy since she doesn't used either.

Richard,

If I were you, I would call Dr. Mayoral and talk to her. Sometimes she may give you more straight answers when a company rep isn't standing over her shoulder and you are talking one on one.

I called one time about Tri-active to talk to one of the principle investigators. Their research helped get it FDA approval. As we talked, you could tell they did not think very highly of it. They came out and told me it was not worth the purchase.

I have also found it beneficial to look up offices that already use it on the internet. Then call as many as you can to find out their thoughts on it. This has helped me decide on making a purchase or not. Most of the time they will be very frank about things.

I'm 48 and want to lift the jowl and eye area. Am trying to determine which way to go with laser. Has anyone heard of coolaser being used by Epione? How does it compare to Thermage? Are results as good with Syneron's skin tightening method?

I had two Refirme treatments, and one Titan. Four months later, I really can't say there has been any real improvement with my skin. I figured because I'm only 31, three sessions would be enough. I live in Korea, and for just a little more money than I spent on the skin tightening procedure, I probably could have had an actual mini-face lift.

Thermage is sueing ALMA lasers for patent infringement. Is this the end of the generic "cheap" laser company from Israel, ALMA lasers, formerly Orion formerly etc......

We have been using Cutera XEO platform with Titan and overall it has exceeded my expectations. It is versatile with Prowave (IPL) for hair NdYag (Vascular telangiectasia and dark skin hair removal) and Titan. Titan is the most requested procedure and using the "slide" technique you can use fluence of 50 with the XL and 65 with Titan V.Rather than keeping the beam in 1 position, which creates heat and some discomfort, you create expanding circles and dissipate the heat. Results immediately good, after three treatments--Wow!

I agree with Lorraine, I also like the Cutera XEO platform. I think the COMBINATION of the IPL for sun damage, hyperpigmentation, malasma,and redness, with the laser Genesis for Rosacea, pore minimization, and even slight acne scarring, then the Titan, using fluences of 50-60 with the technique Lorraine mentioned, the sliding technique, and then tell the patient to put it in the oven for 6 months(just kidding), and we have had VERY happy campers! But there is NO way the complete success of the procedure can be determined until the collagen has had a chance to regenerate. It took awhile for the skin to get to the state it is in, YEARS, it is going to take some time to get the regeneration and see results. THEN, all of this is going to have to be done again at least once a year, ( I am talking about the whole enchilata here, 2-4 Titans, 5 Genesis, 5-7 IPL,s to maintain the regeneration and fibroblast production for the formation of new collagen. Of course a series of microderms thrown in here and there, which if done PRIOR to any laser treatment,( I wait a week in between) there is a better penetration and absorption of the laser, up to 33% better. Also, as what ever head you are using to do the treatments gets close to it's expiration time, the efficacy just isn't there as it was at the beginning or middle of the head usage. Account for that in your passes and methods of delivery. Also with the IPL, how many are using too much gel on the face during the treatment. There should be ONLY a very thin application, just enough to slide the treatment crystal to the next application point, same with the Titan. I know these things may seem rudimentary, but combined they can affect treatment outcomes and efficacy. I also believe in the old motto
"Under promise and over deliver" works every time. These treatments which are delivered in the anti-aging forum are intended to work and build off each other, we should be marketing them as such to our patients for the best outcomes. If this is done, I don't think which manufactures machine we use is as important as HOW and in WHICH combination these treatments are delivered. Technique is a VERY important component of the success of the Anti-aging practice.

I am always suspicious when there are glowing reviews of any treatment that has been almost universally panned in the past. Titan has some effects, but I could hardly say that it has exceeded my expectations. All the seminars I have seen (quite a few) say to absolutely not move the head across the skin because the effect comes from maintaining dermal heating. It has also been strongly suggested to use at least a 2-3 mm layer of gel. If I could ask Jeff to spot check the addresses of the commenters to see if perhaps they are a little too close to Cutera for comfort.

Hmmm. Sliding technique? I remember a Cutera rep. telling us about this...I agree with DermaDoc, sounds like overdramatization!

The technuque I am refereing to is not a "sliding technique" per se, It is more of a dispersement of the heat as you keep the skin and head of the Titan in constant contact, flush, and you make a circular motion aroung the area where the pulse was delivered, It is a very slight movement, and may not even be noticed by the patient or another unless they were observing very closely. Also, was the complete point of discussion completely missed?? Simply, that it is NOT always technology, but the TECHNIQUE that is the qualifier of the success of the treatments. Now if you guys bothered to understand the blogs you would see tha I am NOT any kind of rep...I just think there are a lot of docs on this site that are very quick to put down this technology or that technology and in reality the time element has not been factored in, and the fact that these women/men are not going to erase 50 years of Sun Damamge in 2 little infrared heat, RF, Heat, light,or whatever you use to do it . Doctor's go back to the basics and review the simple principle of tissue trama, wound healing, and cell turn-over, as swell as collage regeneration. The fact that the collagen is regenerating at all is a miracle...we stop making collagen in our early twenties,...usless of couse we have a burn to the area or trama. Tell your patients it may take a WHOLE series of treatments...,by Cutera, Alma, Polaris, Fraxel, you name it, until some real success is achieved. But, I do KNOW it can be achieved.

SkinScience-
The technique you describe in more accurate detail in the second post is the one that most have adopted, ie. a small rotational movement to 'confuse the nerves' and reduce the discomfort. I still find it amazing you have patients tolerate fluences of 50-60 even with that technique. Our convention discussions by many providers didn't recommmend going above 34J witht that technique. And the point of the discusssion was not missed - technique can have a huge impact on results, my point, if you bothered to read it, was that Titan is pretty much considered to be a wet noodle for results by most docs. Except for a few who claim great results but can never define what they are doing differently than any of the rest of us. There has been concern from one of the original clinical trial docs about actually 'melting' collagen at higher fluences.

And just to clarify, I said it has not exceeded my expectations. We are getting results, just not the home-run of skin tightening that Cutera promoted.

Sorry Jeff, I hope this doesn't get stuck at the play-nice filter but I don't like being misrepresented and talked down to.

As a side point - Cutera isn't even marketing Titan as heavily for the tightening effect as it had been because of the backlash from all the unhappy docs. It is now simply saying that it can stimulate new collagen growth but may not have a visible response. That was direct from the national marketing manager.