Emerging laser technologies: Latest devices sure to 'wow' patients

Key Points

Maui, Hawaii - Patients interested in at-home hair removal, fat transfer or facelifts will be interested in the developments in laser technology presented by R. Rox Anderson, M.D., at the MauiDerm '08 meeting.

While much of the emerging laser technology is still being researched or in early marketing stages, it's still good to know what is coming down the pike.

"Your patients will be asking you about these devices," says Dr. Anderson, professor of dermatology at Harvard Medical School and director of the Wellman Center for Photomedicine, Boston.

Specifically, Dr. Anderson refers to a scanned diode laser for home hair removal, which received Food and Drug Administration (FDA) approval in 2007.

Dr. Anderson presented research results that he terms "quite fascinating." A patient used the laser once every two weeks on her legs and was able to maintain hair removal during those intervals.

The device uses a continuous contact scanning mode - rather than the previous stamping mode - and is guided across the skin, much like a razor.

In 10 minutes, he says, an entire leg can be treated without any pain. The laser heats the hair matrix, which arrests anagen hair growth and switches anagen growth to a catagen-like phase.

"You end up with hair that is not anchored, so it sheds," he says, adding that this can be achieved with very low fluences of between 1 and 2 J/cm² . At low fluences, you don't do enough to cripple the follicle, you don't kill the stem cell, or alter its extracellular matrix," Dr. Anderson says.

FAT AND CELLULITE

The outlook for lasers' ability and usefulness for the removal of subcutaneous fat tissue is much less promising. A replacement for liposuction? Not just yet.

Dr. Anderson says he remains "unimpressed with what is out there, including my own work. No one has yet come up with a noninvasive laser to process subcutaneous fat tissue."

Dr. Anderson and colleagues published a study of a free electron laser, which is now in phase 1 clinical trials with a small prototype.

While the laser was able to heat and destroy fairly large volumes of subcutaneous fat, Dr. Anderson says that exposure time lasted a lengthy 16 seconds.

"You can inactivate several millimeters of immediate subdermal fat by propagating this 1,214 nm source through the dermis and epidermis," he says.

FRACTIONAL LASERS

Dr. Anderson likens fractional lasers to computers and digital photography, with which images are created with millions of pixels. This suggests the possibility that a million microscopic wounds is a safe and effective stimulus for tissue remodeling.

"This is the first laser where you set the energy of each pulse and know exactly the anatomic depth that you are treating in the skin," Dr. Anderson says.

To treat mid-dermal or deep-dermal lesions, he considers the nonablative tools to be fairly similar to each other. None is his favorite.

Reaching a depth of 1 to 1.5 mm, they stimulate loss of epidermal pigment, causing fast epidermal repair and making them helpful for lentigines.

Lack of scarring is another benefit, Dr. Anderson says. With the fractional laser's small spot size of 100 to 200 microns, he says, histological results indicate no evidence of scarring.

"We're wounding tissues, and in order to do wound healing, many of the genes expressed in organogenesis get turned on," Dr. Anderson says.

A possible alternative to surgical facelift might lie with ablative fractional CO₂ laser resurfacing, which Dr. Anderson calls "a new paradigm."

"These are the first devices - laser or otherwise - to move or remove dermal volume without producing scars," he says.

"You can drive these ablative processes well through the dermis into fat," Dr. Anderson tells Dermatology Times.

He also examines the possibility of combining a smart fractional treatment system with laser imaging tools. Used together, one device sees into tissue at a microscopic level and the other device shoots a laser beam at the desired target.

"I would love software-programmable laser treatment tools. It is possible to conceive a device where you program the target," Dr. Anderson says.