PEER-REVIEW | DERMATOLOGY | thermal dwell time dependant of


the laser, and depending on whether forehead, chin, nose or cheek requires treatment. In keeping with evolving computer design, DEKA introduced a new stack setting software for the SmartXide DOT laser while this study was ongoing. As the original study had to be repeated owing to an ActiveFX mirror malfunction, it was felt that the new stacked settings with the SmartXide laser could achieve a deeper papillary dermal effect, and therefore increase neocollagenesis. Since the end of this study, DEKA has introduced the


new SmartXide DOT HP superpulse technology, which is a step up from their previous S-pulse shape, allowing one to better control the depth of penetration. Preserving all the features of the 30 W SmartXide DOT, but with 60% more power, the new SmartXide DOT HP allows practitioners to target deeper tissue with a single pulse. It also avoids the need for pulse stacking and spares patients from uncontrolled lateral thermal damage. They have also introduced the SmartXide DOT/RF, merging fractional CO2 C02


and radiofrequency on a multidisciplinary laser platform. Despite this, the Lumenis UltraPulse ActiveFX is


considered a much superior laser. It has six-times the power of most CO2


four-times the depth of penetration of any other CO2


lasers (225 mJ of energy) and laser


(up to 4 mm). It also has 34 FDA-cleared dermatology and plastic surgery indications, an optimal ablation/ coagulation ratio with advanced patented technologies, and has adapted to support a wide spectrum of aesthetic and surgical capabilities. This was very obvious when the operator had to treat a giant congenital nevus at higher settings.


References


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3. Williams EF 3rd, Dahiya R. Review of nonablative laser resurfacing modalities. Facial Plast Surg Clin North Am 2004; 12(3): 305–10


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8. Fitzpatrick RE. CO2 laser resurfacing. Dermatol Clin 2001; 19(3): 443–51


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12. Lask G, Keller G, Lowe N, Gormley D. Laser skin resurfacing with the SilkTouch flashscanner for facial rhytides. Dermatol


60 ❚ Surg 1995; 21(12): 1021–4


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14. Lavker RM. Cutaneous aging: chronological versus photoaging. In: Gilchrest BA. ed, Photodamage. Cambridge, MA: Blackwell Science, 1995


15. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998; 24(3): 315–20


16. Bernstein LJ, Kauvar AN, Grossman MC, Geronemus RG. The short- and long-term side effects of carbon dioxide laser resurfacing. Dermatol Surg 1997; 23(7): 519–25


17. Alster T, Hirsch R. Single-pass CO2 laser skin resurfacing of light and dark skin: extended experience with 52 patients. J Cosmet Laser Ther 2003; 5(1): 39–42


18. Alster TS. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg 1999; 103(2): 619–32


19. Alster TS. Side effects and complications of laser surgery. In: Alster TS. Manual of Cutaneous Laser Techniques. 2nd edn. Philadelphia: Lippinco. 2000


20. Alster TS, Lupton JR. Treatment of complications of laser skin resurfacing. Arch Facial Plast Surg 2000; 2(4): 279–84


21. Sullivan SA, Dailey RA. Complications of laser resurfacing and their management. Ophthal Plast Reconstr Surg 2000; 16(6): 417–26


22. Berwald C, Levy JL, Magalon G. Complications of the resurfacing laser: Retrospective study of 749 patients. Ann Chir Plast Esthet 2004; 49(4): 360–5


23. Trelles MA, Mordon S, Svaasand LO, Mellor TK, Rigau J, Garcia L. The origin and role of erythema after carbon dioxide


laser resurfacing. A clinical and histologic study. Dermatol Surg 1998; 24(1): 25–9


24. Burkhardt BR, Maw R. Are more passes better? Safety versus efficacy with the pulsed CO2 laser. Plast Reconstr Surg 1997; 100(6): 1531–4


25. Bjerring P. Photorejuvenation – an overview. Med Laser Appl 2004; 19: 186–95


26. Treacy PJ. Article on fractionalised lasers. Health & Living Magazine, 2008


27. Goldberg D. Reduced Down-time Associated with Novel Fractional UltraPulse CO2 Treatment (Active FX) as Compared to Traditional Resurfacing. P3115 -65th Annual American Academy of Dermatology Meeting, 2007


28. Smith KJ, Skelton HG, Graham JS, Hamilton TA, Hackley BE Jr, Hurst CG. Depth of morphologic skin damage and viability after one, two and three passes of a high-energy, short-pulse CO2 laser (Tru-Pulse) in pig skin. J Am Acad Dermatol 1997; 37(2 Pt 1): 204–10


29. Fitzpatrick R, Ruiz-Esparaza J, Goldman M. The depth of thermal necrosis using the CO2 laser: a comparison of the superpulsed mode and conventional mode. J Dermatol Surg Oncol 1991; 17(4): 340–4


30. Dover JS, Bhatia AC, Stewart B, Arndt KA. Topical 5-aminolevulinic acid combined with intense pulsed light in thetreatment of photoaging. Arch Dermatol 2005; 141(10): 1247–52


31. Alster TS, Nanni CA. Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing. Dermatol Surg 1999; 25(3): 242–6


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In keeping with evolving computer design, DEKA


introduced a new stack setting


software for the SmartXide DOT laser while this study was ongoing.


Key points


Newer additions to the Lumenis UltraPulse include DeepFX for the treatment of profound wrinkles, with a 0.12 mm spot size; TotalFX, which provides scar treatment, improved skin texture, and resolution of fine lines and wrinkles, with 1.3 mm and 0.12 mm spot sizes; and SCAAR FX, ‘Synergistic Coagulation and Ablation for Advanced Resurfacing’.


Declaration of interest None Figure images © Dr Patrick Treacy Please note that this study is a repeat of a similar study


performed from July 2007 to February 2008. At that time different results were obtained as the Lumenis ActiveFX was not operating at maximum performance. This has since been corrected and the study repeated. Some of the images and histology from the previous study are used here.


No HSV recurrences were seen in 96% of patients


■ The Lumenis ActiveFX gives superior aesthetic outcome between the two lasers when examined at 3 months


(up to 4 mm)


of energy) and four-times the depth of penetration of any other CO2


■ The Lumenis UltraPulse ActiveFX has six-times the power of most CO2


lasers (225 mJ laser


■ The DEKA SmartXide is an easy to use, good value CO2


laser suitable


for most aesthetic practices


receiving Valacyclovir 500 mg twice daily for 8 days. There were 13 (56%) patients with a known HSV history. Approximately less than 5% of patients in the ActiveFX group with a positive history of oral herpes labialis experienced HSV recurrence, compared with none in the SmartXide group. This was much lower than experienced in other studies, and may have been owing to the skin bridge effect of fractionalised resurfacing31


. The author would like to thank Professor Kieran Sheahan


and Dr Tom Crotty, of the Pathology Department, St Vincent’s University Hospital, Dublin, who reviewed the histopathology slides during this study.


October 2013 | prime-journal.com


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