THE DEVICES PRACTITIONERS INVEST IN DICTATE THE QUALITY OF THE RESULTS THEY ARE ABLE TO ACHIEVE. CUTERA PRESENTS A STRONG CASE FOR ITS SUITE OF OFFERINGS.
With every technical advance in the area of medical aesthetic devices there comes a dilemma for practitioners: jump on the first wave of the offering or wait and see how the competition lines up?
There is always going to be a sector of the market that seeks the advantage of being among the first to offer a new and improved modality, especially if it addresses a new indication or bundles capabilities.
At the other end of the spectrum are the cautious buyers who wait for the reviews or even
the second or third generation of a device before investing for their practice.
The ideal is the brand with a longstanding international profile and well established reputation for quality and performance. It’s even better if they develop their products in consultation with their target market, medical aesthetic practitioners. They probably won’t be first to market but they are most likely to offer the best adaptation of technology to purpose – and the best value for money as a result.
Cutera is an organisation that fulfils these criteria. Rated by Forbes as one of the top 200 Best Small Companies for two years running, Cutera has specialised in energy and light-based technologies for 15 years and is as well known for its online knowledge resources and Cutera University workshops as its suite of specialised products.
This business model where practitioner feedback and contribution to best practice benchmarks informs product development and scope of application has enabled Cutera to focus its technologies to respond very specifically to market demand. It has also contributed to a culture where experts in their fields share valuable information about the use of these devices, enabling practitioners who invest in them to realise optimum value in their aesthetic practices.
Aesthetic Medical Practitioner looks at four of them, examining in detail the technologies of each device and its ability to address indications: enlighten for tattoo removal and pigmentation, Excel V for venous conditions and pigmentation, truSculpt for uniform body contouring and the two Pearl laser variations (2790nm using YSGG technology plus a fractional version) for skin resurfacing.
Cutera’s new multi-platform 1064nm/532nm picosecond laser, enlighten, was developed with the mandate of significantly advancing tattoo removal. It enables the effective removal of red and black inks (in additional to the traditional blue) and also offers the broadest range of treatment modalities for any device in its class.
“If I was just starting out in practice, it would be the first device that I would buy,” says Dr Tahl Humes, founder, medical director and owner of Vitahl Medical Aesthetics in Colorado, United States.
The enormous versatility of enlighten enables the operator to adjust pulse duration between 750 picoseconds and 2 nanoseconds, wavelength from 1064nm to 532nm and spot size from 2 to 8 millimetres, without changing handpieces.
This means that it can be used to achieve greater clearance of unwanted tattoos in fewer treatments, a huge advantage over competitor devices.
In an exhaustive clinical trial conducted to validate its application for US Federal Drug Administration (FDA) clearance for tattoo removal, the 1064nm wavelength was used to target dark tattoo inks and multicoloured tattoos in all skin types and the 532nm wavelength for red, yellow and lighter coloured inks in Fitzpatrick 1 to 3 skin types, with convincing results. The enlighten was granted FDA clearance for tattoo removal in November 2014.
Beyond its competitive advantage in tattoo removal, with the highest power in its class enlighten can also be used for the removal of benign pigmented lesions, where its flexibility enables the treatment of a range of conditions, including the many sun damage and pigmentation problems seen in Australian aesthetic patients.
￼AT A GLANCE
• High powered
• Dual wavelength
• Zoom handpiece
• Direct imaging
• Less patient discomfort
The only tunable laser on the market, the Excel V delivers variable pulsed 532nm KTP wavelength and Cutera’s award-winning Nd:YAG 1064nm technology via a handpiece that allows for tailored spot size. This enables the practitioner to precisely control the depth, target area and energy of the treatment, making the Excel V a remarkably flexible tool.
Its key applications are to a broad range of venous conditions and also pigmentation concerns, particularly in sensitive Asian skins.
Chairman of the Department of Dermatology at Kangbuk Samsung Hospital Professor in Seoul, South Korea, Professor Wonserk Kim MD, PhD nominates the Excel V as his laser of choice for treating Asian skins.
“Excel V is very, very useful in Asian skin,” he says. “Asian skin is totally different from Caucasian skin and requires a different approach.”
“The major indications for Excel V are recalcitrant pigmentation problems, including melasma, rosacea, acne and erythema; and gentle skin rejuvenation through multiple treatments.”
Professor Kim uses varied KTP wavelengths, pulse duration and low fluence with a larger spot size, in multiple treatments to shut down melanocyte activity in pigmentation conditions, combining KTP and Nd:YAG protocols using long pulses with high fluence for skin remodelling to improve texture and pore size.
￼￼￼AT A GLANCE
• Dual wavelength
• Single handpiece
• High precision
• Ideal for Asian skin
Pearl and Pearl Fractional
The Pearl laser’s innovative yttrium scandium gallium garnet 2790nm wavelength revolutionised skin resurfacing when it was launched in 2007, providing a more predictable and consistent result than traditional ablative procedures. With a water absorption coefficient falling between that of the Er:YAG (2940nm) and CO2 (10,600nm) lasers, the Pearl laser heated tissue to achieve coagulation and skin cell sloughing to a depth of 10 to 13 microns, achieving confluent improvement to pigmentation, texture and fine lines and wrinkles, with considerably reduced side effects and only a few (typically three) days of downtime.
With the advent of fractional technology using micro thermal treatment zones and skin sparing to create skin remodelling in the dermis, Cutera adapted the Pearl’s YSGG wavelength to deliver this deeper treatment for smoothing deeper folds and wrinkles, and improving laxity and irregularities in pigmentation. Unlike other fractional devices, Pearl Fractional could be successfully used in the periorbital and perioral areas.
Both devices lent themselves to combination treatments, then United States ophthalmic surgeon Dr Brian Biesman pioneered Pearl Fusion, the combination of stacking Pearl laser epidermal resurfacing and then Pearl Fractional skin remodelling in the dermis and to achieve a new best practice standard in Fitzpatrick 1 to 3 skin types.
“Pearl Fractional is especially good for treating the periorbital, perioral and jawline areas. When combined with the Pearl laser for full epidermal renewal, it’s a unique solution for a deep and full coverage treatment,” Dr Biesman says.
￼AT A GLANCE
• ‘Detuned’ wavelength
• Can be used periorbitally
• Less downtime
• High level of patient satisfaction
Developed based on scientific research into adipose cell viability in relation to time-exposure to temperature, truSculpt’s 40cm2 handpiece features a unique electrode design that delivers deep, uniform heat distribution without hot spots or edge effects for fat reduction and body contouring.
The precise RF-generated heating targets fat only at 7 to 15mm depth. In addition
to impressive fat loss in the treatment area in clinical trials, “tightening is one of the big indications for truSculpt”, according to Professor Kim, who has achieved positive results for sub-mental contouring targeting the jowl and double chin area. truSculpt’s dual action of combining apoptosis with tissue remodelling provided 10 percent reduction in laxity, as measured by caliper and ultrasound with repeated treatments over a 12- week period.
Denver appearance medicine specialist Dr Tahl Humes is another truSculpt advocate. She praises its effectiveness and ability to treat multiple areas, both large and small, and regards the lack of patient discomfort and side effects such as bruising as significant selling points.
“truSculpt achieves 25 per cent improvement in one to two months of one-hour treatments,” she states.
AT A GLANCE
• Uniform radio frequency energy delivery
￼• Handpick designed for large treatment areas
• Less patient discomfort
• Rapid results