RevLite from Cynosure is the latest weapon in the fight against melasma. Words by Caitlin Bishop.

It’s well known for its capabilities in tattoo removal. Now, the RevLite Q-switched laser from Cynosure, has been approved by the Food and Drug Administration (FDA) in America for the treatment of melasma.

The device is registered for use with the Therapeutic Goods Administration (TGA) in Australia, but the latest US development has granted yet another string to the machine’s ever-expanding bow.

“RevLite has changed the paradigm for treating melasma,” Victorian Associate Professor in Dermatology Dr Greg Goodman explains. “No longer do I feel like hiding under my desk when melasma patients walk in.”

Originally, RevLite was created as a solution for tattoo removal. It incorporates a selection of hand pieces, at a variety of wavelengths, to combat the full spectrum of coloured inks. This same versatility has been applied to skin rejuvenation – with the RevLite used to treat a number of anti-ageing and skin concerns.

“The versatility of the machine is what attracted me in the first place,” Dr Goodman explains. “The 1064nm laser is used for rejuvenation and melasma, as it penetrates skin quite deeply. There are very few targets that it picks up on, so it is absorbed up to 5mm to 6mm. It does get extinguished eventually, by vascularity and deep pigment.

“The 532 wavelength is extinguished quickly, with increased absorption of melanin. It targets superficial freckles and lentigines.”

Theoretically, the 1064 Q-switched laser light exhibits reduced absorption by melanin, however US researcher in bio-laser science and dermatology Dr Abnoeal Bakus says the consistency of 1064 treatment can still achieve effective results in melasma patients.
“The energy delivered in each pulse is very consistent and remains the same throughout the course of the treatment,” Dr Bakus explains. “This means there is still enough melanin absorption to affect both epidermal and dermal reduction of increased melanin, melanocytes and melanophages in our melasma patients.”

As well as optimising results, this consistency also protects against complications during treatment and helps prevent abnormalities in the final result.

“There are no hot spots over the full area of the spot size. And this cannot be said for other QS 1064 YAG lasers which are out in the market at the present time. It helps by lightening the lesion without harming the skin texture,” Dr Bakus explains.

Treatment regimens

RevLite is often used as a pillar in a comprehensive melasma treatment regimen. Dr Goodman often combines RevLite treatments with topicals to maximise results.

“We use RevLite alongside tranexamic acid and skincare products containing bleaching agents,” he says. “Usually, we treat every two weeks for the first four treatments; every three weeks for the next four; and every four weeks for the final two. The results are then maintained with monthly treatments.”

As with most melasma and pigmentation treatments, lesions can sometimes rise to the surface and scab following treatment. Other than this, the downtime following RevLite is minimal.

“We use low fluencies when treating melasma patients with the RevLite,” Dr Bakus explains. “Multiple passes with no downtime makes it a very accommodating treatment for patients’ busy lifestyles.”

Importantly, these lower fluencies are also effective in treating patients with Fitzpatrick skin types IV and V.

“One revolutionary treatment with RevLite is to use low energy with the Q-switch on patients with very olive skin – grade IV or V,” Dr Goodman explains. “It doesn’t appear to do very much for the first five treatments, and then you can really see results. The treatment helps reduce post- inflammatory pigmentation and hypopigmentation.”

With traditional modalities, the fickle nature of melasma is what makes treatment so arduous. However, Dr Bakus has seen long-term results in melasma patients when they have upheld a protective skincare regime after RevLite treatment.

“From my experience, patients who have seen significant lightening of their melasma, and who continue using sunscreen after their last treatment, have been able to maintain their results over several years,” Dr Bakus explains. “Sunscreen is very important in order to maintain results and control melasma.”

Other business opportunities –
other practical possibilities

“The RevLite is used extensively in our practice. It does not only treat melasma and hyperpigmentation but it can also treat active acne, removal of hair, tattoos, skin rejuvenation and scarring,” Dr Bakus explains.

The versatility of the device – as well as the documented results – means RevLite can easily be incorporated into your practice, and used as both a stand alone and adjunctive system.

“The RevLite is easy to feed into any treatment plan, and can be used by other team members, which is beneficial to the practice,” Dr Goodman explains. “It’s great for reducing pore size and pigmentation, but needs to be used in conjunction with other modalities to reduce scarring and blood vessels.”

The applicability of RevLite across a wide patient population, as well as its ground-breaking potential in treating melasma patients, means the device neatly fills a gap in the Australian aesthetic market.

“The return on investment for RevLite is pretty healthy – if you’re using it properly you should expect to pay it off relatively easily,” says Dr Goodman. “The results are reproducible, and the device can be used on any skin colour, and within most skin regimes. Most importantly, the RevLite has changed the game in treating melasma.”


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