In the setting of rapidly changing technology tone must make a decision on whether he or she places a premium on being an “early adopter” of technology or delay purchasing decisions until there is adequate proof that a particular technology is useful. Laser devices are a significant capital expenditure, and therefore members of the second group who base their purchasing decisions on evidence-based medicine may be able to avoid deploying capitol into a purchase that becomes obsolete as quickly as it appeared.
Key points
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Ablative skin resurfacing provides reliable improvement in skin texture.
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Non-surgical skin tightening has moderate evidence for efficacy.
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Light-based therapies are safe and effective for improving sun-damaged skin.
Introduction
The field of facial laser medicine is at the nexus of multiple medical specialties. Facial plastic surgery, dermatology, and plastic surgery each have significant demand for facial rejuvenation and improvement without surgery. Given this high degree of demand, it should come as no surprise that there is a rapidly enlarging market for new technologies. In a setting in which there are multiple technologies and rapid change, it can be difficult to determine what specific technologies will deliver the results for patients. There is even more confusion for practitioners, as the intense market competition can force manufacturers to make bold claims about their devices in a hope to capture market share.
This is the exact scenario in which evidence-based medicine (EBM) can be most useful. In the setting of rapidly changing technology, tone must make a decision on whether he or she places a premium on being an early adopter of technology or delay purchasing decisions until there is adequate proof that a particular technology is useful. Early adopters will have the obvious advantage of being first and attracting certain types of patients who will want the newest laser technology. Laser devices are a significant capital expenditure; therefore members of the second group who base their purchasing decisions on EBM may be able to avoid deploying capitol into a purchase that becomes obsolete as quickly as it appears.
Another equally critical reason to pursue and utilize EBM in laser medicine is to accurately and effectively communicate expectations with potential patients. Although it may be clear what degree and type of improvement are possible with traditional ablative laser resurfacing, it can be much more difficult to quantify for patients the changes they can expect with newer nonablative technologies. Happy patients are well counseled and have proper expectations set. EBM is a great way to communicate likely outcomes that depart from the traditional and sometimes unsupported claims of manufacturers. In no way should this article dissuade practitioners from utilizing or purchasing devices that they are interested in. Rather the authors hope that this article would serve as an additional reference and help facial cosmetic physicians determine what devices might be right for them.
Introduction
The field of facial laser medicine is at the nexus of multiple medical specialties. Facial plastic surgery, dermatology, and plastic surgery each have significant demand for facial rejuvenation and improvement without surgery. Given this high degree of demand, it should come as no surprise that there is a rapidly enlarging market for new technologies. In a setting in which there are multiple technologies and rapid change, it can be difficult to determine what specific technologies will deliver the results for patients. There is even more confusion for practitioners, as the intense market competition can force manufacturers to make bold claims about their devices in a hope to capture market share.
This is the exact scenario in which evidence-based medicine (EBM) can be most useful. In the setting of rapidly changing technology, tone must make a decision on whether he or she places a premium on being an early adopter of technology or delay purchasing decisions until there is adequate proof that a particular technology is useful. Early adopters will have the obvious advantage of being first and attracting certain types of patients who will want the newest laser technology. Laser devices are a significant capital expenditure; therefore members of the second group who base their purchasing decisions on EBM may be able to avoid deploying capitol into a purchase that becomes obsolete as quickly as it appears.
Another equally critical reason to pursue and utilize EBM in laser medicine is to accurately and effectively communicate expectations with potential patients. Although it may be clear what degree and type of improvement are possible with traditional ablative laser resurfacing, it can be much more difficult to quantify for patients the changes they can expect with newer nonablative technologies. Happy patients are well counseled and have proper expectations set. EBM is a great way to communicate likely outcomes that depart from the traditional and sometimes unsupported claims of manufacturers. In no way should this article dissuade practitioners from utilizing or purchasing devices that they are interested in. Rather the authors hope that this article would serve as an additional reference and help facial cosmetic physicians determine what devices might be right for them.
Non-invasive technologies
Nonablative laser devices are among the fastest growing sections of laser medicine. Much of this is, of course, driven by patient demand. Devices in this category include light therapy devices such as Intense Pulsed Light (IPL), Broad Band Light (BBL, Sciton, Palo Alto, California) and a multitude of devices that are designed to improve skin laxity without external wounds or down time. Not surprisingly, each of these devices and their attractive marketing campaigns generate significant patient interest. In this section, the authors will collate the available data and attempt to discern what devices have data to back up their claims.
Intense Pulsed Light and Broad Band Light
IPL was originally approved by the US Food and Drug Administration (FDA) for the treatment of telangiectasia in 1995. It has gone on to have an expanded series of indications and is currently used for treating vascular lesions, pigmented skin lesions, and even hair removal. Multiple generations of devices have been produced and its newest iteration is called BBL. This device has marketing that suggests that regular treatment with BBL can slow or even reverse the aging process. The authors will examine the data to determine what one can safely convey to patients in regards to these devices.
The IPL devices have been clinically successful at reducing solar lentigo and capillaries. When moving beyond the clinical anecdote toward EBM, one needs to have studies that can confirm or deny what is seen clinically. A useful study from 2007 does just that (level 4 evidence). In this study, treatment groups were split into primary capillary (rosacea) or melanosis groups (solar lentigines). Treatments were performed at standard settings (fluence 21 J/cm ; pulse width 20 ms; spot size 10 × 15 mm 2 ), and a spectrophotometric analysis of photography was performed ( Fig. 1 ). The therapy was particularly effective for rosacea-type skin, with post-treated lesions approaching appearance of normal skin areas (efficacy rate, 91.6%, N = 12). For patients with solar lentigines, skin was also significantly improved after a single treatment (efficacy rate, 66.6%, N = 18). Most therapeutic programs involve more than 1 session of IPL, but this study presents a clear and effective model for evaluating the results of IPL treatment in an objective fashion. Each arm of the study had fewer than 20 patients, but most importantly, this study confirms in a scientific fashion an already known clinical effect.
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