16850 Dallas Pkwy
Dallas, TX 75248
The SmartXide DOT (dermal optical thermolysis) laser is a fractional C02 laser system that provides ablative thermal energy using a 350-µm spot. The accompanying hand scanner lets the physician deliver a customized scanned pattern with adjustable power, scan density, and dwell times.
According to the product’s distributor, Eclipsemed Ltd of Dallas, C02‘s longer wavelength, combined with fractional laser technology, goes deeper into the dermis than current, minimally ablative fractional treatments.
Instead of removing entire portions of skin, the SmartXide DOT laser handpiece lays down rows of tiny, microscopic laser wounds, evenly spaced across the skin, leaving areas of untreated skin between them. The treated skin contains only tiny pixilated surface wounds instead of a contiguous, oozing burn.
This approach reduces the risks of patients developing hypo or hyperpigmentation and scarring, as one might find after employing traditional C02 lasers. Reportedly, downtime is a few days, not weeks.
C. William Hanke, MD, a board-certified dermatologist, dermapathologist, and Mohs micrographic surgeon, is among the first physicians in the United States to use DOT Therapy on his patients.
He chose to invest in this technology because he was “looking for something to bridge the gap between superficial chemical peels and deep C02 resurfacing,” he says.
The SmartXide’s handpiece comes with an Infinite Delivery Options feature, from which physicians can select from a wide range of settings to handle different treatments—from a superficial “soft” treatment with no downtime, a moderate treatment requiring a few days of downtime, or an all-out ablative laser resurfacing treatment.
SmartXide C02 Laser System
Wavelength: 10.6 µm
Power to Tissue: 30 W (max)
Pulse Energy: up to 60 mJ (per dot)
Repetition Rate: 5 Hz to 100 Hz
Pulse Length: 0.2 ms to 80 ms
Delivery System: 7-mirror articulated arm (Titanium)
Aiming Beam: Laser Diode, 3 mW @ 635 nm to 670 nm
User Interface: LCD Color touch screen
Electrical Requirements: 110 V/1.8 A (maximum)/60 Hz
Size: 47″ high x 14″ wide x 9″ deep
Weight: 66 pounds
Dermal Optical Thermolysis (DOT) Scanner
Scan Area Size: 15 mm x 15 mm (maximum)
Spot Size: 350 µm
Scanning Modes: Standard and DOT
Dwell Time: 0.2 ms to 2 ms
Dots Pitch: 0.2 mm to 1.0 mm
In addition, the technique can reduce downtime by leaving some of the skin untreated, according to Eclipsemed. The dots stimulate new collagen growth to reduce sun damage; treat pigment, skin laxity/texture, wrinkles, and acne scars; smooth rough or uneven skin texture; reduce the symptoms of aging; fade acne scarring; and soften facial lines.
“DOT therapy can be used in conjunction with IPL, PDT, and various other light-based treatments,” notes Hanke, who is in private practice in Indianapolis and is also clinical professor at Indiana School of Medicine.
Some physicians—early adopters such as Bill Johnson, MD, a cosmetic surgeon in Dallas—claim that DOT Therapy should be considered the new gold standard for moderate to severe wrinkles, age spots, and acne scars.
As part of the product’s initial February 2008 rollout, Johnson was quoted widely as one of the first physicians to use DOT Therapy on patients. At one point, he observed “a real improvement in fine lines and wrinkles. I even noticed excellent skin tightening. I envision DOT Therapy becoming the treatment of choice for acne scars and facial scars.”
In the intervening months, more physicians have used the treatment, including Hanke.
“The main indication for DOT therapy is photoaging, which consists of dyschromia and fine wrinkling. The dyschromia will resolve nearly completely with one treatment. Fine wrinkling may require two to three treatments,” he says.
Eclipsemed has done a good job of saturating the Internet with quotes from Johnson and a few others who have only nice things to say about the product, which was recently approved for use in the United States by the FDA.
Published reports on the efficacy of the Smartxide product are scant. Even in the online forums, there is little discussion of the technology. This means the product is not in wide use at this time. However, it appears to hold some promise.
In one anecdotal report published on the Internet, British cosmetic surgeon Patrick J. Treacy wrote, “If fractionalized laser skin resurfacing with minimal downtime is now considered the new method of softly treating patients for minor skin conditions, such as photoaging, then the SmartXide DOT has cost advantages to the operator. However, the lack of an internal exhaust device to remove the laser plume is a distinct disadvantage.”1
A quick check of the used market for this product worldwide showed that it can cost between $70,000 and $90,000. The product is manufactured by DEKA, Firenze, Italy.
The inherent risks and potential complications of the CO2 laser are minimized with the fractional delivery, while still offering lifetime results with one treatment. This procedure can be performed in the office with simple topical anesthesia in about 30 minutes.
How have Hanke’s patients reacted to DOT therapy treatments?
“[They] have been very accepting of DOT therapy because of minimal downtime,” he says. “The procedure is done using topical anesthesia. The entire face can be treated in less than 15 minutes. The neck and upper chest can also be treated. Patients are able to wear makeup on the second or third postop day. The duration of the redness is 7 days.”
- Active Fx Vs SmartXide lecture. www.slideshare.net/ptreacy/active-fx-vs-smart-xide. Accessed August 28, 2008.
DOT Therapy Primer
What does DOT Therapy treat?
Sun damage; acne scars; stubborn pigmentation; enlarged pores; fine lines; wrinkles; skin laxity of the face, neck, chest, arms, and hands; and surgical scars.
How many treatments may be needed to get the best result?
Depending on the damage to your patient’s skin, and the desired outcome, plan on one to three treatments performed approximately 4 to 6 weeks apart.
What kind of results can the patient expect?
After a few weeks, patients will see improvement in the color, texture, and quality of treated skin, with increased improvement after all treatments are complete.
During treatment, what can the patient expect in terms of pain?
There is little or no discomfort during the procedure. A mild burning sensation may occur. No topical anesthetic is required, although patients should wear eye shields.
What should patients expect immediately after a treatment?
Most patients exhibit a slight pinkness to the skin. Some may experience minor edema, which goes away in approximately 24 hours. Makeup can be worn the next day. Most physicians recommend taking off 5 days from work. Application of skin moisturizers during the day for the first 5 to 7 days, as the skin may feel dry.
Palomar Medical Technologies
82 Cambridge St
Burlington, MA 01803
Palomar is among the top tier of research and development firms that have created laser-based systems for aesthetic surgery uses.
The most notable advances from Palomar have been in laser hair-removal technology.
Its Epilaser system, for instance, which the firm debuted in 1997, was developed at Massachusetts General Hospital’s Wellman Laboratories of Photomedicine and was the first ruby laser system for hair removal.
Although other laser companies, such as Reliant, also developed products in conjunction with Massachusetts General Hospital, Palomar advanced the technology by incorporating laser capabilities into modular handpieces that attach to its multipurpose laser systems.
In the late 1990s, Palomar introduced the original Q-switched medical laser, which to this day arguably remains the standard for cutaneous pigment removal.
In addition, via mergers and acquisition, Palomar developed and released products to treat scars, burns, and wrinkles; as well as systems for the treatment of leg veins, psoriasis, burn diagnosis, and tonsillectomies.
In 1999, Palomar obtained FDA permission for a subzero cooled laser system. Two years later, it rolled out the Q-Yag 5 system, a portable tattoo-removal system that uses dual wavelengths for multiple ink colors; the system has three spot sizes for versatile treatments.
More recently, Palomar is developing laser-based products for home use.
The StarLux 500 platform allows the attachment of several laser and pulsed-light handpieces, such as the Lux1540 and LuxDeepIR handpieces, which are used for nonablative skin resurfacing and fractional skin tightening. Other applications include hair removal, reduction or removal of acne scars, and leg vein treatment.
The pulsed-light handpieces use the company’s AccuSpectrum filtering technology, which offers targeted light for each treatment application and increased patient safety, according to the firm.
The Lux1540 fractional laser system is a 1540-nm erbium glass laser handpiece for the StarLux 500 laser and pulsed-light system.
The handpiece divides the laser into microbeams that can penetrate up to 1 mm, and with pulse widths of 10 or 15 milliseconds. It can deliver high power without the need for long pulse widths.
The LuxDeepIR delivers infrared light into the dermis, creating islands of deep heating and inducing the body’s natural healing response.
This allows for the generation of new tissue, thereby reducing the appearance of skin laxity on areas such as the neck, abdomen, and legs.
Palomar also offers the Lux1440-nm handpiece, a 1440-nm laser that is intended for “gentler treatments,” according to the company.
Unlike ablative lasers, these systems have fewer side effects, as well as faster recovery times and minimal downtimes.
For example, common side effects of the Lux1540 include a dry skin texture, mild bruising, and some redness that goes away after a few hours.
This technology delivers an array of small beams creating a periodic lattice of isolated hyperthermic columns between 1.5 mm and 3.0 mm in depth to the reticular dermis.
The Lux2940 handpiece, on the other hand, is an ablative laser system that functions in the same manner as the Lux1540 but delivers very deep ablative columns.
The Lux2940 can be run from the same StarLux 500 platform as the Lux1440 and Lux1540 nonablative lasers.
The device’s microfractional technology allows for faster recovery, as only damaged tissue is targeted while any healthy tissue in the area is preserved.
The strength of the laser beam can be altered according to each patient’s needs in order to achieve optimum results. This laser can achieve results with just one treatment, according to several published reports.
Another IPL system from Palomar, the Estelux system, is a popular model for hair-removal treatments. It is known for fast, efficient treatments that are long lasting.
Palomar recently announced the new SlimLipo body-sculpting laser, which, according to the company, quickly and effectively liquefies fat in a minimally invasive procedure.
It simultaneously blends 924-nm and 975-nm wavelengths for preferential absorption by fat and dermal tissue, respectively.
Single-use, interchangeable treatment tips and continuous-wave photothermal technology provide control of thermal effects for optimal treatments.
The SlimLipo laser runs off of the company’s new Aspire laser platform, which offers a variety of new aesthetic treatments.
The company announced the Aspire laser platform and the SlimLipo laser-assisted lipolysis device at the American Society for Laser Medicine & Surgery (ASLMS) meeting in April 2008.
According to the company, the Aspire system and SlimLipo laser-assisted liposuction handpiece boast unique tip designs and selective wavelengths for melting fat and providing the desired thermal effects on surrounding tissue.
The new system “uses optimal wavelengths to melt fat and provide the appropriate amount of heat to the surrounding tissue,” Palomar CEO Joseph P. Caruso stated at the ASLMS unveiling.
The Aspire “is an ideal complement to the StarLux platform for providing opportunities for even more treatment modalities,” Caruso continued.
“With the new aesthetic procedures that will be possible with Aspire, and the many popular treatments, including hair removal, skin rejuvenation, and skin resurfacing, available with the StarLux 500, practitioners will be able to offer a complete suite of the most-requested aesthetic procedures,” he added.
The Aspire Platform and SlimLipo device have received FDA clearance and are available in the United States.
Palomar Intense Pulse Light Handpieces and Their Applications
- LuxY A yellow-light filtered handpiece Used mainly for permanent hair reduction, photorejuvenation, and pigmented lesions (predominantly in patients with Fitzpatrick I, II, III, and IV skin types)
- LuxR A red-light filtered handpiece Used for hair removal on all skin types, including tanned skin
- LuxRs Hair removal in all skin types
- LuxG A green-light filtered handpiece for hyperpigmentation; facial vessels, including rosacea; and rejuvenation of face, neck, and chest skin vascular lesion treatments
- LuxV For the treatment of mild to moderate acne and pigmented lesions
- LuxIR Infrared light pulses penetrate the dermis, where it triggers a biological response that leads to collagen remodeling in the deep dermis
- LuxDeepIR Uses infrared light to produce heat in the dermis, with selectable depths of 1 mm to 3 mm
- Lux1064 Treats leg spider veins and varicose veins
- Lux1440 and Lux1540 A nonablative fractional resurfacing handpiece for hyperpigmentation, facial rejuvenation (improvement of skin texture), and scar revision
- Lux2940 An ablative fractional resurfacing handpiece used for wrinkle reduction, facial rejuvenation, and resurfacing scar revision