Persistent Energy: Devices with Practice Longevity

Innovation is the name of the game in the energy-based device space, but sometimes the latest product isn’t the one that gets the most use. Modern Aesthetics® magazine asked aesthetic experts which devices have the longest history of use in their practices. We also asked whether they would bring back any devices that have become obsolete or disappeared from the market.

Here’s what they had to say.

Tried and True

By Jill Waibel, MD

I have had this thought often over the past five years that although there are now many, many energy-based devices—some fads that come and go—the most tried and true are my “oldest, wisest” lasers. Most of them were created by our genius Dr. Rox Anderson and his team and Jim Hobart and Dan Negus. My workhorses, complete with steam coming out of them, include the pulsed dye laser, the non-ablative 1550nm and 1927nm thulium, and the fractional CO₂ and erbium lasers. We do about 25-30 laser procedures a day, and these are used in most cases.

It also strikes me that the oldies but goodies I mentioned still have the best efficacy. Some of these devices are in their third or fourth generation with the companies always improving these gems.

Old devices I miss are the SmoothBeam for sebaceous hyperplasia (although downtime was excessive), but again Drs. Rox Anderson and Fernanda Sakamoto to the rescue with their emerging 1726nm device to treat acne, which appears to also help with sebaceous hyperplasia.

Taken for Granted

By Joe Niamtu, III, DMD

I thought about this topic long and hard and narrowed this down to two devices that I have used in my office for decades. Number one is the Ellman 4.0 megahertz radio wave surgery system and the other is the Iridex Varlite vascular laser.

My practice is limited to cosmetic facial surgery and I am not a big device person. When thinking about this topic I narrowed this down to two devices that I purchased over 20 years ago, use almost every day, and have never had a service problem.

I don’t have any service contracts on either device and, as stated, they have never required service, so I guess you could say they’re not only workhorses but good investments. I use the Ellman device for various surgical procedures including but not limited to blepharoplasty, facelift, browlift, mole and lesion removal, and generalized hemostasis. The Iridex Varilite laser is quite useful because it has a 532nm and 940nm setting, which makes it extremely versatile for vascular lesions including but not limited to telangiectasias, venous lakes, cherry angiomas, facial and lip varicosities, and DPNs.

I have somewhat taken these devices for granted but considering this topic has reinforced their quality, usefulness, and durability.

Can’t Live Without It

By Tina Alster, MD

My oldest laser that is my workhorse laser and that I continue to use several times daily is my pulsed dye laser. I use it to treat a variety of vascular lesions and scars, including port-wine stains, hemangiomas, telangiectasias, rosacea erythema/flushing, hypertrophic scars, keloids, ILVEN, etc. I don’t know what I would do without it!

I wish the 510nm pulsed dye laser (produced in the early 1990s by Candela and used to treat café-au-lait birthmarks and lentigos) was still available. It was superior in its ability to remove epidermal pigment—even better than the newer Q-switched and picosecond lasers! There weren’t many such units produced and, after a few years (and introduction of newer Q-switched systems), they could no longer be supported.

Hanging Tight

By Jason Bloom, MD

I have always loved the idea of the percutaneous RF treatments. I have had ThermiTight since 2014 and FaceTite since 2016. I have done hundreds of cases with these devices and still really like them because the results are very predictable. These are great treatments for the patient who wants a non-surgical, one-done treatment with good results! I truly think these are devices that can offer the best amount of improvement—short of surgery.

Unlike Any Other

By Michael H. Gold, MD

The two most used devices in my office remain my IPLs and my pulsed dye lasers. For the IPLs, the original ones have been replaced by much more sophisticated ones, but the premise is the same—they treat vascular, pigment, and have an effect on the collagen and elastin—unlike any other energy-based device we have. Now we use the Lumenis Stellar IPL, the Sciton BBL Hero, and the InMode Lumecca. And I still have my Candela V Beam Perfecta that I have had for years and years. It gets regular service, and we use it daily, as well.

I would love to have my original EpiLight for hair removal. It was the first IPL approved for hair removal, and we did studies in the day that showed how effective the IPL was, that with the right filter and settings, we could treat all skin colors. This is unusual with IPLs, but with the 755nm filter, this was possible. It worked really well in our hands.

Everyone Benefits

By Nazanin Saedi, MD

Fraxel restore!

I love it so much, even though it has been around for over 10 years.

Every patient is happy every time and it works for so many conditions: pores, texture irregularity, scars, depression, discoloration, acne scars.

Everyone could benefit from a Fraxel.

Evolutions and Upgrades

By Amy Forman Taub, MD

Fraxel Dual would be my top pick and Thermage my second.

I got the second generation Fraxel 1550 Restore in 2004 and upgraded to the Dual when it came out circa 2005. I still have the same device I had back then, and it has barely given me any problems. At first, we used it mainly for acne scars but then the combo treatment of the Dual is still a stalwart of overall rejuvenation in my practice for both texture and color. Nobody ever comes back and says they don’t see a difference, and we have mastered it so that we have few if any complications. Also, that introduced me to the 1927nm wavelength, which I consider central to the practice for sun damage. I now also have the Clear + Brilliant Permea and the LaseMD Ultra, all of them 1927nm. We use these constantly to wipe away years of sun damage on the face, chest, neck, arms.

Thermage is an oldie but goodie that has been upgraded over the years. We have upgraded to all four new iterations. It took a while back in the day to figure out how to get good results, but it has continued to provide us with consistent, reliable results.

I had a Cutera Xeo Coolglide back in 2002 that lasted until 2018. It had the most powerful long pulse 1064nm at the time, and I did a lot of leg veins with it. When it was about to die, I got the Candela Gmax Pro 755/1065, which is a workhorse in our practice. I do miss the Titan, a little broadband light device for skin tightening that was maddeningly slow but really did a great job, especially after Dr. Macrene Alexiades came out with a paper on using it in motion. At times I miss the Lumenis Multilight with 1064, my very first energy-based device. It was a violin, and I knew how to play it. The newer devices are more programmed, they don’t have the variability that that had, but in general I love newer devices that usually have figured out what was missing from the old ones and improved on that.

Tri'd and True

By E. Victor Ross, MD

The longest-used laser my practice is probably my TriVantage from Candela. I think we bought that in 2007, and it truly is a workhorse. I feel that way because it treats lentigines and brown spots really as well or better and effortlessly as any other device I have. 

A device left behind that I would like to see back would be the Aura laser that was built by Laserscope years ago. It would be great if that laser would come back because it was a little portable KTP laser that was very nice and elegant. It was powerful enough to do a whole face, but small enough you could really move it from room-to-room better than some of the more modern technologies.