GentleMax Pro®: A Go-To Device for Laser Hair Removal, Pigmented Lesions, and Small Vascular Lesions

The GentleMax Pro System (GPro System) is a dual wavelength laser platform that combines a fast and powerful 755nm Alexandrite laser with an equally powerful 1064nm Nd:YAG laser for high performance treatment capabilities in terms of speed, efficacy, ease-of-use, performance, proven results, and patient satisfaction. I've been using this device for about two years, but have worked with the GentleLase Pro and GentleYag Pro, which together comprise the GentleMax Pro, for about 13 years.

The GPro system, in my practice, is a go-to for laser hair removal, pigmented lesions, and small vascular lesions. For me, it's about consistency and reliability. Also, the platform is very user-friendly and efficacious. It's great for experienced physicians who can adjust settings and treatment parameters based on their personal experience and preferences, as well as for new users who can effectively treat patients following Candela's suggested parameters.

Laser Hair Removal. In the past, we often heard how frustrated patients and consumers were with laser hair removal because they did not get the results they hoped for after several treatments. Intense pulsed light for laser hair removal just wasn't effective enough. But for the past 13 years, the majority of my patients that have Fitzpatrick Skin Types 1-3 have been so pleased with treatment with the 755nm laser of the GentleMax Pro. And, as a physician in South Florida, the fact that I can also treat with a 1064nm Nd:YAG with great success with any skin type is a benefit. For patients who have the darkest skin type, or who have underlying sun damage, or have been out in the sun tanning, or who I know will be outside in the sun, I have the option of using the 1064nm Nd:YAG with great safety. This is because the longer the wavelength of light, the less likely you are to disrupt the pigment in the overlying skin, and you're able to penetrate deeply enough to really focus on the hair follicle, delivering that energy to the bulb of the hair follicle. You want to protect everyone's overlying skin. You don't want to disrupt pigment and cause hypo- or hyperpigmentation after the treatment. So, in my ethnically-diverse practice in South Florida, we are fortunate enough to basically be able to offer laser hair removal to all of our patients.

More often than not, patients are extremely happy with the outcome in terms of achieving close to, if not permanent, dark hair reduction. It's very, very satisfying for patients. Typically, patients are treated at one-month intervals for five to seven treatments. Of course, some areas tend to respond more quickly than others, requiring fewer treatments. And other areas may be more challenging, requiring more than the average number of treatments. We never promise anything, but we can tell patients what the averages are. We typically treat at one-month intervals, but there are areas where the hair cycle tends to be a little bit longer, such as the lower legs where you can generally wait up to two months in between treatments.

Figure 1. Age/Sun spots before and after treatment with the 755nm Alexandrite laser.
Photos courtesy of Jonathan S. Crane, DO

For laser hair removal, we offer use of a topical anesthetic that a patient can apply about an hour before treatment to make it more tolerable. We tell patients that the discomfort is fleeting. I liken it to a semi-hot rubber band, and once the feeling has passed, it's passed. It's just that quick snap that you feel. The larger the area that you're treating, such as a man's back versus an armpit, the longer the treatment time, and the greater the discomfort. Typically, a back takes a solid 30 minutes, the legs take about 20 to 30 minutes, and the bikini area can be done in about 10 minutes. But most patients tolerate it, because they are highly motivated by outcomes. Patients are instructed to avoid waxing, tweezing, threading, electrolysis—anything that is removing the hair from the follicle—for at least two weeks.

But, unlike waxing or threading, laser hair removal doesn't require a lot of hair. You just need a hair that has been generated or begun to grow within the follicle. In fact, we often ask patients to shave the day before, because the less hair that's sticking out from the skin, the less of a source it is to be heated up. When you have long hairs that are above the skin surface, they're going to absorb heat as well. And it's just unnecessary heat being delivered to the surrounding areas. You just need that little bit of hair inside the follicle for it to work.

Post-treatment, patients should avoid the sun post-procedure when the skin is still somewhat inflamed. Although patients should be informed that inflammation is not a bad thing. Our endpoint for laser hair removal is perifollicular erythema and edema, which indicates that we've delivered enough energy to be effective.

Pigmented Lesions. When targeting pigmented lesions, as with hair removal, we do not want to disrupt someone's underlying pigment or natural pigmentation. I will always err toward treating patients with lighter skin types when treating pigmented lesions with an Alexandrite laser. There are protocols that have come out of Asia where they have extensive experience treating pigmented lesions, such as lentigines, in Asian skin types—generally skin type 3, and sometimes pushing toward a 4, but even using those parameters, from my experience I've found you really need to make sure that you're comfortable with the device and have enough experience to watch carefully and know your patients and how they might respond.

Figure 2. Before and after treatment with dual-configuration 755nm Alexandrite laser and 1064nm Nd:YAG laser.
Photos courtesy of Marcele Kutun, MD

Patients are typically very satisfied with outcomes for this treatment. And as with any aesthetic treatment, setting proper expectations is key. Often the first question patients ask when inquiring about treatment for brown spots is, “Will they come back?” The answer is always, “Of course they can come back, and if they do we can treat again.” But patients are often surprised at how long it takes for the lesions to reappear. Typically, for pigmented lesions on the face, I get about 75 percent on the first treatment and the remaining at follow-up treatment one to two months later. Then patients may come back for another treatment every couple of years, and it's never quite as expensive for the patients to have those follow-up rounds in the years to come.

Treatment is quick—I can treat a face in about 10 minutes, but patients should apply a numbing cream before treatment. When targeting pigmented lesions, the optional dynamic cooling device spray used during hair removal treatments—the mechanism that cools the surface of the skin on the device—is turned off because you want to heat that very surface portion of the skin, that top superficial layer, so patients feel more heat. A numbing cream helps make the treatment comfortable. If there are hairs in the same place as the pigmented lesions, patients should except more discomfort.

Post-treatment, the skin tends to be a little tender and patients should know that any brown spots that were treated will look significantly darker for five to 14 days, depending on the location. On the face, in particular the central face, patients should expect those brown spots to peel off in about five days. Around the perimeter of the face, it can take about a week. On the chest, cell turnover takes even longer, so I counsel patients not to expect to see results for at least two weeks.

Vascular Lesions. For small vascular lesions, I love using the GMax Pro—the 1064nm Nd:YAG laser head is phenomenal for those fine little traceable blood vessels on the face. It's very effective—even more effective than some of the other vascular lasers that I use. And it is also phenomenal for cherry angiomas on the face or body. Patients see tremendous clearance after just one treatment session, so satisfaction is high. Treating blood vessels on the face usually takes 10 to 20 minutes, and treatment is not uncomfortable. It does not require any anesthetic or other preparation prior to treating—you can do it when a patient comes into the office.

Most patients do not experience any downtime. There isn't really any bruising. The worst-case scenario is that a really thick vessel may shrink in diameter, but it might look like a black pencil line. It can turn to a dark color and then the body absorbs that residual blood and clears it within a week. Other than that, there's no downtime, and most patients are highly satisfied after one treatment.