CARLSBAD, CALIF.At a symposium on laser and cosmetic surgery sponsored by SkinCare Physicians, Dr. E. Victor Ross Jr., shared what he looks for in a good intense pulsed light device.
First, he looks for variability in spectral shapes. This allows tailoring and fine-tuning of applications to control the clinical outcome, said Dr. Ross, director of the Scripps Clinic Laser and Cosmetic Center in San Diego.
The ability to predictably treat vascular lesions while preserving epidermal pigmentation includes the ability to treat through a tan. "I always hear people from the northeast say, 'We don't treat tanned patients.' You have to be cautious, but you can do it," he said. With tanned patients you need to use "all the weapons [you have], which means external cooling and internal cooling, particularly between the vascular lesions."
Efficient cooling is also important. "It's not about cooling the skin," he said. "It's about keeping the hand piece cool."
IPL devices should also support some laser platforms, such as the erbium:YAG, the neodymium:YAG, or the erbium glass laser, he said, adding that a reliable external calibration system that interrogates the entire system from the power supply to the quartz or sapphire end piece is important. He also recommended user-selectable pulse durations that allow for the proper balance of fluence, wavelength, and cooling.
Dr. Ross also mentioned the importance of reproducibility in outcomes from machine to machine based on the same panel settings, and long lamp lifetimes with minimal degradation over thousands of pulses.
Rounding out the list of qualities are flexibility in spot size, reasonably fast repetition rates, and ergonomic simplicity.
Undesirable IPL features, he said, include no integrated cooling, small spot size, no capability for laser upgrades, and subpar calibration algorithms.
Candidates for his "Miss IPL" contest include the StarLux, the Luminus One, the Omnilight and the Xeo. "But there are many [others] I just haven't gotten in contact with," said Dr. Ross, who disclosed that he has research relationships with Palomar, Cutera, and Laserscope. "These are the ones I like and know."
He concluded that the best IPL "is the one you feel most comfortable with, the one you use so much that your fingers intuitively move to the right locations on the instrument panel, and the one you feel comfortable teaching people about."
In a panel discussion, Dr. Christopher B. Zachary echoed that notion. "It's all about getting a device that you trust, that you know, that you are capable of using day in and day out," said Dr. Zachary, professor and chair of the department of dermatology at the University of California, Irvine. "There's a huge difference between using the old intense pulsed light devices and the new ones. The new ones are much more efficient."