Most Diverse Hair Removal
For All Skin Types

Apogee Elite by Cynosure Inc.

Combining the 755nm Alexandrite (Apogee 5500) and 1064nm Nd:YAG (Acclaim 7000) in one system made this laser an obvious winner. The 755nm is the “gold standard” for skin types I-III while the high powered Nd:YAG is the “gold standard” for types IV-VI. This is a serious “no compromise” laser for hair removal. The Elite is variable pulsed with both the 1064nm and 755nm wavelengths. The 1064nm may also be effectively used as vascular and nonablative laser. In addition, shortening the pulse width on the 755nm wavelength to .05ms will treat specific pigmented lesions. The independent SmartCool system allows for very light handpieces which significantly reduce operator fatigue when treating large areas.

HONORABLE MENTION

LightSheer XC by Lumenis Inc.

The 800nm XC is the most powerful (and expensive) of the outstanding LightSheer line. The XC boasts a 12 x 12 square spot, 2 Hz rep rate, and 2900W of power. The device has integrated epidermal cooling with its contact sapphire ChillTip. If you require a portable device, the LightSheer ET is your best bet.

Best Hair Removal Laser
(Dark Skin Types)

CoolGlide Excel by Cutera

The 1064nm Excel has variable “on-the-fly” spot sizes 3, 5, 7, and 10mm. The pulse structure is absolutely perfect. A 12mm spot would be nice when doing large anatomical areas, but this is still a superior long pulsed Nd:YAG for darker skin types.
The Excel model allows shorter pulses than the CoolGlide Classic, and this helps when treating finer brown hair which presents less of a target for the Nd:YAG. The Excel is also an excellent vascular laser. Proven performer in this category. Integrated sapphire contact cooling.

HONORABLE MENTION

GentleYAG, Candela Corporation Acclaim 7000 by Cynosure Inc.

Both of these lasers are proven high powered 1064nm Nd:YAG’s that operate at high speeds. The GentleYAG and Acclaim have larger spot sizes than the 10mm Excel. For epidermal cooling the GentleYAG utilizes integrated cryogen spray and the Acclaim uses cold air. Both of these lasers may also be used for vascular and non-ablative collagen synthesis treatments with specific settings and techniques. Both are excellent devices with many treatment possibilities.

Best Hair Removal
(Light Skin Types)

Apogee 5500 by Cynosure Inc.

The Apogee 5500 is a variable pulsed Alexandrite and a proven performer. 12.5mm and 15mm spot sizes with variable pulsed technology make treating large areas easy and comfortable. 755nm Alexandrite lasers which reach 20 milliseconds do not decrease efficacy when the proper settings are used. What it does accomplish are more comfortable treatments without affecting efficacies. The idea of having an independent epidermal cooling system has many advantages. First, handpieces are very light which greatly reduce operator fatigue. Secondly, if one handpiece fails, the practitioner may simply snap in another and avoid canceling appointments. Simply a great laser for lighter skin types. In addition, the practitioner may treat pigmented lesions with the 5mm spot and .05 millisecond pulse durations.

HONORABLE MENTION

GentleLase Plus by Candela Corporation

The 755nm GentleLase is a proven device in this category. 12-18mm spot sizes. Candela is making great strides with user interfaces, but the GentleLase needs to be variable pulsed. Integrated DCD cooling (Cryogen Spray). The GentleLase now comes in many versions.

Best Laser For Superficial Leg Veins

CoolGlide Excel by Cutera

The 1064nm Excel edges out other high powered Nd:YAGs in this category once again. The device has variable “onthe- fly” spot sizes 3, 5, 7, and 10mm. Please be mindful that sclerotherapy is still the gold standard, and it is advised that the practitioner be well trained when treating leg veins with the Nd:YAG due to the very high fluences required. The term “superficial” means most vessels less than 1.5mm in diameter. It is important to note that vessel closure has been reported in larger diameters. Please refer to your experienced colleagues for guidance.

HONORABLE MENTION

Acclaim 7000 by Cynosure Inc. GentleYAG by Candela Corporation

Both of the above-mentioned high powered Nd:YAGs are very capable in this category.

Best Laser For Facial Telangectasia

Vbeam by Candela Corporation

This 595nm Pulsed Dye laser is a proven performer in the category with variable pulse duration up to 40ms. Candela has made significant technical improvements for easier service. More improvements are forthcoming. It is important to be cautious with darker skin types when using pulsed dye lasers.

HONORABLE MENTION

PhotoGenica VStar by Cynosure Inc.

This 595nm Pulsed Dye laser is a real close second to the Vbeam. Cynosure and Candela are the only companies which manufacture the pulsed dye laser for aesthetic applications. The pulsed dye laser is making a strong comeback due to technical advances in pulse structures which create new treatment options and safer, more convenient operation. Cynosure’s Cynergy may prove a real challenger in many vascular categories next year.

Best IPL For Photo
Facial Treatments

StarLux by Palomar Medical Technologies

The StarLux is Palomar’s top-of-the-line IPL device. The StarLux has integrated sapphire cooling tip technology, an elegant intuitive touchscreen interface, and even an option for a medium powered Nd:YAG laser handpiece. A regulated closed loop power supply helps to ensure that over treatment is minimized. At last count 7 handpieces were available with the newest addition of the Lux1064 handpiece for leg veins and vascular conditions. StarLux is a table-top powerhouse and represents the apex of IPL technology.

HONORABLE MENTION

Quantum SR by Lumenis

The Quantum SR also has many of the features and benefits of the StarLux. The SR also has contact sapphire cooling, an intuitive touchscreen interface and many options to meet the needs of varying skin types. It should be noted that Lumenis was the pioneer in the IPL field and Quantum SR is in many respects comparable to the StarLux.

Best Laser for Vascular
Malformations

Vbeam by Candela Corporation

This pulsed dye laser has a long and reputable record with specific port wine stains, hemangiomas, and other vascular disorders/conditions. The device is a proven performer with variable pulse widths out to 40ms. The Vbeam is also used on a wide variety of more superficial aesthetic conditions such as smaller telangectasias, specific angiomas, etc. The device has the appropriate spot sizes for most cases including an elliptical spot. Look for major technical improvements with the Vbeam in 2006. Integrated cryogen spray (DCD) for epidermal cooling.

HONORABLE MENTION

PhotoGenica VStar by Cynosure Inc.

The VStar is a great pulsed dye laser. It is my opinion that Candela won the balloting because they have a much larger installed base. The downsides of the pulsed dye laser have traditionally been service and side effects. Side effects are mainly purpura and service being mainly the complexity of changing dye packs. The dye pack changeouts and other service issues have been for the most part technically solved. The purpura issue has been significantly reduced to improvements in “sub pulses” which make up what a practitioner may consider to be a single pulse. Over a 30ms pulse or “shot,” there are “peaks and valleys” in between. Cynosure and Candela are the only manufacturers of the pulsed dye laser, and both companies arise from a common “lineage.” Both companies are demonstrating new and fully legitimate uses for this well investigated wavelength. Interestingly, the two companies are pursuing differing new aesthetic applications for the pulsed dye laser.

Best Laser For Acne

CoolTouch CT3 by CoolTouch Inc.

There are two light based methods which address acne. One method is to deliver thermal energy to the sebaceous gland to partially “shrink” the gland and thereby reduce its sebum production. The second method uses ultraviolet light to create a phototoxic reaction which reduces the bacteria in the philosebaceous canal. The CoolTouch CT3 1320nm Nd:YAG is theoretically the best wavelength (due to its coefficient to water) to deliver the most heat at the average depth of the philosebaceous gland in the facial area. This is still a controversial category with many physicians reporting varying degrees of success. The CT3 system combines feedback control to minimize over treatment. It has a 10mm spot size and cryogen cooling for epidermal protection.

HONORABLE MENTION

Smoothbeam by Candela Corporation

Candela’s 1450nm diode Smoothbeam is a table-top device which won this award category previously. The 1450nm requires higher fluences to achieve equivalent temperatures to the sebaceous gland, and clinical results vary widely. Because of the higher fluences, there is considerable pain during treatment which may lead to elective discontinuation of a treatment by the patient. Nevertheless, the 1450’s “affinity” for the target chromophore of water is a close second to the 1320nm Nd:YAG. Perhaps a synergistic treatment approach is required for both lasers in this category. As more patients, and the parents of patients, are reluctant to take systemic drugs, the industry must develop new creative strategies in the treatment of acne.

Best Non-Laser Device For Acne

ClearLight by Lumenis

The ClearLight operates in the 405nm to 420nm range. This spectra is absorbed by products of bacteria in the philosebaceous canal. In simple terms, the UV exposure causes a phototoxic reaction which attacks the bacteria which are part of the inflammatory condition of acne. Numerous studies demonstrate no relationship between diet and acne. The causes of acne are multi-faceted and are still not well understood. Androgens and genetics play an obvious role. The adjunct use of 5-aminolevulinic acid (5- ALA) as a photosensitizer “enhances” the effect of the UV dose. Once again, patients, and the parents of patients, are seeking alternative treatments which control acne other than the use of systemic drug therapy. This is not to say that in all cases topical or system drugs should not be used. Adult acne, especially in females, is still one area where our industry should employ more research and development. An important consideration is the depth which these UV devices can penetrate. This type of therapy cannot effectively reach the philosebaceous gland due to its wavelength but will reduce the bacteria in the canal.

HONORABLE MENTION

OmniLux Blue by PhotoTherapeutics Ltd.

The OmniLux Blue is in the approximate spectra as ClearLight. While OmniLux states a standard dose is 48J/cm2, the clinical evidence remains inconclusive. PhotoTherapeutics Ltd., as well as other light emitting diode devices, were covered in my article: The Photobiology of Light Emitting Diodes (Winter 2004). Both ClearLight and OmniLux represent a method to control the infection which is part of the condition. The value of this therapy needs further inquiry as to cost benefit and more comprehensive clinical studies. The involution of the philosebaceous gland, without the toxicity of systemic drug therapy, should logically be the goal of the medical/photonics industry. What this practically means is the development of a drug which reduces the inflammatory aspect but also interrupts the root cause of why the infection arises in the first place. Years of observation in the use of isotretinoin reveal that once the gland is partially involuted, the condition often resolves. It appears that if the glands remain small, androgen receptors lose their ability to “dock.” This is a theory, but many years of observational evidence support this hypothesis. The use of isotretinoin is now of great concern to dermatologists due to the expanded litigious climate which is now a reality.

Best Non-Ablative Laser
For Wrinkle Reduction

CoolTouch CT3 by CoolTouch Inc.

CoolTouch was the pioneer in the non-ablative collagen synthesis category. The 1320nm wavelength of this laser is superior in the deposition of thermal energy in the upper papillary dermis. With all non-ablative lasers, results vary widely. This is yet another controversial area in medical aesthetics. It is advised to manage patient expectations carefully. Anatomical area(s), degree of wrinkling, patient age, and other factors ultimately determine clinical outcomes. It is very important to consider these factors and consult your trusted colleagues. It may appear curious that what laser wavelength is best for acne is also best for nonablative collagen synthesis. The physics of the coefficients cannot be ignored where water is the target chromophore. Simply put, the more heat which can be selectively deposited in the upper papillary dermis, the greater the odds are that moderate wrinkles in specific areas will improve. Complementary adjunct treatments should be implemented to achieve a greater degree of patient satisfaction. These include skin care regimens such UV protection, properly dosed tretinoin, and a simple routine of high quality skin care products. In addition, diet and lifestyle must be considered.

HONORABLE MENTION

Smoothbeam Candela Corp.

Candela’s 1450nm diode Smoothbeam wins in this award category once again. Most of the above comments above apply equally.

Best Non-Laser
For Wrinkle Reduction

Titan by Cutera

Titan’s infrared spectrum is both predictable and easily understood based on the known coefficients to the target chromophore of water. The Titan uses a spectral profile which will deposit heat in the upper papillary dermis where a wound healing response may generate collagen synthesis to resolve fine wrinkles in specific anatomical areas. While the device is marketed for skin laxity as reported in my article, (September/October 2004), practitioners appear to be extremely satisfied with this device as a non-ablative device. The device has a simple and intuitive interface, and minor alterations to its settings have been reported to produce excellent results in this very controversial category. The device has integrated contact sapphire cooling and precise feedback to reduce the chances of over treatment. The precise cooling mechanisms and narrow output may be one of the reasons the device is reported to be as effective as lasers in this category.

HONORABLE MENTION

ThermaCool by Thermage

In the laser ATnT awards, ThermaCool won the most promising new technology award. Shortly after this, practitioners and patients reported a variety of unwanted side effects. As with any new technology, technical modifications are sure to follow. Physician education and improved techniques have subsequently reduced over treatment and have improved clinical outcomes. Once again, this is another device designed for “skin tightening” which seems to have a great following in the non-ablative wrinkle reduction category. The category is very controversial for very real reasons which require further scientific debate. In any event, this is monopolar radiofrequency device technology which has significant physician support. ThermaCool is not a light based device, and these awards are specifically for light based devices. Next year we may see more non-light devices as well as whole new categories as technology inevitably moves forward. It is the intent of both myself and Aesthetic Trends that we recognize these new technologies in aesthetics which may not incorporate light based components.

Best Laser Resurfacing: CO2

UltraPulse Encore by Lumenis

Once again the Lumenis Encore has no equal in the industry. While CO2 procedures are declining, many practitioners are forgetting that the CO2 is the ideal laser for many conditions. For lighter skin types with deeper wrinkles it is still the undisputed gold standard. There are numerous techniques which minimize downtimes, and one should not forget it has many other valuable uses such as the removal of specific epidermal cysts, moles, etc. I applaud Lumenis for not only maintaining this superior laser, but improving on its already great design. The UltraPulse Encore now has a more compact design, and significant advances have been made with its scanning technology. Serious surgeons in the aesthetic field will find that this laser still has no substitute in many cases.

Best Laser Resurfacing: ER:YAG

NaturaLase LP by Focus Medical

NaturaLase LP by Focus Medical The Er:YAG is without doubt the most misunderstood laser in our industry. Misunderstood in the context of the benefits it provides and how its “synergistic” use leads appropriate candidate patients to great satisfaction. Please refer to: The Erbium YAG, New Options and Treatment Strategies (March/April 2005). NaturaLase LP has emerged as the undisputed leader in this technology. The output is a 3 Joules per pulse at 8 pulses per second. This device represents a new approach to the Er:YAG which has many advantages at a great price. The unit has fluence corrected multiple spot sizes between 4 to 10mm. No scanner is required. The unit is bundled with the Cryo-5 Zimmer cooler. The use of the Zimmer combined with topical anesthesia allows excellent patient comfort and precise ablation.

HONORABLE MENTION

Profile Contour 2940nm by Sciton

The Sciton family of products may be ordered in many configurations to suit the physician’s needs. Specifically, this Er:YAG can produce up to 50 pulses per second at 0.9 Joules per pulse. Sciton has an almost endless array of new configurations.

Most Promising New Laser Technology

Fraxel SR by Reliant Technologies

The basic concept of Fraxel is to create microscopic wounds of approximately 60-100 microns in diameter to depths of 400–700 microns. The distance between these microscopic wounds is stated to be currently optimal at around 200 microns. This will indeed spare many dermal and epidermal cells which are uniformly ablated by the CO2 laser and lead to the negative side effects and significant patient downtime of the CO2 laser. This is indeed a most innovative and interesting approach to skin rejuvenation and collagen synthesis. The comparisons to the CO2 laser should be considered in terms of side effects and comparative results as the Fraxel SR wavelength is 1550nm, and the CO2 is 10,600nm. They are obviously two very different technologies. Len DeBenedictis, Reliant’s President and former Chief Technology Officer of Coherent Medical, is the brainchild of this technology and the technology was further developed by Drs. Rox Anderson and Dieter Manstein of Harvard’s Wellman Photomedicine Labs. The Fraxel SR handpiece is designed for uniform delivery and pattern density relative to the speed the physician moves the handpiece. For instance, if the physician moves the handpiece at 2 cm per second, the device’s scanner will automatically adjust itself so the desired wound density and number are created in that area. This is an automatic fail safe feature but may be adjusted by the physician. A second fail safe feature is that the device will not operate if the laser handpiece is not in contact with skin. This is one of the few technologies I have investigated which represents a new viable paradigm. As with all new approaches, we must look at independent clinical results and proceed from this vantage. However, there is a combination of great imagination, engineering prowness and a logical extension of previous art which separates this technology from other new technology in very profound ways. It is my firm belief that Fraxel is destined to be a technology of major significance in aesthetics.

Best IPL Technology For Hair Removal

StarLux LuxR™ and LuxRs™ by Palomar Medical Technologies

Palomar was the first company to receive a patent for laser hair removal, and it continues to shine in this category with the StarLux™ Pulsed Light and Laser System. The StarLux LuxR™ and LuxRs™ handpieces are especially effective, since they are cleared for permanent hair reduction and can treat skin types I - VI, including tanned skin. The LuxRs fluence extends up to 70 J/cm2, with pulsewidth up to 500ms, and it had a relatively large spot size, which is ideal for treating small to medium anatomical areas. The LuxR has a maximum fluence of 45 J/cm2 and uses a very large spot size of 16 x 46mm. This allows very fast treatments for large anatomical areas. StarLux also has an advantage of contact sapphire cooling in the handpiece and a true “flat-top” pulse structure, which lets practitioners take advantage of these high fluences with significantly reduced side effects. StarLux performs equally, and in some cases better than some of the leading lasers on the market in hair removal.

HONORABLE MENTION

Clareon by Novalis Medical

While Novalis is not a "top tier" company, their patented krypton/xenon gas approach to IPL in targeting melanin is both logical and innovative. A small epidermal cooling system is recommended. The Clareon is a table-top device and also has handpieces for acne and photo facial applications.

Most Affordable IPL Device

Spa Touch Pro by Radiancy

The SpaTouch Pro has a new look and a UV handpiece for acne. Listing at $19,500 this is the clear winner in this category once again. I assume the UV handpiece will increase this base price. Most readers may be surprised that Radiancy has the largest installed base of IPL units in the world.

HONORABLE MENTION

Skin Station by Radiancy

The Skin Station at $29,900 still owns this category. 400nm–1200nm. The Radiancy products use a combination of a traditional non-selective heat element and IPL handpieces which they refer to as LHE technology.

Best Tatoo Removal Laser

MedLite C6 by Hoya ConBio

ConBio’s commitment to this complicated area of aesthetics should be applauded. The statistics on the tattoos applications and their subsequent desire to remove or alter them are astounding for use of the “baby boom” generation. Excision can be an option, but practitioners who can master this complex art in urban and some suburban areas will find this a very profitable business. The Medlite C6 creates wavelengths of 1064nm, 532nm, 585nm, and 650nm. The dye-impregnated polymer rods create the wavelengths of 585nm and 650nm. These additional wavelengths add much need flexibility to the numerous tattoo dyes which are largely unregulated. The device is at heart a frequency doubled Q-Switched Nd:YAG operating a 1000mj. Q-Switching is very fast and uses differing principles than other long pulsed aesthetic lasers. Basically, the device creates photo acoustical effect and breaks apart the pigments. These pigments are then scavenged by macrophages. Several treatments are required depending on the color(s) and size of the tattoo. The Medlite™ C6 effectively has four wavelengths in one laser.

HONORABLE MENTION

NaturaLase 2J by Focus Medical

NaturaLase offers the same wavelengths as the Medlite C6. The NaturaLase 2J Q-Switched tattoo laser actually has more power than the Medlite C6 at 1800mj. The NaturaLase 2J also claims a flat top pulse structure which is preferable over the Gaussian pulse structure. This device may be a serious contender for Best Tattoo Laser next year as more NaturaLase devices enter the marketplace.

Most Diverse Aesthetic Laser

Lumenis One by Lumenis

Lumenis incorporates their great 800nm LightSheer ET, a medium powered 1064nm Nd:YAG and a brilliant and diverse intense pulsed light system in this one remarkable aesthetic device. The IPL handpiece moves away from the latest trend of multiple handpieces and creates a single handpiece. Lumenis calls this the “Universal IPL.” The handpiece has extraordinarily easy-to-change cut-off filters at 515, 560, 590, 615, 640, 695, and 755nm. The two laser wavelengths and the 7 IPL filters are all controlled with an elegant and intuitive touchscreen interface which incorporates a solid knowledge base with each treatment modality. The information contained in the user interface is the closest thing the industry currently has to having an experienced laser physician in your treatment room. Add this to sapphire epidermal cooling with all treatment heads, the new ergonomic designs of the treatment heads, the smooth and regulated pulse structures, and what we have here is a very remarkable work of versatile engineering. There are many other features, benefits and specifications too numerous to mention. Needless to say, Lumenis’ engineers are not resting on the pioneering work of their past.

HONORABLE MENTION

The CoolGlide Xeo Cutera

Cutera’s Xeo combines their versatile long-pulse Nd:YAG laser technology with superior and innovative IPL technology. Cutera’s IPL technology includes contact sapphire cooling, precise operator feedback, and regulated output. One important aspect of the Xeo’s IPL component is that it allows more flexibility in treating lighter hair which the Nd:YAG has difficulty with. The Xeo also has an intuitive user interface and is upgradeable in a variety of configurations which can include the Titan skin tightening and non-ablative applications. Cutera’s engineers have created a great family of products around the CoolGlide platform.

Best Customer Service/Support

Syneron

Syneron is a very large rising star in aesthetics. Very often with devices which are very close in efficacy, it is dedicated customer training and support which ultimately create loyalty and make the difference. A great majority of Syneron customers have a special loyalty to the company.

HONORABLE MENTION

Candela Corporation and Cutera

I have personally witnessed the dedication of Candela’s customer service and fully expected them to win this category. Candela has made great strides from the technical side which allows for customer service to naturally improve. The pulse dye laser is a classic example. Cutera has a very unique approach and also has its very loyal following. Cutera actually holds seminars which are not designed as marketing vehicles in various regions of the United States and Canada. The purpose of the seminars is to educate and allow practitioners to compare notes, ask questions, and challenge the company. A very strict “no selling” policy is the rule. Also seen with Cutera’s customer service and support is the evolution of the educational approach to increasing the number of satisfied customers and retention of those customers for years to come. The word of mouth by those customers will help to gain new ones.

Most Educational Website

Candela Corporation

Candela’s web site is elegant, easy to navigate, and provides comprehensive information about their products and company. The “My Candela” portion of the web site was designed to assist aesthetic practices in marketing and other important aspects which make for a more complete relationship with their customers.

HONORABLE MENTION

Lumenis

Lumenis’ web site allows the user to select a product or application with ease. Specifications, white papers, and other useful information are easily accessible. With Candela and Lumenis, as well as Cutera and other web sites, it would be helpful if more graphical animation would be employed to relate the concepts of laser and light tissue interaction.

Best Stand-Alone Epidermal
Cooling Device

Cryo-5 by Zimmer Elektromedizin

The Cryo-5 Zimmer wins in this category once again. No serious aesthetic practice should be without one. This device can provide increased patient comfort and safety even when a device has integrated cooling. Its applications range from hair reduction photo facials, chemical peels, Er:YAG resurfacing, BOTOX injections. The device may be used for pre and post treatments in a variety of ways. In fact, there are so many uses for this device, they are almost impossible to list.