Intense Pulsed Light Versus Flourescent Pulsed Light for Photodamaged ...

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Following informed consent the patients washed their
faces, and a thin layer of refrigerated cooling gel was
applied to all treatment areas. No topical anesthesia was
used on either facial half. One side of the face was treat-
ed with the Lumenis One using the 515-nm, 560-nm and
590-nm cut-off filters (double pulsed, 3.04.0 ms pulse
durations, 1020 ms pulse delay). Three passes were
done using aggressive fluences (1421 J/cm 2 ), chosen fol- lowing a test pulse that achieved a clinical endpoint of
erythema and heat. The contralateral side of the face was
treated with the Harmony platform using the green
(540950 nm) and yellow (570950 nm) fluorescent
pulsed light handpieces (single pulsed light, 10-12 ms
pulse durations). Three passes were done using aggres-
sive fluences (1420 J/cm 2 ) chosen following a test pulse that achieved a clinical endpoint of erythema and heat.
Patients were instructed not to actively tan between treat-
ments, and to use sunscreen when venturing outside. Photographs of the frontal and oblique views of the face
were taken of all subjects before treatment and one removal. The retail price of the
basic unit (left) with the Universal
IPL handpiece costs about
$90,000, not including the addi-
tional equipment. The Harmony (Alma Lasers, Israel,
US headquarters in Chicago) is a
multi-technology platform that
can accommodate 11 different
handpieces delivering pulsed light,
Q-switched and/or long pulsed
Nd:YAG, Er:YAG, fractional Er:YAG, infrared light (8001320 nm) for nonablative skin tight-
ening, and more. The device weighs 40 kg with dimen-
sions of 65x45x40 cm. Due to this small footprint and
weight, the Harmony unit can be shipped to Chicago for
depot servicing. Downtime due to device malfunction is
reduced to about one day because Alma Lasers sends
out a loaner device via overnight carrier. Depot service
is usually half the cost of traditional on-site technical
service and provides more rapid turn around time. The
Harmony device equipped with the green
and yellow pulsed light handpieces
used in this study costs about
$60,000, and an additional
nine modalities can be
added. The purpose of this
prospective study was to
determine if fluorescent
pulsed light from the
Harmony (right), a system
that is less then half the
size, weight, and price of the
Lumenis One IPL, could pro-
vide similar results for global pho-
torejuvenation of the face. METHODS Eight volunteers recruited from a single group practice
received a series of three to five split-face treatments
three weeks apart, in which one half of the face was
treated with the Harmony pulsed light device, and the
other half was treated with the Lumenis One IPL device.
All patients were Caucasian (mean age 45 years, skin
types IIV) with a modest degree of photoaging (mean
score 2 on the 04 Global Score for Photoaging) includ-
ing dyspigmentation, erythema, telangiectasias, and tac-
tile roughness. Intense Pulsed Light Versus Flourescent Pulsed Light for Photodamaged Skin: A Split-Face Comparison Martin Braun, M.D. Vancouver Laser & Skin Care Centre Inc., Vancouver, B.C., Canada ABSTRACT Intense pulsed light (IPL) has been the standard for
treating photodamage nonablatively. This prospective,
randomized, controlled, single-blind split-face trial com-
pared two multi-technology broadband pulsed light
platforms for the treatment of photodamage: The
Lumenis One IPL system (Lumenis Corporation, Santa
Clara, CA) and the upgradeable Harmony pulsed light
system (Alma Lasers, Chicago, IL). Eight volunteers (skin
types IIV, mean score 2 on the 04 Global Score for
Photoaging) received three to five treatments three
weeks apart utilizing the Lumenis One on one half of the
face and the Harmony on the other. Parameters were
aggressive and determined by test spot application with
endpoints of mild erythema and heat. Patients received
three complete passes during each treatment session.
Refrigerated cooling gel was applied prior to treatment.
No topical anesthesia was used. Investigator and patient
self-assessments, as well as evaluation of before and
after photographs by two blinded dermatologists,
showed similar fading of dyspigmentation, telangiec-
tasias and erythema, as well as similar textural improve-
ment. Patient assessment of discomfort during treatment
was also comparable. There were no adverse effects. INTRODUCTION For more than ten years intense pulsed light (IPL,
5001200 nm) has been a popular nonablative modali-
ty for telangiectasia, erythema, lentigo, dyspigmentation
and reduced skin quality secondary to photoaging. In
2000, visible improvement in wrinkling, dyspigmenta-
tion, telangiectasia, coarseness, and pore size was
shown in more than 90% of patients in a full-face study
of IPL by Bitter, 1 in which downtime was minimal and patient satisfaction surpassed 88%. At least six manufacturers actively market IPL devices in
the United States, and thousands of competing systems
have been sold. However, to the authors knowledge,
there have not been any split-face trials comparing the
efficacy of various IPL devices. Lumenis One is from
Lumenis Corporation (Israel, US headquarters in Santa
Clara, CA), a platform with a Universal IPL handpiece
capable of delivering wavelengths from 515 to 1200 nm
with multiple cut-off filters in the 515 to 755-nm range.
It is also the most expensive IPL on the market today
and is quite large (154 kg., 67x47x159 cm), requiring it
to be serviced on site. The Lumenis One can also be
equipped with a long-pulsed Nd:YAG (1064-nm) hand-
piece and an 810-nm diode laser handpiece for hair Figure 1. A 40-year-old woman (skin type II) before and after five split-face pulsed light treatments at 3-week intervals. Left face (Harmony): two passes with green head (540 nm, 15-20 J/cm 2 , 10-12 ms pulse duration) followed by one pass with yellow head (570 nm, 16-20 J/cm 2 , 10-12 ms pulse duration). Right face (Lumenis): 515/560/590-nm cut-off filters, double pulses (4.0/4.0 ms, 20-nms delay); 590-nm cut-off filter, triple pulse (3.0/3.0/3.0 ms, 30-ms delays); three passes at 17 to 20 J/cm 2 . DISCUSSION Photographs taken one month following the final treat-
ment were compared by blinded evaluators to similar
photographs taken at baseline. Investigators did not see
any objective difference between the two sides of the
faces with respect to dyspigmentation, vascular changes,
or textural improvement. Patients were asked to evaluate the pain associated with
each treatment, and to compare the results of the left
and right sides. At the conclusion of the study patients
evaluated their results by comparison with pretreatment
photographs, and were asked if they saw any differences
between the left and right sides of their faces. None of
the patients reported any subjective difference between
the two sides of their faces with respect to dyspigmenta-
tion, vascular changes, or textural improvement, and
they unanimously rated both sides global improvement
as equal. Additionally, both treatments were equally
well-tolerated, with no difference in the incidence or pro-
file of adverse effects. The Harmony platform is smaller, lighter, less expensive
to purchase and maintain, and can be upgraded with a
variety of additional light-based modalities the Lumenis
One does not offer. Because efficacy between the two
instruments is basically equal with regard to photoag-
ing, Harmony has a clear advantage over the Lumenis
One for a clinician who wishes to offer other light-
based modalities without purchasing another system. CONCLUSIONS After treatment, comparison of facial halves did not reveal
any clinically obvious differences by investigator evalua-
tion or patient self assessment. Both treatments were well
tolerated, with no difference in the incidence or profile of
adverse effects. In an increasingly competitive market-
place for cosmetic light-based treatments, the more cost
effective, multi-technology Harmony platform offers a
competitive advantage over the overall costs of multiple
stand-alone systems without compromising efficacy. DISCLOSURE The author has received honoraria and equipment dis-
counts from both Lumenis and Alma Lasers. The study
was devised and funded by the author. REFERENCE 1. Bitter P. Non-invasive rejuvenation of photodamaged skin using
serial, full-face intense pulsed light treatments, Dermatol Surg
2000;26,835-843. Table I: Patient Improvement Telangiectasia & Erythema Pigmentation Skin Texture Patient Harmony Lumenis One Harmony Lumenis One Harmony Lumenis One 1 3 4 4 4 3 4 2 3 3 3 3 4 4 3 3 3 4 4 3 4 4 3 3 4 4 4 4 5 3 3 3 3 4 4 6 4 4 4 4 3 3 7 4 3 3 3 3 3 8 2 3 3 3 3 3 *As graded on a scale of 1 to 4 where 1=025% improvement, 2=2650% improvement, 3=5175%improvement, 4=76100% improvement. month after treatment, using a Canfield Fuji S2 digital
camera with a standard fixed focal distance and chin rest
to assure consistency. Patients washed their faces prior
to photography. RESULTS All eight patients completed the study. Two blinded
dermatologists evaluated telangiectasia, erythema, mottled pigmentation, and textural improvement on a
14 scale (1=025%, 2=2650%, 3=5175%,
4=76100%) by comparing pre treatment and post-
treatment photographs. Table 1 shows the results for the improvement of telang-
iectasia and erythema, pigmentation and skin texture as
graded by evaluators. There were no clinically obvious
differences. Figure 2. A 30-year-old woman (skin type III) before and after five split-face pulsed light treatments at 3-week intervals. Right face (Harmony): three passes with yellow head (570 nm) and green head (540 nm) at 16 to
19 J/cm 2 and 10-ms pulse duration. Left face (Lumenis): three passes with 560-nm cut-off filter, double pulses (4.0/4.0 ms, 20-nms delay) and 16 to 19 J/cm 2 .

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