With treatment options ranging from IPL, to lasers and prescription medication options, vascularity expert Gilly Munavalli, MD explains the tools best suited to address each type of vascularity fro
Taking Advantage of the Versatility of the Nordlys™ System
Versatility is one of the most important characteristics when shopping for a laser system to introduce into your cosmetic dermatology practice. You want a system that is going to be a workhorse, one that can be used to treat a variety of patients with a variety of conditions.
The Nordlys by Candela is one of the most versatile platforms on the market, offering three foundational technologies in the same device – an intense pulsed light (IPL) laser, a non-ablative fractional laser, and a neodymium (Nd):YAG laser. This device is FDA cleared to treat 21 different dermatologic conditions, including port wine stains, telangiectasia, rosacea, and many others.
The workhorse of the Nordlys is the Ellipse IPL. The Ellipse comes with 8 different handpieces, each targeting a different narrow wavelength spectrum ranging from 400 to 950 nm. The narrowband of wavelength output allows users to target what they are trying to treat while avoiding unwanted damage to adjunctive areas. Studies have shown that these narrower wavelength bands enable treatment of photodamaged skin using sometimes as little as half the fluence of broadband IPL. Also, fewer treatments can achieve comparable results.1
In cosmetic dermatology, there are three areas that we are typically targeting – blood, melanin, and water. IPL devices focus primarily on the blood and melanin. With the Ellipse IPL, the handpieces that operate at the lowest wavelengths – most notably the PL400 – are generally most effective when targeting these two chromophores and addressing pigment-related issues such as red and brown spots in patients with lighter skin. Those handpieces that operate at higher wavelengths are most effective for issues such as skin rejuvenation and hair removal. With the Nordlys, there are handpieces geared specifically for light skin and others for darker skin.
More information on each Ellipse IPL handpiece is included in Table 1.
One of the advantages of the Ellipse IPL involves the size range of each handpiece type. Because of the small dimensions of the 8 mm diameter hexagonal crystals, you can maneuver each handpiece into tight concavities and convexities, especially around the nose, areas that are often difficult to treat with other IPL devices currently on the market. On the other hand, the 10x50 mm larger crystals allow for rapid coverage of larger flatter areas such as the cheeks, back, and arms.
The Ellipse IPL features dual-filtration technology. The first filter focuses on ultraviolet light, filtering out everything between approximately 330-420 nm. The second filter focuses on filtering out those higher wavelengths that typically heat water. Because water is generally not a target of IPL treatment, the extra filtering decreases bulk heating of the background skin.
Another advantage of the Ellipse IPL is its customizability based on operator experience. There are guided and expert modes. The guided mode is the initial default, helping new operators gain confidence in the device with less delivery of energy. As you gain experience with the Ellipse IPL, you can introduce more personalization into the device interface, modifying the amount of energy delivered, pulse duration, number of pulses in a train, and time between subpulses. You can even record and save settings used for particular patients, which can be extremely helpful when you have patients coming back for multiple visits. Even if you don’t want to use the exact settings at subsequent visits, it’s helpful to have that prior baseline at your fingertips.
The Nordlys system is easily maneuverable with four lockable wheels and incredibly quiet. It’s the only IPL device I’ve used where I can carry on a conversation with my patient and/or staff while the laser is in operation.
The manufacturer support that Candela provides for all of its technology is outstanding. Updates to the Nordlys interface can be accessed wirelessly, which is a big advantage when there are new features added.
In a nutshell, the Nordlys is a perfect technology for a practice just starting out with laser technology. It is FDA cleared for treatment of 21 different indications, many of which are commonly seen on a daily basis. Its versatility assures that it will be used and used often in any cosmetic dermatology practice.
Bjerring P, Christiansen K, Troilius A, Dierickx C. Facial photo rejuvenation using two different intense pulsed light (IPL) wavelength bands. Lasers Surg Med. 2004;34(2):120-6.
|PL400||400-720 nm||Pigmented lesions|
|PR(S) 530||530-750 nm||Skin rejuvenation, vascular lesions|
|VL(S) 550||555-950 nm||Skin rejuvenation, vascular lesions|
|HR 600||600-950 nm||Hair removal (Fitzpatrick I-V)|
|HRL 600||600-950 nm||Hair removal for large areas|
|HRD 645||645-950 nm||Hair removal for darker skin (Fitzpatrick IV-VI)|
|Nd:YAG 1064||1064 nm||Leg veins, vascular lesions, onychomycosis|
|Frax 1550||1550 nm||Skin resurfacing, textural irregularities|