The versatility of laser platforms

The Dermatology Times Podcast Series is brought to you by a Candela, a global leader in the aesthetic medical device marketplace.

In this edition, host Scott Kober talks with Dr. Joseph Niamtu, cosmetic maxillofacial specialist based in Midlothian, Virginia. Dr. Niamtu examines improvements and innovations made in laser technology during the more than 20 years that he’s been practicing. He also talks in detail about how the CO₂RE laser from Candela has improved his business and patient outcomes.

Scott: Thank you, and welcome to this podcast. My name is Scott Kober with Dermatology Times and today we’ll be talking about the use of versatile laser technology-based platforms to address patients’ maxillofacial aesthetic needs.

I’m happy to be joined today by Dr. Joseph Niamtu, a cosmetic maxillofacial specialist at Niamtu Cosmetic Facial Services in Midlothian, VA. Dr. Niamtu is a consultant and speaker for Candela. 

Welcome Dr. Niamtu, and thank you for joining me.

Dr. Niamtu: Thank you for having me.

Scott: When did you first begin user laser technology for surgical and aesthetic procedures? 

Dr. Niamtu: I started doing laser treatments in the mid-1990s when it was kind of an uncharted frontier because the technology was so new. There were no instructional manuals, so to speak, for us to follow. It was a steep learning curve for those of us who were early adopters, and there was a lot of trial and error. It was exciting, but also scary. Fortunately, the technology has come a long way and our experience now makes the use of lasers much safer and more predictable.

Scott: What are some of the primary ways in which laser technology has improved in the 20 years since you began using it? 

Dr. Niamtu: First of all, we learned a lot of lessons on how to treat and how not to treat patients, as well as which individuals are likely respond better to laser procedures and which are more likely to have problems. 

Some of the earliest laser technologies utilized a lot of energy and there was a lengthy healing process. Ultra-pulse lasers were one of the earliest advancements – they had very short pulse times so that the lateral heat damage was minimized during treatment and results became more predictable.

The next major step was the introduction of erbium lasers, which were followed by fractional lasers. Fractional lasers allow you to treat approximately 80% of the skin surface instead of the entire surface. In all honesty, I was not a big supporter of fractional lasers in their earliest days because I didn’t see the same quality of results as with other lasers, but the technology has improved significantly in the last few years. There are now smaller, lighter lasers available, the recovery time following procedures is much less, and the results are consistently very good.

Scott: How would you characterize your experience with CO₂ lasers and specifically the CO₂RE laser? 

Dr. Niamtu: CO₂ lasers are basically all I’ve ever used since the mid-90s. I’ve done thousands of cases with my initial CO₂ laser, and it still produces excellent results, but the machine is a bit bulky. A year or so ago, I began considering a replacement, so I began asking colleagues whose opinions I respect for their recommendations, and the one device that kept coming up was the CO₂RE laser from Candela. I ending up buying that laser in the summer of 2017.

In the few months since I acquired the CO₂RE laser, I’ve noticed several benefits. First of all, it’s a small, light machine that is extremely portable. I can quite literally lift the machine off the ground by myself. 

If you look at the energy delivery component of the CO₂RE laser up close, it looks like a small donut. Most lasers work like a paint roller, so if you move them over a treatment area, it covers the whole canvas. The fractional technology of the CO₂RE laser works differently. It’s like putting polka dots on the wall. The laser treats the polka dots but leaves the spaces in between them – in this case, the surrounding tissue – untouched. Since you are only treating the intended target and not damaging the surrounding tissue, I find that my patients are healing faster thanks to the CO₂RE system’s fractional technology.

What is particularly impressive about the CO₂RE laser is that there is spike of laser treatment going through the center of that doughnut that can be particularly powerful. When the laser is used in what is called Fusion Mode, the laser penetrates deep into facial tissue, allowing you to treat both the superficial skin and deeper tissue simultaneously.

Since I acquired the CO₂RE laser, I would estimate that I’ve used it for approximately 60 facelifts, more than 100 eyelid surgeries, and several scar repairs in the last year. The technology has proven to be predictable and affordable.

Scott: Are there any surgical procedures for which you use the CO₂RE laser?

Dr. Niamtu: Yes, in addition to eyelid surgery and scar repair, I have used the CO₂RE laser for otoplasty, which is the treatment of protruding ears, as well as for the treatment of moles and lesions. If you do some of these surgeries with a traditional scalpel, there can be significant bleeding, while the CO₂RE laser produces a bloodless incision. And when you don’t have any bleeding, you have less bruising, less pain, and faster recovery.

Scott: Do you feel that the CO₂RE laser could have clinical utility outside of dermatology practices?

Dr. Niamtu: Most definitely. My background is maxillofacial surgery, and my friends that have this laser range from dermatologists to ENTs to plastic surgeons. There’s something in this laser for any type of practice where you’re doing cosmetic laser or surgical treatments. There are several indications specific to Ob/Gyns as well. The CO₂RE laser a versatile platform cleared by the FDA for use in more than 100 indications across 10 medical specialties.

Scott: Excellent. I think that this has been an excellent summation of how far laser technology has come in the last 2 decades.