summer 2004 volume 3 issue 4 Apogee Elite CYNOSURE INC. By David M.Cauger, Contributing itor nvestigatng new light-based aesthetic site at ther facilites. These reviews wil sxamine both the strengths and weakness se new products from a purely wil be using test meters and asking ese devices. [wl facturers that agree to thee reviews "The goal of these reviews is de the physician an unblased Took ow light based devices and what they Finding any compensation fom the companies reviewed in this series of articles or Aesthetic Trends & Technologies. These reviews do not sarily reflect the opinion of Aesthetic ends & Technologies. ADAT isn no wy efor the outcome ofa i her posite ornagative if hey ehaoee to purchase one ofthe produ series to report on product 2 provide an avenue of understanding ynosure, Inc. revealed the Apogee Elite at the Annual Meeting of ‘American Academy of Dermatology im Washington, Dip in March of this yeafon June 10h {visited (Cynosure at their headquarters in Chelmsford, MA, to examine the dual wavelength laser. The Elite is high-powered variable pulse 1064nm Nd:YAG, and proven variable pulse 75snm Alexandrite in one single unit, This is, without question, the ‘best designed marriage of two long pulse wavelengths in the emerging trend! of mult-wavelength aesthetic lasers While several companies do offer 1 1064/755nm laser, they are lacking in the required fluences on the 1064nm side as well as other critical specifications. The Elite does not share these problems and dalivers an sao, ows laser & light technology impressive 80 Jem with a 10mm spot with the its 1064nm N&-VAG. The Elite has spot siz of 3, 5,7, 10, 12 and 15mm, pulse durations between 0.4ms to 300ms, and repetition rates of up to 5 shots per second. These specifications provide incredible versatility For example, it will allow a hair removal treatment ofa skin type Il patient with a 75am mode; and in less than 30 seconds, it ean be treat- ing reticular leg veins with 2 1064nm mode. This is but one scenario whieh distinguishes the Elite asa frst ‘choice laser for those offices that do not currenty own a high-powered Nd:YAG or an Alexandrite. “There has never been, nor will there ever be, a single wavelength whieh ean teat the same cosmetic conditions on all skin types. II coulduta view this asa downside. However, this approach allows for lighter Dhandpieces as well as assurance that if. lens on one handplece requires replace-ment, whichis common to all lasers, one can simply substitute another size, thus keeping the laser {in operation. Changing spots sizes is very simple and easy. I did it successfully on my very first try Simply remove the hendpiece from the end of the cable, snap on anew fone and place it in the calibration port in the top ofthe machine ‘The Elite automatically senses the spot size, and you are ready to select parameters and treat, It you fare switching between 755am and 1064 modes, the Elite will remember your previous settings or you have the option o override. The hand- FDA-Cleared Treatments, ‘Apogee Elite pick only two wavelengths fora cos- metic practic, it would be @ 55am Alexandrite and a variable pulse high powered 1064nm Né:YAG. Having both of these wavelengths in one single unit with the Elites supe- Roth the loser and the facilities plece connects to a SmartCool™ Flor power specifications sets anew ere well designed and orden. The (Cryr0 5 Zimmer) chiller. This is an standard forall aesthetic laser Cynosure staff allowed me to test the elegant and quiet stand-alone refrig- companies controls, and Iwas given complete eration unit whieh will bring surface {spent five hours reviewing the instruction inthe use and operation skin temperature down near freezing clinical uses and design with Marina ofthe laser, Ater this session, three in about 30 seconds, Kamenakis, VP of Marketing: Evan ol tentigos of approximately 3mm The SmartCool provides a good Sherr, Director, Clinical Research; in diameter on my upper back were epidermal cooling strategy and can successfully also be incorporated into many other treated treatments not related to those of the The Elite has a straightforward touchpad interface ite, Examples ofthis would be chemical peels or Erbium YAG with a monochrome LCD display. ELITEOPERATION resurfacing. The Elite has a staight- ‘The Elite can forward touchpad interface with a be ready in ‘monochrome LCD display. Rafael Sierra, Ph.D,, Chief Technical Nd:YAG mode within 7 seconds of COtticer; and James Bol, Director, turning it on. The Alexanctite crystal [New Product Development. All the takes only about ten minutes tobe ‘above personnel were very candid ready for operation. After this point land did not hesitate to answer some one can switch seamlessly between ‘of the tougher questions [had pre- both wavelengths without having to pared. Iwas allowed a full internal reboot the laser. Handpieces are inspection of the laser as well asthe very light and ergonomic. reduction facilites forall of “The spot sizes cannot be “dialed ‘Cynosure’s products in to various sizes, and some may L sor ews‘APOGEE ELITE SPECIFICATIONS a eens tonnes iamersnipettng coger a aetclaetanaon ction namecwneneete : ‘poatcatons inthe format = roteousion Scns Ean 2 a 5 ELITE HAIR REMOVAL: 755NM =) Eo ALEXANDRITE & 1064NM ND:YAG Pea Maximum Fluence near epee = cremate cin perspotsize cwnbothatigh-powered fooanm pnd Na'YAG anda got 55m = ae ‘Alen nl pet si nmi rae Por Frapetice yes hate nt in tat, hy aga eee 755nm Alexandrite. If the patient is a Aiming Beam Ftaptick pe VL hey amo tive tit owe he 184 NEA Skin Cooling ‘The only variance of choice is with tecrcal "ypeV where depending upon he app eve re pe size tet wi etnn rand : ‘hen ont with Alon, Three ed ‘son for this is that the 755nm has @ Higher coeticint toe target ‘traren npn on Le PecFCATIONS tnximum Maenca at hm aahleNGYAG Tam very pees tose tht spotsneatagiven pulse draton, th Aletandnte so good Cymer provides rnepareny in and alo the speed arr can gush n good working conten theirpruc specication For once elven second. The eit eptc abd appopiate parameters {eid nothavetove-cnrtactor tone Fal avaible pee ute, ili almost al aes catlnte maxim ences Hecate aos end epidermal cong, produce inant higher rate o thoy are sated ently nthe backot is important tonoe that olla deste thn ven the car tashaeluear rly edo ave_ igh powered NGYAG, Thi ven vines puschsing alee ist pube tn eter hn 5 mil decide what you wish to teat, know seconds so don't bother to consider the predominant skin types of your anything beyond that as a benefit. It patient base, and check the repu- any company's specification states tation ofthe company. After that, “up to” 300 J/cm, ask them with Duy on specifications. ‘what spot size and pulse duration do Specification ultimately wi they achiove that fluence. Itis best to termine treatment outcomes. Do ask them the maximum fluences with not waste Your time reading ‘each spot size and whether or not it sponsored clinical studies or 4s independent of pulse duration. physician testimonials. Buy on specl- The chart above shows basic but fications. The key specifications are critical specifications ofthe Apogee 3 amass‘ABSORPTION COEFFICIENT ‘SUGGESTED PARAMETERS, HAIR REMOVAL 755 nm Alexandrite 1064 nm ND:YAG. Ssintye—Ndmmilo—PbeDuation mien’ ueDuraon ro i laser & light technology wn ra tauer with alr which has les mass ris ight brown, Furthermore, hairs nn eT eR ral treatments and therefore present less of a target. Very simply = an Nd:YAG requires a greater target aw than does the Alexandrite. The " N&:¥AG also has an affinity forthe v ehromophores of both oxyhemo- ‘lobin and water While this characterise gives the 1064nm N&LYAG its qreat versa- Se er am ity, alo means it requires higher tag te rales gaara nl ‘uences to overcome the competing ‘chromophores and its relatively ‘weak ettzaction to melanin Aslan skin would be but one 1 miniaturization occurs, it would (On the other hand, the downside example of how the tandem use of be wise to shoren the pulse duration. of any Alexandrite isthe risk of the Eis 755/1064nm wavelengths 1 teaing anatomical locations where adverse reactions when treating skin could be creatively sed. In lighter alr are deeper seated suchas the types IV-V1 or tanned patients Asions skin types the practioner publeegion, ts wise to use the Fluences have to be lowered to avold may test the patient with 755am at 15mm spot with slightly longer pulse risks of hyperpigmentation, hypopig- 15 J/cm’ @ 40ms with a 12mm spat, durations. These rules are set forth in ‘mentation and burns. These lower If perifolicular edema is achieved Cynosure' clinical guidelines, and fluences may result in delayed re- and no pigment changes occur in the the LOmm spot should be used only in ‘growth, but the odds in permanent skin, then its common to increase areas where itis nat practical to use follicular death drop dramatically inthe fluences by 1 Joule inatervals. the 12mm spot. proportion to these lowered fluences. If no unwanted side effects are However when treating darker ‘The Absorption Coclficient chart, observed, then that isthe fluence Asian types, typically classified as a ‘above, will provide a visual refer which should be used for that skin types 4 or 5, itis bost to start ‘ence ofthese realities, ‘enatomieal location with the N@:YAG, performing a test 4 a wensspot at 40 J/cm’ @ 20ms with a 10mm ELITE VASCULAR TREATMENTS: spot. Ifno side effect is observed, _1064NM ND:YAG move up in fluence in increments of The specifications of the Apogee. 9 J/cm to a maximum of 60 W/cm’. Ete will allow it to successfully Aiter the 3rd treatment you may treat telangiectasias ofthe face and. notice that the hairs have less diam- legs, cherry angiomas, and leg veins ter but are stilla cosmetic concern up to 2.6mm in diameter. laser & light technology tothe patient. In this cate itmay With venels ver 2.0mm is my wise to prescribe tyrosinase firm conviction tha sclerotherapy be Inhiber such a hydroquinone $9 the tet teat ent modalty ‘ite cea {alowed bythe NEYAG to remove sonbock any iting whieh ey our pot When Il obterved thet the trextnent ‘Wit telangiectasia itis best to peeled pind athe Leg veins over im ere rc cee eevee’ ae eee cia Rot al ee EC ei 1otam Acetinie Resowers SSAA ales oertlp win cpa ito ar age re ‘Acree aT Anish ofthese miniaturized hairs." Whentteting vessels itis__—_«may be required. The table onthe This strategy works fine for areas recommended that a coating of cold lat contains suggested treatment Which ate not large such a8 men's itrasonie gl or substantial parameters ing the Hit's 1084 backs where applications ofthe equivalent be used in conjunction wavelength. prescriptions are not practical. In withthe SmantCoat system designed those cates where tyrosinase provide epidermal cooling during LITEPIGMENTED LESIONS inhibitors cannot be used inorder eatment. TREATMENTS: 755M ALEKANDRITE es ‘The Apogee Ele wis short pulie durations ofthe NEVAG in SUGGESTED PARAMETERS oe on enemas. ‘VASCULAR TREATMENTS remove simple and solar lentigos During my visit to Cynosure's offices ‘Thad four solar lentigos on my upper proportion to hair diame tis best to advise patients that ie ae et of nl back treated. lam pleased 1 report required tocehieve an cceptahie that hee ar now compet absent ‘emit any event the strategy of | Jen) mom | 18/15] an one would require anther wet: prise amram it at a higher fluence. No adverse powered Nd:YAG in tandem for CI peter ce in ee vege |mm| vom | man] | ean cere. The tbe on he advanced practitioners have been eae beers (oie doing successfully for several “arte | sam | oes | ro=wo| 1-2 | Paremeters for Pitzpatrici: types II. years. Having both of these options {im one device allows the most com- prehensive approach to hair ELITE NON ABLATIVE TREATMENTS: eam | ote] 1-2 | 1064 NDLYAG The non-ablative skin rejuvena- removal and subsequent patient satisfaction ‘-am | tam) 1-1 | tion treatment of the Apogee Elite ‘The chart on the previous page will generate new collagen synthesis contains my basic suggested param. PTE Mutarteryenceeatstonawmas in select patients and improve the ters for hair removal with Apogee Smsiminmanarmmnarnertimnt appearence of some rosacea sub Biite, er nconie eeianenanoe ‘types and superficial telangiectasias. 5 anne evasion‘The objective in achieving collagen treatment which lends Itself to the synthesis isto heat the upper conjunctive use of BOTOX™ and papillary dermis by absorption of dermal fillers, laser energy by water and diffusion of heat from the microvasculature to.a temperature between 45°C ‘SUGGESTED PARAMETERS, 2 [NON-ABLATIVE TREATMENTS and 50°C. ‘The face is treated in sections of eT approximately 20-25 square centime- Pe tors, The tip ofthe Smm spot is held Taetl dtie ean] ose about 1-2 centimeters from the skin surface. This will defocus the beam to about fmm, Move the handpiece ‘across the area in a relatively fast PRICE, KEY FEATURES, AND ‘motion back and forth over the treat. WARRANTIES ‘ment area in aleftto right and top to System Price. The list price of ‘bottom. Once the first pass is the Apogee Elite is $115,000. This ‘complete, repeat the same pattern at includes 6 spot sizes and a the original starting location and SmartCoo!™ for epidermal cooling. ‘then move to the next area. In ‘This is hetty price tag but for ‘general, patents in their 20 to early the office which does not own a ‘50% with mid hytdes respond best high-powered Nd:YAG or an to this teatment. Non-dynamic Alexandrite, it iv bargain, You ‘hyfides also respond better so it isa el80 save by paying only one ‘warranty and have to deal with only one ge ne ee company for fe eae eee ee service. In addition, the ‘SmartCool™ say be used for other purpos Spot Sizes. 3, 5, 7,10, 12 & ‘SUGGESTED PARAMETERS, 15mm. Changing spot sizes is fast PIGMENTED LESIONS Cee land easy. The ability to switch ‘wavelengths with these luences is. ‘major break-through and can Tut | son | aSm | t-aigw | Allow several different treatments [le [am [asm [acai] one eson Warranties. The Elite carr full 1 year warranty: After 1 year the service plan is $6,900 annually Consumable Cost. None, ens or fiber from Tethacskuntsoedsageemmeatecau except the Usb Seimacereeerentiacesnsaertrersooe Sateictremonmintsersion "time to time, sh evasion ‘CONCLUDING COMMENTS ‘This is my third analytical oduct review, and some of the {althful ATaT readers are perhaps wondering why each device has ‘recelved high marks. The reason is that al of my assignments have boon with the very latest product offerings from the top tier companies. It goes without saying that Iwill ot be reviewing sub-par devices in the neat future, and there are many sub- par devices on the market. ‘There are many produets 1 ‘wouldn't buy as paperweights and rome which obviously are superior to others. [can say with the fullest con- fidence and without reservation that the Apogee Elite is @ superior laser If you do not already own a good Alexandrite or one ofthe few high- powered Nd-YAG's on the market, this isthe best option currently ‘vallable, The tandem use of these ‘wave-lengths is wel established, and you will iavariably ind them ‘employed in most experienced cosmetic practices. (Cynosure has quite a number of excellent products, having been & top tier company for many years. Howaver, the Ete is cleary its most advanced product to dato. In ‘Addition, for its outstanding specifications with both its 755m, and 1064am wavelengths, the ‘Apogee Elite currenty stands ‘without an equal in the aesthetic laser industry, i laser & light technology