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When two become one

A unique marriage of two technologies leads to amazing results, according to one dermatologist. And, it’s a first in Canada.

Why settle for one, when you could have two? A Toronto-based dermatologist is taking her clinic to the next level with an innovative device that combines two popular technologies — the fractional CO2 laser for skin resurfacing and radiofrequency (RF) microneedling for dermal remodelling — in a single device. 

“Both modalities are very popular, and a lot of our patients are getting those treatments separately,” says Dr. Renita Ahluwalia, lead dermatologist and co-founder of the Canadian Dermatology and Plastic Surgery Centre. “To combine them within one machine in one treatment session, the results can be just amazing. I’m always looking for the best technology for our clinic.” 

She found what she was looking for in Cutera’s Secret PRO. For Dr. Ahluwalia, the opportunity to treat patients in one session with one device, the first in Canada, was appealing. “At the Canadian Dermatology Centre, we want to be cutting edge, we want to bring in new technologies, and we want to challenge ourselves and get the best results for our patients. So this fit right in.”

While the CO2 laser fractionally ablates the outermost layers of the skin, the invasive RF technology reaches the deeper dermal layers. With this combination, the clinic can treat the full thickness of the skin to address superficial photoaging while also stimulating collagen and hyaluronic acid production for more youthful, healthy-looking skin.

The CO2 laser creates microscopic punctures in the skin at different controlled depths. “A lot of our patients choose a lighter CO2 in combination with the RF treatment. We’ll polish the superficial layers of the skin to get that laser peel and that exfoliation to eliminate the superficial browns and reds. And, if we go more aggressive with it, they’ll notice fewer wrinkles and more overall skin tightening.” 

The procedure also promotes collagen production to address scarring, and it reduces crepey skin through fractional skin resurfacing in a single treatment. Treatment options range from a light laser micropeel for prejuvenation to intense comprehensive skin renewal for aging skin. 

“We’re able to offer treatment options to patients with all skin types, which is really important to us.”

The intensity of the treatment can be customized to target problem areas, like around the mouth and the eyes, as well as wrinkles, fine lines, pores, acne scars, and stretch marks. While more intense treatments can be done only on patients with fair skin, the laser can be adjusted to emit fewer joules of energy and much lighter peels for darker skins. The more aggressive approach is particularly popular among older patients who have a lot of fine lines and wrinkles, or who have a lot of pigmentation.  

The CO2 component can be painful, so for more aggressive treatments Dr. Ahluwalia will premedicate her patients. “We use a strong topical numbing cream. I often give [patients] an Ativan and a Tylenol 3 or Percocet.” (If patients are given Percocet, the clinic always ensures somebody drives them home.) “I find it makes the treatment much more comfortable. And since I started giving more medication prior to the treatment, patients are able to tolerate a more aggressive setting and get better results.” 

The medication helps “because, while you’re coming to a clinic, you want to have a nice experience. If you’re in too much pain, you’re not going to have a positive experience. We’ll probably have to lower the settings and then you won’t get as great a result.” For the RF needling, however, a good numbing cream is usually sufficient, she adds. 

Downtime after treatments also varies. “With the RF needling alone, the downtime is really minimal. A lot of people look red right after the procedure. And then by the evening, they’re fine,” says Dr. Ahluwalia. “With the CO2, if you go very aggressive, it could take up to two weeks for recovery. If you go light, [it’s usually] just a couple of days for most of our patients.” 

Her advice for clinics thinking of incorporating this type of device? “Especially when dealing with the CO2 component, it would be nice to have a physician come in and review some of the science behind the machine and go through the dangers and what to look out for, because when you’re trying to do more aggressive settings to get some of those better results, you really need to make sure you know what you’re doing.” 

To get up to speed with the use of the machine, she suggests taking baby steps, beginning with lighter treatments, like the RF, and then incorporating the lighter CO2, working up to the more aggressive levels. 

“Make sure you’re comfortable and you’re safe. I think the one thing about the laser industry is that there are really no regulations at all. Anyone can buy a laser and start firing it in their basement. And that’s what really concerns me. I want to make sure that anyone who’s using this device knows its power and its strength. In order to get the best outcomes, you need to be able to use it to its full capabilities, because it can do so much.”

She cautions that good training is critical because the machine is unlike any that spa staff may have used previously. “You need to be very skilled, and you need to be confident — especially for the CO2 portion. The Cutera team will train physicians and technicians, with both didactic presentations and hands-on experience,” explains Dr. Ahluwalia.

In the short time the clinic has offered the treatment, it has quickly become popular among patients. “It was a very easy sell for them because the results are so good,” she explains. 

“We’re a full-service dermatology, plastic surgery, and medical aesthetic spa, so we like to have that experience where possible for our cosmetic patients, because there are a lot of options out there and we’re happy they’re trusting us. We want to make sure their experience is as comfortable as possible,” she says.

“It really is a great treatment, and it’s really become our most popular. My technicians are telling me to get another [machine] because we’re booked out six to eight weeks with it. We’re really happy with the device and with the results we’re getting — and so are our patients.” 

Jana Manolakos
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