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With four Q-switched wavelengths, the StarWalker by Fotona (Ljubljana, Slovenia) allows operators to safely treat a variety of pigment problems and tattoos, in addition to benign and vascular lesions and the appearance of aging skin.
Ruben Del Rio Gil, M.D., a dermatologist in Barcelona, Spain, likes the StarWalker’s power (up to 10 J), combined nanosecond and picosecond pulses, as well as the competitive price.
“Most Q-switched picosecond lasers are very costly and offer limited applications,” he said. “But with the StarWalker, you get 14 indications, so you can treat more than pigmented lesions and tattoos.”
The StarWalker Modulated Acoustic Q-Switched (MaQX) works through photoacoustic, rather than photothermolytic, effects. By creating a shockwave within the skin, “it breaks the melanosomes into smaller particles for elimination by macrophages and the lymphatic system.”
Dr. Del Rio Gil uses StarWalker to treat all types of benign epidermal pigmented lesions – most frequently solar lentigines. A typical lentigo measures 3 to 5 mm. He uses the 532 nm KTP laser with a 3, 4 or 5 mm spot size at 1 or 2 Hz. “On the face, we tend to use 1.5 to 2 J/cm2. For the décolleté, trunk or hands, we tend to use 1.3 to 1.5 J/cm2.”
When treating lentigines in phototype II or III skin, he added, 90% of patients require just one session. “But with tanned skin or phototypes IV and V, you can get post-inflammatory hyperpigmentation (PIH) so you need two or three sessions, with 15% to 20% lower fluence, depending on skin thickness,” Dr. Del Rio Gil noted.
For pigmented dermal lesions, he uses the 1064 nm Nd:YAG laser. “With melasma, for example, we combine chemical and laser treatments, using low fluences with the Q-switched system and a larger spot size.” Typically, patients require eight to ten sessions, spaced one week apart, with concurrent oral tranexamic acid and topical Kligman’s formula.
Additionally, Dr. Del Rio Gil uses the StarWalker to treat thin, pigmented actinic keratoses and seborrheic keratoses. “We also treat all kinds of benign pigmented nevi, including nevus spilus, congenital nevi – even giant ones measuring more than 20 cm – and poikiloderma of Civatte on the neck and face,” he shared.
The StarWalker also treats all tattoo colors with the 532, 585, 650 and 1064 nm wavelengths, he said. Furthermore, a fractional handpiece, available for the 1064 nm wavelength, facilitates the FracTAT approach.
In addition, StarWalker’s software allows operators to choose from predetermined settings for superficial, medium or deep treatments. These settings match the appropriate fluence with the depth of unwanted pigment.
“With tattoos, I always use deep mode to fracture, or FracTAT with the fractional Q-switched handpiece, first,” said Dr. Del Rio Gil. Histologically, this step creates vacuoles – empty spaces in the dermis after tissue disappears, he explained. Immediately after FracTAT treatment, “We apply the full 1064 nm conventional beam.”
Unlike thermal treatments with erbium or CO2 lasers, which work in milliseconds or microseconds, Dr. Del Rio Gil said that with StarWalker’s pulses in the nanoseconds or picoseconds, “there’s no deposition of heat, so you avoid post-inflammatory hyperpigmentation. This is important in phototypes IV and V.”
