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Fractional Photothermolysis (FP) has been used to treat a number of indications, primarily skin resurfacing and scar treatments. Ablative lasers, such as carbon dioxide, are widely used in the medical aesthetic field, however, due to the longer downtime, higher risk of thermal injury and adverse effects associated with ablative lasers, non-ablative lasers are used as an alternative.
Lavieen, developed by Wontech (Daejeon, South Korea), is a unique thulium fractional laser system that is classified as a non-ablative modality. In my clinical experience, I have found Lavieen to be an effective and safe multipurpose laser for various indications of all skin types.
Due to the higher absorption coefficent to water than that of Er:Glass, the penetration depth of the 1927 nm is superficial to the epidermis.
In other words, thermal damage or downtime is much less than an Er:Glass laser. Furthermore, the target layer of Lavieen is in the stratum basale of the epidermis where melanin is present. Lavieen’s fractionated laser beams act as a melanin shuttle in the heat of microscopic epidermal necrotic debris (MEND). Consequently, a single procedure can greatly improve pigmented lesions in the epidermal layer (i.e. lentigines, age spots), as well as skin tone.
To further clarify, Er:Glass targets the dermis to rejuvenate the skin via collagen remodeling. In comparison, Lavieen’s 1927 nm wavelength targets the epidermis and/or stratum corneum, to improve rough skin and pigmented lesions, creating not only lighter and brighter skin, but also a glowing effect on the skin. This is why Lavieen is also widely known as the Blemish Balm (B.B.) laser, because results are similar to the effect of applying B.B. makeup cream.
Customization
Although the thulium laser is categorized as non-ablative, a prominent advantage of Lavieen is that the power and pulse duration can be individually adjusted to produce different degrees of skin ablation, from non-ablative to sub-ablative to ablative. With this feature, the physician can account for the characteristics of each lesion and utilize the appropriate degree of ablation to create more customized procedures and deliver satisfactory outcomes to the patient.
For instance, lower power and shorter pulse durations can create non-ablative effects that cause tissue denaturation without damaging the stratum corneum. The patient experiences mild erythema, edema and micro-crusting for approximately three days. This level of treatment is suitable for patients with sensitive skin and/or melasma, or someone who wants skin resurfacing with minimal downtime. Also, the ability to individually select power and pulse enables this mild treatment to be easily combined with other energy-based devices for synergistic outcomes.
Lavieen is shown to be highly effective in treating melasma that has not responded to other energy-based devices, as well as post-inflammatory hyperpigmentation (PIH). This occurs because Lavieen accelerates the turnover cycle of exfoliation, which ultimately speeds up the clearance of pigmentation.
A patient came to me with PIH on her mid-lower face. The PIH was causing her a great deal of stress and affecting her social life. We treated her with Lavieen monthly, and with Pico-toning intermittently. We were able to clear the PIH and improve the appearance of her skin tone and texture (Figure 1).
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Sub-ablation can be achieved by adjusting to moderate power and pulse duration settings. With this level of treatment, the epidermis is partially damaged histologically, but the stratum corneum is preserved.
Scar Treatment
I have also found that Lavieen can be as effective as CO2 lasers in scar treatment when using higher power and a longer pulse width to produce fully ablative effects from the stratum corneum to the upper dermis. Higher power damages and removes skin tissues to stimulate growth of new tissue, and the longer pulse duration provides a photothermal effect that stimulates neocollagenesis and collagen remodeling. Although its effects are similar to CO2 lasers, the Lavieen is much safer with minimal adverse effects. For these reasons, I sometimes use Lavieen as a method of scar prevention.
In addition, patients with scarring, especially scars with PIH, show a great improvement after treatment. I treated a surgical scar with Lavieen and Triamcinolone Acetonide injection, and the volume and color of the scar normalized, as shown in Figure 2.
Another remarkable advantage with Lavieen is that the laser beam shape and size can be modified in consideration of the size and location of the lesion. This allows the operator to conveniently perform more delicate treatments during the procedure. Specifically, the physician can use both a stamp technique, for localized lesions, such as pigmented lesions and scars, and a moving technique that shortens the procedure time for skin resurfacing on the face or body.
With other thulium fractional laser systems, the user cannot change the shape and size of the beam pattern freely, so there is limited efficiency in the localized treatment area. Moreover, Lavieen does not require consumables.
Laser-Assisted Drug Delivery
Another procedure that is regularly performed with Lavieen is laser-assisted drug delivery. Lavieen delivers fractionated laser beams to the skin, creating microscopic necrotic columns (MNCs). These columns enhance the permeability of cosmeceuticals into the skin, resulting in fast recovery and synergistic effects. The physician is able to use different brands of cosmeceuticals that contain good ingredients for skin regeneration and/or moisturization.
Lavijue, a cosmeceutical product designed for use with Lavieen, includes epidermal growth factors, fibroblast growth factors, Tranexamic acid, Polydeoxyribonucleotide, y-PGA (polyglutamic acid) and more. All of the ingredients in Lavijue are liposomized into nano-sized capsules to assist with absorption in the skin.
In summary, Lavieen is an outstanding fractional laser system that is effective and safe for a variety of skin indications and lesions. I strongly recommend it not only for the efficacy and safety, but also the convenience and capability.
