With new upgrades, Cutera’s excel V+ platform
delivers a best-in-class device

WENDY LEWIS is President of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy, author of 12 books, and Founder/Editor-in-Chief of www. Her newest book is
Aesthetic Clinic Marketing in the Digital Age
(CRC Press 2018)
contact [email protected]

LASER- AND LIGHT-BASED DEVICES that target vascular lesions are increasingly relied upon by providers worldwide based on their versatility and effectiveness on commonly presented vascular conditions. Cutera’s excel V+ platform is proving to be a best-in-class device and a workhorse for practices due to its unmatched versatility.
The excel V+ platform can address over 20 unique conditions, including leg veins, facial veins, spider veins, telangiectasias, diffuse redness, angiomas, port wine stains, poikiloderma, rosacea and more, all while sparing the surrounding skin — and often in just one treatment. The platform also comprises Cutera’s signature Laser Genesis™ procedure for skin revitalization, and its new micro-pulsed 532 nm Green Genesis treatment.

Superficial to deep

The wow is in the how. Excel V+ features two clinically proven wavelengths: 532 and 1064 nm in both long-pulsed and micro-pulsed modes. These wavelengths are preferentially absorbed by the chromophores of browns and reds, namely melanin, oxyhemoglobin, and water as well as fine lines and wrinkles.
‘The excel V+’s 532 nm wavelength

is one of the more advanced vascular wavelengths available today,’ says Vivian Bucay, MD, founder of the Bucay Center for Dermatology and Aesthetics in San Antonio, Texas. ‘With the CoolView handpiece it is easy to adjust the spot size and to switch between the 532 nm wavelength for treating superficial vascular lesions and the 1064 nm wavelength for treating deeper structures, such as periorbital blue veins. Not having to change handpieces adds to treatment efficiency, something we really value during our busy days. The integrated sapphire contact cooling increases treatment comfort while adding another level of safety.’

Upgrades equal even greater versatility

excel V+ can deliver effective non-ablative skin revitalization laser treatments with the new micro-pulsed delivery of the 532 nm wavelength, Cutera’s Green Genesis™ treatment.
‘We can improve the superficial microvasculature and pigmentation comfortably, with no downtime, which is ideal for busy patients.’ says Dr. Bucay. ‘It’s also a great compliment to the Laser Genesis treatment, which stimulates collagen production and gently removes scars and improves skin quality on all skin types.’

Moreover, the excel V+ Dermastat is a pencil-like tracing handpiece that provides enhanced versatility and precision to quickly treat small, discrete vascular and pigmented lesions. ‘It’s available in a 1 mm and 2 mm spot size to expand capabilities with the

532 nm to include challenging, hard-to-treat areas on the face and body,’ says Dr. Bucay. The excel V+ CoolView handpiece can deliver higher energy at spot sizes up to 16 mm and shorter pulse durations or adjust spot sizes in 0.5 mm and 1 mm increments to precisely match spot size to the treatment area, eliminating unnecessary collateral tissue damage, Dr. Bucay explains.

‘With the CoolView handpiece, we can adjust spot sizes from 2-16 mm and integrated sapphire contact cooling from 5-20 C to deliver the most comfortable treatments for our patients,’ she says.

‘The enhancements to the excel V+ are hugely impactful in day-to-day practice,’ she adds. ‘The larger spot sizes allow faster treatments. For example, a treatment that used to take 15–20 minutes now takes 3–5 minutes without increased discomfort for the patient.’

One platform, multiple uses

excel V+ has quickly become a workhorse for Dr. Didac Barco, a dermatologist at Corium Dermatology in Barcelona, Spain. ‘Needless to say, this device is top notch when assessing more popular vascular indications such as rosacea, poikiloderma, cherry angiomas or port wine stains, since it offers two different wavelengths and different pulse durations to address superficial and deep structures in the dermis,’ Dr. Barco says.
‘We use this device to treat acne, acne scarring and keloids since 532 and 1064 nm are known to have anti-inflammatory properties and reduce the risk of atrophic scarring if applied in active acne,’ Dr. Barco says. ‘As for keloids and hypertrophic scars, controlling angiogenesis with these two wavelengths promotes their reduction.’
Dr. Barco also uses the 532 nm wavelength of excel V+’s CoolView handpiece to deal with side effects of steroid injections such as perilesional atrophy and elangiectasias.
This platform stands out from the fray, he says. ‘You can also treat melanin with 532 and 1064 nm, not only hemoglobin. It makes this device more versatile than pure vascular lasers such as the pulsed dye laser.’

Moreover, you don’t need to change the tip of the handpiece and calibrate the device if you want to change the spot size. ‘excel V+ features automatic, intra-pulse calibration to ensure consistent energy delivery, and the device does not require any consumables.’

Another plus? ‘532 nm lowers the risk of purpura as PDL normally does: the patient will be grateful for this,’ he says.
With two wavelengths, you can address a wide range of vascular lesions: the superficial areas with the 532 nm and the deep ones with the 1064 nm. ‘If you use just 585 or 595 nm to treat a nodular port wine stain, you do not reach its deep component and you are just causing superficial fibrosis that will not allow any deep improvement with further sessions,’ Dr. Barco explains.

Treating rosacea flushing with both Laser Genesis and Green Genesis in the same session can also maximize benefits.

For this indication, Barco uses 532 nm, 0.5 ms, 1 J/cm2 and immediately after uses 1064 nm, 0.3 ms, 7 J/cm2 with 2,000 shots per half a face of each.
If you stack the 532 nm wavelength, ‘you can deliver two consecutive pulses at lower fluences to improve treatment efficiency,’ Dr. Barco says. ‘The first pulse transforms hemoglobin to methemoglobin, which can then be absorbed by the 532 nm more effectively. This way you can use less fluence in each separate pulse.’
When dealing with a nodular capillary malformation, he treats the nodules with 1064 nm first and then does a second pass with 532 nm in flatter areas.

Figure 1 (A) Before, (B) after 3 treatment with excel® V+. Photos courtesy of Kelly Stankiewicz, MD
Figure 2 (A) Before, (B) immediately after treatment with excel® V+. Photos courtesy of Vic Ross, MD

Combination procedures

At the Dr. Tatiana Aesthetic Dermatology Clinic in London, skin therapists can perform a Laser Genesis immediately prior to an injection of Profhilo®.
‘The device is also excellent with helping to address bruising following injectable treatments,’ says Dr. Rishi Mandavia, MBBS, BSc, MSc, MRCS(ENT), an ear, nose and throat specialist and managing director at the practice.
Clinic namesake and Director, Tatiana Lapa, BSc, MBBS, MSc (Hons), MRCGP often combines the excel V+ with other modalities; for example, the Genesis mode with PRXT33 peel and Profhilo injections for maintenance of skin health. ‘This adds value to patients because Genesis helps to stimulate collagen in the skin for long-term rejuvenation. It’s become a workhorse,’ Dr. Tatiana says.
‘Aesthetic therapists perform treatments to address facial acne, redness and other indications while our doctors can use the device for more advanced indications such as periorbital veins,’ says Dr. Mandavia.
The Laser Genesis facial is a popular treatment option, he says. ‘Laser Genesis offers an excellent and, importantly, low-risk option for collagen stimulation, treatment of vascularity and pigmentation,’ Mandavia says. ‘One of the things I love the most is that you can use the 1064 nm Laser Genesis on all skin types for fine lines, wrinkles, scars, microvasculature and pigmentation,’ he says. ‘It’s really a game changer, especially if your patient base is varied, as is the case in London!’
Dr. Tatiana agrees: ‘We love the versatility of the device. We can use it for non-ablative laser facials as well as for more complex conditions.’
‘With rosacea, for example, we can adjust the parameters at each appointment to ensure multi-level treatment of the skin,’ Dr. Lapa says, ‘This is important because the overgrown network of capillaries that we see in rosacea are affecting multiple depths of the dermis, all of which need to be addressed to see a long-term improvement in rosacea symptoms.’

Safe for all skin types

Patients of any skin type and with concerns such as acne, rosacea, sun damage, melasma, telangiectasia, leg veins, scars and skin quality concerns can be treated with the excel V+.
‘The sapphire cooling tip is comfortable for patients, and the combination of the 532 nm and 1064 nm wavelengths mean that all skin types and numerous indications can be treated with this laser,’ Dr. Lapa says.
Speeding up the learning curve

Patch testing can help improve patients’ comfort level and treatment experience, he says. From there, Dr. Mandavia gradually increases treatment intensity until the results are optimized. ‘This approach serves to obtain excellent outcomes safely and improve your knowledge on how to get the best from the device.’
Dr. Lapa concurs with this approach. ‘Our settings are based on careful patch tests prior to treatment and also at the end of each appointment to ensure we identify optimal settings for the next treatment,’ she says.

‘I was pleased to find that the recommended settings for the excel V+ are fairly accurate in terms of the optimal parameters for various indications,’ Lapa says. ‘This has meant that there has been a very short learning curve with the device and we are able to consistently achieve excellent results for patients.’
‘It doesn’t take up too much real estate either, which adds to its appeal,’ she says. ‘It is also a compact machine with very easy-to-use handpieces, no need for repeated recalibration and no consumables.’
Another bonus? ‘We have experienced excellent support and training from Cutera, reducing learning curves and improving patient outcomes from the outset,’ says Dr. Lapa.