Haewoong Lee discusses the range of applications for the Lavieen laser system technology from Wontech 

Skin resurfacing and rejuvenation is a steadily growing market in the medical aesthetic field. Fractional lasers have been widely used for skin resurfacing, skin rejuvenation, and other indications since the early 2000s and treatment using fractional lasers has shown to be effective. I have been using Lavieen, a unique 1927 nm Thulium fractional laser developed and manufactured from Wontech, Co, Ltd. (Daejeon, South Korea). This laser system is excellent for aesthetic medical applications with its versatility, efficacy, and safety in that it can treat various indications for all skin types and ages.

HaeWoong Lee, MD, PhD, at Louis Dermatologic Clinic, South Korea

The 1927nm wavelength has a higher absorption co-efficient to water than that of Er:Glass therefore its penetration depth is superficial to the epidermis, especially the target layer is at the stratum basale where melanin is present. It acts as the shuttle of melanin in the heat of microscopic epidermal necrotic debris (MEND), effectively treating epidermal pigmented lesions (i.e. lentigines, age spots) as well as brightening effects.

With a single procedure of Lavieen, patients experience great improvements in skin resurfacing; improved uneven skin texture, dull skin tone, and superficial pigmentations. This is why Lavieen is also widely known as B.B (Blemish Balms) laser, which is similar to the make-up effect of applying B.B cream. In addition, as a non-ablative modality, Thulium lasers complement for the disadvantages of ablative lasers such as CO2 or erbium, which often lead to longer down time, high risk of thermal injury, PIH (post-inflammatory hyperpigmentation) or/and scarring.

Although 1927nm thulium lasers are categorized as non-ablative modality, ablation degrees with Lavieen can be adjusted from non-ablation, sub-ablation to ablation by separately controlling power and pulse duration as the utmost advantage with Lavieen. The physician allows to apply delicate parameter settings and to effectively treat various indications of epidermal pigmentary disorders (i.e. lentigines, age spots), melasma, scars, superficial wrinkles and many.

In addition, with this feature, the operator can perform a customizing skin resurfacing by controlling downtime and clinical outcomes, taking into account patient needs. For instance, low power and short pulse duration histologically show non-ablative effects in the skin, tissue denaturation with maintaining stratum corneum intact. Such non-ablative effect causes almost no erythema and edema, resulting in brightening effects showing within 3 days of the procedure day. Sub-ablation effects by moderate power and pulse width lead to 5 day down time with mild to moderate erythema and edema, and bring outstanding results in skin resurfacing.

Device applications

Laser-assisted drug delivery is commonly done with Lavieen; the Lavieen delivers fractionated laser beams to the skin in order to create microscopic wounds, which are also called microscopic necrotic columns (MNCs) and these columns enhance cosmeceuticals permeability into the skin. By applying a cosmeceuticals followed by a Lavieen procedure, the patient is promised synergistic effects with the solution that restore and regenerate the skin. For drug delivery, any cosmeceutical compounds can be applied after a Lavieen procedure including vitamins, EGF, FGF, hyaluronic acid and more. Even fillers or Botox can be applied.

Figure 1 (A) Before and (B) after photos of melasma treatment using Lavieen. Photos courtesy of Dr. HaeWoong Lee

Since Lavieen has features of non-ablation effect and separately controlling energy and pulse duration, it can easily be used with other energy-based devices such as a picosecond laser, RF needles and extras. Combined therapies that utilize Lavieen do not make the physicians worry about longer down time or risk of thermal injury. Rather, the patients get the synergistic effects and maintain long lasting results at its best.

As a good example, a woman patient of Fitzpatrick skin type IV appeared to have melasma, shown in the figure 1. The patient was treated with a laser toning first using a picosecond laser, followed by Lavieen procedure with 8mJ/shot, which served as a game changer and then applied a few drops of cosmeceutical onto the MTZs that are created by Lavieen and done hammering ultrasound for hastening the absorption. As can be seen from the figure 1, the patient with melasma has been greatly improved as well as improved overall skin tone and texture.

Figure 2 (A) Before and (B) after photos of skin rejuvenation using Lavieen. Photos courtesy of Dr. HaeWoong Lee

Lavieen can also be as effective as CO2 lasers by using higher power and pulse width to produce ablative effects, but it is much safe with minimal adverse events. Longer pulse duration provides photothermal effects that stimulate neocollagenesis and collagen remodeling. When the patient had a skin resurfacing treatment with intensive parameter settings, the patient will get not only skin resurfacing effects but also skin rejuvenation effects; large pore reduction, wrinkles improvement, skin tightening and skin laxity decrease. However, downtime or risk of the thermal injuries is lower than CO2 lasers.

An 80 year old lady was complaint of her under eyes with multiple eccrine hydrocystomas and wrinkles. She had Lavieen treatment and then Botox was applied on periocular area for a restorative effect by drug delivery technique (mixed with 2.5cc of lidocaine). She had great improvements on hydrocystomas, color and wrinkles of under eyes. Also overall skin texture, laxity and wrinkles shown to be greatly alleviated.

One of the benefits of Lavieen is that, unlike other Thulium fractional lasers available on the market, the physician can selectively use both stamp and moving techniques when treating different portions of the lesions; stamp technique is useful for local lesions such as lentigines, scars or wrinkles on periorbital area, and moving technique is efficient for large portion of the lesions such as melasma, skin resurfacing on entire face or a part of body. The best thing about Lavieen is that the shape and the size of the laser beam can be modified in considerations of the size and the location of the lesion. This provides the operator with great convenience during the procedure.  In addition, Lavieen does not require consumables.

In summary, Lavieen is an advanced fractional laser system designed to treat, restore and rejuvenate the skin healthier, younger and better. I strongly recommend to use Lavieen alone for skin resurfacing, drug delivery or combines with other treatments. Either way, the lavieen will give you the satisfactory results in treating a variety of indications of all skin types and with minimal downtime.