Future Technologies in Future Technologies in DermatologyDermatology
Dieter Dieter MansteinManstein, M.D. Ph.D., M.D. Ph.D.
Wellman Center for Wellman Center for PhotomedicinePhotomedicine Massachusetts General HospitalMassachusetts General Hospital
Harvard Medical SchoolHarvard Medical School
DisclaimerDisclaimer
Presentation is intended to stimulate use of Presentation is intended to stimulate use of new technologies & concepts.new technologies & concepts.
The selection of is based on authorThe selection of is based on author’’s s assessment and not complete.assessment and not complete.
General Objectives
Efficacy Selectivity, safety Side effects, down time Pain Overcoming skin barrier
getting things in or out Skin ‘rejuvenation’ Costs
Cooling is the New Hot - Selectivity without Laser -
Typically cooling as adjunct with SP (Epidermal protection for laser)
Selective Cryolipolysis:
Selective Selective CryolipolysisCryolipolysis Yucatan PigYucatan Pig
A
B
C
D
Manstein et al., ASLMS 2008
Untreated 16 Days Post Treatment
CryolipolysisCryolipolysis CoolsculptingCoolsculpting -- ZeltiqZeltiq
Control Unit
Cooling is the New Hot - Selectivity without Laser -
Typically cooling as adjunct with SP (Epidermal protection for laser)
Selective Cryolipolysis: Selective effects on fat, biological selectivity
rather than selective temperature field Other indications (Acne, Xanthelasma,
Cryoneuromoduloation, etc.) Modify geometry, T/t, T
Pain Management w/o Drugs
Cooling
Surface cooling with laser (epidermal protection)
Cryoanalgesia
Very small laser spots
No pain due to lack of spatial or temporal summation
Gate control
Competitive pain blockage (distraction)
Repetitive exposures / treatments
Repetitive Pulses = Enhanced Efficacy Pulse stacking (quick, high energy, bulk heating, To ) Repetitive pulses (quick, low energy)
EN =Es x N-1/4
N=16 2x
N=81 3x
N=256 4x
N=615 5x
Repetitive pulses (slow, minutes)
Altered tissue optics (erythema, edema)
Altered chromophores (rupture, stasis, color change)
Altered biological response (HSP, sub-lethal damage)
Multiple treatments (slow, days)
Tissue repair limitations
*Roider J, Hillenkamp F, Flotte T, Birngruber R. Microphotocoagulation: selective effects of repetitive short laser pulses. Proc Natl Acad Sci U S A. 1993 Sep 15;90(18):8643-7.
Variation of Treatment Interval & Energy / Tx
Time
Energy / TX
Energy / TX
Total Energy40 U
Total Energy40 U
Combination: 1+1=3Combination: 1+1=3
Cooling and massageCooling and massage Heating and massageHeating and massage Preheating and SPPreheating and SP
RF & SPRF & SP US & SPUS & SP IR & SPIR & SP
1111
Skin as a Barrier
Limited drug delivery (SC) Limited light penetration
Absorption of melanin & blood Scattering of shorter wavelengths Small beams rapidly diverge
Limited trans(epi)dermal elimination Tattoo ink, lipids
Skin without Barriers -Getting Things in and out-
Small diameter holes as a gateway
1414
Small Diameter Holes as a GatewaySmall Diameter Holes as a GatewayIncreasing Laser Pulse Energy
Small Diameter Holes A new Gateway into the Skin (?)
Skin without Barriers -Getting Things in and out-
Small diameter holes as a gateway Drug delivery Optical energy delivery
Needle Arrays Fractional RF Optical fiber arrays Drug delivery
Getting things out
True Rejuvenation
Currently ‘rejuvenation’ used vaguely and no accepted standards by FDA
True rejuvenation by (fractional) laser procedures (?) Regeneration by controlled destruction Reduction of senescent skin cells Allowing for controlled cell proliferation from
SCs Rejuvenation hallmarks of aging
Smart DevicesSmart Devices
Smart is saferSmart is safer RealReal--time pigmentation feedbacktime pigmentation feedback Aim and shootAim and shoot Tracking (avoid bulk heating) Tracking (avoid bulk heating)
Smart saves energySmart saves energy Most of SP energy is not utilizedMost of SP energy is not utilized More energy efficient More energy efficient == more cost effectivemore cost effective
1818
2 x 2 splitter
Broadban d light source
Light to reference arm
Light focused on skin
mirrorBroadband Light (1
OCT OCT -- Schema Schema --
Detection of interference fringes= one A-line
0 1.2 mm
Group: Johannes F. de Boer
OCTOCT Examples of Skin ImagingExamples of Skin Imaging
platematrixnail bed
Eccrine ducts
1.2 mm
HairPhotos: John Strasswimmer Group: Johannes F. de Boer
Fluorescence and Fluorescence Anisotropy Imaging of Nonmelanoma
Skin Cancer
Fluorescence Emission
FluorescenceAnisotropy
Micronodular BCC
Fluorescence confocal image;stain MB
Collagen
Cancer
Histopathology; Stain: H&E
Yaroslavsky et al., 2006Group: Anna Yaroslavsky
Robotic DevicesRobotic Devices -- Putting Diagnostic and Treatment Putting Diagnostic and Treatment
Together Together --
1 Month post TX, 1 Month post TX, =1206 & 1065 nm=1206 & 1065 nmP= 1.5 & 10 W ,t= 1.5 sP= 1.5 & 10 W ,t= 1.5 sE= 17.25 J, focusingE= 17.25 J, focusing
H & E stain1 mm
OCT device and imaging:
Johannes F. de Boer & Mark Pierce
ASLMS 2001: SPATIALLY CONFINED PHOTOTHERMOLYSIS OF DERMAL TARGETS USING AN IR-FIBERLASER IN COMBINATION WITH FOCUSING AND CONTACT COOLINGD. Manstein, M. Poureshagh, R. R. Anderson, I. Yaroslavsky, G. B. Altshuler
The Future TrendThe Future Trend -- Driven by Market Size Driven by Market Size --
Dermatologists and Plastic Surgeons (Special(max. ~10.000 users)
General practitioners and other physic
Spas and Salons
Consumers
Adva
nces
in te
chno
logy,
enha
nced
safet
y and
cost
redu
ction
(mas
s pro
ducti
on)
Market Size
173 million15 - 60 years old
(US Census 2000)
Marke
t-driv
en tr
end
Specific Needs for Different Specific Needs for Different MarketsMarkets
SpecialistSpecialist’’s Devices Device EfficacyEfficacy OthersOthers
Home use DeviceHome use Device SafetySafety SafetySafety Safety Safety OthersOthers
Summary
Cooling from a new perspective Pain management Skin without borders Repetitive pulses/ treatments Combination: 1+1=3 True skin rejuvenation Smart devices (Imaging & Tx) Home use devices
ThanksThanks
Wellman Center for Photomedicine, BostonHarvard Medical School
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