Recently, the BMLA (British Medical Laser Association) released its guidelines on the resumption of laser & IPL treatments post Covid-19 lockdown.¹ We asked industry expert and laser trainer, Kevin Williams (Wynyard Aesthetics Academy), to evaluate the recommendations and discuss the safety and clinical advantages of in-contact cooling during laser treatments.
Kevin D Williams - Chief Technical Officer at Wynyard Aesthetics Academy
Throughout my time of teaching laser courses and qualifications, I have always focused on three key benefits of highly efficient contact cooling compared to other cooling methods like cool airflow and cryogen-spray cooling.
An increase in treatment efficacy. By lightly applying pressure to the treatment area, an increase in absorption of the target chromophore is achieved.
A dramatic reduction in the incidence of side effects and an increased level of comfort for the patient. In a study conducted by Dr. D. Goldberg, 28/28 patients found the treatment with the Cutera excel HR contact cooling more comfortable than a well-known competitor's cryogenic method.²
A reduction in the incidence of aerosol generations and plume particulates. Contact cooling is proven to suppress laser plume, reducing the risk of exposure to airborne particles.³
Despite the clinical and practical benefits listed above, it is the risk of airborne particle transmission that is, for obvious reasons, a key concern for many practices as they begin to plan for their post-COVID reopening.
The post-COVID guidelines released by BMLA are based on two published papers focusing on the effects of laser plume and airborne particulates. The first paper is written by a leading physicist and bioengineer, Mike Murphy, and discusses the biohazard risks of laser plume and the impact that it could have on COVID-19.
"The evidence clearly shows that laser and IPL plumes must be considered as a biohazard. Appropriate measures must, therefore, be taken to protect the operators and their patients. These include gloves, gowns or scrubs, appropriate masks, high flow rate suction systems with good filtration, and proper training in their use".
The BMLA also cited a paper written by Dr. Victor Ross et al³, where he compared the concentration of airborne particles during laser hair removal treatments performed with contact cooling and cryogen cooling. Measurements of plume and airborne particles were taken at baseline and continuously throughout the 7-minute laser treatment. (Figure 1) Throughout the treatment the measurement of airborne particles remained at baseline for sapphire contact cooling while the cryogen cooling produced levels of plume 72-fold higher than baseline.
Figure 1: Airborne Particulate Concentration during LHR with Cryogen vs. Cold Sapphire (Cutera excel HR) 1064 nm, 20 J/cm2, 18 mm spot treatment. Left back treated with excel HR (Sapphire), right back treated with GentleMax (Cryo)
The authors conclusion was that "Cold Sapphire Skin cooling with gel effectively suppresses plume during laser hair removal, obviating the need for smoke evacuators, ventilation systems, and respirators during LHR. Thus, Cold Sapphire Skin cooling with gel may be a safer treatment for laser operators provided proper contact is maintained and gel used".
Cold Sapphire Contact Skin Cooling with excel® HR
The evidence available is overwhelmingly in favor of contact cooling, and when used with a medium, such as gel, reduces the risk of biohazards from plume or airborne particles. In addition to a higher safety profile, contact cooling for laser treatments shows an increase in treatment efficacy and, more importantly, patient comfort.
When evaluating lasers that use integrated contact cooling, it is important to understand that not all devices are created equal. Understanding the exact type and efficiency of the contact cooling used in a device will ensure the highest efficacy, reliability, and safety.
Efficiency, which is measured as the length of time it takes the handpiece to reach temperature, or its ability to maintain temperature throughout a treatment varies significantly among devices. The Cutera’s excel HR, for example, is very efficient and continuously monitors the cooling during the treatment to ensure consistent cooling temperatures are maintained.
Having used several different devices from a range of manufacturers, I have noticed a considerable variation in the efficiency and durability of contact cooling devices. Our current laser of choice is the Cutera excel V+, which combines a state of the art Peltier cooler with a large Sapphire window. Sapphire is an extremely durable material (9 on the Mohs scale of hardness) and can only be cut by a diamond. It's also an ideal delivery medium as it increases the transmission of laser energy, reduces laser scatter, and provides consistent pre-, parallel, and post-cooling without the undesired pitting or spot burns often seen with glass or quartz consumable windows.
Wynyard Aesthetics Academy will be offering an educational webinar on the benefits of contact cooling and what to consider when purchasing a Laser Hair Removal device. Visit Cutera's webinars for more information.
References
1. Dr Vishal Madan, BMLA - Resumption of Laser/ IPL skin services post COVID-19 lockdown- British Medical Laser Association (BMLA) guidance document. 2. A comparative study by Dr. D Goldberg, using 28 individual patients and treating them with both the Cutera excel HR with sapphire contact cooling and a leading competitors Alexandrite Nd:Yag laser device with cryogenic cooling. 3. Edward V Ross, Gary S Chuang , Arisa E Ortiz, Scott A Davenport. Airborne Particulate Concentration During Laser Hair Removal: A Comparison Between Cold Sapphire With Aqueous Gel and Cryogen Skin Cooling. Lasers Surg Med 2018;50:280-283. AP003535 rA