The Aesthetic Guide May-June 2008 : 1
Currently pending Food and Drug Administration clearance, the HarmonyXL from Alma Lasers, Inc. (Buffalo Grove, Ill.) offers ten different technologies and more than 60 applications in a single plat- form. This upgraded platform provides efficacy, versatility and expandability to aesthetic medicine veterans as well as those seeking to enter the mar- ketplace for the first time. continued on page 3 May/June 2008 Circulation 20,000 www.miinews.com
Harmony Addresses Economic Concern
Currently pending Food and Drug Administration clearance, the HarmonyXL from Alma Lasers, Inc. (Buffalo Grove, Ill.) Offers ten different technologies and more than 60 applications in a single platform. This upgraded platform provides efficacy, versatility and expandability to aesthetic medicine veterans as well as those seeking to enter the marketplace for the first time.
HarmonyXL Features Upgraded
Technology Platform for Expanded Versatility and Efficacy
Martin Braun, M.D., medical director of the Vancouver Laser and Skin Care Centre in Vancouver, British Columbia, Canada, uses the original Harmony platform regularly in his practice. “What makes Harmony especially useful is its versatility. It provides results that are as effective as other devices at a fraction of the price,” he said. “For example, I did a split-face study comparing Advanced Fluorescence Technology (AFT) — Alma’s equivalent to intense pulsed light (IPL) — to the Lumenis One IPL from Lumenis Corporation (Santa Clara, Calif.). Improvements in dyspigmentation, erythema, telangiectasis and skin texture were similar on both facial halves according to blinded evaluators. Subjects’ perceived level of discomfort during treatment was also comparable.”
According to Patrick Neff, director of marketing at Alma Lasers, HarmonyXL features a number of improvements over the original Harmony platform. “The XL is the same weight (60 kg) and size (39.7 x 55 x 123 cm) as the original Harmony,” he said. “but with 17 available handpieces as opposed to 12, including a new light-emitting diode (LED) module for dermal heating, temporary relaxation of muscles and pain relief.” Some handpieces have been enhanced. “Improved AFT handpieces provide greater fluence at twice the repetition rate and the pulse durations of several handpieces have been tuned to improve clinical efficacy,” Mr. Neff continued.
The addition of contact cooling to some HarmonyXL modules is what truly separates the new platform from its predecessor according to Stuart Melnick, M.D., medical director of the Laser and Cosmetic Center (Los Gatos, Calif.). “The most common aesthetic complaint in younger women is facial dyschromia, so being able to produce topnotch outcomes with your photofacials is crucial. To do that you’ve got to crank up the energy,” said Dr. Melnick. “In our practice we’ve discovered that if you keep skin temperature down, you can increase the energy and get excellent outcomes, but it all hinges on proper skin cooling, otherwise you will see blistering or burning. And if it’s uncomfortable you have to turn down the energy.”
“With contact cooling, you can use more energy without sacrificing tolerance so much,” Dr. Melnick continued. “The risk of complications is reduced, although it’s always present to some degree. Integrated cooling also saves money, which is great if you’re starting a new practice or you need to buy new instrumentation.”
According to Dr. Braun, the financial impact of a device like Harmony goes beyond its relatively low purchase price. “For example, say you have two devices that cost $100,000 each, the service agreement for each will amount to about 10% of the cost, or about $20,000 total,” he explained. “Harmony is one platform, so you only need one service agreement. And Harmony’s versatility means you’re more likely to get your money’s worth out of it.”
Dr. Melnick uses Harmony most often for photofacials. “Since Alma Lasers has come out with the new 515 nm handpiece, it’s given us more possibilities for patients with spider veins or brown spots. We’ve got the 570, 540 and now the 515 nm handpieces. I’ll use all three starting with the 570, and if the patient tolerates that, I’ll go to the 540, then end with the 515. Basically, we can treat skin types I through V.”
HarmonyXL also features In-Motion technology, a combination of technique and pulse form first featured on Alma’s 810 nm SopranoXL diode laser hair removal platform. “On the Soprano, the pulse form delivers low power in rapid pulses, but high total energy,” said Dr. Braun, who is currently studying the SopranoXL in clinical trials. “The user makes six to eight fast passes, sort of like when you’re ironing a shirt, over an area about the size of your hand. The temperature of target hair follicles is raised more slowly, delivering more energy over a longer period of time instead of frying hair follicles like other devices do, which is why hair removal tends to be a painful procedure.”
Alma applied this technology to its SHR near infrared (NIR) handpiece, which delivers higher average power with longer pulses, instead of incorporating a separate diode laser into the platform. It’s a different technology but the concept is the same. “The result is relatively pain free hair removal, which is very popular with patients,” Dr. Braun continued. “So far, efficacy with SopranoXL appears to be equivalent to other devices, and future studies will show whether this proves true in the long-term.”
Pain free hair removal has had a profound effect on Dr.Melnick’s practice. Like Dr. Braun, he uses SopranoXL. “Women can tolerate the pain associated with hair removal treatment, but when you do a man’s whole back the skin becomes extremely sensitive,” Dr. Melnick explained. “Sometimes men don’t return for further treatment because of the pain. With In- Motion technology, men get the results they want without the pain.”
“Also, there have been rare but potentially devastating complications for patients using cream or topical anesthetics prior to coming in for treatments, where patients have applied excessive amounts of topicals to numb the skin. In- Motion technology removes that possibility by making anesthetics unnecessary,” Dr. Melnick added.
The gentler delivery of energy associated with In-Motion technology also reduces the incidence of other adverse events such as pigmentary alterations. “This is particularly important for darker skin, which is much more sensitive to these types of procedures,” added Dr. Braun.
It was the ability to treat photodamage with fractional resurfacing using Harmony’s Pixel 2940 handpiece that originally brought Dr. Braun to the Harmony. “I didn’t have enough IPL business to keep a machine busy eight hours a day, six days a week, but by adding fractional resurfacing I get more use out of it. So now I’m in the fractional resurfacing business at a fraction of the price of other devices,” he said.
A newer higher powered Pixel 2940 handpiece – delivering up to 2500 mJ per pulse, compared to the original Pixel module which only delivers up to 1400 mJ – is available for the HarmonyXL. “The higher power allows you to go even deeper,” said Dr. Braun. “This will be more effective for photo-aging and acne scarring, allowing practitioners to treat more aggressively.”
Harmony’s Pixel 2940 handpiece is also a mainstay of Dr. Melnick’s practice. It comes with two different filters, the 7x7 pixel and the 9x9. “I use the 7x7 for rhytides mostly, when I want deep penetration, or for acne scars. During the same treatment session I’ll sometimes switch to the 9x9 handpiece to treat pigmentation,” he said. The new module can also be used as a non-fractional Er:YAG laser for skin resurfacing and laser peels.
Dr. Melnick finds the idea of a more powerful Pixel handpiece particularly appealing for photo-aging and acne scars. “Right now, if I had an instrument that was more powerful it would save time and reduce discomfort,” he said. “With the current Pixel 2940 I often do two to three passes over the face. For acne scarring or severe rhytides, I have to stack over those another two to three times. Pixel treatment as it stands now is relatively painless, but as you stack passes, you start to burn,” he observed. “We have ways to treat patients using local anesthetic cream after treatment, but again, you do two to three passes and it’s already uncomfortable during the middle of the second pass. If we could do a single pass, then go immediately to the cream, it would be more comfortable for the patient.”
Another strength of the Harmony platform is the ability to rapidly switch between modules during treatment. “You just plug in the appropriate handpiece and go to work,” Dr. Braun noted. “After doing AFT, for example, I can address textural issues with the Pixel 2940 module, which you can’t really do with an IPL type treatment.”
“Every office has its own special needs,” Dr. Melnick said. “To give patients a total treatment you might need two, three or four different lasers. With Harmony you have one platform with different handpieces, taking the place of larger devices. You can start with one handpiece, treat, and then switch to a different one very quickly and easily. I like having my Pixel, Q-switched, AFT and skin tightening handpieces with different wavelengths at arm’s length. Alma also offers a wall mount system for handpiece storage which is very convenient.”
According to Mr. Neff, Laser360 is a 60 day skin rejuvenation program that represents this treatment combination, although not always during the same treatment session. “Laser360 brings together AFT for pigmentation, the ST handpiece which uses NIR heating leading to skin tightening and the Pixel 2940 module for treating some of the finer structures and wrinkling. The fractional Er:YAG laser has been clinically proven to penetrate to the ideal depth, promoting neocollagenesis,” Mr. Neff explained.
“Every patient has different needs and each practitioner has his or her own experience and comfort level with different technologies, therefore the protocol for Laser360 is deliberately vague,” noted Mr. Neff. “We lead them through the basics and they develop their own protocols. A lot of physicians feel comfortable that they’ve developed something that works well in their hands, which is one reason it’s been so successful. The basic protocol doesn’t work on every patient, and not everyone is comfortable with it.”
While the HarmonyXL offers a lot to the experienced dermatologist or cosmetic surgeon, Alma Lasers recognizes that it will most likely catch on with the new aesthetic practitioner, or with physicians outside the field looking for a gateway to aesthetic dollars. In an effort to more effectively support this growing customer base, Alma has created a marketing support system available to physicians who purchase Alma instruments. “HarmonyXL is a versatile, expandable platform using effective, proven technology, but if a new practitioner can’t effectively market to the existing patient base and attract new business as well, what’s the point?” Mr. Neff questioned. “Many physicians, new to aesthetic medicine, have a difficult time looking at their practice as a money maker, and are mired in care provider thinking. They also worry that such a venture is too great a financial risk, so we are going to change that perception.”
This support (available online through www.officebyalma.com) serves as a onestop shop for a variety of tools and materials to help physicians promote their aesthetic practices. Access to this web based marketplace is currently free with the purchase of an AccentXL, SopranoXL or Harmony platform. The cost of materials and services is very reasonable, according to Mr. Neff. “Officebyalma.com offers everything from brochures and counter stands to postcards and posters, as well as other great tools for the practitioner. We even have ad slicks, which are predesigned advertisements meant to help physicians promote themselves in newspapers and magazines. Many items can be customized for the individual practice.
Physicians do not know how to create these things themselves, or where and how to submit them,” said Mr. Neff. Additionally, physicians can submit patient databases in Excel format for mass emailing purposes. Mr. Neff also added that many more materials and services are in development.
Overall, Dr. Melnick sees Alma’s HarmonyXL as a response to trends within this rapidly growing aesthetic industry. Physicians want efficacy and versatility, especially new practitioners looking to harness the aesthetic market’s profit potential. “Of course patients want less risk, less pain, less downtime, plus efficacy and the industry is responding,” he added. “It’s rapidly becoming a walk in, walk out, look good, tell your friends business. And the absence of pain is critical. The less you hurt people, the more they’ll tell their friends.”
