1. Photopneumatic Therapy
Clinical Roundtable
Promises to Change Future
of Aesthetic Practice
Editor’s Note: The following Clinical Roundtable discussion is focused on the exciting new PPx
technology from Aesthera and was moderated by Vic Narurkar, M.D., cosmetic surgeon in private
practice and assistant clinical professor of dermatology at U.C. Davis.
What advantages does photopneumatic therapy
(PPx) offer over today’s ablative and non-abla-
an excellent overall improvement of the skin. This is a
tive technologies?
great advantage to patients.
Ralph Levi-Carasso, M.D. – The greatest advantage
Paul Drago, M.D. – PPx has three key advantages over of PPx is that it is absolutely painless. As a pain spe-
conventional non-ablative technologies available today. cialist, I am very sensitive to the issue of pain and rec-
The greatest benefit is that PPx is ognize that pain is a major reason why patients stop
painless. Second, PPx achieves treatments. Eliminating pain is a major advantage of
excellent clinical efficacy without PPx. In my experience, compared with other laser/light
compromising on safety. The third based devices, PPx reduces treatment times by up to
major benefit is speed of treat- 75%. For all of us, time is money. Additionally the PPx
ments. The PPx absorption curve system is extremely user-friendly making it easy to use
highly overlaps the absorption and quick to master.
curves for melanin and hemoglo-
bin rendering the technology high- Vic Narurkar, M.D. – Over the past few years, the
ly effective for hair, vascular and Paul Drago, M.D. trend has been for devices to use longer wavelengths
pigmentary targets. Elevating tar- and higher energies. As a result, we have seen poor effi-
gets reduces the loss of energy that occurs with other cacy and an increase in complications. In contrast,
devices. Changing the optical characteristics of the skin Aesthera PPx is the first technology to manipulate the
results in treatments that are highly effective, painless optical characteristics of the skin and effectively use
and five times safer than conventional lasers. shorter wavelengths for high clinical efficacy and safe-
ty on all skin types. Manipulating skin optics allows us
Jacques Otto, M.D. – I am convinced that PPx tech- to effectively use a fraction of the energies that are typ-
nology is the safest treatment for all skin types. PPx is ically used in conventional technology. The result is
the fastest non-ablative light-based treatment avail- high safety and painless treatments for the patient.
able. For my practice, the greatest advantage of PPx Both these advantages are highly significant from a
over other non-ablative technologies is the elimination patient and physician perspective.
of topical numbing. Patients no longer need to arrive at
the office an hour before treatment for the application Shingo Wakamatsu, M.D. – The PPx system is very
of topical anesthetic cream. This benefits us and compact. This is particularly important in a country
patients. Treatment for any single indication results in like Japan, where office space is limited. The PPx
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2. Clinical Roundtable
device can also be easily moved from room to room or tip. For the nose, around the upper lip and the lower
shared between clinics. A great advantage of PPx com- lip area, I use the small tip.
pared with other devices is that vacuum allows you to
move targets closer to the skin’s surface. This allows Dr. Wakamatsu – For facial skin rejuvenation, we
for safer treatment because there is less energy lost or have treated a maximum four times, at one month
absorbed by surrounding normal tissue. In addition, intervals. A session lasts about ten minutes. For hair
treatment is associated with less pain. Over 80% of removal, we have scheduled up to three sessions,
our patients feel only very mild discomfort, and none spaced six to eight weeks apart. Treating the lower
of our patients report levels of pain associated with extremities takes 20 minutes. This is a great time sav-
other lasers or light sources. ing device over traditional diode systems where treat-
ments can take up to two hours.
What is your typical treatment protocol for skin
rejuvenation and hair removal with PPx? What clinical results are you achieving for these
two indications? Any adverse events?
Dr. Drago – For skin rejuvenation, I typically schedule
three sessions, spaced about one month apart. I also tell Dr. Drago – The results for skin rejuvenation have
patients they will require an additional session 6 to 12 been quite incredible. I haven’t had one disappointed
months after final treatment. I use no topical anesthet- patient yet. I would say the improvement is in the 70%
ics. Normally, for the face, we use a medium tip. This to 90% range. For hair removal, outcomes are also
seems to treat nearly every area. Hair removal is per- excellent. Usually there is a 75% reduction in overall
formed approximately every four weeks for a total of hair after five or six treatments. The greatest clinical
about six treatment sessions. One of the greatest advan- advantage is our ability to treat fine facial hair. The
tages of PPx is that we’ve been able to successfully use most common adverse event for either indication is
the hair removal tip to treat women who have facial typically a redness around the skin. The redness is
hair. They no longer feel embarrassed and we’ve seen a transient and quickly dissipates.
very high demand for the elimina-
tion of fine facial hair. Dr. Carasso – For hair removal, we’ve seen excellent out-
comes by the third treatment session. The best outcomes
Dr. Carasso – For hair, I normal- for women have been observed during treatment of the
ly schedule four to six sessions, at armpits and the bikini line. In men, the results are com-
two week intervals. I also always parable to other machines I use. For skin rejuvenation, we
use a large tip. There is no need notice the skin becomes slightly dry. This is a very desir-
for any pain medication. After 20 able outcome especially in women older than 45 years. PPx
exposures, I cool the tips. achieves a light peeling effect. After four or five sessions,
Ralph Levi-Carasso, M.D. patients end up with very nice smooth skin without all the
Dr. Otto – For younger patients side effects associated with chemical peeling. We have also
who desire skin rejuvenation, I tend to schedule two observed skin tightening, improvement in texture and
or three sessions, spaced two weeks apart. The result reduction in pore size. Overall, patient response to treat-
is very bright and tight skin. Older patients with loss ment has been highly enthusiastic because PPx treat-
of elasticity and more sun damage usually require ments are very quick and painless. Most of our patients
four or five sessions, three weeks apart. Maintenance are fairly educated when they come in for a photofacial
may consist of one or two additional sessions at one rejuvenation consult or a hair removal consult. They
year for a younger patient, and one session every six assume that there is going to be a lot of pain and lengthy
months for an older patient. A typical session for treatment sessions. So when you tell them that this is new
rejuvenation on the face, neck and chest area takes technology that is neither painful nor slow, patients
about 20 minutes, compared to between 60 and 90 become quite enthusiastic about PPx treatments.
minutes with other light devices. For the chest area
and neck, I use the large tip. But for the cheeks or Dr. Otto – The results for skin rejuvenation are quite
the jowl line and the forehead, I use the medium size excellent. The brown spots diminish in color at day three
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3. Clinical Roundtable
or four, so when I see patients two to three weeks later, skin feels smoother and tighter overall. The fact that
their skin looks more uniform in appearance, smoother tightness is noticed a few weeks after treatment leads
and much brighter. Skin truly looks rejuvenated. me to believe that it results from collagen remodeling.
Sometimes immediately after treatment, there can be a Acne patients have also remarked a dramatic decrease
bit of redness due to the application of vacuum. Redness in pore size. At follow up treatments, we noticed the
typically disappears within a few hours of treatment. skin looking and feeling less oily. PPx lifts the seba-
Overall, any side effects are fewer and less long lasting ceous gland, opening it up to remove sebum from the
when compared to those with intense pulsed light (IPL) gland – in essence cleaning out the gland.
or laser treatments.
Dr. Narurkar – Patients have noticed skin tightening
Dr. Wakamatsu – For skin rejuvenation, we are seeing and improvement in texture. We’ve started a formal
brighter and healthier looking skin, the lightening of the study using very low energies for skin tightening in
lentigines and telangiectasis. Overall texture of skin is both the face and non-facial areas. I’m very encouraged
greatly improved and reduction in by preliminary results. I believe the pneumatic
pore size is noted. We are very approach used by PPx provides clinically documented
impressed with PPx’s efficacy on beneficial effects of tightening and texture. Overall
melasma. This is very resistant rejuvenation has been quite dramatic, including a
and typically a difficult condition reduction in pore size.
to treat in Asian skin. We have
seen good results with acne treat- Dr. Wakamatsu – We have seen reduction in fine
ments as well. The reduction rate facial lines and softening of wrinkles also as a by-prod-
of the hair with PPx is much better uct of PPx treatments. Our patients are very pleased.
than with the conventional diode Shingo Wakamatsu, M.D.
Any suggestions to help your colleagues
laser. PPx is particularly effective
incorporate PPx into their practices?
for vellus hair. This is very important in Japan.
Treatments are also very fast because of the large spot
size. Normally, treatment time can be reduced by two-
thirds to one-third those taken by diode or other lasers. Dr. Carasso – It is important to promote the fact that
One adverse event is moderate irritation of the vessels, PPx is the only painless and effective treatment
which lasts about six hours. modality available today. Painlessness is very attrac-
tive to patients. In fact, our patients actually enjoy
Dr. Narurkar – We’re seeing some very nice results treatments and describe them as relaxing, often
for skin rejuvenation. We’re also achieving more uni- likening the treatment to a warm massage. Patients
form coverage in areas that are traditionally very diffi- also like that a PPx session lasts only 20 minutes ver-
cult to treat, like the neck, chest and extremities. Hair sus 90 minutes or two hours with other technologies.
removal results are also very good. Outcomes are effec- This also translates into improved profitability for
tive in areas that we are otherwise hesitant to treat the practice.
because of time and pain, such as legs and backs. We’ve
also seen some very nice clearing of fine facial hair Dr. Drago – We offer PPx for hair removal on large
which has, to date, never been achieved by other hair areas – the back and legs. This is a new income stream
removal technologies. Adverse events include occasion- that we previously could not access. We do not charge a
al suction marks, which resolve quickly. premium price for no pain treatment.
Have you observed any additional patient
Dr. Narurkar – In practices such as ours, where we
response to treatment?
have a lot of existing lasers and other light sources, we
use PPx for pain sensitive patients, for the treatment
of larger anatomic areas such as the back and legs,
Dr. Otto – Patients who I treat for facial hair removal and for non-facial rejuvenation. We also use PPx for
often comment that they feel their skin tighter around acne because it is very effective. Part of our internal
the jowl line. Other patients have said they notice their marketing is offering to treat a small area with PPx,
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4. Clinical Roundtable
Aesthera PPx Clinical Photos
Photos courtesy of Vic Narurkar, M.D.
Chest before Tx Chest after Aesthera PPx Tx
Photos courtesy of Shingo Wakamatsu, M.D.
Hair count before Tx Hair count after Aesthera PPx Tx
Photos courtesy of Vic Narurkar, M.D.
Vascular lesions before Tx Vascular lesions after Aesthera PPx Tx
Aesthetic Buyers Guide November/December 2005 www.miinews.com 23

5. Clinical Roundtable
so that patients can experience PPx and directly com- other words, Aesthera is actually partnering with you
pare its comfort and speed with our conventional tech- in both busy and slow times.
nology offerings.
Dr. Carasso – Patients like both having their own per-
Dr. Wakamatsu – PPx is very versatile and we believe sonal tip and taking them home. This is very hygienic
that combining PPx with laser light or radiofrequency for both physician and patient and helps us market
will likely produce even better results. PPx. You can also charge for the complete cost of the tip
upfront. Compared to all other aesthetic machines I
What benefits have you derived from
use, PPx is the best from my patients’ perspective.
offering PPx?
Patient feedback is very good. They like the short treat-
ment time, no pain and the results.
Dr. Carasso – I have saved money by not using aes- Dr. Otto – The greatest advantage of the PPx system
thetic creams that cost up to $50 a tube. for me is the cost of the PPx device and the very rea-
sonably priced tips. Costs are much lower than those
Dr. Drago – The less time my staff is in any particular for other devices. These savings allow me to charge less
patient’s room, the more time they can devote to dif- for treatments. As a result, the volume of patients
ferent procedures. PPx makes my staff very efficient. A demanding PPx is greatly increased. Reduced patient
typical session for skin rejuvenation lasts less than 20 downtime is also a big benefit. Another important
minutes. Hair removal, even on a back, lasts less than advantage of Aesthera’s business model is that it
20 minutes. This is a major time saving and revenue allows me to predict my overhead and costs in advance.
advantage. Not needing to apply any anesthetic removes one very
costly item of overhead. The hygienic factor with tips is
Dr. Narurkar – For us the ability to offer a no pain very appealing to the patient as well.
treatment has been great. Also, being able to treat
large areas such as the back and legs was something Dr. Narurkar – I charge the same for PPx as I do for
we were unable to do profitably prior to the introduc- other modalities. But the lack of pain makes PPx
tion of PPx in our practice. treatment faster, so in a way revenues are increased
because it takes me less time to
What are your thoughts on the benefits of
perform treatment. The Aesthera
Aesthera’s unique business model?
business model is very appealing
to the physician. There are no
complete software upgrades that
Dr. Drago – I strongly believe that Aesthera’s offer- cost tens of thousands of dollars.
ing is the most cost effective way to get into aesthet- Mature practices are able to
ics. I really like the company’s business model. PPx is offer another technology without
a very affordable device compared to other lasers having to break the bank. And
which can cost up to $150,000 for the same applica- for those physicians starting out, Vic Narurkar, M.D.
tions. Once a laser company sells you a laser, the laser who are gun-shy about invest-
company doesn’t really care how successful you are ing, PPx is a nice way to get into the business with a
because they have already made the sale. With safe and very effective technology. Because you are
Aesthera, this is not the case. Aesthera is committed paying as you go, you use the technology for the
to ensuring you are successful because their revenues appropriate indications. As a consumer, it is only
are driven by the number of tips you purchase. If you a matter of time before PPx becomes the ultimate
buy a traditional laser, you have to pay the lease business model.
whether or not you are busy. This can be very hard for
practices that are just starting out or who are experi- Dr. Wakamatsu – PPx technology is very exciting
encing a slow period. With Aesthera, during a slow and is the wave of the future. Combining PPx with
period, you don’t need to fork out a tremendous laser light or radiofrequency will likely produce even
amount of money for a high priced lease or for tips. In better results. I
24 Aesthetic Buyers Guide November/December 2005 www.miinews.com