Smoothbeam puts wrinkle removal in hands of primary-care physicians

Two years after predicting that the cosmetic-laser market was on the verge of a technology "revolution" that would put compact, low-cost, easy-to-use systems in the hands of nonspecialists, Gerry Puorro, president and CEO of Candela, has followed through on his promise (see Medicalwatch, Laser Focus World, August 1999). The company has developed a diode-laser-based nonablative skin "remodeling" system called Smoothbeam that weighs less than 40 lb and sells for under $50,000. The product was formally launched at the American Academy of Dermatology meeting this month.

"Smoothbeam will enable physicians to offer nonablative skin renewal services to their patients at a fraction of the cost of competing laser systems," Puorro says.

Puorro also expects the new laser system to further grow Candela's profit margins. The company made a conscious choice a few years ago to transition away from products intended only for dermatologists and plastic surgeons, of which there are only 15,000 in the United States. By contrast, Candela has identified about 110,000 physicians in other relevant disciplines—such as obstetrician/gynecologists and and eye, nose, and throat specialists—and is now marketing products that appeal to those customers as well.

The Smoothbeam also takes advantage of advances in diode-laser design and production to further reduce manufacturing and production costs and pass these savings on to the customer, he adds. The system utilizes 1450-nm diode-laser energy and Candela's Dynamic Cooling Device (DCD) technology, licensed from the University of California, Irvine. The 2-Hz device delivers the energy to tissue via a 4-mm spot size.

Candela claims the wavelength also offers clinical advantages. The company has dubbed the Smoothbeam approach "laser-assisted skin renewal" for collagen remodeling. The 1450-nm wavelength heats the upper dermis, inducing mild thermal injury but not removing any layers of skin. Instead, the body's natural healing response initiates collagen remodeling and the deposition of new, "organized" collagen, smoothing fine wrinkles from the inside out.

Candela claims its approach is different from the skin rejuvenation promoted over the last few years by such companies as Cooltouch (formerly Laser Aesthetics), ESC, and Biolase; but skin rejuvenation is also described as a nonablative procedure that uses laser energy to prompt changes in collagen structure beneath the skin's surface (see figure).

"Smoothbeam is unique in that the wavelength it offers enables one to localize thermal injury to the upper dermis, which is closer to the skin's surface, providing more visible results," says Dilip Paithankar, senior scientist at Candela.

The DCD cryogen spray that cools the skin is also critical in protecting and preserving the epidermis before, during, and after lasing, he adds. This is particularly important given that the Smoothbeam is designed for outpatient procedures that take less than an hour to perform and require little to no postoperative care.

"This laser uses a unique combination of optimum wavelength and skin cooling protection to take skin renewal to new levels of efficacy, safety, comfort, and ease of use," says David Goldberg, MD, chief of dermatologic surgery at New Jersey Medical School and a clinical investigator for Candela.

Still, the laser has some drawbacks, primarily in terms of the spectrum of wrinkles it can treat. In clinical trials in Japan and Switzerland, the system was shown to be most effective on superficial and fine wrinkles, particularly around the eyes and upper lip, according to Puorro.

Candela introduced the laser in Europe and Japan, one of its strongest cosmetic markets, earlier this year. While the system has US Food and Drug Administration clearance for general dermatology applications, the company is still awaiting additional marketing clearance specifically for wrinkle removal.