Fraxel re:pair (CO2)

This past weekend I went to a Fraxel re:pair seminar at Reliant Technologies. The re:pair is a CO2 laser that uses Reliant's patented scanning technology to lay down a precise pattern of laser  pulses on the skin. There us no doubt, in my view, that Fraxel has the most sophisticated technology in the field. The scanner is fast and precise, and the relatively high power of the laser allows deeper penetration than competing lasers.

Reliant Technologies has been unique in that they have performed a large number of clinical studies  before releasing the laser. The general rule is that most lasers are released with very little clinical data to back up their effectiveness. The purchasing physician and his patients become the beta testers to find out what the machine can and cannot accomplish.
The founders of Reliant Technologies are veterans of Coherent Inc., the manufacturer of the Ultrapulse laser which was the premier CO2 laser in its time. It was only after the Ultrapulse laser was released, that its benefits and drawbacks were fully understood. The founders of Relaint determined that they were going to do things differently this time. Prior to the release of this laser it was used to treat over 500 patients . Over 100 of them have been treated 18 or more months ago. This is important, because some of the side effects of the original CO2 laser, particularly the loss of skin pigmentation, did not appear until 12 months or later after treatment. Reliant technologies is to be commended for doing such a thorough job. To the best of my knowledge, they have done significantly more than any other laser company.
There is still more work to be done, however. All the published studies about this laser have related to wrinkle reduction and skin tightening. Dr. Christopher Zachary, Chief of Dermatology at UC Irvine, and one of the principal investigators using the machine, is very excited about this benefit and thinks that the use of  the Re:pair will reduce the need for facelifts (Video of Dr. Zachary being interviewed on the Today Show). This may be a somewhat exaggerated expectation, but the treatment results are quite impressive.
Acne scarring is another important use for this type of device. Reliant has not yet released information about the effectiveness of the Re:pair in acne scarring, although I have had verbal communication with one of the investigators who said it appears to be about 30% more effective than the Fraxel Re:store, which has been widely regarded as the treatment of choice for acne scarring (Fraxel Re:store photos) (Fraxel re:pair photos). The original version of the CO2 laser was well established as an effective treatment for acne scarring. Nevertheless, when we  recently had a patient with acne scarring who was interested in the  Re:pair treatment, I felt obligated to tell her that the expected results for this problem have still not been fully   clarified.
Overall it appears that we may have in hand a new tool that will significantly expand our skin rejuvenation capabilities with a much better risk/benefit ratio than older modalities.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA

Comments

[Kevin]

Dr. Bock,

If you are interested in microspot fractional CO2 devices, you should take a look at the MiXto SX by Lasering USA. The MiXto delivers as good or better results of the re:pair. But your patients will not be in so much pain and you won't have to deal with the bloody mess a re:pair treatment renders. It gets better, the MiXto cost $45,000 less and there are no consumable costs. I know Dr. Zachary is on the Reliant payroll, but if you aren't, take a look at the MiXto.

Your blog is very informative and well organized. Thank...Kevin

This is typical of the approach of the Fraxel wannabees. First of all, Dr Zachary is not on the Reliant payroll. He has no financial interest in Reliant or in the success of its products. He was provided a machine for use at UC Irvine, where he is head of the Department of Dermatology. He impresses me as a very honest individual who tells it as it is, and has accurately discussed thr pros and cons of competing machines.
Second, there are a number of manufacturers out there that claim to have machines that are the equal of the Fraxels. The problem is that these claims are based on no evidence. This is the way that the laser industry used to operate: release a product with big claims and then, if it sells, in a few years find out what the machine can actually do. Almost all the competing machines are significantly underpowered, compared to the Fraxel re:pair. None of them have the unique scanner which provides uniformity of treatment, and none, despite any claims of equal effectiveness, have a track record of patient use and safety equal to that of the Fraxel, which has been used on over 500 patients. The nearest competitor to the Fraxel may well be the Sciton, which is currently hobbled by the fact that it uses a different wavelength which is associated with considerable bleeding, making the procedure extremely difficult to complete. As I've said before, I believe that patients currently being treated with these other machines are involuntary experimental subjects.

Gerald N. Bock MD
California Skin and Laser Center
Stockton & Lodi, CA

[Cosmetic surgery Atlanta]

Good information for all those who are suffering from the problem of acne.Those going through the problem already know that it is very hard to get rid of the skin rash.