Reliant's Fraxel Laser Earns Doctors' Praise for Resurfacing Skin

San Diego Union Tribune - December 17, 2004

by Teri Somers, Union Tribune Staff Writer

Lasers that have been improved by San Diego-based Reliant Technologies are a local dermatologist's tool of choice to remove the dark scars and pockmarks that teenage acne leaves behind.

Dr. Richard Fitzpatrick, a La Jolla dermatologist, is using the same laser to remove spots, wrinkles and that crepey texture from the skin of a growing number of baby boomers. And for the first time, he and other dermatologists have a laser resurfacing treatment for hard-to-treat areas such as the neck, chest and backs of the hands.

"The results I'm able to achieve . . . the healing and repairing of the skin without causing damage is unlike anything I've seen before," Fitzpatrick said of Reliant's Fraxel laser.

Dr. Richard Fitzpatrick of Dermatology Associates in La Jolla used Reliant Technologies' Fraxel laser to treat college student Rochelle Currier of San Clemente.

Reliant Technologies began developing the Fraxel laser in 2001, received Food and Drug Administration clearances in July and released it to market in the beginning of the fourth quarter. It has so far been placed in the offices of 41 dermatologists or plastic surgeons around the country.

With 65 million baby boomers in the United States, many of them wanting to maintain a youthful appearance and willing to pay out of pocket for the service, privately held Reliant expects more than $40 million in revenue next year, said Mark Tager, vice president of marketing and sales. Tager said the company achieved a positive cash flow in November, but he declined to comment further on its current finances.

The company, which employs 65 at its San Diego headquarters and a Palo Alto manufacturing facility, is the brainchild of brothers Maynard and Roger Howe, along with Len DeBenedictis, who has worked in the laser development field for more than 30 years.

Most lasers used for cosmetic purposes are clumsy black boxes with a big footprint, Tager said. The Howes and DeBenedictis thought they left the industry ripe for the development of innovative uses for those powerful streams of light energy. The company's executives also saw the opportunity to take advantage of the telecom bust by hiring engineers with novel ideas for lasers they had become familiar with in their old jobs.

Reliant licensed the concept that became Fraxel from physician Nikolai Tankovich, who patented a treatment concept that used the laser on only portions of the face, sparing much of the surface tissue.

Working with Dr. Rox Anderson at Wellman Labs at Harvard University, DeBenedictis and company scientists developed a method for regenerating skin using fractional patterns, or microscopic spots spread out like the tiny pixels in a photograph.

The end product is a laser and supporting software that have the capacity to see an area that needs to be treated and deliver a precise beam that can be altered to specific dosage sizes.

Fitzpatrick, the La Jolla dermatologist, has been using lasers in his practice since 1979 for myriad uses including correcting skin problems and removing hair. The Fraxel laser is the latest in that line of equipment.

The laser beam the Fraxel uses, the depth it penetrates the skin and the area of tissue that is treated are just some of the reasons the device is so unique, said Fitzpatrick, who participated in clinical testing of the laser on patients.

Rochelle Currier, 23, a college student from San Clemente, started receiving the Fraxel laser treatments from Fitzpatrick in late May. Though the laser has FDA approval for use on age spots, lesions and wrinkles around the eyes, Fitzpatrick has been using the laser "off label" for acne.

For Currier, the process required arriving at the doctor's office an hour early so that a topical anesthetic spread on the treatment area had time to take effect. Her face was also covered in a blue dye, making it a mouse pad for the hand piece the doctor would glide across her skin, administering the laser beams.

The hand piece and its accompanying software detect the blue and identify it as the treatment area. If the wand passes onto untinted skin, it will not emit any laser beams.

The software also allows the doctor to determine how far apart the laser beams should be spaced on a patient's skin and the depth to which they should penetrate.

The laser beams heat the water in the skin, causing a wound. During the healing process, the body produces collagen, which plumps up the skin.

There are lasers that treat the skin's surface, peeling away damaged cells. This process, called ablative resurfacing, leaves a patient's skin raw and can lead to oozing and crusting. Recuperation requires weeks of downtime, and there's always the possibility of scarring.

Other laser techniques, called nonablative resurfacing, leave the skin's surface unscathed but are concentrated on the layers beneath. The theory is that when collagen moves to the subcutaneous wounds for healing, surface wrinkles are plumped up.

The technique doesn't have a lengthy recovery like that after ablative resurfacing, but its effects aren't as successful.

The Fraxel is a combination of the two techniques.

Its laser beams, about one-tenth the circumference of a hair follicle, are spaced farther apart than those used in ablative resurfacing. They treat columns of skin, from the surface to a specified depth below. But the columns are spaced so far apart that the tiny wounds are invisible.

About 15 percent of the surface is treated during each session. The patient's skin may be temporarily red, but the treatment shouldn't lead to peeling or require any downtime for the patient.

The beams are sharper and more concentrated, so that the intentional damage below the surface is more effective, Fitzpatrick said.

Currier chatted comfortably, and even giggled at a visitor's questions, as the doctor passed the wand across her face. But she said she was a bit more sensitive on the second pass of the wand, when Fitzpatrick paid special attention to the indentations the acne had left behind.

Ten minutes after Fitzpatrick started on her, Currier was up and washing the blue dye off her face - the most difficult part of the procedure.

Currier said she noticed an improvement in her skin after the first treatment. Now, after numerous visits to Fitzpatrick, her skin shows a clear improvement from the way it looked in photographs taken previously - pockmarks appear to have disappeared and others are less noticeable, while red scars have been erased.

"I just feel more confident about my skin," Currier said. "That's the biggest thing."

Dr. Tina Alster, a clinical professor of dermatology at Georgetown University in Washington, D.C., was at first not very interested in the Fraxel when contacted by a Reliant representative.

"I just thought, 'We don't need one more resurfacing system,' " said Alster, who runs the Washington Institute of Laser Surgery.

She finally agreed to buy one of the laser systems with the agreement that if she hated it, she would tell everyone and Reliant would have to buy it back.

"Now I love it," Alster said. "It marries the best of what we had with ablative resurfacing and evening out pigment, with the best of nonablative because you don't have to have downtime. My patients can take a long weekend and see a vast difference in their skin, even after one treatment."

Alster, like Fitzpatrick, found that she can use the laser on areas other than the face. With other treatment systems, the neck, chest and hands tend to scar, she said, adding that this isn't happening with the Fraxel.

Dr. Douglas Key, a Portland, Ore.-based dermatologist, also was ecstatic about the neck and chest results.

"The Fraxel takes it from zero to 100 miles per hour," said Key, who runs the Key Laser Institute for Aesthetic Medicine.

That's good news for people who in the past would have work done on their face, only to have their neck or hands give them away.

In San Diego and Washington, D.C., treatments range from about $1,000 to $1,500 for the entire face, but the price can go up if a session also includes neck and chest, doctors said. In Portland, Ore., it costs about $1,200 for the face and around $1,600 for the face, neck and full chest treatment. Ablative treatments could cost $4,000 to $5,000.

Patients are learning about the treatment through word of mouth, news stories and mentions in fashion magazines, said doctors who use it - and business is booming.

Of the 25 patients Alster saw yesterday, six were treated with the Fraxel. Five of those patients had the laser treatment on their face and neck, and one was treated for dark circles under the eyes.

At an international dermatology conference in Florence, Italy, last month, Key told doctors from Europe and Asia that the Fraxel is "one of the most important advances in treating sun aging to come along."

He said that besides getting rid of the wrinkles and pigment discoloration, his patients have seen tightening of the skin and a rejuvenation of brightness and luster.

Article courtesy of SignOnSanDiego.com by the Union Tribune