8/14/2019 The Aesthetic Guide - Affirm CO2 (Katz) - Fall 2008

1/2

THE

September/October 2008

By Bob Kronemyer, Associate Editor

According to Bruce Katz, M.D., directorat JUVA Skin and Laser Center in New YorkCity, N.Y., the Affirm CO2 Workstationfrom Cynosure, Inc. (Westford, Mass.)

provides micro ablative treatment with awide-range of settings for incredible flexi-bility. Dr. Katz schedules everything fromsuperficial wrinkle treatments to deep CO2laser resurfacing but with minimal recov-ery time ranging from one to five days.Acne scarring, pigmentary disorders, skintexture, surgical scars and traumatic scarscan also be improved with this next-gener-ation micro ablative technology.

I think well even be able to treat photo-damage, such as actinic keratoses, Dr.Katz noted. Treatment is effective becausemicro ablative resurfacing creates micro-channels, leaving normal skin betweenthese channels, therefore you have muchfaster healing than was possible with olderablative CO2 devices, which basicallyablates the entire skin surface.

Furthermore, since the Affirm is CO2based rather than erbium or non-abla-tive, you are bound to achieve muchbetter results and some noticeable skintightening due to collagen rejuvenationwhich we were not able to really observewith erbium micro ablative lasers, Dr.Katz advised. The current trend is defi-nitely toward CO2 lasers for micro abla-tive treatments. We can achieve 70% to80% of the results we previously attained

with ablative CO2 lasers, but with amuch shorter recovery time and less like-lihood of complications such as hypopig-mentation, occasional infections and

scarring. These adverse events should beextremely rare, if not non-existent, withmicro ablative CO2.

For superficial wrinkles, three or foursessions may be required with the AffirmCO2, spaced two to three weeks apart.For this indication, Dr. Katz initially uses15 watts of electrical power, along witha dwell time of about 500 microsecondsand a pitch (distance between the indi-vidual dots or micro ablative channels) ofapproximately 500 microns. Topicalanesthetic is used for patient discomfort,which is really adequate for a majorityof these treatments and eliminates sys-temic risks from anesthesia. However, forreally deep treatment, we might use someregional nerve blocks. After a series oftreatments for superficial wrinkles, wevirtually achieve full clearance of the

wrinkles. Patients are red and puffy fabout one day. Results should last seveal years. More aggressive treatmenparameters may lead to more dramati

outcomes in fewer sessions with ttrade-off of a longer downtime period up to five days approximately.

For acne scarring, depending on scadepth, four to six sessions may be necesary, again at two to three week intervalSettings are 20 watts, a 700 to 800microsecond dwell time and a pitch about 400 microns. Patients can expecanywhere from 60% to 80% clearance,Dr. Katz conveyed. There is probably twdays of downtime with redness an

swelling. However, the results are likpermanent.

Cynosures Affirm CO2 ModernizesCO 2 Treatments

Medical Insight, Inc. 120 Vantis #470, Aliso Viejo, CA 92656 (949) 830-5409 Facsimile: (949) 830-8944 www.miinews.com

Bruce Katz, M.D.DirectorJUVA Skin and Laser CenterNew York City, NY

After Affirm Tx

Before Tx

Photos courtesy of Bruce Katz, M.D.

We can achieve 70%to 80% of the results

we previously attainedwith ablative CO2

lasers, but with a muchshorter recovery timeand less likelihood of

complications.

8/14/2019 The Aesthetic Guide - Affirm CO2 (Katz) - Fall 2008

2/2

For patients with deep wrinkles andsome skin laxity, Dr. Katz uses between 20and 25 watts, a 1,000 microsecond dwell

time and a pitch ranging from 200 to 300microns. Patients should see a 70% to80% improvement.

Dr. Katz is the principal investigator ofan ongoing study evaluating the AffirmCO2 Workstation in 15 patients with mod-erate-to-severe wrinkling and/or photo-damage. After only one session, peopleare reporting visible improvement, but wehave to wait to complete the entire seriesof sessions, he said. The single-site studyconsists of one to three sessions at three

week intervals.Dr. Katz recommends that physicians

start out at lower wattages until they feelcomfortable with the response from theirpatients, however, the Affirm CO2 is afairly easy laser to use. There is not asteep learning curve. You have a lot offlexibility in adjusting the pulse duration.You also need to ask the patient howmuch downtime he can afford. Patientsdesiring only one day of downtime shouldbe treated with the appropriate settings

for more superficial changes, whereaspatients who agree to three or four days

of downtime can be treated with highersettings for deeper penetration of thelaser and faster results. Dr. Katz also sug-

gests test spots for skin types IV to VI.According to Dr. Katz, many people

have heard about micro ablative technolo-gy, therefore its pretty easy to talk topatients about the Affirm CO2. Many ofmy patients have been eager to try it. Tobe honest, it is a technology that sells itself.People are intrigued with the concept oftreating a fraction of the skin with normalhealing between the micro-channels.

Dr. Katz also feels that the Affirm CO2

is great for treating the eyelids alone

(rejuvenating the upper and lower eyelidswith only a few days of downtime. Manwomen who are not ready for an eyeli

right now find this treatment very appeing. After just two treatments one of DKatzs female patients in her early fiftiwas thrilled with the results. Wrinkliand laxity significantly improved. She wpleasantly surprised. Dark rings on thlower eyelids can also be treated effectivly with the Affirm CO2.

Dr. Katz has treated his 81 year olmothers deeper wrinkles with the AffiCO2. Living in Florida, my mother hsignificant wrinkles. After two sessio

they were much improved. Overall, yocan treat any age from patients in thethirties who have a lot of sun damagfrom when they were kids, all the way uto patients in their eighties who have wrkles, pigmentation changes and texturairregularities. Some of these older patienmay also have acne scars.

Off-face areas, including the neckdcollet area of the chest and backs othe hands can also be treated with thAffirm CO2. With the original CO2 laser,

these were areas we would not treaupon due to the risk of scarring, Dr. Kaexplained. Now we can use micro ablative CO2 on these areas with very nicresults. Two or three treatments, spacetwo to three weeks apart, will typicalproduce good results in non-facial areasOne example is Dr. Katzs observation significant improvement in wrinklibetween the breasts with the Affirm CO2Workstation. Up until now, we havenbeen able to do much for these wrinkleWomen are very happy. Many have stared to wear low-cut dresses again.

Treating non-facial areas with thAffirm is becoming increasingly populaCompared to micro ablative erbiumlasers, micro ablative CO2 allows us topenetrate deeper and achieve more substantial results.

Compared to microablative erbium lasers,

micro ablative CO2allows us to penetratedeeper and achieve

more substantial results.

Before Tx After Affirm TxPhotos courtesy of Bruce Katz, M.D.