September/October 2010
HOYA ConBio Lasers Successfully
Treat Melasma
By Bob Kronemyer, Associate Editor
Practitioners are increasingly turning to
light sources to effectively manage melasma, a pigment condition most commonly
presented in Asian populations. The RevLite
and MedLite C6, both Q-switched Nd:YAG
lasers from HOYA ConBio (Fremont, Calif.),
are showing some very promising results.
In a recently published prospective study
that appeared in the Journal of Cosmetic
and Laser Therapy (2010; 12:126-131),
treatment of refractory melasma with the
MedLite C6 laser and alpha-arbutin found
that 30% of patients achieved more than
81% improvement and 37% of patients
achieved between 51% and 80% improvement at six months. Patients were treated
every week, for a total of ten sessions, with
10 to 20 passes per session using a 6 mm
spot size at 3 J/cm2 to 3.4 J/cm2.
“Even though the MedLite C6 has a nearly perfect flat beam profile and high energy
pulse, the skill of the physician in placement
of pulses, stacking of pulses, angle of exposures and recognition of clinical tissue reactions, are crucial factors that determine
success or failure of treatment,” reported
study author Niwat Polnikorn, M.D., director of Kasemrad Aesthetic Center in
Bangkok, Thailand. “Keeping good photographic records of patient results and
hands-on training with experienced physicians is also important.”
Mixed type melasma before Tx
Photos courtesy of Niwat Polnikorn, M.D.
been treating melasma with the MedLite
C6 laser since 2006. “We’ve been able
to successfully treat melasma that is recalcitrant to topical therapies alone because
the laser has the ability to reach deeper
into the dermis, whereas topical fade
creams cannot,” he said.
Niwat Polnikorn, M.D.
Medical Director
Kasemrad Aesthetic Center
Bangkok, Thailand
However, Dr. Polnikorn pointed out that
high energy alone is not enough for precise
breakage of melanins. “You need a large
spot size (at least 6 mm) to go deeper and
a flat beam for even pigment breakage,
without damage to the basement membrane,” he explained. These features are
found in the MedLite C6 laser, plus high energy fluence (> 1,000 mJ). The flat beam
also provides for minimal tissue injuries.
Moreover, the laser allows “for perpendicular and steady hand movement speed
for minimal overlapping between pulses,”
Dr. Polnikorn noted. “Closely monitoring
clinical endpoints is critical as well.”
In particular, Dr. Polnikorn prefers the
Medlite C6 and RevLite as first line treatment in skin types IV through VI “due
to the predictable results, less post-inflammatory hyperpigmentation and the
additional benefits of overall skin lightening and rejuvenation.”
G. Anthony Slagel, D.O., a dermatologist
in private practice in Fayetteville, Ga., has
Mixed type melasma after ten bi-weekly
Rebound melasma before Tx
Photos courtesy of Niwat Polnikorn, M.D.
G. Anthony Slagel, D.O.
Fayetteville, GA
Patients schedule eight sessions, approximately three weeks apart. The first treatment is typically at a fluence between 2.5
J/cm2 to 3.0 J/cm2, depending on skin
type, along with a 6 mm spot size and 10
Hz. “With each subsequent treatment, we
adjust the fluence upwards, about 10%,”
Dr. Slagel advised. After a series of treatments, “the vast majority of even the most
hyperpigmented areas of melasma are either gone or lightened to the point where
they are much more easily concealed with
a little make-up.”
After completing the series, patients return for a quick touch-up once every three
months, in which the initial setting is repeated. “These touch-ups basically allow
us to keep the melasma from returning,”
Dr. Slagel said.
Rebound melasma after two treatments,
two weeks apart
Dr. Slagel has seen patients
burned with intense pulsed
light (IPL) devices; therefore,
he believes that Q-switched
Nd:YAG technology achieves
safer and superior results
than IPL for treating melasma.
The 1064 nm “is such a safe
Medical Insight, Inc.® • 120 Vantis #470, Aliso Viejo, CA 92656 • (949) 830-5409 • Facsimile: (949) 830-8944 •