Erchonia's Zerona laser
Special report: Lighting up the laser industry
March 29, 2011
This report originally appeared in the March 2011 issue of DOTmed Business News
By Kathy Mahdoubi, DOTmed News
The entire surgical and cosmetic laser enterprise involves several disciplines from dermatology to neurosurgery and an ever-broadening spectrum of procedures from laser hair-removal and acne treatment to the diagnosis, therapy and surgical treatment of cancer and degenerative disease. So-called light medicine is making a name for itself with innovative photodynamic therapies, lit-up nanoparticles and photobiomodulation — used to disrupt cell biology, reduce inflammation and help cells heal. These days, lasers and optical technologies are not only being used in the operating room for the surgical removal of tissue, but also for diagnostic purposes, and new laser research may clear the way for smarter and more sensitive prosthetic limbs.
On the business side, elective cosmetic procedures still account for the largest share of procedures in the laser market, and some experts believe that global sales are finally beaming a bit brighter this year after a few particularly dim years thanks to expanding international markets for both OEMs and resellers of cosmetic lasers.
Photobiomodulation of a
chronic wound of
the distal tibia
Minimally invasive aesthetic procedures used to trim the waistline, eliminate varicose veins and smooth blemished and hirsute skin continue to be mainstays for the laser industry. It may not be the most glamorous procedure, but hair removal is still by far the most in-demand laser treatment, says E. Duco Jansen, president of the American Society for Lasers in Medicine and Surgery.
An array of technologies
Some of the most widely used lasers include YAG (yttrium aluminum garnet) and CO2 lasers, but in recent years an increasing number of alternative and minimally invasive technologies have been brought to light, including multi-device platforms that use non-surgical intense pulsed light and radio frequency technologies.
While cosmetic procedures are widely known as the main drivers in the industry, the whole spectrum of laser applications includes imaging, optical diagnostics, surgical and therapeutic applications. Lasers have been used in medicine for decades, but a field called photodynamic therapy, which means the combined use of lasers and pharmaceuticals, has been enjoyed growing interest, especially now that it is being implicated in an area of nanomedicine.
“Photodynamic therapy classically means using a laser device to excite a drug or some substance within a cell or tumor to cause fluorescence, so it gives off light to be able to detect something, or to destroy the tissue or lesion by various mechanisms, one of which is causing the compound in the tissue of interest to retain oxygen radicals, among other things,” says Dr. Raymond Lanzafame, a general surgeon in private practice in Rochester, N.Y. Lanzafame is also editor of Photomedicine and Laser Surgery and director of education for ASLMS.
This technique is already being used in ophthalmology to treat macular degeneration and in urology to treat bladder cancers.
“Success of photodynamic therapy has been mostly outside of the U.S.,” says Jansen. “From a regulatory standpoint it’s been a real nightmare getting this into the broader arena in the commercial sector.”
Light nanomedicine
In the research lab, photodynamic therapy is now moving into the realm of nanomedicine. Scientists are uniting gold and other metal particles and therapeutic antibodies and using light energy to heat up the tissues containing the nanoparticles for a highly targeted cancer therapy. If approved, this form of nanomedicine could be introduced into clinical use in as little as five to 10 years.
“The appeal of these kinds of technologies is that you can get to things you might not otherwise get to easily in a classical surgical paradigm,” says Lanzafame.
Photobiomodulation
Low-intensity light therapies are also being used to manipulate cell biology for a range of ameliorative effects from pain relief and wound healing to the promotion of spinal cord tissue regeneration.
“What that discipline is most centered on is the interaction of tissues with light so that one can turn on or off various cellular processes,” says Lanzafame. “There’s a whole cadre of science and research being done in that discipline.”
Preventing resurgeries
Optical diagnostics are becoming a focus in the operating room and may end up saving patient’s lives and a great deal of money. No matter how experienced a surgeon is, statistics show that about 40 percent of cancer surgeries fail to eliminate all traces of the cancer, requiring additional surgeries, says Jansen. “We have the laser sources and we have these fantastic tools to do microsurgery on all sorts of tissues with almost cellular precision, but right now, unless you know what to cut and what not to cut, it doesn’t do you any good.”
New imaging and spectroscopy devices are enabling real-time optical diagnostics during surgery. Surgeons can shine white light on tissues or use fluorescence and analyze the returning spectrum of light to make diagnoses about tissues.
“You can think of this as sort of a Swiss Army Knife,” says Jansen “We’ve now got a bunch of different tools in our toolbox.”
Smart prosthetics
Jansen is also a professor of biomedical engineering and neurosurgery at Vanderbilt University in Nashville, Tenn. His research focuses on biomedical optical research for novel prosthetic limbs using fiber optic nerve devices. Scientists and engineers are shining tiny laser pulses on neural cells in the brain in order to relay signals about pressure and other important aspects of touch and motor control to the prosthetics in an effort to mimic natural sensory feedback. These new prosthetics will allow a greater range of motor function, including the ability to gently grasp and hold fragile objects without crushing them. Funding for this research is coming from the Department of Defense.
“There are a large number of folks coming back from the Middle East with missing limbs,” says Jansen. “These people are in their early twenties and they have a long life ahead of them. We want to restore function for these patients.”
Laser sales improving slowly
Cosmetic lasers are the real money-makers in the industry and the six big manufacturers in the game are Palomar, Syneron, Cynosure, Cutera, Lumenis and Sciton. There was fallout during the recession and many small aesthetic operations that purchased some $80,000 to $200,000 cosmetic lasers could not make payments — many medi-spas closed shop entirely. As a result, used lasers flooded the market and drove down prices.
Some reports indicate that from 2008 to 2009 the industry saw approximately a 30 percent drop in global laser sales. Robert Ruck, global vice president of worldwide marketing for Sciton, says those numbers flattened out and started heading back up in 2010.
“I suspect high single-digit growth somewhere around the 7, 8 or 9 percent range,” says Ruck. “This is primarily due to international markets reporting strong growth.”
That is especially the case in China and throughout the European Union and in places like Australia and Brazil, where sales have rebounded pretty strongly, says Ruck, but this is so far not the case in the U.S. market. American sales remain flat, at best.
There may finally be some loosening up on financing for new lasers where previously there was a big cinch, and now more practices look like they are getting back into the business of buying. Some challenges are expected for existing laser manufacturers as new competitors emerge and attempt to carve out their niche in the industry.
Freezing the fat
The hottest news in cosmetic procedures is actually more on the cold side. The FDA recently approved two new devices for selective fat reduction that perform “cold lipo,” or cryolipolysis on those unwanted love handles. The new procedure essentially entails cooling underlying tissues causing cell death within subcutaneous fat tissues. This is being seen as a minimally invasive alternative to liposuction and has not been shown to cause long-term side effects. One of these devices is the Zerona laser, manufactured by Erchonia and another is a device manufactured by California-based Zeltiq.
Some successes for resellers
In the used and refurbished market there continues to be a flood of lasers, but some businesses are still booming. The Laser Outlet, a medical and cosmetic laser marketplace headquartered in Jupiter, Fla. has experienced significant growth, according to Sam Lehrer, president and CEO of the company.
Lehrer attributes the success to online marketing strategies and the opening of international markets, but he also acknowledges that refurbishers face a challenge.
According to Lehrer, the greatest challenge to resellers and refurbishers is getting support from original manufacturers in terms of manuals and parts sourcing. The FDA requires manufacturers to provide these resources, but Lehrer says some OEMs ignore the requirements or make it extremely difficult for resellers and refurbishers to obtain the parts and infomration. Lehrer says OEMs are charging “astronomical” recertification fees before providing service for their lasers — as much as $30,000 for lasers that cost less than $100,000 new.
In addition to difficulties in servicing a wide range of lasers, another issue is sourcing parts for these technologies. “Getting parts is a grind,” says Lehrer. “Every single day we are on the phone having to source parts.”
Some of the technologies moving in the used market are fractional erbium YAG and CO2 lasers and those synergistic platforms that offer combination therapies like IPL or RF technologies and lasers in one device.
A full spectrum industry
Laser hair removal may account for as much as one-third of all laser treatments, but on the clinical side, new research and emerging technologies in laser and optical medicine are advancing therapies and helping surgeons operate with more precision and diagnostic insight. There’s no doubt that new procedures like those used to freeze your midsection and heat up cancer cells using tiny gold particles will continue to shine a light on this focused brilliant industry sector.
DOTmed Registered Surgical and Cosmetic Lasers Sales & Service Companies
Names in boldface are Premium Listings.
Domestic
Vin Wells, Rock Bottom Lasers, AZ
DOTmed Certified
Christopher Ostler, Wholesale Aesthetics, LLC, CA
DOTmed Certified
Robert Ruck, Sciton, CA
Charlie Wynn, Advanced Technology Laser, CA
Jim Mousseau, The Laser Network, CO
Shawn Burkey, The Laser Warehouse, FL
DOTmed Certified
DM 100
Samuel Lehrer, TheLaserOutlet.com, FL
DM 100
Luis Eduardo Malagon, Professional Aesthetic Clinic, FL
David Spirko, Laser Labs, Inc., FL
DOTmed Certified
Robin Santana, Laser Ventures, GA
Monte Montain, Alternative Source Medical, IL
DOTmed Certified
DM 100
Bob Gaw, PRN, MA
DOTmed Certified
DM 100
John Gladstein, Medical Device Depot, MD
DOTmed Certified
Alison Fortin, Global Inventory Management LLC, NH
DOTmed Certified
DM 100
John Yorke, LaserMedix, NY
Patrick Clark, Medical Laser Dynamics, Inc., TX
Mark Crabtree, Equipment Placement Services, TX
John Crownover, Laser Scientific, TX
DOTmed Certified
DM 100
Dan Herbert, Laser Concepts-Cosmetic Laser World, TX
DOTmed Certified
DM 100
Tommilyn (Tommi) Amos, LuxaCare, LLC, WA
Lee Atkins, Advanced Medical Inc, WA
DOTmed Certified
International
Shinichi Fujiyama, SAIL International Co., Ltd. , Japan
Evgeny Amelin, ESELA , Czech Republic
By Kathy Mahdoubi, DOTmed News
The entire surgical and cosmetic laser enterprise involves several disciplines from dermatology to neurosurgery and an ever-broadening spectrum of procedures from laser hair-removal and acne treatment to the diagnosis, therapy and surgical treatment of cancer and degenerative disease. So-called light medicine is making a name for itself with innovative photodynamic therapies, lit-up nanoparticles and photobiomodulation — used to disrupt cell biology, reduce inflammation and help cells heal. These days, lasers and optical technologies are not only being used in the operating room for the surgical removal of tissue, but also for diagnostic purposes, and new laser research may clear the way for smarter and more sensitive prosthetic limbs.
On the business side, elective cosmetic procedures still account for the largest share of procedures in the laser market, and some experts believe that global sales are finally beaming a bit brighter this year after a few particularly dim years thanks to expanding international markets for both OEMs and resellers of cosmetic lasers.
Photobiomodulation of a
chronic wound of
the distal tibia
Minimally invasive aesthetic procedures used to trim the waistline, eliminate varicose veins and smooth blemished and hirsute skin continue to be mainstays for the laser industry. It may not be the most glamorous procedure, but hair removal is still by far the most in-demand laser treatment, says E. Duco Jansen, president of the American Society for Lasers in Medicine and Surgery.
An array of technologies
Some of the most widely used lasers include YAG (yttrium aluminum garnet) and CO2 lasers, but in recent years an increasing number of alternative and minimally invasive technologies have been brought to light, including multi-device platforms that use non-surgical intense pulsed light and radio frequency technologies.
While cosmetic procedures are widely known as the main drivers in the industry, the whole spectrum of laser applications includes imaging, optical diagnostics, surgical and therapeutic applications. Lasers have been used in medicine for decades, but a field called photodynamic therapy, which means the combined use of lasers and pharmaceuticals, has been enjoyed growing interest, especially now that it is being implicated in an area of nanomedicine.
“Photodynamic therapy classically means using a laser device to excite a drug or some substance within a cell or tumor to cause fluorescence, so it gives off light to be able to detect something, or to destroy the tissue or lesion by various mechanisms, one of which is causing the compound in the tissue of interest to retain oxygen radicals, among other things,” says Dr. Raymond Lanzafame, a general surgeon in private practice in Rochester, N.Y. Lanzafame is also editor of Photomedicine and Laser Surgery and director of education for ASLMS.
This technique is already being used in ophthalmology to treat macular degeneration and in urology to treat bladder cancers.
“Success of photodynamic therapy has been mostly outside of the U.S.,” says Jansen. “From a regulatory standpoint it’s been a real nightmare getting this into the broader arena in the commercial sector.”
Light nanomedicine
In the research lab, photodynamic therapy is now moving into the realm of nanomedicine. Scientists are uniting gold and other metal particles and therapeutic antibodies and using light energy to heat up the tissues containing the nanoparticles for a highly targeted cancer therapy. If approved, this form of nanomedicine could be introduced into clinical use in as little as five to 10 years.
“The appeal of these kinds of technologies is that you can get to things you might not otherwise get to easily in a classical surgical paradigm,” says Lanzafame.
Photobiomodulation
Low-intensity light therapies are also being used to manipulate cell biology for a range of ameliorative effects from pain relief and wound healing to the promotion of spinal cord tissue regeneration.
“What that discipline is most centered on is the interaction of tissues with light so that one can turn on or off various cellular processes,” says Lanzafame. “There’s a whole cadre of science and research being done in that discipline.”
Preventing resurgeries
Optical diagnostics are becoming a focus in the operating room and may end up saving patient’s lives and a great deal of money. No matter how experienced a surgeon is, statistics show that about 40 percent of cancer surgeries fail to eliminate all traces of the cancer, requiring additional surgeries, says Jansen. “We have the laser sources and we have these fantastic tools to do microsurgery on all sorts of tissues with almost cellular precision, but right now, unless you know what to cut and what not to cut, it doesn’t do you any good.”
New imaging and spectroscopy devices are enabling real-time optical diagnostics during surgery. Surgeons can shine white light on tissues or use fluorescence and analyze the returning spectrum of light to make diagnoses about tissues.
“You can think of this as sort of a Swiss Army Knife,” says Jansen “We’ve now got a bunch of different tools in our toolbox.”
Smart prosthetics
Jansen is also a professor of biomedical engineering and neurosurgery at Vanderbilt University in Nashville, Tenn. His research focuses on biomedical optical research for novel prosthetic limbs using fiber optic nerve devices. Scientists and engineers are shining tiny laser pulses on neural cells in the brain in order to relay signals about pressure and other important aspects of touch and motor control to the prosthetics in an effort to mimic natural sensory feedback. These new prosthetics will allow a greater range of motor function, including the ability to gently grasp and hold fragile objects without crushing them. Funding for this research is coming from the Department of Defense.
“There are a large number of folks coming back from the Middle East with missing limbs,” says Jansen. “These people are in their early twenties and they have a long life ahead of them. We want to restore function for these patients.”
Laser sales improving slowly
Cosmetic lasers are the real money-makers in the industry and the six big manufacturers in the game are Palomar, Syneron, Cynosure, Cutera, Lumenis and Sciton. There was fallout during the recession and many small aesthetic operations that purchased some $80,000 to $200,000 cosmetic lasers could not make payments — many medi-spas closed shop entirely. As a result, used lasers flooded the market and drove down prices.
Some reports indicate that from 2008 to 2009 the industry saw approximately a 30 percent drop in global laser sales. Robert Ruck, global vice president of worldwide marketing for Sciton, says those numbers flattened out and started heading back up in 2010.
“I suspect high single-digit growth somewhere around the 7, 8 or 9 percent range,” says Ruck. “This is primarily due to international markets reporting strong growth.”
That is especially the case in China and throughout the European Union and in places like Australia and Brazil, where sales have rebounded pretty strongly, says Ruck, but this is so far not the case in the U.S. market. American sales remain flat, at best.
There may finally be some loosening up on financing for new lasers where previously there was a big cinch, and now more practices look like they are getting back into the business of buying. Some challenges are expected for existing laser manufacturers as new competitors emerge and attempt to carve out their niche in the industry.
Freezing the fat
The hottest news in cosmetic procedures is actually more on the cold side. The FDA recently approved two new devices for selective fat reduction that perform “cold lipo,” or cryolipolysis on those unwanted love handles. The new procedure essentially entails cooling underlying tissues causing cell death within subcutaneous fat tissues. This is being seen as a minimally invasive alternative to liposuction and has not been shown to cause long-term side effects. One of these devices is the Zerona laser, manufactured by Erchonia and another is a device manufactured by California-based Zeltiq.
Some successes for resellers
In the used and refurbished market there continues to be a flood of lasers, but some businesses are still booming. The Laser Outlet, a medical and cosmetic laser marketplace headquartered in Jupiter, Fla. has experienced significant growth, according to Sam Lehrer, president and CEO of the company.
Lehrer attributes the success to online marketing strategies and the opening of international markets, but he also acknowledges that refurbishers face a challenge.
According to Lehrer, the greatest challenge to resellers and refurbishers is getting support from original manufacturers in terms of manuals and parts sourcing. The FDA requires manufacturers to provide these resources, but Lehrer says some OEMs ignore the requirements or make it extremely difficult for resellers and refurbishers to obtain the parts and infomration. Lehrer says OEMs are charging “astronomical” recertification fees before providing service for their lasers — as much as $30,000 for lasers that cost less than $100,000 new.
In addition to difficulties in servicing a wide range of lasers, another issue is sourcing parts for these technologies. “Getting parts is a grind,” says Lehrer. “Every single day we are on the phone having to source parts.”
Some of the technologies moving in the used market are fractional erbium YAG and CO2 lasers and those synergistic platforms that offer combination therapies like IPL or RF technologies and lasers in one device.
A full spectrum industry
Laser hair removal may account for as much as one-third of all laser treatments, but on the clinical side, new research and emerging technologies in laser and optical medicine are advancing therapies and helping surgeons operate with more precision and diagnostic insight. There’s no doubt that new procedures like those used to freeze your midsection and heat up cancer cells using tiny gold particles will continue to shine a light on this focused brilliant industry sector.
DOTmed Registered Surgical and Cosmetic Lasers Sales & Service Companies
Names in boldface are Premium Listings.
Domestic
Vin Wells, Rock Bottom Lasers, AZ
DOTmed Certified
Christopher Ostler, Wholesale Aesthetics, LLC, CA
DOTmed Certified
Robert Ruck, Sciton, CA
Charlie Wynn, Advanced Technology Laser, CA
Jim Mousseau, The Laser Network, CO
Shawn Burkey, The Laser Warehouse, FL
DOTmed Certified
DM 100
Samuel Lehrer, TheLaserOutlet.com, FL
DM 100
Luis Eduardo Malagon, Professional Aesthetic Clinic, FL
David Spirko, Laser Labs, Inc., FL
DOTmed Certified
Robin Santana, Laser Ventures, GA
Monte Montain, Alternative Source Medical, IL
DOTmed Certified
DM 100
Bob Gaw, PRN, MA
DOTmed Certified
DM 100
John Gladstein, Medical Device Depot, MD
DOTmed Certified
Alison Fortin, Global Inventory Management LLC, NH
DOTmed Certified
DM 100
John Yorke, LaserMedix, NY
Patrick Clark, Medical Laser Dynamics, Inc., TX
Mark Crabtree, Equipment Placement Services, TX
John Crownover, Laser Scientific, TX
DOTmed Certified
DM 100
Dan Herbert, Laser Concepts-Cosmetic Laser World, TX
DOTmed Certified
DM 100
Tommilyn (Tommi) Amos, LuxaCare, LLC, WA
Lee Atkins, Advanced Medical Inc, WA
DOTmed Certified
International
Shinichi Fujiyama, SAIL International Co., Ltd. , Japan
Evgeny Amelin, ESELA , Czech Republic