SDEF: When to Discard and Replace Lasers, Factors Considered

DANA POINT, CALIF. - Between 1985 and 2011, Dr. Gordon Sasaki retired or discarded an estimated 15 devices used for aesthetic plastic surgery, including two erbium lasers, three CO2 lasers, and an external radiofrequency system for tissue lifting.

Factors that played into the dismissal of these devices included obsolescence of technology, the rise of improved, similar technologies, and competing devices in the office.

At the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF), Dr. Sasaki, clinical professor of plastic surgery at Loma Linda (Calif.) University Medical Center, shared why he chose to retire or let go of certain devices and embrace others.

Sometimes he stopped working with a device after comparing the cost of buying or leasing it with its positive return on investment, he said. Other factors he considered included the cost of disposable equipment, warranty renewals, and unanticipated costs for reparative procedures when a patient had unsatisfactory results or complications.

One device Dr. Sasaki retired was a high frequency eradicator, which is a low-powered, nongrounded electrosurgical device used for desiccation of subdermal lesions and fulguration of superficial lesions. His rationale included its cost to purchase ($1,000-$1,500), cost of the disposable tip ($1.50 each), and nontransportability from room to room.

He replaced it with the Medi-Pak handheld battery-powered cautery device, which achieves acceptable results yet costs only $9.95 per device, has no disposable components, and can be used multiple times until loss of battery power. After battery power loss, a new device is purchased.

Dr. Sasaki, who has a private aesthetic plastic surgery practice in Pasadena, Calif., also retired a nonablative monopolar radiofrequency device he used for tissue lifting and volumetric heating of dermis, septae, and fat. The initial cost of the second-generation device was $65,000, with a warranty that ranged from $2,800 to $3,300 per year. The annual cost of disposable tips added another $450-$949 per year. "Although the device produced satisfactory results in some patients, it also had unpredictable responses, as well as patient and operator fatigue, especially for body contouring procedures," he said. "There was low patient request for this device, and new, improved technology became available."

He put aside the nonablative radiofrequency device in favor of a multilevel focused and imaged ultrasonic tissue lifting device that provides an imaging level of treatment, precise thermal coagulation points, and more predictable patient responses. In his experience, 80%-90% of his patients showed clinical improvement by 3 months, and results tend to last 1-1.5 years. "There is minimal to moderate pain during treatment, and there is a high patient request for this procedure," Dr. Sasaki said.

Costs of the unit, including a 3-year warranty, were $87,500, he said. Additional warranties cost $10,000 per year, and the cost of a disposable transducer amounts to $2,100, which can last for at least four patient treatments, depending on the area of treatment.

Dr. Sasaki said that he currently shares a fractional CO2 resurfacing laser, in part because of its high purchase cost ($152,000, plus $240 for a box of 30 disposable tips), but also because of patient and operator fatigue, complex patient recovery, unpredictable and unsatisfactory patient responses, and low patient requests for the technology.

As a substitute for selected patients, Dr. Sasaki uses croton oil peels for patients who request facial resurfacing. Concentrations ranging from 0.0125% to 0.4% can be prepared, he said, and the procedure does not require application of a topical or local anesthesia. Costs are reasonable. In his practice a 1-ounce container of phenol costs $23.75 and a 1-ounce container of croton oil costs $106. "The preferred treatments are in patients with Fitzpatrick I-IV skin types," he said. "There are predictable and satisfactory patient responses."

Dr. Sasaki disclosed that he has been a paid consultant for many laser and device companies.

SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. - Between 1985 and 2011, Dr. Gordon Sasaki retired or discarded an estimated 15 devices used for aesthetic plastic surgery, including two erbium lasers, three CO2 lasers, and an external radiofrequency system for tissue lifting.

Factors that played into the dismissal of these devices included obsolescence of technology, the rise of improved, similar technologies, and competing devices in the office.

At the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF), Dr. Sasaki, clinical professor of plastic surgery at Loma Linda (Calif.) University Medical Center, shared why he chose to retire or let go of certain devices and embrace others.

Sometimes he stopped working with a device after comparing the cost of buying or leasing it with its positive return on investment, he said. Other factors he considered included the cost of disposable equipment, warranty renewals, and unanticipated costs for reparative procedures when a patient had unsatisfactory results or complications.

One device Dr. Sasaki retired was a high frequency eradicator, which is a low-powered, nongrounded electrosurgical device used for desiccation of subdermal lesions and fulguration of superficial lesions. His rationale included its cost to purchase ($1,000-$1,500), cost of the disposable tip ($1.50 each), and nontransportability from room to room.

He replaced it with the Medi-Pak handheld battery-powered cautery device, which achieves acceptable results yet costs only $9.95 per device, has no disposable components, and can be used multiple times until loss of battery power. After battery power loss, a new device is purchased.

Dr. Sasaki, who has a private aesthetic plastic surgery practice in Pasadena, Calif., also retired a nonablative monopolar radiofrequency device he used for tissue lifting and volumetric heating of dermis, septae, and fat. The initial cost of the second-generation device was $65,000, with a warranty that ranged from $2,800 to $3,300 per year. The annual cost of disposable tips added another $450-$949 per year. "Although the device produced satisfactory results in some patients, it also had unpredictable responses, as well as patient and operator fatigue, especially for body contouring procedures," he said. "There was low patient request for this device, and new, improved technology became available."

He put aside the nonablative radiofrequency device in favor of a multilevel focused and imaged ultrasonic tissue lifting device that provides an imaging level of treatment, precise thermal coagulation points, and more predictable patient responses. In his experience, 80%-90% of his patients showed clinical improvement by 3 months, and results tend to last 1-1.5 years. "There is minimal to moderate pain during treatment, and there is a high patient request for this procedure," Dr. Sasaki said.

Costs of the unit, including a 3-year warranty, were $87,500, he said. Additional warranties cost $10,000 per year, and the cost of a disposable transducer amounts to $2,100, which can last for at least four patient treatments, depending on the area of treatment.

Dr. Sasaki said that he currently shares a fractional CO2 resurfacing laser, in part because of its high purchase cost ($152,000, plus $240 for a box of 30 disposable tips), but also because of patient and operator fatigue, complex patient recovery, unpredictable and unsatisfactory patient responses, and low patient requests for the technology.

As a substitute for selected patients, Dr. Sasaki uses croton oil peels for patients who request facial resurfacing. Concentrations ranging from 0.0125% to 0.4% can be prepared, he said, and the procedure does not require application of a topical or local anesthesia. Costs are reasonable. In his practice a 1-ounce container of phenol costs $23.75 and a 1-ounce container of croton oil costs $106. "The preferred treatments are in patients with Fitzpatrick I-IV skin types," he said. "There are predictable and satisfactory patient responses."

Dr. Sasaki disclosed that he has been a paid consultant for many laser and device companies.

SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. - Between 1985 and 2011, Dr. Gordon Sasaki retired or discarded an estimated 15 devices used for aesthetic plastic surgery, including two erbium lasers, three CO2 lasers, and an external radiofrequency system for tissue lifting.

Factors that played into the dismissal of these devices included obsolescence of technology, the rise of improved, similar technologies, and competing devices in the office.

At the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF), Dr. Sasaki, clinical professor of plastic surgery at Loma Linda (Calif.) University Medical Center, shared why he chose to retire or let go of certain devices and embrace others.

Sometimes he stopped working with a device after comparing the cost of buying or leasing it with its positive return on investment, he said. Other factors he considered included the cost of disposable equipment, warranty renewals, and unanticipated costs for reparative procedures when a patient had unsatisfactory results or complications.

One device Dr. Sasaki retired was a high frequency eradicator, which is a low-powered, nongrounded electrosurgical device used for desiccation of subdermal lesions and fulguration of superficial lesions. His rationale included its cost to purchase ($1,000-$1,500), cost of the disposable tip ($1.50 each), and nontransportability from room to room.

He replaced it with the Medi-Pak handheld battery-powered cautery device, which achieves acceptable results yet costs only $9.95 per device, has no disposable components, and can be used multiple times until loss of battery power. After battery power loss, a new device is purchased.

Dr. Sasaki, who has a private aesthetic plastic surgery practice in Pasadena, Calif., also retired a nonablative monopolar radiofrequency device he used for tissue lifting and volumetric heating of dermis, septae, and fat. The initial cost of the second-generation device was $65,000, with a warranty that ranged from $2,800 to $3,300 per year. The annual cost of disposable tips added another $450-$949 per year. "Although the device produced satisfactory results in some patients, it also had unpredictable responses, as well as patient and operator fatigue, especially for body contouring procedures," he said. "There was low patient request for this device, and new, improved technology became available."

He put aside the nonablative radiofrequency device in favor of a multilevel focused and imaged ultrasonic tissue lifting device that provides an imaging level of treatment, precise thermal coagulation points, and more predictable patient responses. In his experience, 80%-90% of his patients showed clinical improvement by 3 months, and results tend to last 1-1.5 years. "There is minimal to moderate pain during treatment, and there is a high patient request for this procedure," Dr. Sasaki said.

Costs of the unit, including a 3-year warranty, were $87,500, he said. Additional warranties cost $10,000 per year, and the cost of a disposable transducer amounts to $2,100, which can last for at least four patient treatments, depending on the area of treatment.

Dr. Sasaki said that he currently shares a fractional CO2 resurfacing laser, in part because of its high purchase cost ($152,000, plus $240 for a box of 30 disposable tips), but also because of patient and operator fatigue, complex patient recovery, unpredictable and unsatisfactory patient responses, and low patient requests for the technology.

As a substitute for selected patients, Dr. Sasaki uses croton oil peels for patients who request facial resurfacing. Concentrations ranging from 0.0125% to 0.4% can be prepared, he said, and the procedure does not require application of a topical or local anesthesia. Costs are reasonable. In his practice a 1-ounce container of phenol costs $23.75 and a 1-ounce container of croton oil costs $106. "The preferred treatments are in patients with Fitzpatrick I-IV skin types," he said. "There are predictable and satisfactory patient responses."

Dr. Sasaki disclosed that he has been a paid consultant for many laser and device companies.

SDEF and this news organization are owned by Elsevier.