Sculpting, toning and smoothing: Aesthetic lasers can beautify us in ever more innovative ways. And with lasers operating at more wavelengths, configurations and options than ever, the number and range of treatments continue to expand, making the aesthetic laser industry a lucrative one. Most of us will admit to wanting to look better, younger and fitter, but going under the knife can seem a bit drastic. The laser aesthetic market offers a noninvasive and, oftentimes, cheaper way to erase some of our less attractive features. And business is growing. The market is worth between $400 million and $500 million in the US, according to a 2011 industry report by iData Research (www.idataresearch.net) of Vancouver, British Columbia, Canada, a medical device and pharmaceutical market research firm. This is driven primarily by the more expensive CO2 and YAG laser systems, which can sell for more than $50,000 each. Lasers can be used to erase some of our less attractive features. The laser aesthetics market is worth between $400 million and $500 million and includes treatments such as hair removal and skin resurfacing. The company said the market for cosmetic surgery, facial aesthetics and medical lasers is expected to almost double in size, exceeding $3 billion by 2017. Lasers are used to treat a wide range of conditions – everything from skin photodamage dyschromia to scars, warts, acne, wrinkles, hair and tattoo removal, body contouring, and leg and facial veins. But it’s not all clear sailing. Safety regulations and product approvals pose a huge challenge to manufacturersof aesthetic lasers, and it’s not getting any easier. The market began in the mid- to late 1960s – almost as soon as dermatologists and researchers began experimenting on living tissue. But the field really only gained traction in the 1990s. Advances in laser-based aesthetic treatments saw the market blossom in the late 1990s. The adoption of pulsed lasers allowed the output energy to be emitted in controlled pulses. This, coupled with the use of lasers with appropriate wavelengths, enabled selective targeting of specific structures, such as blood vessels and hair follicles within the skin. As laser technology improved, so did the range of applications and patient care. Today’s lasers can target and penetrate more deeply into the dermis of the skin, so much so that they are rivaling facelifts for results. And with the added advantage that patients do not have to endure the longer recovery times associated with surgical procedures, there is demand for noninvasive laser-based treatments. Syneron-Candela’s CO2RE Fractional CO2 Resurfacing System is the first to receive FDA clearance for all of its operating modes, including the four major fractional treatment modes. Images courtesy of Syneron-Candela. Coherent Inc.’s 10.6-μm CO2 lasers operate at powers between 30 and 100 W and are used in a variety of aesthetic procedures. Taking advantage of waveguide technology, they can be used in increasingly popular fractional procedures. As the name suggests, fractional treatments involve selecting damaged areas of the skin for rejuvenation or resurfacing. This is a promising path compared with the rather abrasive procedures used initially. For hair removal applications, infrared semiconductor solid-state lasers with long pulse operation gained wide adoption. More recently, Coherent’s visible optically pumped semiconductor lasers are being used by systems builders in dermatology procedures including localized treatment of spider veins or pigmentation because they absorb yellow wavelengths in melanin better than legacy green lasers do. The analysis by iData Research identified the aesthetic laser and light therapy markets for skin resurfacing, hair removal and laser lipolysis as the fastest growing segments. Emerging drivers of the market seem to be doctors who are looking to supplement their practices with additional revenue streams. Douglas Fung, analyst manager at iData Research, said, “Traditionally, [lasers] have been bought by dermatologists and plastic surgeons and are considered fairly essential pieces of equipment in a modern medical aesthetics practice. Recently, a number of US gynecologists and obstetricians have also purchased laser systems in order to supplement their mainstay practices with additional revenue sources.” Changing the face of aesthetic lasers It’s no surprise that the aesthetic laser market was hit particularly hard by the economic downturn. As people were forced to tighten their belts, the demand for elective nonessential procedures consequently waned. Coping with the downturn forced a change in the way laser makers did business. Before, providers invested in the technology that best met their needs, with a balanced perspective on cost. Since then, however, cost has become a primary driver in purchasing decisions. Successful companies now must focus on reducing cost while delivering the clinical results demanded by patients. As a direct result of market pressures, two major players in the medical aesthetic devices arena – Syneron Medical Ltd. of Yokneam, Israel, and Candela Corp. of Wayland, Mass. – merged in January 2010 to form the largest aesthetic medical device company. Syneron-Candela generated revenues of approximately $190 million in 2010 from a portfolio of laser- and other energy-based devices that address hair removal, facial rejuvenation and body contouring. Its latest offering is a fractional CO2 laser, a device typically used in cosmetic procedures to ablate only a portion of the skin. Ablation usually is restricted to small areas, making the laser useful for addressing problems such as pigmentation and scarring. Syneron-Candela’s patent-pending CO2RE Fractional CO2 Resurfacing System targets the skin’s superficial, middle and deep dermal levels simultaneously, addressing problems such as pigmentation and wrinkles in a single treatment. In addition, it can perform traditional CO2 resurfacing and laser excision of lesions. “The system [also] can be used for fractional CO2 resurfacing and traditional ablation and is ideal for skin rejuvenation and other aesthetic procedures,” said Dr. James C. Hsia, chief technology officer at Candela Corp., now a wholly owned subsidiary of Syneron. Solid-state lasers also are commonly used for aesthetic treatments. Here, generation of a number of wavelengths at the same time is enabling practitioners to perform some clever disappearing tricks. Syneron-Candela’s Alex Trivantage, for example, is a solid-state laser system that uses a unique laser-pumped-laser technology to generate multiple wavelengths in a single laser system. This capability enables effective removal of tattoos made up of multiple-color inks on patients with various skin types. What’s more, the choice of wavelength allows the optimum treatment of pigmented lesions such as age spots and freckles of a wide range of shades on patients with various skin types and colorations. As with other medical treatments, the length of the procedure is a critical component of the economics of use as well as of patient comfort. But the availability of higher output power lasers means that treatments such as hair removal are being performed faster than ever. Regulatory hurdles Just as in the medical laser field, the myriad product approval and safety regulations are perhaps the biggest challenge for aesthetic laser makers. “This is probably where the aesthetic laser market is the weakest, as the body of scientific literature is not conclusive about the effectiveness of all laser procedures,” said iData Research’s Fung. “A further issue is that the laser output properties (power, beam width, pulse duration) are often proprietary to each brand. Most people agree on which wavelengths are appropriate for which patients, but it is often difficult to compare competing systems.” Candela’s Hsia observes that there is a clear global trend for more product approval and safety regulations. “These regulations are often country-specific and have increased in intensity,” he said, adding that the approvals represent a significant challenge and are often seen as a barrier for laser companies entering the medical aesthetic arena. But with global markets – particularly Japan, Brazil, Korea and China – representing huge growth areas, laser manufacturers will be forced to come to grips with the regulatory minefield. Matthias Schulze, Coherent’s director of marketing for original equipment manufacturer components and instrumentation, said that, aside from skin resurfacing, key markets in aesthetics are hair and tattoo removal. “The rise in popularity of hair removal treatments can be attributed to the burgeoning Asia-Pacific market. The US market is the biggest legacy market, but Asia-Pacific is catching up as those regions become more wealthy and ready to spend both reimbursed coverage and discretionary spending.” Laser-based treatments also are expected to move out of the doctor’s office and medical spa and into the home, beginning with hair removal. However, Schulze warns that challenges with worldwide regulations mean that adoption will take time. The future of the industry is promising, despite the tough economy. Lasers are a more cost-effective solution than invasive surgeries such as facelifts, drawing in clients that perhaps would not otherwise have considered such an option. What’s more, iData Research reports that skin resurfacing lasers, especially the “fractionated” types, have now displaced traditional chemical peels for skin rejuvenation. As the industry continues to strive for more targeted, innovative therapies – particularly laser therapies that minimize side effects and downtime – aesthetic laser manufacturers must increase their product portfolios. “Gone are the days when a laser company could enter the medical aesthetics market because it had an innovative and cheap single-modality laser,” Hsia said. “Today, a company should not consider entering this market without multimodalities, significant clinical evidence of efficacy and global distribution.”