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Retrospective Analysis of Outcomes with a Unique IPL System

Intense Pulsed Light (IPL) technology is well accepted in the medical aesthetic field for the treatment of various skin lesions, including pigmented and vascular lesions. The light penetrates into the skin and is selectively absorbed by lesion chromophore. Absorbed energy is converted into heat, coagulating the lesion, which naturally fades following the treatment. The current article presents a retrospective efficacy evaluation of an IPL device with high peak power. Methods: Representative treatment results were collected from several clinics based on photographs taken at baseline and after treatments. Photos were evaluated and analyzed for aesthetic improvement of the various skin conditions in different facial and body areas. Results: Analysis included cases of pigmented and vascular lesions, textural lesions, and more specific conditions such as melasma and rosacea. The two evaluators’ scoring demonstrated improvement in all cases according to the Global Aesthetic Improvement Scale (GAIS) scale. Conclusion: The vast experience gathered from the market in treating various skin lesions supports the safety and efficacy of the investigated IPL device. The device’s particular specifications contribute to the successful results and ease of treatment for the practitioner and the patient.

1. Introduction

Intense Pulsed Light (IPL) technology is based on principles of selective photothermolysis. The light penetrates into the skin and is selectively absorbed by lesion chromophore (e.g., melanin or hemoglobin), having a darker color than surrounding tissue. Absorbed energy is converted into heat, coagulating the lesion which disintegrates and is eliminated by the immune system, thus fading during a few weeks following the treatment. IPL systems are high-intensity light sources, which emit polychromatic light. Unlike laser systems, these flashlamps work with noncoherent light in a broad wavelength spectrum of 515 nm – 1200 nm. These properties allow for great variability in selecting individual treatment parameters and adapting to different skin types and indications. Various skin lesions, including benign vascular lesions and pigmented lesions, as well as rhytides, are improved by IPL treatment through a photo-rejuvenation process.

IPL is considered a gold standard treatment of a variety of vascular and pigmented lesions. The broad spectrum of IPL covers the visible and near infrared spectrum and can be easily adjusted for specific applications by using filters and optimizing pulse structure.

According to the principles of selective photothermolysis, some treatment characteristics should be met for safe and effective treatment of vascular and pigmented lesions; the optical energy penetration depth should be high enough to reach the treatment target; the light absorption by the treatment target should be higher than that by the surrounding tissue, and the light should be delivered in pulses with pulse duration that is equal to or shorter than the Thermal Relaxation Time (TRT) of the treatment target.

The current retrospective results analysis is intended to demonstrate the safety and efficacy of the Lumecca IPL device for the treatment of pigmented, vascular and textural lesions, based on user experience.

2. Materials and Methods

The Lumecca IPL device (InMode Ltd., Yokneam, Israel) is used for treatment of vascular and pigmented lesions in clinics around the world since the year 2013. Lumecca treatment instructions include the following information and guidelines: Two types of Lumecca handpieces are available: 515 nm (range 515 nm – 1200 nm) recommended for treatment of pigmented and vascular lesions in
Fitzpatrick skin types I-II and 580 nm (range 580 – 1200 nm) recommended for Fitzpatrick skin types III-IV. The use of the two filters may be customized. Thus, deeper lesions may benefit from the use of 580nm on skin types I-II, whereas light pigmented lesions on skin type III may be better treated by 515 nm. The Lumecca handpieces are suitable for treatment of superficial vascular and pigmented lesions on skin type I to IV. The Lumecca handpiece with either 515 nm filter or 580 nm filter.

Lumecca IPL exclusion criteria are similar to those of other IPL devices in the market, including current or history of skin cancer, or current condition of any other type of cancer, or pre-malignant moles; pregnancy and nursing; impaired immune system due to immunosuppressive diseases, such as AIDS and HIV, or use of immunosuppressive medications; severe concurrent conditions, such as cardiac disorders; sensory disturbances; any active condition in the treatment area, such as sores, psoriasis, eczema, and rash; history of skin disorders, keloids, abnormal wound healing, as well as very dry and fragile skin; poorly controlled endocrine disorders, such as diabetes or thyroid dysfunction and hormonal virilization; use of Isotretinoin (Accutane®) within 6 months prior to treatment; known skin photosensitivity or use of drugs increasing skin photosensitivity and diseases that may be stimulated by light, such as epilepsy, lupus and urticaria. Certain delay is recommended if other recent treatments such as light, laser or
RF were performed on the treated area. Patients with a history of diseases stimulated by heat in the treatment area, such as recurrent Herpes Simplex, may be treated only following a prophylactic regimen.

The number of recommended Lumecca treatment sessions typically varied from 1 – 5 sessions every 3 – 4 weeks. The treatment session usually lasts only a few minutes according to the size of the treatment area and depends on the number of pulses required. Pigmented lesions usually require less sessions than vascular lesions. Treatment fluence was ranging from 8 to 16 J/cm2 , employing lower fluence for darker skin types. Specific treatment protocol was adjusted to patient according to the skin type characteristics and the lesion condition. A unique characteristic of the Lumecca IPL is related to the pulse shape of both spectra, 515 nm – 1200 nm and 580 nm – 1200 nm. The short pulse shape is narrower than in other IPL systems (laser-like) and creates a high peak-power in the spectrum range of 500 nm – 600 nm, which is well absorbed by melanin and hemoglobin.

Clinical evaluation of Lumecca treatment efficacy was based on photographs of treated areas taken at standard conditions at baseline, after the treatments and at follow-up visits in several clinics. Clinical evaluation of treatment safety was performed during and after each treatment with specific attention to sensitive areas such as loose or thin skin areas. Side effects, if any, were documented and followed.

The photos were collected by the company (InMode Ltd.) from the clinics and were handed to the author who also provided ten cases to the pool of results. Evaluation of change was scored by two qualified evaluators. Before and after patients’ photos were presented to the evaluators who scored skin appearance improvement, using the Global Aesthetic Improvement Scale (GAIS) below.

3. Results

The current retrospective summary includes representative photographs, demonstrating Lumecca’s treatment effects. The photos were taken at baseline and at follow-up time points of 54 subjects, gathered from 27 clinics. Nine cases were of Asian skin that were treated for pigmented lesions according to the general guidelines. Treatment procedures were conducted according to instructions in the Lumecca Operator Manual. Number of treatment sessions and parameters were adjusted according to individual conditions and needs. All cases included in this retrospective summary showed an improved appearance of pigmented, vascular and textural lesions, with no reported unexpected or significant side effects.

Results demonstrated that epidermal and junctional pigmented lesions are treated very effectively, often in one session. Deeper and multilayered pigmented lesions such as melasma are more difficult to treat and recommended regimen may include combination with bleaching agents and use of very low fluence. Regarding vascular lesions, papillary and upper reticular dermis vascular lesions are a challenge for treatment by IPL, as the safety margin is narrower than pigmented lesions. Nevertheless, Lumecca is able to treat these lesions in 1-3 sessions, due to its unique characteristics.

The results include 34 cases of pigmented lesions, 5 cases of vascular lesions, and 7 having a combination of skin lesions—pigmented, vascular and/or textural lesions. In addition, there are 3 cases of rosacea, 2 cases of melasma, 1 case of acne signs and 1 case of scar redness. All skin imperfections improved after Lumecca treatments on various face and body areas. Areas of treatment included face—34, décolleté—5, arms—3, hands—6, head/forehead—2, nose—3 and 1 test patch. No unexpected or significant side effects were reported among the included patients.

Facial sun spots and skin imperfections before (left) and after (right)
treatments. Photos courtesy of Dr. Judith Hellman.

4. Discussion

Photo-rejuvenation by IPL is a common procedure vastly used in aesthetic medicine for over 20 years, to treat pigmented, vascular and textural lesions, mainly on the face but also on the neck, chest, and back of hands.

Despite the inclusive facial treatment regimens, there are specific characteristics for each indication that are described in detail: vascular lesions, textural lesions, and pigmented lesions. In all of them, the wavelength can be customized according to lesion depth and skin type—the longer wavelength cut-off filter is used for the deeper lesions and for the darker skin.

More recent articles published in 2012-2014 focus on the efficacy, safety and advantages of using IPL alone or in combination with steroids for the treatment of various aesthetic and medical dermatological indications. These publications are in line with the previously published experience and even expand it to special indications such as melasma, hand and chest rejuvenation, rosacea, keratosis, acne and more.