Neil Sadick is one of the foremost dermatologists and phlebologists in the US, practicing out of three New York offices when he’s not conducting research with the Sadick Research Group or advising one of the numerous beauty companies or medical organizations with which he works. In a rare spare moment, Dr. Sadick sat down with me in this, the first installment of our new column, which gives you a sneak peek at your peers and their offices, devices, techniques and best practices advice.
VM: Neil, what is the one device in your practice you won’t work without?
NS: I use the Cutera Excel V dual wavelength laser. It’s the Gold Standard for the treatment of vascular lesions, as far as I’m concerned. It has the greatest variability, versatility and the highest power of any laser; and it gives you the advantages of a pulse style laser without the disadvantages of inducing purpura after treatments. For the treatment of leg vessels it has the greatest versatility, as far as high energy efficiency in delivery. It has advanced cooling devices and you can vary the spot size of the beam for very tiny vessels <1 mm or vessels up to 4 mm in diameter. It also has the ability to change pulse durations and deliver very high fluences with very good contact cooling that allows effective treatment for legs or spider veins with fewer treatments.
VM: So tell us how you use the device in your daily practice?
NS: We use the 532 nm KPT wavelength for facial rejuvenation, facial flushing syndromes, and facial vascular problems, such as rosacea and telangiectasias, and periorbital veins around the eyes.
We use the semi-long pulse Laser Genesis 1064 nm hand piece for treatment of acne, for someone who wants some mild skin toning improvement, or for long-term collagen stimulation in conjunction with other skin rejuvenation programs, and for deep flushing syndromes or diffused red rosacea syndromes.
We use the long pulse 1064 nm Nd:YAD for treatment of leg vessels and telangiectasias.
VM: Are there any cases that stand out where the platform has performed with surprising results?
NS: Some people can develop matting on their legs during sclerotherapy. Utilization of the KTP 532 nm wavelength on the Excel V has proven to be very effective for the treatment of matting. In addition, we get a large number of individuals who come to our practice for treatment of veins around the eyes. Again, the long pulse 1064 nm Nd:YAD is very effective at safely treating those unwanted periorbital vessels. Many people may shy away from treating them, but this is a safe way to treat them. Sclerotherapy or ambulatory phlebectomy are less safe ways to address those issues.
VM: Any advice for those who are looking to add these types of procedures onto their practice?
NS: There are four things I look for in the technology: 1) effectiveness, 2) versatility, 3) reliability, and 4) integrity of the company. I think that the Excel V technology really satisfies all of those things, and Cutera has created a machine that works really well and has almost no maintenance issues.
If you’re going to have a full-service phlebology practice, you need to have the ability to treat very large veins with endovenous laser or radiofrequency technologies, or one of the new catheter devices. But even if you are only going to treat cosmetic spider veins in your practice, it’s not enough to just treat with sclerotherapy as your only tool. Sclerotherapy is a great advancement in phlebology treatment of spider veins, but for those individuals where the spider veins have very tiny vessels that bother them, and they are unable to cannulate using a needle, you need something more. To have a full service phlebology practice, you’ll need a laser with a 1064 nm Nd:YAG and 532 nm KTP to service all your patients’ needs.