Interview with Doctor Gerard Toubel
Dr Toubel is a Dermatologist with a private practice in Rennes, Ille-et-Vilaine, Brittany, France. With a slew of lasers at his disposal including a PDL (Pulsed Dye Laser) and a KTP, Dr. Toubel is thought to be the ideal medical professional to assess the usefulness of the ADVATx in routine use in a busy private practice. A year in, he describes his experience.
Why the ADVATx?
I already have a yellow laser, a PDL, and I consider this technology to be the gold standard. We have garnered a lot of experience over the last 30 years, with many papers published. Therefore, it comes with a very high safety and efficacy profile. In short, I love yellow!
The downside of PDL is financial. It is both expensive to purchase and to run due to high costs in maintenance and consumables. And when, like me, you finance the laser on your own, it gets painful.
Early on, I did try another solid-state yellow technology: the Pro-Yellow from Asclepion, but though I found the wavelength interesting, it was too cumbersome to operate, so I did not keep it. Over the past year, I have had the opportunity to use the ADVATx routinely in my practice.
Which indications do you treat with ADVATx?
The laser comes with a small (1 mm) spot size, but the scanner compensates for this. With the ADVATx, I tend to treat all vascular indications we typically come across in private practice (as opposed to more complex ones like port wine stains on children, which I treat at the clinic under general anesthesia). The most frequent indication here in Britanny is rosacea, and I do treat a lot of those. In addition, all typical vascular conditions like telangiectasias of the face and legs, spider and cherry angiomas, vessels of the nasal fold can all be treated.
I have also used it a few times to treat inflammatory acne. Whilst there are very effective pharmaceutical options to treat acne, the medication may be contraindicated in certain sub-segments of patients. When treating patients for acne, I follow the protocol developed by Advalight: a first pass at 1319 nm to reduce sebum production and a second pass at 589 nm to reduce both inflammation and the bacterial load. I remember a patient referred to me who had been operated from a brain tumor and for whom Roaccutane was contraindicated. I treated him four times at two-week intervals and could clearly see an improvement with each treatment. So, even though most of my practice is vascular, the second infrared wavelength does come in handy.
Is the ADVATx easy to use?
The user interface is extremely intuitive. However, I did have to adapt treatment parameters from my PDL experience. A different technology does mean different settings. Once those are set, the scanner makes the whole laser delivery very easy.
What about results?
I have a Cutera XLV in my practice that I have been using for years to treat vascular lesions and that I consider the gold standard for benign vascular lesions. I get identical results with the ADVATx with similar patient discomfort but without edema which I consider a major benefit. In short, similar efficacy but less transient side-effects.
Any other comments?
Whilst the ADVATx is somewhat slower than your typical large spot size laser, I do treat a face in 15-20 minutes, thanks to the scanner. The added benefit of having a scanner is that you can select patterns that conform to the pathology you are treating. The patterns I use most are squares when I treat whole faces and circles whenever I want to trace a target. With the scanner I can increase the effective spot size to 2 or 3 mm. More economical to purchase, the ADVATx does not require specific maintenance and there are no consumables.
This laser is perfectly suited to treat vascular lesions and acne in a private setting.
Doctor Gerard Toubel
Dermatologist, Rennes, France. Medical degree and CES of Dermatology 1983. Member of the French Society of Dermatology (SFD). Past chairman of the SFD Laser Group. Board Member of the Francophone Society of Medical Lasers. Fellow Member of the American Society for Laser Medicine and Surgery.