ReviVa CO2

 

 

The ReviVa CO2 laser has the capability to do facial resurfacing and gynecological procedures. This is a very dynamic unit that achieves great clinical results.

  • FRACTIONAL SKIN RESURFACING
    • Scanner Head with multiple patterns and sizes
    • Fractional for increased healing and less down time
    • Reduces wrinkles
    • Increases collagen
    • Produces brand new skin cells for a more youthful appearance
  • SURGICAL CUTTING AND NON-SCANNER ABLATION HAND PIECES
  • SUPERPULSE AND CW MODES
  • IN OFFICE TRAINING

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OVERVIEW
The ReviVa CO2 laser by ZianMed is one device that can cover all of your skin resurfacing needs such as gynecological, Fractional facial resurfacing, non-scanner resurfacing, along with surgical cutting applications. The device has no consumables so there are no hidden costs. The CO2 laser wavelength of 10,600nm is the gold standard for skin and vaginal fractional resurfacing. This wavelength has the perfect water absorption percentage for ablation and thermal depth penetration. Don’t be fooled by novel devices which utilize combination lasers or other thermal modalities in an attempt to achieve the CO2’s perfect resurfacing and ablative characteristics.

The ReviVa also performs facial fractional resurfacing. Fractional resurfacing only resurfaces a certain percentage of the skin to allow faster healing and more comfortable down time. The old days of full face resurfacing which required over 2 weeks of downtime are now history. By fractionally resurfacing the skin, it can now heal from the sides as well as from below with little down time. The amount of fractionalization can be set by the operator to allow anywhere from 1 to 5 treatments. Treatments are usually 4 to 6 weeks apart and typical patient cost for fractional facial resurfacing treatment is $900 – $1400 per treatment depending on where you live.
There are also 2 ablative hand pieces with different spot sizes for tissue cutting, such as removing skin tags or warts.

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CLINICAL THEORY AND BACKGROUND

The following information will cover the various physical and clinical aspects of the ReviVa CO2 laser. We will first cover laser/tissue interaction and the different forms of resurfacing such as Ablative vs. Non-ablative, Superpulse vs. Continuous Wave, and Fractional Resurfacing vs. Full Resurfacing. We will then cover the clinical aspects of Fractional Resurfacing and Facial Rejuvenation in addition to discussing surgical ablation.

 

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RESURFACING LASER/TISSUE INTERACTION
The term “Resurfacing” is used to describe how a device, laser or otherwise, damages or removes the top layer of skin and the body would heal and generate a new layer of skin to replace the damaged or removed skin. Hence the term Resurfacing. This can be done mechanically like dermabrasion, chemically with chemical peels, or thermally with devices utilizing lasers, radio frequency, or plasma. Even though there are many methods of resurfacing, we will only be discussing the laser method as it is the most popular and effective.
To resurface skin utilizing lasers, you must pick an absorbing chromophore as the target. Since skin cells are like tiny water balloons, one must use a laser wavelength that absorbs into water. The percentage of light that is absorbed into water is very important and it is determined by the wavelength of light. The more light that is absorbed by water, the higher the temperature of the skin cell and the less depth penetration of the light. Lets use 3 lasers as examples. The diode laser at 1470nm, the Er:YAG laser at 2940nm, and the CO2 laser at 10,600nm. These lasers water absorption percentage are shown in the graph below.

One can see by the graph that the Er:YAG has the greatest absorption, followed by the CO2, with the 1470nm diode being the lowest water absorbing of these 3 lasers. How does this affect the skin cell? The higher the absorption into water, the higher the temperature of the skin cell since the light is turning into heat. Due to this, the Er:YAG wavelength will instantly turn the water into steam and explode the skin cell. In addition, since the water is absorbing almost all of the light at the 2940nm wavelength, the thermal damage is limited to the a very shallow depth creating a thin ablation peel with little to no damage beneath this thin ablation layer. The CO2 wavelength of 10,600nm has less absorption in water than the Er:YAG laser. The effect of this allows more of the light to pass to the lower layers of the skin. At the right energy, the skin cells are still exploded, but with a deeper thermal damage and ablation depth. This provides a better controlled wound for more healing and collagen production response. The 1470nm diode laser has the least water absorbing properties and because of this, is used for Non-Ablative skin resurfacing. This is when the laser damages the skin cells, but they are not removed via ablation. The body then heals the damaged cells as opposed to replacing them.

 

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WHAT IS FRACTIONAL RESURFACING?
Skin resurfacing has been an extremely effective procedure for correcting skin texture, color and laxity for decades. Fractional Resurfacing is a fantastic addition to the tried and true procedure. Skin resurfacing in the past consisted of removing the entire epidermis. This requires the body to heal from the ground up; building an entire epidermis from the dermis below. Removing the entire epidermis requires constant ointment for 10-14 days during recovery. As the epidermis is the seal that keeps your plasma in. The results are fantastic, but most patients struggle with the down time. With fractional resurfacing, which only ablates small holes in the epidermis as opposed to the entire epidermis, this allows much quicker healing as well as much less severe down time and recovery after treatment. The reason the healing is quicker is due to the fact that the tissue can now heal from the side as well as up from the dermis below since there exists small wound channels. This can be seen in Figure 2. First, the operator can select the percentage of fractionalization for the procedure; 20%, 30%, 50%, etc. The percentage of fractionalization determines how much of the skin is resurfaced in one treatment. This in turn determines how many treatments you will need to completely resurface your skin and the severity of the wound you will receive. If you choose a 20% fractional resurfacing treatment, your healing will be very mild, but you will need 5 treatments to achieve resurfacing on the entire epidermis. If you choose a 50% fractional treatment, the healing will be more severe, but you will only need 2 treatments to completely resurface the epidermis. There is no right or wrong decision, only what makes sense to the patient.
Another aspect of Fractional Resurfacing is that any skin lesions such as solar lentigines will not be completely removed in one treatment as seen in Figure 2. You can see in Figure 2 that once the Fractional CO2 Laser is irradiated on the skin, there will be ablated wound channels in the skin and any lesion. Once the skin heals, there will be visible remains of any sun damage or lesion due to the fact that we are only partially resurfacing the skin in a single treatment. By performing a series of treatments in which the number is determined by the percentage of Fractionalization, results will be equivalent to a full epidermal resurfacing procedure. The result of Fractional Laser is a much more tolerable post treatment recovery. The only negative aspect is that more than one treatment is necessary. However, this trade off is very well received and preferred by patients.

 

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SKIN REGENERATION AND ABLATIVE VS. NON-ABLATIVE RESURFACING

The beneficial effects of fractional ablative resurfacing are due to the healing process from the controlled damage that is inflicted. When the skin cells are destroyed and thermal damage is created, the body will grow brand new skin cells and tissue as well as release growth factors that will cause the fibroblasts to create new collagen and also grow new micro vessels. This new growth is what creates more youthful skin and connective tissue. One can see the wound channels immediately after fractional CO2 laser in Figure 3. First notice the ablation region (the region closest to the skin surface that has no tissue) which has fully ablated all the skin cells. Second, notice the non-ablated region (the region below the ablated region which contains thermally damaged skin cells) which contains skin cells and tissue, but is thermally damaged. The unique water absorbing characteristic of the CO2 allows a large ablated depth along with a large non-ablative depth. This makes for a perfect combination of both. An Er:YAG laser which has an extremely high water absorption characteristic will have a very shallow ablative region and almost no non-ablative region below the ablative region. The result of the Er:YAG is a superficial treatment with less beneficial results. The 1470nm diode laser which has the lowest water absorption characteristics will have no ablative region, and only a non-ablative region. Since there is no ablative region, the skin cells will not be completely replaced as some non-damaged tissue still exists in the area. The result of both these lasers is a less impressive result than that of the CO2 laser. The healing of the epidermis and collagen formation can also be seen in Figure 3. Since fractional ablation allows healing from the sides as well as below, you can see the ablation region is already filled in by day 2 along with the beginning of collagen synthesis. By day 14 you can see complete epidermis regeneration and continued collagen synthesis. The clinical result is brand new skin with a more youthful plump healthy look.

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Specifications:
Laser Wavelength: 10.6μm
Scanning Area:        Min 3x3mm; Max 20x20mm
Screen:                       LCD 12.1″
K161925

 

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