Dr. Nabil Fakih has spent many years studying Facial Plastic Surgery as a surgeon. In his studies, he became more aware of advanced therapeutic techniques, including non-surgical therapies, that outshine traditional methods and technologies. One of his greatest achievements was performing multiple clinical studies to conclude the efficacy of popular lasers, such as CO2, fractional and Erbium YAG technology. In this article, we will discuss the key differences between these well-known technologies as well as the benefit of combining Aerolase lasers for enhanced treatment results.
Understanding the Science
To better understand the fundamental differentiators that surround laser technology, Dr. Nabil Fakih first had to analyze each individual wavelength. Typically with CO2 lasers, the laser energy is emitted using an 11,600 nanometer pulse duration. While the absorption of water is relatively high with this speed, Dr. Nabil Fakih also concluded that “it creates more hyperemia, more irreversible tissue damage, and more coagulation creating a deeper penetration. This deeper penetration is permanent damage. In fact, a collateral side effect. That means these damages, though they can improve the area, can also create more problems, more pigmentation, more PIH, more scarring, and other problems that you don’t want.” Not only does the CO2 fractional laser pose more risk of adverse effects, but it also is extremely unsafe for skin type IV-VI patients to use. As a result, this increases a practitioner’s liability as well as puts limitations on their treatment options for skin of color patients.
Dr. Nabil Fakih then turned his focus towards the Aerolase Erbium YAG laser, the Era Elite. The Era Elite emits laser energy using a 2940 pulse duration. To Fakih’s surprise, the Era Elite was capable of penetrating the skin at the same level as the CO2 and fractional. According to Dr. Nabil Fakih: “The Era absorption is 10 times more than the CO2 laser. You can say that it’s between CO2 and fractional. You can really have a high result like CO2 but with less collateral downtime and damages. You don’t need too much coagulation. You don’t need thermal damage. What you really need is an ablation of what you want and this is something that the Era gives.”
Dr. Nabil’s curiosity grew as he continued to compare these lasers. In one of his studies comparing four different lasers for acne scars, Fakih found that the “CO2 had greater downtime than the Erbium YAG but with all, you can reach similar results.” In another article about fractional versus ablated erbium, Fakih concluded that “one session of Erbium YAG is better than multiple sessions with fractional lasers. That’s very important. We don’t need to make the patient do more sessions.”
It was time for Dr. Nabil Fakih to investigate the Era Elite in an individualized acne scarring test. The fifth study was based on superior resurfacing results using the Erbium YAG laser. In the study, they concluded that the “ablative Erbium YAG laser resurfacing for facial atrophic acne scars is effective and safe in patients with mild to moderate CV acne scars.”
After completing numerous clinical trials, Dr. Nabil Fakih was able to define the distinct properties of the Era Elite that set it apart from its competitors.
The Era Elite
Aerolase’s Erbium YAG laser is highly attracted to water, reaching a depth of 2960 nanometers. It is capable to reach this depth with low thermal, residual, and collateral damage compared to the CO2 and fractional devices. The Era Elite has a 300 microsecond [0.0003 seconds] pulse duration to make this possible and can perform either complete epidermal rejuvenation or mid-epidermal rejuvenation. According to Dr. Nabil Fakih, “it’s faster and faster means creating less collateral damage, and fast skin recovery. Era has a precise unparalleled control over the depth of ablation, but has similar penetration, treats different depth, addresses individual needs, and no demarcation lines with minimal downtime, which CO2 cannot give you.”
In addition to creating less damage while reaching various depths, the Era Elite’s speed also allows skin types IV-VI to be treated. Dr. Nabil tested this theory when he treated his own staff member; “I have a nurse in my clinic who is a Fitzgerald 6, and we did 3 passes, lens 10 and it’s safe. Nothing happened and it had really improved her hyperpigmentation that she had in an area. This made me feel very safe to use lens 6, 3 passes up to patients with Fitzgerald 6. Is there any other Erbium YAG that you know that can really target patients with Fitzgerald level 6? Let me know.”
It’s ablation control capabilities also allowed Dr. Nabil Fakih to treat the entire face; “I can treat the eyes and the face if I really need it to hit side by side. It will heal very well. With other lasers, you can’t do this. It has downtime really at 5-6 days. I performed 6 passes on a patient’s fce which is going for a high level. And on the sixth day, patients really recovered which other lasers require much more.”
Aerolase is known for its substantial ability to perform laser therapy with lesser downtime compared to their competitors. While the Era Elite may require minimal downtime, the Aerolase Neo Elite requires no downtime at all. Dr. Nabil Fakih claims: “the Aerolase Neo Elite targets melanin, water, and hemoglobin, so it’s a powerful laser that targets the three lights, a wavelength that we have in medicine which we can really improve a lot of things with in the skin.” The Aerolase Neo Elite is a unique device that Dr. Nabil Fakih finds many benefits in.
The Aerolase Neo Elite
The Neo Elite is a 650-microsecond Nd-YAG that can target up to 36 indications. It’s patented 650 Microsecond Technology is proven to be uniquely safe and effective on patients of all skin types/ages. Dr. Nabil Fakih said: “it targets other things, creating for the patient much more high results. You can treat pigment, redness, pores, acne, facial veins, skin rejuvenation, skin tightening, and hair removal. Whereas with other lasers, you may require to use more than one laser to give the patient the optimal result.”
Dr. Nabil Fakih saw that other lasers were subject to adverse effects unlike the Neo Elite; “this laser has really changed my hair removal for the face. In my country, there are a lot of patients when we do hair removal, they start having acne breakouts. The other lasers hit pulp inside and the new pulp makes a cyst. When it surfaces, it creates acne activation. I don’t offer my patient the other machines. For people who have sensitive skin, I offer them the Neo Elite.”
With susceptible skin conditions such as melasma, choosing the proper treatment can be difficult. Some lasers may burn the patient’s melasma, making it worse. Dr. Nabil Fakih recalls the difficulty of treating melasma claiming, “after hydroquinone, patients start having tolerance or then have a pulse therapy between retinol and hydroquinone but you need something to maintain the patient at that moment and really give them a support treatment. It really has boosted a lot of my results with melasma. I really recommend it because it suppresses melasma not to reactive it, and it targets the pigment inside.”
On the other hand, Fakih also found success with the Neo Elite for the treatment of rosacea. Fakih had a case where a patient came in with stubborn redness and pigmentation; “The patient had been doing Nd: YAG in a friend’s clinic and she was doing it with sedation. She was suffering from pain every session and decided to choose Aerolase. This patient became addicted to Aerolase. All the redness and vessels were improved and now the skin feels fresh. She has seen a lot of improvement in pores. She decided to do Aerolase forever in her life every two-three months. This patient had rosacea and it reduces the redness in her skin.”
Fakih claims that the Neo Elite can reduce bruising and redness after injections as well; “You inject someone, you do the surgery, and you want to really reduce bruising fast. In four days after one session of Neo Elite, it can reduce bruising.” After continuing to use the Neo Elite for other multiple treatments, such as nail fungus and skin rejuvenation, Dr. Fakih claims: “the Aerolase Neo Elite has no limits.”
Treatment expansion is a direct result of Neo’s versatility. According to Dr. Nabil Fakih, “it’s one device that has more than 25 indications and it doesn’t care about what age you are. I mean this makes reliability of the laser to pay it back much easier because more indications, more cases, more you can get the money back. There is no numbing cream and no downtime. You don’t need to have to pay anything else except small filter replacements which cost nothing. I have 6 machines in my practice. It took me five months to pay the machine back. There is no other machine in my life I invested in and have it this quick.”
Not only does Dr. Nabil financially benefit from the Neo Elite, but so do his patients. It’s versatility makes treatment costs budget-friendly for many patients. Dr. Nabil Fakih claims that “it’s a very affordable treatment because at the same time, the patient is paying for one treatment but they’re gaining the improvement of vessels, redness, hair removal, pigmentation. I tell the patient that this laser will do a lot at one time. The patient loves that they’re paying for many things.”
Besides being a multi-modal treatment for one approach, the Neo Elite is also compact making it highly portable. The Era Elite is similar in that aspect of portability as well. According to Dr. Nabil, “it’s very time efficient. As a surgeon, sometimes I need to resurface after the surgery. My hospital that I’m working at is a bit far from my clinic and I am required to move my lasers. That’s very easy because I can really box it and take my Aerolase there to resurface the skin after a facelift, to resurface the eyes after a lower Blepharoplasty or upper Blepharoplasty. This is really an important point in these two lasers because they have facilitated me. This is the future of things.”
Dr. Nabil Fakih saw great potential in both Aerolase lasers. From their easy portability features to their high safety/efficacy profiles, Fakih decided to merge both treatments into one. Since both devices can safely treat the skin, this would provide patients with enhanced treatment results as a combination therapy.
After achieving great results with both the Era Elite and the Neo Elite, Dr. Nabil Fakih was determined to study the results using the two lasers in combination. According to Dr. Fakih, “it’s extremely powerful because the downtime with the Neo is no downtime. The downtime with the Era is very little. When we combine them for multi-purpose treatments, you can really reach a very high result. There is no key to success, it’s always a combination.”
Dr. Nabil Fakih first saw potential in combining the lasers after studying the difference in modalities. The Aerolase Neo Elite is used to correct the inside of the skin, meaning it refreshes and resurfaces the dermis of the skin. In contrast, the Era Elite is used to peel the surface of the skin, meaning it renews and restores the epidermis. By using the two lasers in combination, Dr. Nabil Fakih is able to perform complete restoration of the skin; “I always tell the patient, ‘First, I will build the inside of the skin, and then when the inside is good, I will correct the outside.”
This approach turned out to be very successful after he saw great improvement in his client’s acne and rosacea; “I had a very hard case with a patient from the United States. He was a businessman overseas and traveled. He had acne activation, very aggressive rosacea, and he also had pores and bad skin quality. He tried several treatments and he kept failing. I did a very aggressive session with the Aerolase Neo Elite. Then after I did the Aerolase Era. I resurfaced the skin, I took out part of the skin then hit it again with Aerolase Era. It really made magic. The skin redness had really improved so much. After this, I really hit back with the Aerolase Neo Elite and I reached deeper and the result was really impactful. He could not ever be more grateful about this. Imagine doing the CO2 on this redness? For sure, a complication. I never thought that a patient with aggressive rosacea can be treated with a high laser at a high dose without creating a problem.”
His doubts vanished as Dr. Nabil Fakih continued to use this multi-modal approach in both his hospital and clinic; “I can tell you something, I can’t live without my Aerolase lasers. They have changed my business completely. They are my top two lasers and I can never be more thankful about this technology. Really comprehensive rejuvenation is simplified with less risk and downtime, making things easier with superior patient etiquette. Patients are recommending it. They have good results. I really made business from this. I guarantee you that everyday I have a minimum of 10 patients on the Neo Elite and minimum of 2-3 patients on the Era Elite. This is the only laser in my life that I invested in that was really worth the investment. This is the future. If you need a multi-modal approach, this is the best mix.”
About Dr. Nabil Fakih
Dr. Nabil Fakih Gomez, born in Spain, is one of Lebanon & Spain leading facial surgeons and a recognized worldwide expert in the field of Facial Plastic and Reconstructive Surgery. He is the Former Vice-President of the Spanish Society of Facial Plastic Surgery and Vocal of Aesthetics associate member of the European Academy of Facial Plastic Surgery and associate member of the American Academy of Facial Plastic & Reconstructive Surgery. He is Member of Honor of the Argentinian Society of Aesthetic & Functional Rhinoplasty and International Advisory Board in the American Journal of Cosmetic Surgery.
He prides himself on achieving natural-looking, harmonious results that accentuates one’s face. He exclusively performs Facial Plastic Surgery and Orthognathic Surgery. He specializes in Cranio-Maxillo-Facial Surgery and Facial Plastic Surgery from the most prestigious Hospitals of Spain and USA. His techniques represent the state of the art in facial plastic surgery. He has authored or co-authored several scientific manuscripts and books on facial plastic and reconstructive surgery. He works with a large range of patients whose livelihood depends on their face including models, actresses, and social elite.