Comparative Study between the Vectus™ DiodeLaser System and LightSheer™ Duetfor Long-Term Hair Reduction in the Axilla
Joe Lowery, Rich Cohen, Felicia Whitney, James Childs and Gregory Altshuler
Burlington, MAOVERVIEWT

he use of lasers for hair removal has been well established. The most commonly used devices include Intense Pulse Light (IPL), the alexandrite,
Nd:YAG, and diode lasers1, all of which have proven safeand effective for removing unwanted hair. Recently a newnear-infrared diode laser system (Vectus™, Palomar Medical Technologies, Burlington, MA) has been introduced withfeatures that provide fast, safe and effective hair removal.
Unique design features of the Vectus™ system include
an optimum wavelength for hair removal (800 nm), highpeak power (3000 W), a uniform beam profile, a smoothpulse shape and photon recycling, all of which provide
greater energy delivery to the hair follciles2. A clinical trial to validate the system’s performance and design features was completed to demonstrate long-term efficacy.

relative to baseline. Specific treatment areas in each axilla
approximately 25 cm2 in area were identified using templates to aid in camera registration. Areas were cleaned
and shaven prior to treatment and no anesthesia was administered. Maximum cooling was selected for both thelarge and small sapphire contact optics with exception ofthe LightSheer™ Duet Large HS Tip which has no cooling. Specifications of the Vectus™ are shown in Table 1.

MATERIALS & METHODSThis study was conducted under an IRB approved protocol, and all subjects provided signed, informed consent.
Eight female adult subjects (Fitzpatrick Skin Type II andIII) received treatment for unwanted hair in the axilla in asplit-body fashion using the Vectus™ System on one sideand the LightSheer™ Duet, (Lumenis, Yoakneum, Israel) on
the other axilla. Large and Small Treatment Optics of bothdevices were tested in this study with four subjects randomly assigned to receive treatments with the large optics
and the others receiving treatments with the small optics.
The spot size of the Vectus™ Small and Large Optics were
12x12mm and 23x38mm, respectively; or about 74% and
14% larger than the 9x9mm and 22x35mm Small (ET)and Large (HS) tips of the LightSheer™ Duet. All subjects
received three treatments at intervals of approximately
four to six weeks, and were scheduled with follow-up 6
months after the laser treatment. High resolution photographs of the treatment areas were taken at each visit
so that subsequent hair counts could be performed as ameasure of percent hair reduction, the primary outcome
measure of the study. Hair counts were performed in ablinded fashion by two trained investigators and the percent reduction in hair count was determined for each site

With the Vectus™ system, fluence and pulsewidth wereoptimized for each individual patient and treatment area
using a combination of the SkinTel™ Melanin Reader, theMaxPulse™ pulsewidth auto-selection feature, and the Hair
Specific Fluence Selection system, all of which are integrated as standard components (Fig. 1). The melanin content
of the skin in the treatment areas was measured using theSkinTel™ which converts the melanin content to a numericvalue between 1 and 99, with 1 representing the lightest
skin and 99 the darkest skin, or highest melanin content.
The readings were automatically averaged and transmitted
wirelessly to the Vectus™ base unit where additional characteristics describing the hair color, thickness and density
were entered on the control screen, shown in Figure One.

1The Vectus™ processes the entered information using a sophisticated algorithm to display a recommended starting
fluence for the first test spot. As a final step, the MaxPulse™ feature was selected which, for a given fluence setting, automatically adjusted the pulsewidth to a value thatwill maximize the power, in Watts, of the delivered treatment pulse. For the Duet, the starting fluence for the firsttest spot was determined based upon the treatment guiderecommendations for fluence and pulse width (Auto) for theindividual’s hair character and skin type. For both devices,
after delivering the first test spot to the treatment area, theskin reaction and patient pain tolerance were evaluated,
and the fluence incrementally increased to the highest level that was well-tolerated by the patient, or to the maximum fluence setting of the device. Treatments with theVectus™ were performed with an average fluence of 10.6
J/cm2 and 25.7 J/cm2 with the Large and Small Tips, respectively, versus 11.6 J/cm2 and 29.2 J/cm2 for the Large
and Small Tips, respectively, of the LightSheer™ Duet.

RESULTSAll subjects tolerated the treatments well with both devices,and hair reduction was observed in all areas. Clinical endpoints with the two devices, such as the appearance of perifollicular edema post-treatment were observed. However,treatment with the large area optics consistently had less perifollicular edema/erythema than the small area tip treatments.

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The Vectus™ demonstrated 40% greater hair reduction
at 6 months after 3 treatments than the LightSheer Duetwith an average 64% hair reduction for Vectus compared to 46% for the Duet. The difference in hair reduction was statistically significant (18% ± 16%, p=0.01,n=8 paired T-test). All eight subjects had a higher percentage of hair reduction for Vectus (Fig 2). The baseline
and 6 month follow-up hair count photos for subject LG3
are shown in Fig 3. The average hair reduction for theVectus large and small optics was equivalent, 65% and64%, respectively even though the average treatment fluence was 11 J/cm2 compared to 26 J/cm2 (Table 2). Thelarge and small optics of the Duet similarly had equivalent hair reduction 48% and 44%, respectively, with 12 J/
cm2 and 29 J/cm2 average treatment fluence. There wasno difference in discomfort ratings between the devices.

of a more uniform beam profile, better photon recycling4
and compression with contact cooling providing moreenergy to the hair follicles without decreasing skin safety.
For fixed fluence, energy reaching a target at depth increases with the area of the device in part due to scatter and due to greater energy delivered into the skin. An
additional increase is also realized with photon recyclingthat depends on internal design and also on the area ofthe device. Reflection from the internal surfaces of thedevice will send more captured light back into the skin.
In turn, the percentage of light captured by the device isalso increased with area. A portion of the light reflectedback from the skin escapes beyond the edge of the device’s optic within a distance that is independent of theoptic size and is only determined by skin’s optical properties. This reflected light is lost to recycling. The fractionof the total light that is collected by the optic and recycled back into the skin therefore increases with optic size.
The above considerations explain why similar efficacy
is observed with the large and small optics despite over
50% less treatment fluences (11 vs 26 J/cm2 for Vectus™
and 12 vs 29 J/cm2 for LightSheer Duet, respectively).
The decrease in a device’s fluence can be compensatedfor by increase in area and photon recycling. Design differences between the two systems contribute to the observed performance differences: The special internal goldmirror design provides the Vectus™ Large Tip with more
efficient recycling leading to improvement in efficacy anda more uniform beam profile in both optics increases theeffective spot sizes to nearly the actual window sizes.
This leads to minimal overlapping requirements (about10%) and faster, safer treatment. In addition, a contact
device can compress the skin to decrease tissue scatter and bring the deep targets closer to the skin surface.

DISCUSSION
The split-body comparison of laser hair removal on the axilla is an effective means to evaluate differences between
devices or settings. Both devices were tested using theirmax power setting modes that deliver the selected fluencein the shortest available pulse width. The 40% greater reduction observed with the Vectus compared to the LightSheer Duet was statistically significant. The 48% hair reduction for the LightSheer Duet large optic is similar to the54 ± 24% reported 6 months after 3 treatments on the axilla in the Ibrahami study3 and suggests that settings used inthis study were appropriate. The higher efficacy observedwith the Vectus™ is a consequence of the combination

An interesting observation in both systems is that large
optic treatments cause less perifollicular edema and erythema, but similar efficacy compared with the corresponding small optic treatments. Similar conclusions were presented in a histology study5. Note that injury to the tissue
surrounding the superficial portion of the follicle, e.g., theinfundibular epidermis and possibly the isthmus, manifests itself as perifollicular erythema and edema. The fluence in the superficial layer of the skin is apparently lessfor the large than for the small optic. In spite of this, thesimilar efficacy suggests that effective injury profiles areprovided to the deeper targets by both tip sizes. Since thestudy design treated to tolerable fluences in both optics, it
is not known if the small optic fluences would have been
as effective at lower levels although such a result is notexpected. As discussed above, this desirable feature may
be explained as follows: A larger optic provides more energy to the deeper targets without adding as much energy

3to the epidermis and superficial hair structures. However,increasing area increases the energy required from thedevice. Approximately 2.6 times more energy is required
from the large versus small optic to compensate for approximately 6 times increase in area. The well-known rulethat a 1 cm2 beam area is optimum for heating a target
located a few millimeters deep in human skin is applicable when trying to minimize the device’s required energy
output. Increasing the beam area, besides increasing areaof treatment and speed, continues to add more energy tothe target with less increase in energy to the epidermis.
The above considerations suggest that the current clinicalend-points for laser-based hair reduction treatments may not
be necessary with the new generation of very large optics.

SUMMARY
In a split-body direct comparison on laser hair removal
the 65% hair reduction observed with Vectus™ was 40%
greater than the 46% hair reduction observed with theDuet. The large and small optics were found to be equallyeffective even though the large optic used fluence settings
that were over 50% lower and had reduced perifollicularskin reactions. The higher efficacy observed with the Vectus™ suggests that the combination of higher peak power,larger spot sizes, higher efficiency photon recycling andskin compression provides more effective energy to thehair follicles. At the same time, a uniform beam profile incombination with contact cooling and implementation of
the Skintel Melanin reader with starting test dose range
algorithm are safety features which helps protect the skin.

REFERENCES
1. Dierckx C. Hair Removal by Lasers and Intense PulsedLight Sources. Dermatol Clin 20(1):135-146, 2002.
2. Childs J, et al. Optimization of a Laser Diode for Permanent Hair Reduction. Palomar Published Material.
3. Ibrahimi, O, Kilmer W. Long-term Clinical Evaluationof a 800-nm Long-Pulsed Diode Laser with a Large 		Spot Size and Vacuum-Assisted Suction for HairRemoval. Derm Surg 38: 912-917, 2012.
4. Yaroslavsky I, Altshuler G, Yaroslavsky A, Pankratov
M, Stoll M, Manstein D, Anderson R. Photon Recycling
as a Means of Increasing Efficacy and Safety of Flashlamp Systems. Lasers in Surg Med 2003 (Abstract).
5. Xia, Y, Moore, R, Cho, S, Ross, EV. Evaluation of thevacuum-assisted handpiece compared with the sapphire-cooled handpiece of the 800-nm diode laser
system for the use of hair removal and reduction. J. 		
Cosmet. And Laser Therapy, 2010; 12: 264-268.

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