SPECTRA XT: The New Extended Paradigm

In Nd:YAG-Based Multiplatform Treatment

Bettina Rümmelein1, Tzu Chi Huang2, Ratchathorn Panchaprateep3, Seyed Alireza Miresmaeli4,
Boncheol Leo Goo5 and R Glen Calderhead6

Addressee for Correspondence:

R Glen Calderhead MSc PhD DrMedSci FRSM,
VP, Medical & Scientific Affairs
Lutronic Corporation
219 Sowon-ro, Lutronic Center
Deogyang-gu, Goyang-si, Gyeonggi-do,
South Korea 410-722
Tel: +82-70-4714-6008
email: docrgc@lutronic.com

1 Medical Center See-Spital, Kilchberg/Zürich, Switzerland

2 Po Mei Dermatological Clinic, New Taipei, Taiwan
3 Isky Clinic, Bangkok, Thailand
4 Silver Sand Clinic, Tehran, Iran
5 Clinique L Dermatology, Lutronic Corporation, Goyang, South Korea
6 Medicoscientific Affairs, Lutronic Corporation, Goyang, South Korea
SPECTRA XT: The New Extended Paradigm In Nd:YAG-Based Multiplatform Treatment
Abstract
Background and Aims: Science and medicine
are constantly on the move and the wise
manufacturer moves with them, so there is a
constant drive to develop novel systems even
though existing systems are working well. On
the other hand, it is logistically impossible for a
manufacturer to try to keep launching
completely novel devices without a great deal of
system testing and clinical trials. Rather than
struggling to achieve the latter goal, perhaps the
appropriate concept should be; “Take
something that works really well, and, through
applying science, make it work even better.”
This is exactly what Lutronic, Goyang, South
Korea, has done with its tried, true and tested
workhorse, the SPECTRA™ Q-switched
Nd:YAG: the latest iteration, the SPECTRA
XT™, was launched at the Anti-ageing Medical
World Congress (AMWC) in Monaco, at the
beginning of April of 2014.
The System: The SPECTRA XT represents a
new paradigm in Nd:YAG-based multiplatform
treatment. The SPECTRA XT offers two new
Q-switched wavelengths, 595 nm New
Generation Gold Toning and the 660 nm RuVY
Touch (Ruby-like Versatile YAG) handpieces,
with larger spot sizes. Technological advances
include the Quick Pulse-To-Pulse (Q-PTP)
option delivering higher fluences but with a
more gentle approach for more sensitive or
thinner skin, and Optimal Lattice Technology
(OLT) ensuring even power distribution across
all spot sizes at all fluences, including the large
10 mm spot size. Finally, the new Revital
treatment technique utilizes the higher fluence
of the XT, up to 45 J over 1 second, to deliver
rejuvenation and tightening superior to the
Genesis technique.
Conclusions: Lutronic has thus extended the
already wide scope of the SPECTRA family, so
that the SPECTRA XT takes over and advances
from the very high goals already reached by the
proven SPECTRA family. In addition to the
more efficient removal of tattoos, SPECTRA
XT has added New Generation 595 nm Gold
Toning as a novel and effective approach to
recalcitrant post-acne redness, post-laser
erythema and melasma with an underlying
dermal vascular component, and 660 nm RuVY
2
Touch as a safer treatment for discrete
epidermal pigmented lesions (freckles, lentigines)
on and off the face, e.g., the neck, décolleté and
dorsal aspect of the upper extremities. The 300
µs quasi long-pulsed mode delivering up to 45 J
over 1 second offers flexible and tailored
treatment for onychomycosis, and therefore
even delivery of heat to the nail, nail bed and
surrounding skin. The large 10 mm spot has
proved ideal for low-fluence Q-switched 1064
nm laser toning with faster treatment times, and
can be combined in Q-switched mode with the
Q-PTP and Optimum Lattice Technologies for
gentler and more efficient treatments.
SPECTRA XT – the extended platform – offers
the clinician and his or her patients extended
functionality and efficacy with extended
reliability and flexibility.
Introduction
It is very difficult to improve on perfection, but
that is what Lutronic Corporation has
succeeded in doing with its flagship and
workhorse device, the SPECTRA dual mode Q-
switched Nd:YAG (QSNY) system. A number
of unique features has been added to extend the
indications and capabilities of this well-tried and
tested system to deliver the SPECTRA XT, the
new paradigm in Nd:YAG-based multiplatform
treatment. Lutronic is a great believer in making
science work for the clinician and the patient,
and the unique extended features of the
SPECTRA XT are aimed at achieving just that.
595 nm New Generation Gold Toning:
The solution to inflammation-associated
problems
With the addition of an appropriate dye
handpiece a visible yellow beam at 595 nm can
be produced. Considering the chromophores at
this wavelength, namely blood and melanin
(Figure 1), Lutronic R&D looked at the
absorption characteristics of the target
chromophores, and tuned the dye block to shift
the wavelength by 10 nm to 595 nm (Figure 1,
inset) from the 585 nm of the previous model.
That 10 nm shift to the longer wavelength gives
approximately 0.1 of an order of magnitude less
absorption in both oxyhemoglobin and melanin,

and a much larger difference in
deoxyhemoglobin absorption. This potentially
increases the safety of the 595 nm wavelength
particularly in the epidermis, increases the depth
of penetration into tissue of the 595 nm beam,
and reduces the effect of deoxyhemoglobin as a
competing chromophore thus allowing more
light energy to reach the oxyhemoglobin in the
target vessels in the superficial dermis.
Figure 1 New Generation 595 nm Gold Toning compared with
585 nm relative to the absorption spectra of oxy-, deoxy-
hemoglobin and melanin.
The main targets of this wavelength are the
epidermal keratinocytes and the arterial
microvessels in the superficial and upper dermis
which exhibit abnormal inflammation-related
activity, such as in rosacea, post laser erythema,
acne vulgaris, post-acne redness and in melasma
associated with such abnormal arterial behavior.
When abnormal inflammation-related vascular
activity is seen, a number of cytokines can be
detected, for example vessel endothelial growth
factor (VEGF), and up-regulation of cellular
adhesion molecule (CAM) activity, particularly
endothelial adhesion molecules (ELAMs) and
intercellular adhesion molecules (ICAMs).
These are known to encourage cross-talk
between extracellular matrix cells (mast cells,
macrophages and neutrophils) and the affected
vessels so that a vicious circle is put in place
which keeps the inflammatory process self-
sustaining through synthesis of more
proinflammatory cytokines such as tumor
necrosis factor-alpha (TNF-α), interferon-
gamma (IFN-γ), and interleukin 6 (IL6).[1]
Keratinocyte growth factor (KGF)-mediated
cross-talk also occurs between the affected
fibroblasts and the mother keratinocytes in the
epidermal stratum basale, in which keratinocyte
January 2015
synthesis occurs of more proinflammatory
cytokines, including interleukin 1-alpha (IL-1α),
and TNF-α. These descend into the dermis
where they excite more inflammatory reactions
at the level of T-cells. In addition, higher levels
of all these inflammatory cytokines also support
mast cell degranulation, releasing even more
proinflammatory substances into the already
inflamed area.
This relationship between abnormal dermal
vascular activity and certain types of melasma
has already been shown by Kim and colleagues
in their paper on the vascular characteristics of
melasma, published in the Journal of
Dermatological Science.[2] Rosacea of the
erythematotelangiectatic type is recognized as an
inflammation-mediated condition with
neurovascular dysregulation resulting in ectatic
microvessels in the papillary vasculature, and
involvement of both the innate and adaptive
immune systems and many of their related
cells.[3] In the case of extended post-laser
erythema, the laser treatment has left the skin in
an extended state of inflammation which will
not resolve because of the establishment of a
vicious circle as above. The inflammation in
acne is recognized as the result of the effect of
the colonization of blocked follicles by
Propionibacterium acnes (P. acnes), which results in
recruitment of skin-homing T-cells.[4] These in
turn are reprogrammed by the P. acnes so that,
instead of fighting inflammation, the rogue T-
cells mediate it so an autoimmune problem is
added to the vicious circle. When large, pustular
acne lesions have been successfully treated, in
some cases areas of unsightly and persistent
post-acne redness can be seen. These are not
examples of scarring, but are caused by a
combination of a thin, immature epidermis over
angiogenesis as part of the wound healing
process of the post-lesional damage in the
dermis. This condition will spontaneously
resolve as the epidermis matures and the blood
vessel activity returns to normal, but it can take
several weeks or even months.
In all of these cases, application of New
Generation 595 nm Gold Toning has
successfully resolved the conditions, or speeded
up their resolution, through normalization of
epidermal and dermal homeostasis. Under a
3
SPECTRA XT: The New Extended Paradigm In Nd:YAG-Based Multiplatform Treatment

normal state of affairs, the condition of the

epidermis depends very much on nutritional and
other support from the dermis as the epidermis
itself is avascular: on the other hand,
hyperactive epidermal keratinocytes can
adversely influence the activities of the dermis
through deposition of proinflammatory
cytokines as discussed above.[5] It is
hypothesized that visible light energy at 595 nm
can affect both epidermal keratinocytes, and Figure 2 (a): Melasma associated with dermal vascular activity in
superficial dermal blood vessels, through an Iranian skin type 32 y.o. female at baseline. (b): Lightening is
seen 1 week after 3 sessions of combined Laser Toning and 585
normalization of the abnormal state of both nm Gold Toning.
targets through both a direct photothermal
reaction and also a secondary photoactivative Ratchathorn Panchaprateep MD PhD has her
reaction. This hypothesis is backed up by the dermatological practice in the Isky Clinic,
fact that the role of 595 nm from a pulsed dye Bangkok, Thailand, and has been successfully
laser in the release of matrix component using the original SPECTRA 585 nm Gold
normalizing immunological factors from blood Toning for a variety of inflammation mediated
vessel walls has been reported and proved.[6] conditions. A 20-year-old male presented with
post-acne redness and a few active lesions on
Clinical results with 595 nm Gold Toning: his temporal area, cheeks and white lip. The
The impetus to develop the SPECTRA XT 595 baseline findings are seen in Figure 3a. He was
nm New Generation Gold Toning handpiece treated with SPECTRA 585 nm Gold Toning at
came from the excellent results achieved with Dr Panchaprateep’s usual parameters, and an
the previous first generation 585 nm Gold excellent result was achieved by 2 weeks after
Toning procedure associated with the the 5th treatment session (Figure 3b). Figure 4
SPECTRA system. As an example of this, shows active acne lesions and post-acne redness
Figure 2a shows a patient courtesy of Dr Seyed on the forehead of a 22-year-old male at
Alireza Miresmaeli, Silver Sand Clinic, Tehran, baseline (Figure 4a). The interim result after the
Iran, demonstrating a case of melasma 2nd treatment was good with some
associated with abnormal dermal vascular improvement (Figure 4b) and by 2 weeks after
activity at baseline. The patient was treated with the 5th treatment session, complete clearance
the combination method, whereby the first of both the acne and post-acne redness had
generation SPECTRA 585 nm Gold Toning was been achieved (Figure 4c).
performed first to deal with the vascular
component, followed immediately by 1064 Q-
switched laser toning for any residual pigment.
Figure 2b shows the very good result 1 week
after three combination treatment sessions.
Further sessions will give an excellent result. It
was because of the success of the 585 nm Gold
Toning with the SPECTRA that Lutronic
developed the New Generation 595 nm Gold
Toning handpiece for the SPECTRA XT, so the
very good results seen in Dr Miresmaeli’s
patient can be expected to be even better with
Figure 3 Acne lesions and post-acne redness on the
595 nm New Generation Gold Toning. temporal area, cheek and white lip of a 20-year-old male. (a):
Baseline findings. (b): Total resolution is seen 2 weeks after the
5th treatment session.

4
 January 2015

Figure 4 Acne lesions and post-acne redness on the forehead of a 22-year-old male. (a): Baseline findings. (b): After the
second treatment session, there is some improvement. (c) Total resolution is seen 2 weeks after the 5th treatment session.

Dr Bettina Rümmelein, a dermatologist vascular component visible with a

practicing in Kilchberg/Zurich, Switzerland and
well experienced with the previous version of
SPECTRA, has found the SPECTRA XT 595
nm New Generation Gold Toning ideal for any
case where there is redness or pigmentation
with an underlying vascular-related
inflammatory component. The 4 mm handpiece
is used at a fluence of from 0.3-0.6 J/cm² with a
repetition rate of 5 Hz and an overlap of
approximately 30-50% to paint over the areas of
interest with 2-4 passes. The endpoint is mild
erythema in the treated areas. Figure 5 shows
one of Dr Rümmelein’s patients, a 29-year-old
female who was previously treated for acne,
showing residual mild acne lesions and areas of
post-acne redness (Figure 5a). She was treated
over 5 sessions at a fluence of 0.4 J/cm², 2
weeks apart. Figure 5b shows the result 6 weeks
after the final treatment session, with resolution
of the post-acne redness and no recurrence of
the acne. A 40-year-old female is seen in Figure
6 with dark circles under the eyes having a
dermatoscopic examination (Figure 6a, baseline).
She was treated with 595 nm Gold Toning over
2 sessions at a fluence of 0.3 J/cm² (1st session)
and 0.4 J/cm² (2nd session). Figure 6b shows
the result at 5 weeks after baseline, 1 week after
the second treatment session. The pigmentation
cleared very well, leaving the residual dermal
vascular component visible. After a further 4
weeks without any treatment (Figure 6c), the
vascular activity has resolved even further. No
recurrence of the pigmentation was seen.
Figure 5 (a): 29 y.o. female with residual acne and post-acne
redness at baseline. (b): Good results seen 6 weeks after the
final treatment session with no recurrence.

Figure 6 40 y.o. female with dark circles at baseline. (b): Good improvement in both pigmentation and vascular
component 1 week after 2 treatment sessions. (c): After another 4 weeks, no further treatments, vascular activity is
subsiding. No recurrence of pigmentation.

5
SPECTRA XT: The New Extended Paradigm In Nd:YAG-Based Multiplatform Treatment
Dr Tzu Chi Huang is a dermatologist practicing
in Po Mei Dermatological Clinic, New Taipei,
Taiwan, and he has started using the 595 New
Generation Gold Toning for both active acne
and post-acne redness. Figure 7a is a 28-year-old
female patient at baseline, with large areas of
post-acne redness and some pustular active acne
lesions involving the entire face. She was treated
over 5 sessions with 0.5 J/cm², 5 stacked shots,
2 passes for the first 3 sessions, then 0.3 J/cm²,
3 stacked shots and 1 pass for the final 2
sessions. The good result at 2 weeks after the
5th session is seen in Figure 7b. The post-acne
redness has been eliminated, but the active acne
needs some adjunctive treatment as can be seen
from the lesion in the middle of the patient’s
cheek. The 595 nm Gold Toning can treat the
inflammation caused by Propionibacterium acnes
and the post acne redness, but cannot directly
deal with all active P. acnes. In more severe cases
of active inflammatory acne another modality is
therefore required to target the causative
bacterium together with 595 nm Gold Toning
for the inflammatory-related components to
achieve the best results. LED phototherapy with
HEALITE II using 415 nm optionally followed
by 830 nm offers a good combination approach
adjunctive to 595 nm Gold Toning to target the
active P. acnes.
Figure 7 Acne lesions and post-acne redness involving the
entire face of a 28-year-old female. (a): Baseline findings. (b): 2
weeks after the 5th treatment session. The post-acne redness
has been dealt with well, but the acne is still active (see the
break-out on the cheek) and requires adjunctive treatment to
target the P. acnes.
6
660 nm RuVY Touch: A safer treatment
for epidermal pigmented lesions
Up till now, the 532 nm frequency-doubled
beam of the 1064 nm QSNY has been the
wavelength of choice for discrete epidermal
pigmented lesions, such as freckles and
lentigines. However, it is easy to cause
epidermal damage with too high a fluence, and
in darker skin types the formation of
postinflammatory hyperpigmentation (PIH) is a
distinct possibility as a side effect. To deal with
these lesions in a safer way than the 532 nm
beam, Lutronic developed the 660 nm RuVY
Touch, where RuVY stands for Ruby-like
Versatile YAG. The RuVY Touch handpiece
emits a wavelength which more closely
resembles the ruby laser wavelength of 694.3
nm.
Figure 8 660 nm RuVY Touch wavelength compared with
532 nm relative to the absorption spectra of oxyhemoglobin,
deoxyhemoglobin and melanin.
Figure 8 compares the 532 nm and 660 nm
RuVY wavelengths against the absorption
curves of the biological pigments. As can be
seen, the 660 nm beam is only around 0.5 of an
order of magnitude less well absorbed by
melanin than 532 nm, but it is still high on the
melanin absorption curve. However, this is
more than compensated for by the 660 nm
energy being greater than 2 orders of magnitude
less well absorbed in oxyhemoglobin, and
greater than 1 order of magnitude less in
deoxyhemoglobin compared with 532 nm. The
absorption in melanin is still high enough to
ensure selective photothermolysis in the target
melanin compared with surrounding normal
skin, but the significantly lower absorption in

blood removes that element as a competing
chromophore, and enhances the safety of the
660 nm beam in the treatment of freckles and
lentigines by avoiding any potential damage to
very superficial dermal blood vessels, and
potential inflammation at the dermoepidermal
junction which could result in postinflammatory
secondary hyperpigmentation (PIH), particularly
in darker Asian skin types.
Clinical results with 660 nm Ruvy Touch:
The SPECTRA XT Q-switched RuVY (ruby-
like versatile YAG) Touch was developed as a
safer alternative for the treatment of discrete
epidermal pigmented lesions, such as freckles
(ephilides) and lentigines, compared with the
frequency-doubled 532 nm which was one of
the first treatments of choice for these lesions.
Dr BC Leo Goo, Clinical Director of Clinique L
Dermatology, Lutronic Corporation, carried out
a number of in-house comparative studies to
test the hypothesis that the 660 nm beam was
safer than the 532 nm beam for discrete
epidermal lesions, for all the reasons given
above. Figure 9 shows the results of a split-face
study on a volunteer patient, a 34-year-old
female prone to freckle formation. The baseline
findings are seen in Figure 9a. The right side of
the face was treated with 532 nm and the left
with 660 nm RuVY Touch, single session for
both. The parameters used are seen in Figure 9a.
Figure 9b is the condition 5 days after the
treatment. The right side of the face
demonstrates greater visible damage than the
left side. Any epidermal damage in darker Asian
skin types raises the potential for PIH formation.
Figure 9 In-house comparisons of 532 nm vs 660 RuVY Touch in treatment of freckles in a 34 y.o. volunteer, Korean
skin type III. (a): Baseline condition showing laser parameters. (b): 5 days post-Tx. A greater degree of damage is seen on
the right side of the face treated with 532 nm. (c): 3 weeks post Tx. Clearance has been well maintained with slightly better
results with the 660 nm RuVY Touch treatment than seen on the 532 nm-treated sides.
January 2015
At 3 weeks after treatment (Figure 9c), clearance
has been slightly better maintained on the 660
nm RuVY Touch side than on the 532 nm
treated side.
Dr Bettina Rümmelein (Kilchberg/Zurich,
Switzerland) has also trialled the 660 nm RuVY
Touch, and finds it particularly good for dealing
with pigmented lesions on the back of the
hands. Her opinion is that, compared with 532
nm treatment, the end results are comparable,
but the short-term post-treatment results are
very much in favor of the RuVY Touch in that
the 532 nm treatment leaves the skin with very
much more unsightly crusting than the RuVY
Touch, so this is a great advantage in
maintaining the quality of life of the older
patients who want the pigmentation on the
backs of their hands treated. Figure 10 illustrates
the time course in the treatment and follow-up
for pigmentation of the dorsal aspect of the
hands in a 79-year-old female compared
between 532 nm and 660 nm RuVY Touch
treatment. Figure 10a,d shows the baseline
condition, 10a to be treated with 532 nm and
10d with RuVY Touch. At 5 days post-
treatment (10b,e) the lesions treated with the
532 nm beam are more visibly damaged with
unsightly erythema and crusting shown more
clearly in the insets at higher magnification.
Figure 10c,f shows the findings at 24 days post-
Tx. Lightening of the lesions is comparable,
with slightly better results in the RuVY Touch
treated hand, and no residual erythema.
7
SPECTRA XT: The New Extended Paradigm In Nd:YAG-Based Multiplatform Treatment
Figure 10 Pigmented lesions on the dorsum of the hands in a 79 y.o. female, upper row treated with 532 nm (3 mm, 1.8
J/cm²) and lower with 660 nm RuVY Touch (2 mm, 2.6 J/cm²). (a, d): Baseline. (b, e) At 5 days post-Tx, damage is more
visible on the 532 nm-treated hand. (c,f) 24 days post-Tx, the clearance is comparable between the two hands, with the 532-
nm lesions a little more.
The RuVY touch can be used safely and
effectively for pigmented lesions on the face.
Figure 11 is an example of lentigines on the face
of a 71-year-old female, once again treated by
Dr Rümmelein. Baseline findings are seen in
Figure 11a, and the result 10 weeks after a single
treatment in Figure 11b. Note that, in addition
to clearance of the lesions, there is also
improvement in the overall skin tone and
texture. Figure 12 shows RuVY Touch for the
hands of the same patient, 12a showing the left
hand at baseline and 12b at 10 weeks post-
treatment with excellent clearance and improved
skin texture.
Figure 11 RuVY Touch treatment for facial lesions in a 71 y.o.
female. (a) Baseline findings. (b): 10 weeks after one RuVY
Touch treatment. Good lesion clearance and improved skin
tone and texture are seen.
Figure 12 RuVY Touch treatment on the back of the left
hand of the same patient as in Fig 11 (a) at baseline and (b) 10
weeks post-treatment with excellent results.
8
Dr Tzu Chi Huang (New Taipei, Taiwan) has
found the 660 nm RuVY Touch safe and
effective on and off the face, including the neck,
décolleté and the dorsal aspect of the upper
extremities. Figure 13a shows a 57-year-old
female at baseline with a variety of facial nevi,
including lentigines and seborrheic keratosis. Dr.
Huang treated her with the RuVY Touch, 2 mm
handpiece, 2.2-2.4 J/cm² in a single session
without any anesthetic, and the good result is
seen in Figure 13b, 2 weeks after the treatment.
Significant to complete clearance is seen in the
majority of the lesions with no residual
erythema. Treatment of lentigines on the dorsal
aspect of the upper extremities of a 53-year-old
female is illustrated in Figure 14, with the
baseline findings seen in Figure 14a. RuVY
Touch was indicated (2 mm handpiece, 2.6
J/cm²), and the result at 18 days post-treatment
is shown in Figure 14b. Lightening is good,
perhaps not quite as good as on the face, but
conventional wisdom regarding treatment of
lesions on the extremities with other
wavelengths suggests that they do not respond
quite so well, and require repeat treatment. On
the other hand, there is no sign of secondary
hyperpigmentation. A 67-year-old female is seen
in Figure 15a with lentigines on her face at
baseline. Treatment was performed with RuVY
Touch (2 mm handpiece, 2.6 J/cm²), and Figure
15b shows the good results 5 weeks after
treatment. Even larger lesions, such as the one
in the area of the left eyebrow, lighten well with
no PIH.

Figure 13 RuVY Touch treatment for a variety of facial lesions
in a 57 y.o. female. (a): Baseline findings. (b): 2 weeks after one
treatment.
Figure 14 Lentigines on the upper extremities in a 53 y.o.
female. (a) Baseline findings. (b): 18 days after one RuVY Touch
treatment.
Figure 15 RuVY Touch treatment for facial lentigines in a 67
y.o. female. (a): Baseline findings. (b): 5 weeks after one
treatment.
A recent study by Goo et al. examined the
efficacy and safety of 660 nm RuVY Touch in a
variety of pigmented lesions.[7] An overall
improvement in the global aesthetic
improvement score (GAIS) of 2.1± 1.1 was
reported with good patient satisfaction. Sessions
required were minimal with an average of just
over 1 session per patient in 20 patients. The
authors argued that, at the wavelength of 660
nm, there was a relatively weaker absorption
rate by hemoglobin compared with 532 nm as
already noted in the RuVY Touch discussion
January 2015
above, so the risk of vascular damage with
associated dyspigmentation, such as purpura
and PIH, was lower. Overall, they concluded
that the Q-switched 660 nm RuVY Touch
handpiece was safe and effective for the
treatment of various epidermal pigmented
lesions.
Other indications for SPECTRA XT:
Onychomycosis
The use of the 1064 nm wavelength for the
treatment of onychomycosis has attracted a lot
of attention, particularly with the 300 µs quasi-
long pulsed mode. The recent study by Moon et
al. is typical whereby 22 of 43 nails had
complete or near-complete remission with a
long follow-up, and the result was classed as
good in the remaining 21 nails.[8] This approach
offers a valid alternative to the pharmaceutical
approach, which can be complicated by
potential drug interactions and systemic effects.
The Spectra mode of the SPECTRA XT offers
the 300 µs pulse, together with the unique
optical lattice technology as explained below
and a large range of spot sizes, coupled with the
new higher fluence Revital Mode, delivering 45 J
over 1 second, to give swift but effective
treatment of this condition. Dr Rümmelein has
some considerable experience of using Spectra
mode, and is very satisfied with the efficacy and
latency of the results. Dr Rümmelein’s protocol
involves putting the patients on a reduced dose
of terbinafine tablets, and nibbling off as much
of the diseased nail as possible with clippers.
She then “paints” the affected nails and
adjoining skin with 1064 nm at 300 µs using an
appropriate spot size at 4-6 J/cm² and a
repetition rate of 5 Hz. The endpoint is when
the patient reports the nail has become almost
too hot to bear: this ensures deactivation of the
fungus both on and under the nail, and nail bed.
Treatments are repeated 2-3 times a week for 2-
3 weeks depending on the severity of the fungal
infection. As the new normal nail grows from
the root and matrix, it pushes the old formerly
diseased nail ahead of it. Eventually the nail re-
grows completely. The process and some results
are illustrated in Figure 16.
9
SPECTRA XT: The New Extended Paradigm In Nd:YAG-Based Multiplatform Treatment

Figure 16 A diseased nail (a) is clipped back as much as possible (b), and the laser applied. The fungal
infection is inactivated, and normal nail growth gradually replaces the old nail (c). (d, f): Examples of
onychomycosis involving all 5 toenails. (e,g): The result following treatment with Spectra mode with
complete regrowth of new nail, and no sign of recurrence.

Quick Pulse-To-Pulse (Q-PTP) Optimal Lattice Technology

technology
This is an optional addition to the Q-switched
mode of SPECTRA XT, easily selected and
deselected from the GUI control screen. Rather
than delivering all of the Q-switched pulse
energy in a single pulse, for example, 1200 mJ,
the Q-PTP mode delivers two ns-domain 850
mJ pulses separated by only 80 µs (Figure 17).
This is well below the 1.0 ms thermal relaxation
time of skin so that the tissue is unaware that it
has been hit by two pulses, and “sees” it as one
pulse with a pulse energy equivalent to 1700 mJ,
compared with the 1200 mJ true single pulse.
This represents a more gentle way to deliver
higher energies more safely to older, dry,
sensitive or thin skin compared with the normal
Q-switched mode
Figure 17 Single Q-switched pulse of 1200 mJ compared with
Q-PTP comprising 2 ns pulses separated by 80 µs: the tissue
‘sees’ the equivalent of a single 1700 mJ pulse.
10
The top hat beam profile of the SPECTRA
family of systems was one of the advantages of
SPECTRA over some other QSNY systems,
whereby the energy was delivered evenly over
the entire beam rather than having large and
uneven spikes of energy which could induce
hotspots in the treatment area, resulting in
potential overtreatment and unwanted side
effects. In fact, the flat top mode beam, when
looked under magnification, was not truly flat,
and consisted of multiple small spikes of peak
power against the background of the base
power. The result was that the tissue ‘saw’ the
average of the peaks and the base power.
Although the SPECTRA top hat beam delivered
excellent results, this combination of peaks and
baseline power could be argued to be a
somewhat inefficient way of delivering energy.
Lutronic R&D then developed the Optimum
Lattice Technology (OLT), whereby the
difference between the spikes and baseline of
the former flat top beam was evened out to give
the same power as delivered by the former
beam, but in a more homogeneous fashion,
thereby further improving the beam delivery of
the top hat mode. This OLT concept is
illustrated in Figure 18. The homogeneity of the
beam can be seen in laser impacts on footprint
paper seen in Figure 19, comparing SPECTRA
XT OLT with a competitor system at the same
parameters.

Figure 18 Optimal Lattice Technology (OLT) illustrated. (a):
Top hat beam of former SPECTRA, showing homogeneous
distribution, but actually composed of many spikes against
baseline power (b), delivering an average power as “seen” by
skin. (c) SPECTRA XT OLT standardizes the peaks and
baseline power to give the same output power as SPECTRA,
but without the inefficient spikes. The lower parts of b,c show
an enlarged schematical view of the SPECTRA Top Hat and XT
OLT modes. In the case of OLT, this difference between peak
and base power is evened out, and the laser energy is delivered
more effectively.
Figure 19 Laser impacts measured on footprint paper for the
1064 nm and 532 nm beams from SPECTRA XT with OLT
and a typical competitor system without OLT. (a): SPECTRA
XT OLT: 1064 nm Q-switched beam, 7 mm Ø , 2.4 J/cm²
showing good beam definition with excellent homogeneity. (b):
Competitor: 1064 nm Q-switched beam at the same parameters.
Beam definition is good, but a nonhomogeneous delivery of
laser energy is seen. (c): SPECTRA XT OLT: 532 nm Q-
switched beam, 5.2 mm Ø , 0.3 J/cm² showing a homogeneous
delivery of energy with good beam definition. (d): Competitor:
532 nm Q-switched beam at the same parameters, poor
homogeneity and a distorted definition are apparent.
January 2015
Conclusions
Although it has been a only comparatively short
period since the SPECTRA XT was officially
launched at the beginning of 2014, the clinical
results in a number of areas are already showing
that the science on which the new wavelengths
and technological advances were based has been
vindicated with excellent clinical results,
satisfied users and happy patients. The New
Generation 595 nm Gold Toning has proved to
be an effective approach for inflammation-
mediated conditions: recalcitrant post-acne
redness, post-laser erythema and melasma with
an underlying dermal vascular component all
respond very well to the Q-switched 595 nm
wavelength. The 660 nm RuVY Touch has been
shown to be safer than the 532 nm wavelength
for discrete epidermal pigmented lesions such as
freckles and lentigines on and off the face, e.g.,
the neck, décolleté and dorsal aspect of the
upper extremities. Although the end result may
be comparable to that attained with the 532 nm
beam, the short term appearance of the treated
skin, without unsightly crusting and erythema,
maintains the satisfaction and good quality of
life of the patient. The 300 µs quasi long-pulsed
mode deliverable at 45 J over 1 second offers
flexible and tailored treatment for
onychomycosis, and therefore gives even
delivery of heat to the nail, nail bed and
surrounding skin. The large 10 mm spot has
proved ideal for low-fluence Q-switched 1064
nm laser toning with faster treatment times, and
can be combined in Q-switched mode with the
Q-PTP and Optimum Lattice Technologies for
gentler and more efficient treatments.
SPECTRA XT – the extended platform – offers
the clinician and his or her patients extended
functionality and efficacy with extended
reliability and flexibility.
11
SPECTRA XT: The New Extended Paradigm In Nd:YAG-Based Multiplatform Treatment

References
1: Zhang J, Alcaide P, Liu L, Sun J, et al.
Regulation of Endothelial Cell Adhesion
Molecule Expression by Mast Cells,
Macrophages, and Neutrophils. PLoS ONE,
2011; 6: e14525.
2: Kim EH, Kim YC, Lee ES, Kang HY. The
vascular characteristics of melasma. J Dermatol
Sci, 2007; 46: 111-116.
3: Steinhoff M, Schauber J, Leyden JJ. New
insights into rosacea pathophysiology: a review
of recent findings. J Am Acad Dermatol, 2013;
69(6 Suppl 1): S15-26.
4: Jeremy AH, Holland DB, Roberts SG,
Thomson KF, Cunliffe WJ.
Inflammatory events are involved in acne lesion
initiation. J Invest Dermatol, 2003; 121: 20-27.
5: McCully ML, Ladell K, Hakobyan S, Mansel
RE, et al. Epidermis instructs skin homing
receptor expression in human T cells. Blood,
2012; 120: 4591-4598. Epub 2012 Oct 4.
6: Omi T, Kawana S, Sato S, Takezaki S, Honda
M, et al. Cutaneous immunological activation
elicited by a low-fluence pulsed dye laser. Br J
Dermatol, 2005; Suppl 2: 57-62.
7: Goo BL, Kang JS and Cho SB: Therapeutic
efficacy and safety of wavelength-converted 660
nm Q-switched Ruby-Like Versatile YAG
treatment on various skin pigmentation
disorders. Med Laser, 2014; Epub July 14.
8: Moon SH, Hur H, Oh YJ, Choi KH, et al.:
Treatment of onychomycosis with a 1,064-nm
long-pulsed Nd:YAG laser. J Cosmet Laser
Ther, 2014 Aug; 16: Epub 2014 Apr 29.

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