Israeli companies have been at the forefront of technological innovations in laser technology, with recent progress in aesthetic and anti-aging procedures already transforming the way people are treated.
With more innovations in store, further advancement of this field is expected, as more people are expected to seek treatments for their skin, the largest organ in the human body, and perhaps one day even internal organs.
“This theory described the requirement for light energy to target microscopic elements in tissue while leaving the surrounding tissue unharmed.”Dr. Arielle Kauvar, Clinical Professor of Dermatology at Grossman NYU School of Medicine and Director Of New York Laser & Skin Care
“The pivotal change in how we address skin disorders (and tissue in other organs as well) was the development of a theoretical paradigm, termed Selective Photothermolysis, by Harvard Medical School physician-scientists Drs. Rox Anderson and John Parrish in the 1980s, at the Wellman Center for Photomedicine at Massachusetts General Hospital,” says Dr. Arielle Kauvar, Clinical Professor of Dermatology at Grossman NYU School of Medicine and Director Of New York Laser & Skin Care.
“This theory described the requirement for light energy to target microscopic elements in tissue while leaving the surrounding tissue unharmed,” she says.
It is now possible to have minimally invasive procedures that make scars disappear or the skin look years younger with little to no downtime and without major disruption to a person’s daily routine.
New technologies using different forms of energy – including lasers, radiofrequency and ultrasound-based devices – do not produce wounds on the surface of the skin and leave surrounding tissue unaltered and undamaged.
The discovery was driven by the desire to find a cure for port wine stains - birthmarks comprised of enlarged capillaries that appear as a faint, pink stains in newborns, but become red or purple, often thickened and pebbly in texture, skin deformities in adulthood. These birthmarks may involve areas as large as half the face, the torso or an entire limb.
“The first laser developed based on Selective Photothermolysis was the pulsed dye laser to treat red birthmarks, but treatment indications soon broadened to include telangiectasia (visible capillaries), rosacea associated skin redness and red scars – problems that had no alternative method of safe treatment,” says Kauvar.
Since the 1990s, the principles of Selective Photothermolysis have been used in treating other skin problems, including leg veins, sun spots, brown birthmarks, pigment disorders, tattoo and hair removal, wrinkles and scars.
These treatments use lasers, intense pulse lights (IPL) and other energy sources including ultrasound, radiofrequency and microwave energy, which, Kauvar explains, “literally pass through the surface of the skin without harm or disruption and selectively heat and destroy microscopic targets in tissue.”
Israel is considered one of the world leaders in the field of medical laser technology, with dozens of laser companies currently in operation. Some of the largest laser aesthetics companies originated in Israel, among them Lumenis, Syneron (now Candela) and Alma Lasers.
A recent conference in Israel’s business capital Tel Aviv brought 20 keynote speakers, including Dr. Kauvar, to review a wide range of topics dealing with aesthetics and anti-aging. The speakers discussed innovations as well as the business aspect of the industry.
“There has been tremendous innovation and many startup companies in Israel, some of which have evolved into the largest companies in the world,” says Kauvar.
One such startup is Sofwave, founded by Israeli medical entrepreneur Dr. Shimon Eckhouse. Sofwave has created a novel ultrasound treatment - with no downtime - that noninvasively lifts and tightens skin by helping produce collagen and elastin, proteins and fibers.
Sofwave’s synchronous ultrasound parallel beam technology (SUPERB ™) “is one of the most exciting innovations in aesthetic treatments,” says Kauvar, who was a principal investigator for the first two pivotal FDA trials of the device, including wrinkle reduction and lifting of the eyebrows (forehead) and neck skin.
The device works by heating an area of the dermis approximately 1.5 mm in depth from the surface of the skin. This triggers the skin’s normal wound healing response to generate new collagen and elastin, the proteins that give skin its strength and resiliency, and hyaluronic acid, a molecule in the dermis that provides skin hydration and smoothness.
Kauvar is now completing a clinical study using Sofwave for the treatment of acne scars. She believes that the technology is also promising for lifting skin in other body areas such as the thighs, abdomen, knees and upper arms.
Israeli companies have been instrumental in the development of laser skin treatments for decades, starting with the carbon dioxide lasers used for skin resurfacing in the 1980s with Sharplan and in the 1990s with ESC and Lumenis.
These carbon dioxide lasers literally peel away microscopic layers of skin by vaporizing tissue, and the wounds heal with increased amounts of collagen and elastin to create healthier, tighter, smoother and younger-looking skin.
The anti-aging results were dramatic, but recovery involved 1-2 weeks of healing for open, draining wounds.
Laser skin resurfacing was further refined in the early 2000s with the development of another paradigm for selective tissue injury, Fractional Photothermolysis, by Drs. Dieter Manstein and Rox Anderson at Wellman Center for Photomedicine in Boston and the nearby Harvard Medical School.
The goal was to achieve the same transformational changes in tissue, but without the open wounds and long recovery times, according to Kauvar.
Instead of vaporizing the entire skin surface, small, microscopic channels of skin perpendicular to the surface were either vaporized (removed) or coagulated (heated).
“With no to little damage at the skin surface, safety was dramatically increased while healing times greatly diminished,” says Kauvar. The first fractional carbon dioxide laser was produced by Lumenis.
Fractional injury of the skin for the first time allowed skin resurfacing of the neck and body, which could not previously be performed due to safety concerns. It also yielded an entirely new field of therapy, known as laser-assisted drug delivery (LADD).
Fractional laser injury alone regenerates and remodels the collagen and elastic tissue in aging or sun-damaged skin and scars.
However, when scars have a large amount of hypertrophy (skin thickening), improved results are obtained with the addition of drugs such as corticosteroids and a chemotherapy agent, 5-fluorouracil. These help to reduce excess collagen growth and can be applied to the skin surface and dispersed through the laser-created channels.
“Open, microscopic channels in the skin created by fractional lasers are used as conduits to deliver medications to treat hypertrophic burn and trauma scars,” says Kauvar.
This is now the standard of care for complex scars.
Israeli research on skin cancer treatment
In recent decades, there has been a global increase in both melanoma and non-melanoma skin cancer rates, which could potentially be helped by laser therapy and avoid more invasion treatment methods.
“Research is now being conducted to treat skin cancers by delivering chemotherapy medications into the skin through these fractional skin channels, and has the potential to replace standard surgical methods,” says Kauvar.
Laser-assisted drug delivery bears the potential of transforming the way other diseases are treated as well.
“Over time it has become clear that there is so much more that we can do by administering medications through the skin, including reducing systemic side effects and avoiding invasive surgery,” says Kauvar.
Treatment of scars was one of the first applications of this technology, but Kauvar also points to recent research on chemotherapy agents being delivered into the skin for the treatment of skin cancer.
“We will be able to treat many skin diseases this way in the future and potentially even systemic diseases,” she says.
“Mouse studies showed that stem cells, which had been inserted through laser-created skin channels, dispersed throughout their bodies,” she says.
“Fractional injury techniques can be used to deliver chemotherapy agents, but the effects of the laser injury alone have been shown to improve the signaling between the dermis and the epidermis that helps us protect ourselves from sun-induced carcinogenesis of the skin,” Kauvar explains.
“We have biochemical evidence of some of the pathways that are involved in repairing tissue.”
Pre-cancerous growths can be treated by using these now commonly used aesthetic procedures and a recent study showed that fractional laser injury reduced the risk of developing squamous cell carcinoma of the skin, according to Kauvar.
“We can restore the ability of our skin to recognize DNA mutations and remove and repair them,” she says.
Dr. Eckhouse is also behind the invention of Intense Pulse Light (IPL) technology, which is widely used for various skin treatments and hair removal. Eckhouse attests to 65 patents to his name, many of them in aesthetic medicine.
“When we began using IPL in the 1990s it was to non-invasively treat vascular lesions, redness of the skin and varicose veins,” says Eckhouse.
“IPL gave a narrow solution for this. Throughout the years, we discovered it was very efficient in hair removal. Towards the new millennium, it began to be applied for skin rejuvenation,” he says.
“Until then, the only option was plastic surgery, which was not an option for many people because it involves a lengthy recuperation and a big expense.”
Kauser agrees. “Before the use of laser technology, none of this was possible,” she says.
According to Grand View Research, an American-based market research and consulting company, the global aesthetic laser market size was estimated at almost one billion USD in 2021, and is expected to expand dramatically by 2030.
“To say we have seen an increase in people using treatments would be an understatement,” says Eckhouse, “Our truly unique contribution to the market was the ability to treat completely non-invasively without damaging the epidermis and therefore there is no downtime.”
This has more people rushing to dermatology clinics.
According to the American Society for Aesthetic Plastic Surgery, 2021 saw a massive increase in non-invasive energy treatments. For example, there was an increase of 125% in skin tightening and fat reduction treatments in the US alone. Skin treatment by combination lasers increased by 60%. Concurrently, the British Association of Aesthetic Plastic Surgeons shows a drastic reduction in plastic surgery in 2021.
“Treatments using non-surgical technology are increasing by at least10 percent annually, while invasive face lifts have grown annually by just 1 percent,” according to Eckhouse.
While Sofwave can currently only be used for aesthetic treatments, including acne scars, Eckhouse also has an eye on expanding its use.
“In the future, we might venture into skin cancer treatments,” he says.
Throughout the years, as treatments have become more accessible and shared more openly, there is also a change in the age and gender of their consumers.
“Today, approximately 20-30 percent of the patients are men and the rest women,” says Eckhouse. “In the 1990s, 90 percent of patients were women. People are also much younger nowadays, sometimes even before their twenties,” he says.
“We live longer and we are healthier, but we still age and want to look like we used to.”
“Patients want to look like they feel and without the risks and downtime of major surgery,” says Kauvar. “What’s more, some of the treatments have the added benefit of reducing pre-cancerous growths (actinic keratosis) and the risk of non-melanoma skin cancers.”
According to Data Bridge Market Research, the global medical aesthetics market is expected to account for almost 30 billion USD at the end of this decade. Non-invasive procedures are increasingly favored by people, and, as their availability widens, this trend is expected to continue.