Cold Lasers for Professionals

Broad vs Pinpoint Probes

If you need trigger point or acupuncture-style therapies (including smoking cessation, laser acupressure, or working on small areas like hands), you might want a pinpoint probe. These allow high density (up to 167.4 J/cm²/min) in a concentrated area and make it easier to NOT get energy in the surrounding tissue, which is critical for acupuncture.

For most structural problems and deep problems, you want the largest probe diameter possible. Saturating a damaged quad with a small emitter is like trying to color a full sheet of paper with a ballpoint pen. Many flexible systems like the Apollo, TerraQuant, Avant, and EVOlaser allow both styles of probes, while many of the higher-end units are broad coverage only.

Wavelength

Close to 90%+ of European lasers and 80% of US therapy lasers operate in the 800nm–980nm (NIR) range. Research shows 810nm is by far the best wavelength to get a deep photochemical reaction.

Less efficient wavelengths can offset their lack of efficiency with extra power, but that often costs a lot more and has more potential for tissue heating. Based on research and many years working with lots of different lasers, we consider 810nm the "primary" wavelength and consider everything else to be like icing on the cake.

There are several manufacturers (like Erchonia®) that operate in the 440nm to 680nm wavelength range as a primary wavelength, but they are not the typical laser company.

Pulsed, Continuous & Sweeping

Pulsing a laser provides an additional stimulatory effect in addition to just the dosage that you get with a continuous wave laser. Pulsed and sweeping systems also allow for higher power levels while still being safe, since the tissue and the laser can cool down between pulses.

Research shows that continuous wave is best for neuropathies and nervous system damage, while pulsed is best for almost everything else. Some systems sweep the pulsing frequency through a range (like 1000 to 3000Hz) so that if there is a natural frequency that would have the strongest reaction, the system emits that frequency part of the time during therapy.

Power Output

One of the biggest debates in the industry is about power requirements. There is not one right answer, however in general:

• More power = shorter treatment times
• More power = better coverage of larger and deep areas
• More power = better pain control

Shorter treatment times mean you can help more patients and make more income. If the power is too low, the treatment might not ever get enough energy density into the tissue in a reasonable time.

Under-dosing is a bigger problem than over-dosing. Some manufacturers of lower-power devices have short treatment times but are ignoring the research and often drastically under-dosing. These systems are OK for some shallow, small applications but they typically generate very low energy densities that can take months or years to get the same result that you will get in weeks with a medium or high dosage.

Safety Class

Cold lasers are broken into 4 classes based on their ability to do damage (to the eye):

• Class 1 & 2: Cannot cause eye damage unless the beam is refocused
• Class 3: Moderate power, requires safety goggles
• Class 4: Can cause eye damage at a distance if not used properly—highest power, most flexibility

Higher power class 4 lasers provide the most flexibility, yet this advantage may be offset by the additional risk and liability of having such a powerful piece of equipment in your office. Keep in mind: "With great power comes great responsibility."

Portability

Lasers come in a variety of form factors, including handhelds, battery-operated portables, and desktop units. Desktop units can usually be installed on a mobile cart and can sometimes be used with an articulated arm for hands-free operation. Depending on your office layout and patient load, you might prefer one form factor over another.

Ease of Use

For some practitioners, the cold laser is a supplement to their overall business. In this case, ease of use is a priority since you don't want to put huge effort into mastering the cold laser. For others, the use of a flexible laser is a priority, as it will allow significant expansion of their business.

We understand that busy professionals don't have 20 minutes per patient to research treatment plans or enter individual variables into their laser. The best modern systems have touchscreen interfaces with protocol libraries.

Protocols

Lasers are only as good as the protocols that come with them. Many older systems required a PhD to find a good protocol and get it entered into the system. These days, the best lasers have "cookbook" style protocols, or a graphic menu where users can quickly find a protocol for each patient.

There is also more to the protocol than just documentation: the accuracy and repeatability of the protocol can have big impact on efficacy. The higher-end equipment will measure the output of the laser beams and adjust for condition, patient size and skin color so that every patient gets the optimum power.

Warranty & Repair

The industry standard warranty is 2 years. All manufacturers will repair units after the warranty period at the owner's expense. Warranty is more critical on higher-end units because the lasers are more prone to overheating and the cost of repair is higher.

Some of the best lasers are built in the US and any good laser will have a service center in the US for fast repairs.

*Thor has a 5-year warranty but requires the laser be returned annually for an expensive calibration to maintain the warranty.

Aesthetics & WOW Factor

The aesthetics and form of the laser are important to both the practitioner and the patient. For practitioners, a well-designed product allows them to focus on their patient and not the equipment. For patients, a professional-grade desktop machine often has a big "WOW" factor that gives the patient confidence that they are getting the absolute best treatment.

There is a big difference in customer perception if you compare using the older ML830 (which looks like a flashlight) to the EVO or ReGen laser (which have huge full-color graphic touchscreens).

ROI & Multimodality

Every successful practice must have a good return on their investment, but often there is an indirect result of owning a great therapy laser. More expensive machines allow for more flexibility and can mean faster results. The patients that see great results talk to their friends and this can often bring in more business and build your reputation. When you do your financial analysis, don't forget to factor in some good will.

When it comes to cold lasers, you really do get what you pay for.

For new practices that need many types of equipment to treat the widest variety of conditions, a multimodality system can save some money by combining multiple pieces of equipment into 1 unit. The MR4 LaserStim is unique because it is a laser, an e-stim device and a diagnostic tool. This laser has a better ROI in many cases because it simultaneously does e-stim and laser so you can bill insurance companies for both a 97026 (IR therapy) and 97032 (e-stim)—essentially doubling your income if you work with insurance companies.