By Victor Gabriel Clatici, Dermatologist, Bucharest, Romania.
“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller.
I love science fiction! I grew up with Star Wars, Dune and Star Trek, read books by Isaac Asimov and Jules Verne, and played with laser toys. May the force be with you! As William Gibson said: “The future is here – it’s just not widely distributed yet.” Remember the beginning of Star Trek? The voyage of the Starship Enterprise, space and the final frontier! But what is the final frontier in dermatology, plastic surgery and aesthetic medicine? Possibly the connection between space and time could be the answer? The future will tell us…
On the other hand, there is a big difference between evolution and revolution. There is a famous quote attributed to Henry Ford: “If I had asked people what they wanted, they would have said faster horses.” He gave them a model T! Customers can easily describe a problem they're having — in this case, wanting to get somewhere faster — but not the best solution.
The first and the most important rule in medicine came from Hippocrates – primum non nocere – first do no harm. We must have a good balance between the ideal treatment and the best value for our patients. If we ask a patient what he or she thinks is the ideal treatment, we could have a lot of answers, but the most popular might be: “at home”, “faster”, “safer”, “results that improve with time”, “no pain and no downtime” or “one treatment for everything”. A lot of possibilities to improve treatments!
Another important question is, how we can achieve something brand new, cutting edge, a new approach? We are always gaining new knowledge; for example, the development of biologics for psoriasis or new insights about melasma or new combination treatments, but what is true innovation?
The most important law in laser medicine is selective photothermolysis developed by Anderson and Parish in 1983 [1], and the main factors involved are wavelength, pulse duration, cromophores, thermal relaxation time, fluence, energy and spot. A possible future starting from selective photothermolysis could be based on new wavelengths / new synchrone combinations on the same device – with the same or different targets:
More correlation = wavelength / pulse duration / fluence / target (cromophores) / fine tuning – similar to radio stations!
The exciting development of new cromophores could be:
  • Endogenous / exogenous
  • New cells – fibroblast / fat cell / sebaceous gland, etc.
  • New molecules – collagen / cholesterol / advanced glycated end products, etc.
  • Cells organites – nucleus / mitochondria / membrane cell, etc.
In my opinion, any future therapies must be integrative and holistic, complete and complex, individualised and personalised, modulated and adapted!
I’d like to finish with a quote from JFK: “Change is the law of life. And those who look only to the past or present are certain to miss the future.”

 

References
  1. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220(4596):524-7.
Acknowledgement
This blog represents the personal point of view of the author and is based on a presentation he did with Elena Barinova (Dermatologist, Moscow, Russia) at the 5CC Congress 2019 in Barcelona.