Randy-

I’ve known Phil a long, long time. He’s a good man and a good laser clinician.

The idea of detaching the muscle fibers to increase the zone of attached tissue–actually lowering it–is fine. But I would not be so inclined to do it with either the erbium or Nd:YAG. Remember the inision made with a laser will have an incision thickness the diameter of the round fiber. The thickness of a Bard-Parker incision will be as thin as the razor sharp linear blade can be. Let’s see, round vs linear?

Having said that, the erbium will have less zone of lateral termal injury than any near IR laser, which is more desireable in a zone of esthetics or thin or fragile tissue.

Please try to understand that the goal with lasers is not to try to make a laser work for all the things you might want it to do clinically, but learn and understand when a laser works best for what clinical and tissue challenges you face and where a laser might work better, faster, cheaper for you and your patients. That understanding comes from learning basic fundamentals of laser light, device parameters, and tissue interactions.

We’ll talk about that next Friday………

Bob