Cynergy - Vascular Workstation

With its exclusive MultiPlex™ technology, the Cynergy™ vascular workstation delivers unsurpassed efficacy with minimal side effects. It has been proven effective for pediatric use.1 Cynergy treats all types of vascular lesions, including facial and leg telangiectasias, spider veins, hemangiomas, mature and blebbed port-wine stains, and rosacea.
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Overview

Advanced technology, efficacious outcomes

Cynergy treats vascular and pigmented lesions more effectively than conventional, single-wavelength platforms. With both a high-powered 585 nm pulsed-dye laser and a 1064 nm Nd:YAG laser, proprietary MultiPlex technology enables the sequential emission of two wavelengths from one delivery system for optimised clinical effectiveness.

The Science of MultiPlex™

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Specifications
Cynosure Cynergy specifications
Before & After
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FAQs
What is Cynergy?

Cynergy is the first system to combine a long pulse pulse-dye-laser and a high powered Nd:YAG into one system. These wavelengths were chosen for their absorption characteristics and depth of penetration. Both wavelengths are well absorbed by blood.

Both wavelengths are also absorbed by melanin. The wavelengths are synergistic in their depth of penetration criteria, the PDL has a more shallow depth of penetration while the ND:YAG penetrates deeper.

What is MultiPlex?

MultiPlex is the ability to sequentially fire different laser wavelengths through the same handpiece, with precise timing, to improve the outcome of treatment compared to single wavelength treatment. MultiPlex refers to Cynergy’s combination of PDL followed by

YAG, with short, medium, long and extended delays between wavelengths.

Why is MultiPlex better?

MultiPlex has been shown to provide 75% single-treatment clearance in 75% of subjects when treating facial telangiectasia, with little or no purpura. MultiPlex improves treatment of leg veins as well. MultiPlex has also been shown to improve outcomes for

those with recalcitrant and resistant vascular birthmarks, and to allow treatment of lesions previously requiring surgery.

When should I choose MultiPlex?

MultiPlex is the preferred method of treatment for discrete telangiectatic vessels from 0.2 to 1.2 mm in diameter, on the face and legs. It also provides additional treatment options for resistant or recalcitrant vascular birthmarks.

Why PDL first?

PDL energy is very well absorbed by blood (about 50x better than Nd:YAG), hence very little energy (typically less than 10 j/cm2) is required to heat blood sufficiently to cause conversion to Methemoglobin and/or thrombus (PDL products). Thus there is little

background heating of tissue and less risk of thermal injury. Both Methemoglobin and thrombus provide favourable absorption characteristics for Nd:YAG (~3-5x better then normal blood), thus modest Nd:YAG fluence is required to provide effective treatment.

Because less Nd:YAG energy is used, there is a lower risk of side effects than Nd:YAG alone. The Nd:YAG absorption characteristics of Methemoglobin and thrombus are still much lower (~10x) than PDL, thus depth of penetration is not sacrificed.

If PDL only penetrates up to about 0.75-mm how does MultiPlex allow deeper treatment?

General perfusion causes Methemoglobin and thrombus to flow deeper into the dermal tissue between the penetration depths of PDL & Nd:YAG wavelengths. This allows the Nd:YAG energy to interact at depth, with PDL exposure products that were created more

superficially. Detailed studies have shown that even when a vessel appears to be clotted, there is typically some residual flow, allowing propagation of PDL products.

When to use short, medium, long, extended?
  • Short is required when treating discrete telangiectasia with high flow rates. This allows Nd:YAG to interact with PDL altered blood before it flows away from the treatment area.
  • Medium is used for treatment of large, moderate flow-rate vessels, and for treatment of resistant salmon-coloured Port Wine birthmarks.
  • Long and extended are use for treatment of other resistant vascular birthmarks. The longer delays allow altered blood to perfuse deeply into the lesions while providing time for epidermal cooling between wavelengths. This reduces the risk of epidermal injury when using MultiPlex for treatment of these lesions.
Do I need to use cooling with MultiPlex?

Yes, the PDL does introduce residual heat into the field of Nd:YAG treatment. Without efficient epidermal cooling, this can lead to epidermal injury.

The vessel disappeared, isn’t that a good thing?

Immediate vessel disappearance during laser treatment is a sign of vasospasm. Vasospasm occurs when a vessel is damaged, or irritated, but not necessarily destroyed. In the majority of cases, a vessel that displays vasospasm has been under treated, and will

return within days or weeks. Intravascular coagulation (darkening of the vessel itself, which cannot be blanched) is the preferred endpoint for treatment of telangiectasia, suggesting effective damage to the vessel wall. Intravascular coagulation generally

resolves within 1-3 weeks.

Clinical Data

As a recognised industry leader, Cynosure’s Cynergy technology is strongly supported by clinical research.

  1. Alster TS, Tanzi EL. Combined 595-nm and 1,064-nm laser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults. Dermatol Surg 2009;35(6):914-8; discussion 918-9. doi: 10.1111/j.1524-4725.2009.01155.x. Epub 2009 Apr 9.
  2. Boixeda, P., et al. Advances in treatment of cutaneous and subcutaneous vascular anomalies by pulsed dual wavelength 595- and 1064-nm application. Medical Laser Application 2008;23:121–126.
  3. González, J.A., et al. Angiolymphoid hyperplasia with eosinophilia treated with vascular laser. Lasers Med Sci 2011;26(3):285-90. doi: 10.1007/s10103-011-0892-3. Epub 2011 Feb 24.
  4. Jung, J.Y.,et al. Comparison of a pulsed dye laser and a combined 585/1,064-nm laser in the treatment of acne vulgaris. Dermatol Surg 2009;35(8):1181-7. doi: 10.1111/j.1524-4725.2008.34427.x. Epub 2009 Jan 21.
  5. Karsai, S., Roos, S., Raulin, C. Treatment of facial telangiectasia using a dual-wavelength laser system (595 and 1,064 nm): a randomized controlled trial with blinded response evaluation. Dermatol Surg 2008;34(5):702-8. doi: 10.1111/j.1524-4725.2008.34131.x. Epub 2008 Mar 3.
  6. Larson, A.A., Goldman, M.P. Recalcitrant rosacea successfully treated with multiplexed pulsed dye laser. J Drugs Dermatol 2007;6(8):843-5.
  7. Li, G., Sun, J., Shao, X., Sang, H., Zhou, Z. The effects of 595- and 1,064-nm lasers on rooster comb blood vessels using dual-wavelength and multipulse techniques. Dermatol Surg 2011;37(10):1473-9. doi: 10.1111/j.1524-4725.2011.02090.x. Epub 2011 Jul 18.
  8. Min, S., et al. Comparison of a long-pulse Nd:YAG laser and a combined 585/1,064-nm laser for the treatment of acne scars: a randomized split-face clinical study. Dermatol Surg 2009;35(11):1720-7. doi: 10.1111/j.1524-4725.2009.01086.x. Epub 2009 Feb 22.
  9. Mordon S, Brisot D, Fournier N. Using a “Non Uniform Pulse Sequence” can improve selective coagulation with a Nd:YAG laser (1.06 microm) thanks to Met-hemoglobin absorption: a clinical study on blue leg veins. Lasers Surg Med 2003;32(2):160-70.
  10. Saafan AM, Salah MM. Using pulsed dual-wavelength 595 and 1064 nm is more effective in the management of hemangiomas. J Drugs Dermatol 2010;9(4):310-4.
  11. Saluja, R. Laser Treatment for Venous Lakes. Review of Ophthalmology. Jobson Medical Information LLC 2011.
  12. Saluja, R. Laser Treatment Aids Rosacea Patients. In: Bernardino, R.C. ed. Review of Opthomology. Aug 2009.
  13. Tanghetti E, Sherr E. Treatment of telangiectasia using the multi-pass technique with the extended pulse width, pulsed dye laser (Cynosure V-Star). J Cosmet Laser Ther 2003;5(2):71-5.
  14. Trelles MA, Weiss R, Moreno-Moragas J, Romero C, Vélez M, Alvarez X. Treatment of leg veins with combined pulsed dye and Nd:YAG lasers: 60 patients assessed at 6 months. Lasers Surg Med 2010;42(9):609-14. doi: 10.1002/lsm.20972.
  15. Tenenbaum, M.J. Cynergy vascular workstation treats rosacea and facila redness with excellent results . Cynosure Whitepaper . 921-0130-000.
  16. Alster, T.S. Cynergy Multiplex Treatment of Port-Wine Stains. Cynosure Whitepaper 2007. 921-5000-000.
  17. Enokibori, M. Treatment of Photoaging in Asian Skin Using Cynergy Pulse Dye (PDL)/Nd:YAG with MultiPlex Feature. Cynosure Whitepaper 2007. 921-1012-000.
  18. Enokibori, M. Pilot Treatment of Vascular Lesions in Asian Skin Types with the Cynergy Pulse Dye (PDL)/Nd:YAG MultiPlex Laser. Cynosure Whitepaper 2007. 921-1011-000.
  19. Neugebauer, D. Treatment of Psoriasis using the 0.45-msec, 585-nm Pulse Dye Laser (PhotoGenica V). Cynosure Whitepaper 2001.
  20. Tanghetti, E. Cynergy with MultiPlex™ Treatment of Telangiectasia. Cynosure Whitepaper 2006. 920-0294-000
  21. Taylor, M.B. MultiPlex 1064/585 nm Laser Treatment of Vascular Lesions. Cynosure Whitepaper 2007. 921-1014-000
  22. Adatto, M. Facial Veins. Cynergy Case Report. 921-0018-000.
  23. Adatto, M. Leg Veins. Cynergy Case Report. 921-0019-000.
  24. Adrian, R. MultiPlex for Leg Veins: Treatment Techniques and Observations. Cynergy Case Report. 921-0387-000
  25. Goldman, M.P., Keel, D.M. Facial Telangiectasia and Facial Rejuvenation. Cynergy Case Report 921-0377-000.
  26. Tanghetti, E. Cynergy with MultiPlex™ Treatment of Telangiectasia. Cynergy Case Report 921-0294-000.
  27. Barton JK, et al. Optical and magnetic resonance changes in photothermally coagulating blood. Proceedings of SPIE 2002; 4609:10-19.
  28. Kuenstner JT, Norris KH. Spectrophotometry of human hemoglobin in the near infrared region from 1000 to 2500 nm. Near Infrared Spectrosc 1994;2:59-65.

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