Firstly, this laser is not bad, it just does not suit my mode of practice. See below for a detailed explanation. I do think that HALO is an excellent unit for specialists who would like to delegate their work to nurses or therapists with limited experience. The set parameters of HALO means it has a very fast learning curve, that can give clinical results with several sessions.

The main reason why I do not use this component of the Sciton device is that the maximum parameters of this laser is too conservative for the vast majority of our work at Clinic Cutis. I do have the ablative erbium, fractional erbium, BBL unit, as well as the vascular 1064 Nm NdYag in addition to various focused spot sizes of Scition, but personally I do like to use non-ablative wavelengths greater than 1927 nm, see reasons below.

* Disclaimer: I am not saying that the 1470, 1490, 1540 to 1550 wavelengths are useless, I just cannot get the results I am after with these wavelengths. Your dermatologist or plastic surgeon will probably get much better results than what I or my team can achieve. Do not let my views get in the way of your research as this is my explanation of my experience with lasers.

These are my personal thoughts about hybrid lasers as I have used both erbium, CO2, and non-ablative wavelengths from 1927 to 1550 over the past decade. I am only basing my viewpoints on experience, my time as an investigator with Fraxel as well as other laser companies, in addition to referencing various research papers in the past 10 years.

Let’s set a few points clear. Firstly, I practice in Brisbane Australia, my personal patient demographic is between 40 to 70 years of age, with lots of prior UV exposure. Majority of my patients will have at least one sunspot, many with dozens. I do see the extreme of solar damage in Australia as the Gold & Sunshine Coast is only an hour away.

Secondly, I do use SCITON devices including their BBL, ProFractional, Fully Ablative Erbium as well as their 1064nm vascular laser. Sciton Erbium is probably equal to my CO2 in the context of the number of times I employ this device (at least 3-6 times a day for the past decade). The majority of my work is around 400 microns minimum, going to 1400 microns occasionally. This is 4 to 14 times what HALO can give me. The above refers to ‘fractional mode’, however most of the time when I use erbium I am in the fully ablative at 400 to 1000 microns. Once again well beyond the range of HALO.

What about my nurses? Well, my ethos in clinical practice is to provide the BEST outcomes with minimal risks, downtime & expense to the patient. On this basis I prefer my clinical team to practice at the cutting edge of technology. This is why we add 3 to 4 devices every 6 months. Lasers come and go at Cutis Clinic. Some lasers are outdated very quickly, the ones that we employ most often are probably the pick of the bunch!

In the context of skin rejuvenation, we prefer the 1927 wavelength. This is of course Fraxel Dual, the ‘Dual’ side of this name uses a very similar wavelength as HALO (1550 vs 1470). In the context of all the lasers we have at Clinic Cutis, the NA wavelengths greater than 1927 are usually underwhelming. If I require minimal downtime with maximal results, my usual equipment of choice is the 1927 LaseMD as it treats pigment better than deeper NA wavelengths. If I require a ‘hybrid’ wavelength my pick would be the CO2. This can be dialled in at various power levels & various densities to give bespoke healing times. I do have access to the HALO erbium wavelength of 2940, albeit a density limit of 22%. The flipside is that I can deliver 15 times the depth of HALO if so required.

The option to use CO2 instead of fractional erbium is well recognised to provide more dermal collagen stimulation & tissue tightening. This is undisputed in the literature. The flipside is a higher rate of PIH or skin darkening, again undisputed in the literature. The solution? Easy, keep densities, low, use short pulse duration lasers. This is why we have 5 different types of CO2s at Clinic Cutis, Fraxel RePair (defunct), Mixto, CORE CO2 Candela, Ultrapulse CO2 Lumenis, & eCO2 Lutronic. The flipside is that we do not necessarily require lasers to give dermal remodelling as I can achieve deeper, safer & better regeneration of collagen with insulated RFM (Genius RF).

Having access to multiple devices across all aspects of cosmetic dermatology allows me & my team to deliver better clinical results with less risk, expense & downtime. Our hybrid laser procedures are not limited to one device, but a selection of over 25.

*This paragraph is correct at the time of writing, early 2021. As we add more equipment over the next few months my viewpoint on devices as mentioned above may change. For an updated POV refer to my Instagram @101.skin

HALO is marketed as a minimally invasive, low downtime, laser that can be delegated to nurses & dermal therapists. Hence it has a super easy interface with limited capacity to cause unexpected side effects. Using both wavelengths HALO can address following conditions (usually with 2-4 sessions)

• Skin ageing including fine lines, wrinkles, uneven skin quality, poor skin tone
• Freckles & pigmentation (Sciton BBL is better for the former).
• Enlarged pores
• Acne & surgical scars
• Signs of ageing
• Skin resurfacing

This paragraph is directly from the marketing site of SCITON, the parent company of HALO. I do agree with the Physician Benefits as this laser has limited capacity to cause unwanted side effects, hence it can be delegated to laser operators. It is one of the easiest lasers to use with a learning curve that can be mastered within a very short period of time. Downtime is very short, even with maximal settings as it is 15 times LESS ‘powerful’ than its big brother- the SCITON JOULE. 

• High revenue and profit generating procedure
• Consistent, predictable results in just 1-2 treatments
• Easy to perform and safe to delegate
• Off face software templates for neck, chest, and hands
• All Fitzpatrick skin types
• Fast treatments with customizable energy density settings

HALO Patient Benefits

• More comfortable than traditional fractional resurfacing
• Fast healing, patients back in make-up within 24 hours
• Low downtime, patients are able to go back to work within a couple of days
• No occlusive post-care
• Noticeable improvement within weeks

HALO can treat acne scars. Are there other better solutions for acne scars? The answer is yes! The ablative laser of HALO is called the erbium fractional. Erbium is my preferred wavelength used to treat superficial acne scars, using much the same scanner as HALO. I use the ‘big brother of HALO’ made by the same company. This laser is called the SCITON JOULE.

HALO limits the depth of ablation to 100 microns or 1/10 of a millimetre. The SCITON JOULE goes to 1500 microns or 15 times the depth of HALO. The majority of acne scars lie between 300 to 1000 microns (in the context of box car, pick, ice pick scars). Hence JOULE will have better targeted penetration to this depth. Of course, we can dial back the depth of fractional to equal that of HALO, but that would be missing the point, & importantly missing the acne scars.

Now, let’s consider the NA or non-ablative wavelength of HALO at 1470. This wavelength goes deeper than the 100 microns of erbium ablative (the other laser built into the HALO laser). The problem with this wavelength is that it can take 3-6 days before swelling subsides, & skin recovery may take 4-7 days. This in the context of treating acne scars, not in the minimal downtime setting. The ‘minimal downtime’ advantage is lost. Now, there will be other dermatologists & plastic surgeons who would probably give better results than I could with this wavelength, however I have found the NA wavelengths between 1470 to 1550 underwhelming in the context of acne scars. (The 1927 however, in the context of photo-rejuvenation is another story). Yes, HALO can give some improvement in acne scars, however there are many devices, including HALOs big brother, the Sciton ProFractional Laser that give better results.

If you would like to try the HALO combination of very superficial erbium laser in combination with non-ablative fractional laser, dialing in maximal erbium settings of 100 microns, coupled with our non-ablative 1540 or 1550 wavelengths, my clinical nurses can discuss your expected results & downtime. I personally do not use fractional ablative lasers at that depth (once again in the context of acne scars).

With any procedure (laser, peels, RF, RFM, microneedling etc…) the aim is to reset the clock. In some cases such as fully ablative lasers, deep peels we reset 20 years, for superficial treatments like HALO, light Fraxel, light LaseMD Ultra, super light CO2, laser toning, pico toning, etc.. We reset the clock back 1-5 years.

Where you go from there depends on many factors including your lifestyle, sun protection, care for your skin, stressors, ethnicity & importantly your genetics. Laser resurfacing is the easy step, maintaining your skin’s future health is more important. 

All lasers can give some tightening of skin, either in the superficial, medium or deep layers of your skin. Yes, HALO can give superficial tightening that typically lasts for months- up to a year with a series of treatments. The flipside is that we know that CO2 lasers give superior tightening. I prefer to use CO2 on this basis, occasionally I combine different wavelengths including 1927 to bulk heat the dermal layers. In fact, for maximal collagen regeneration deep chemical peels are even better (Journal of the American Academy of Dermatology. Author P. Rullan et al, 2019).

If skin tightening with an erbium fractional laser is required, I normally employ this wavelength at a depth of 400 to 700 microns (4 to 7 times the depth of HALO). Other methods I use include RFM or radiofrequency microneedling as well as Tempsure. I also employ HIFU (Ultherapy) as well as MINT threads to help lift & tighten.

Is a spanner better than a hammer… it really depends on the job. If you only have a hammer everything looks like a nail. Best to employ devices based upon the skin condition. Take for example skin rejuvenation. The aim is to improve fine lines, wrinkles, pores, pigmentation, sun pots & to provide better light transmission in the skin. This equates to better luminosity. If this is your aim, I would not choose the Fraxel, nor the HALO. I approach this concern with ‘what are the best wavelengths for this job?’ I then select lasers based on this end goal. The next question is downtime. If we follow the ethos of HALO & Fraxel (multiple sessions 2-5) with a minimal downtime of 48- 96 hours. If one adds up the downtime, time taken for each procedure & expense, you are literally investing 8-10 days downtime, & probably 3-6K in treatment to get this job done.

This is how I would approach this. My aim is to rejuvenate with minimal downtime, risks, pain, & costs. To achieve this, I would dial in a moderate to high density of 1927 laser, add low density CO2 fractional, downtime of about 5 days. One session only. Job done. Cost saving of approximately one third the costs of current HALO & Fraxel, with infinitely better results than ‘mini-laser treatments.’