Episode #27: Fotona 4-D Face and Neck, from the inside and out.

In this episode of Just Laser It with Dr. Minni Saluja and Kane Rogers, we dive into one of the most talked-about technologies in modern aesthetic medicine, the Fotona 4D. Dr. Saluja explains how this advanced dual-wavelength laser (Nd:YAG and Er:YAG) works in four synergistic steps to tighten, volumize, and smooth the skin, without needles or downtime.

You will learn how the intraoral “SmoothLiftin” mode stimulates collagen from within, why this treatment is sometimes called a “laser facelift,” and how it compares to other rejuvenation options like RF microneedling or fillers. Kane adds his take on patient experiences, recovery expectations, and what makes this treatment a favorite among those seeking natural-looking results.

Whether you’re a curious patient or a fellow practitioner, this episode breaks down the science behind the glow and the precision behind the lift, proof that innovation doesn’t always have to mean invasive.

Thank you for your listenership!

Transcript

Kane Rogers 0:00

[Mic bleed] today? I am wonderful. Thank you. I'm actually really excited to talk about our topic tonight.'Cause I, I wanna learn more about it.

Dr. Minni Saluja 0:25

Wonderful. Let's dive right in. This is now November 1st and I can't believe this is the month of Thanksgiving and I just wanna start by saying what I'm thankful for right now, and that's my dynamics. Max has finally entered the building and we're, we've been using it now for about four weeks and super excited about it.

Kane Rogers 0:45

Awesome. I'm thankful that you're thankful.

Dr. Minni Saluja 0:47

Good. I'm just gonna dive right into it and this laser cane. It represents, it can do so many different things. There's a hundred different FDA cleared treatments with this laser. We're not gonna talk about all of those today. We're just gonna talk about the four D treatment. And also, I'm just gonna touch base on the fractional components and also the smooth eye. But what this laser is, it's represents one of the most sophisticated

Kane Rogers 1:14

Can I, can I'm sorry to

Dr. Minni Saluja 1:15

interrupt. Oh sure.

Kane Rogers 1:15

sure. But you keep saying this laser, can we, so it's the photo. Dynami

Dr. Minni Saluja 1:20

Max. The Dynami

Kane Rogers 1:22

Photo is the name of the manufacturer of the company that makes it. And Dynamist Max is Theus. Dynami, yeah. I actually like my name, Dynami Max is the latest and greatest version of their devices.

Dr. Minni Saluja 1:38

It is, it had a predecessor, the SP Dynamics. And this is the newest iteration and it has some built in features that really made me stop in my tracks and say, yes, I wanna get the Dynamics Max. And we're actually the first one on the East coast to have this particular laser, which I'm also very excited about. But some of the built-in features is, it has. Which we'll talk about. It has a temperature monitoring system, and I'll tell you why that's really important as we talk about the the four D phase. And it also has cooling mist that, that keeps the patient comfortable in a certain step as well. So again, and a lot more power, et cetera. But. Anyway. So what we're gonna talk about today, we're gonna go over the photo of 40 D face. We're also gonna talk a little bit about the fractional side of it, as well as the smooth eyes. We'll just briefly talk about that. We might do a separate episode on that as well.

Kane Rogers 2:29

Okay.

Dr. Minni Saluja 2:30

Okay. So this, again, this laser truly is a really sophisticated laser. It is a laser that has two wavelengths. It has what is. Thought of as the shortest wavelength, the Erbium, and what is thought of as the deepest penetrating wavelength, which is Indy yag. But if I stopped there and said It's got a Erbium and Indy yag, I would just be talking about other lasers in the market.

Kane Rogers 2:53

Yeah. There's other Erbium in, there's other

Dr. Minni Saluja 2:55

Correct. And we've worked with both of them before in the past for laser hair removal and also resurfacing. This laser, what makes it so special is that with the Erbium YAG and the Indy Yag, it has so many different parameters. It has so many different pulse durations that can be selected to turn the Erbium into a deep penetrating one, to turn it into something similar to a CO2. But I don't want it to be a CO2. We have a CO2 in our practice. I probably use it cane. 1% of the time now because of this laser. But there are so many different things that we can do, which we'll talk about and I won't bog you down with too many of the details. I wanna go straight to what the four D is and what is this? What does four D stand for? It stands for the four different dimensions of the skin that we're trying to target. And it's not just the skin, but the full thickness of tissue that we're trying to target. And so there are four steps in this particular procedure, and it's almost like you're getting four lasers in one laser treatment.

Kane Rogers 4:00

Okay. Yeah. You're gonna have to help me wrap my brain around that.

Dr. Minni Saluja 4:03

Sure. So the first step is called the smooth lifting and Kane, the craziest thing. And when I was reviewing this laser, it's actually delivered. intraorally. So inside of the mouth is where the first laser delivery is. And the reason why that's important is because they're using the Erbium in a smooth lifting mode, which means it's not ablative, it's not ablative inside of the mouth, but yet it's penetrating energy deep into the tissue so that you're basically heating from the undersurface upward. That's the first step.

Kane Rogers 4:36

Okay. So the first thought that comes to my mind is that would hurt because if I bite my tongue or bite, bite my cheek is very sensitive and very painful.

Dr. Minni Saluja 4:44

No, it doesn't hurt. It is. So the mouth is very hydrated, right? The oral mucosa is very hydrated. Erbium loves water, so you're delivering this energy. Now, I will say, as you get closer to the lips, you can feel the little burning sensation, but you deliver it in such a method to keep the patient comfortable while getting. All the energy there. You also avert the lip and you deliver energy on the undersurface of the lip. And so many patients when they come in, they say, I'm bothered by these lines above my lip. They're always bothered by those what they call smokers' lines. I call them sunshine lines, but they're basically those hashtags above their lip. So you deliver energy underneath that from, again, from the under surface upward. It also helps with the nasal labial fold and the marionette area. So it, it's such a brilliant way to deliver this energy.

Kane Rogers 5:39

Okay. So I understand we're delivering the energy inside the mouth, but help me understand why. What we're accomplishing by doing that. Again, I know you said it initially, but I didn't really,

Dr. Minni Saluja 5:49

so it's penetrating the energy from the inside going upwards. So you can get energy all the way up to the sma, to that superficial, muscular, apron neurotic system around the musculature. But you're, you are targeting nasal labial fold. You're targeting the marionette lines and as well as you're targeting from the under surface first the lines in the skin itself. So you're just delivering, doing

Kane Rogers 6:11

what? This is

Dr. Minni Saluja 6:12

collagen? Yep. It's stimulating collagen, so that's step number one. Step number two, three, and four are on the outer side. The traditional way that we deliver laser energy, they're on the skin surface. Step number two is called a FRAC three, and what that uses, it uses the Indy YAG in really small poll alterations. And what you're doing here is you are targeting the vasculature, the red blood vessels you're helping to tighten the pore size. You're helping to stimulate collagen again from the upper surface. This is the one. That the dynamics, max has got a cool mist that sprays as I'm doing this. So this particular step is so comfortable for patients. You don't even feel, it just feels like cool mist on the skin. Now, So it's just an amazing second step. Now, the third step is called a piano mode. And Kane, this is where you bulk heat the tissue. Now this is important because it has a temperature sensing monitor, and so patients always ask, okay, if you're bulk heating are, can you cause fat atrophy? Fat atrophy can occur with anything that you overheat at a higher temperature. This particular mode, if I wanted to, let's say, slim down a neck, sure, I can put in cooling. I can go to five minutes. I can get to 45 degrees Celsius on the epidermis, which is deeper in the dermis to try to do that. That's not what this step is. This step takes you to about 41 to 42 degrees Celsius. There's a timer. You keep it at three minutes and less. And what it's doing is it is really stimulating your elastin and collagen and post procedure. You can see patients almost look filled in and, three months down the road, they almost look like they've created more of their fat So this is one of the key tightening steps.

Kane Rogers 8:01

Help me understand the difference between the second step and this step.'cause it sounded like you were basically saying it was doing the same thing.

Dr. Minni Saluja 8:09

The second step has got really short pulse duration, so you're targeting more of the vasculature, the blood vessels, and you're targeting more of collagen stimulation, just more in the superficial realm. Although it goes deep, but you're targeting it more in the texture you can say, of the skin or the vasculature. Whereas this step, this has longer pulse duration, and this is really giving you. Collagen contraction, and it's also stimulating collagen in a more profound way.

Kane Rogers 8:37

So this third step is where you start to see The tightening effect? Correct.

Dr. Minni Saluja 8:41

This is really more of your tightening key thing. And in fact, sometimes I will do procedures with resurfacing and I'll, I will include this piano mode step just to improve upon the results that I'm getting.

Kane Rogers 8:52

So the so the first step is working from the inside out to stimulate collagen. Correct. The second step is stimulating collagen, but also the reds and the vascularity.

Dr. Minni Saluja 9:02

And even the

Kane Rogers 9:02

And then the third step is, okay, now we're really working on the tightening

Dr. Minni Saluja 9:06

Correct. It's like a deep tissue type of tightening. The final step is called the superficial. And it's just basically soup. Artificial with Erbine Erbium, and it's basically a light resurfacing. So you're taking off that top epidermal layer. You're you're basically airbrushing them and giving them a really nice glow to their skin. Okay, so those are the four steps, Kane, and again, it's so key because when I look at faces. From forties, fifties, sixties, we all get loose on the lower third of our face. And that first step,

Kane Rogers 9:44

raising my hand.

Dr. Minni Saluja 9:45

Yeah. And me too. And that first step is so good going from inside of the mouth at tightening that lower third. And then of course you've got the supplementation with two, three, and step four.

Kane Rogers 9:58

So I'm looking at myself or if a patient's out there and they're. They're looking at their face and saying, would this be good for me? What are some of the things that they would look for? Where the answer to that is yes. So for instance I'm starting to develop these little jowls. Would this be a good procedure for me because I don't like my jowls?

Dr. Minni Saluja 10:16

Absolutely. It would be a, and it would also, on top of it, it wouldn't just stop at the jowls. Like some different devices are targeting just that area. It will do your whole skin though. So that's one component, but then it'll also freshen your skin up altogether. What's also interesting about is let's say, we have patients that come in for consultations and the first thing I ask them is, what bothers you? And then I ask them, what would you like to see now if they're really pulling their neck up and their face back, that's more of a surgical. Facelift or a neck lift and then I refer them out to a lot of the talented surgeons that are around us. But if they are saying, yes, I wanna lift as much as a minimally invasive device can do, I don't want surgery at this time. What can you do? Certainly this is it. Or if they've had surgery before in the past and they wanna see a little more improvement, this is certainly a great procedure too. But if someone's sitting in my chair cane. And I see a lot of weathered look to their skin. Maybe their skin is just in poor dermal health. They've got a lot of textural issues. I might say, yes, we can do a four D, but let's first resurface your skin, get you into better dermal health. Get that skin better hydrated. Then let's go on to four D.

Kane Rogers 11:29

are you using like the Erbium for that?

Dr. Minni Saluja 11:32

I sure am. I'm using, so that kind of lends us into the next treatment. I do a fractional treatment and there's a different handpiece for that. The FS oh one I use for that, and that is where I can go mild, I can mildly resurface them or I can go pretty deep with it as

Kane Rogers 11:49

so let me ask you, you emphasize, when you say the word fractional, you kinda emphasize that a little bit. Why is that? What is that and why is it important?

Dr. Minni Saluja 11:55

So fractional, there's full field where I can use a tip and I can resurface the entire tissue. That's got very long downtimes. That's more like a 10 day type of downtime.

Kane Rogers 12:07

so that's really

Dr. Minni Saluja 12:08

Correct. That's really aggressive. I don't do those as much in our practice. There's a wonderful doctor Dr. Mark Taylor, who's. Wonderful at resurfacing the Skin with a, and he's down in Utah, I believe. But what I do is more of the fractional mode. There's still a downtime and even within this fractional mode, so fractional means that I am delivering. High energies into certain pixelated components of the tissue, where some of the tissue beside it is untouched so that you heal quicker from it so it's not the full area of the pulse that's being treated. And then you can go high and, but it's a fractional component of the skin that you're treating. But I can go. High with it and have about a four day, five day downtime. We're actually doing a series of patients where we are showing day one, day two, day three to four, day four. So people can get a perspective of that. Or I can go moderate, or I can go very low. If I'm trying to get the skin into better Dermal health for something, I might just do a mild laser peel to get them into better dermal health and then proceed with another

Kane Rogers 13:11

Would that just be like a one time thing or do you need multiple

Dr. Minni Saluja 13:15

You might need to, it depends again, on the depth of the treatment and whatnot and how aggressive you are with the treatment. But it might be a two treatment thing. Now, the photo of four D, we do it in a series of three. Some people have even done four. Again, it depends on where patients start and their whole journey and what they're trying to do with their, with the tissue of their face.

Kane Rogers 13:33

So the four D is a series of three about every four to six weeks To really get you where you want to be. And it's called the four D non-surgical facelift, because that's what it is. Without getting cut,

Dr. Minni Saluja 13:47

Without getting cut, but it will not give facelift results. It will give nice lifting, but still, if someone truly needs a facelift, go get a facelift.

Kane Rogers 13:57

But not only is this lifting, but it's also helping just with your overall dermal health and skin texture And and even vascularity,

Dr. Minni Saluja 14:07

It helps with the reds, the browns, the quality of the skin, and even the lifting component. What does all of that in, in one treatment? It's

Kane Rogers 14:14

Yeah. I've heard this device described as the Bentley of devices. If you were thinking of it as a car, this is a

Dr. Minni Saluja 14:19

Well, it's so well engineered and this company's been around for 60 years. They're not a pop-up company. They've been around a long time. They've, they really have quality, but they've engineered so many wonderful features. I'm barely even. Touching the surface as I'm talking about all the different parameters, and when you look at patients, again, they don't come in one, they're not 40 year olds aren't just 40 year olds. 50 year olds aren't just 50, but it has to do so much with what, how much time they spend outside in the sun, where they smokers their diet, even just their genetics. Granted, genetics is. Is a small percent. Epigenetics is the primary component of how we age, but sometimes it's more laxity. It's just you see descent of fat that you wanna try to get back to. Its to its proper

Kane Rogers 15:04

lift it back up a little bit.

Dr. Minni Saluja 15:05

so to speak.

Kane Rogers 15:06

So let me ask you this couple just real quick questions. So from a downtime perspective,

Dr. Minni Saluja 15:11

ah,

Kane Rogers 15:11

the, for the four D Yeah. What does that look like and how painful is it?

Dr. Minni Saluja 15:16

So we, when you look at the literature, it says you don't need numbing. We do numb. Why not? Because again, that last step might be a little tiny touch. Bernie, the last step is so light though, that I really could do this without numbing, but for now we numb everybody for it overall.

Kane Rogers 15:33

it's generally well tolerated.

Dr. Minni Saluja 15:36

very well tolerated. The first step can be a little pinchy around the lips. That's where we stack the pulses with the erbium. And remember, that's when it's delivered in this smooth mode that's not ablative inside the mouth. And you wanna make sure that if the tissue gets too dry, you're having the patient stop and lick their lips or lick the inside of their mouth so that you moisten the tissue again, and then it's more comfortable. But that step takes about. 10, 12 minutes. It's not a long step at all. But there really isn't much of a downtime because remember, a lot of lasers cane are cooking the skin from the top down, right? This is going from the undersurface up. From the surface down, and it's doing it in a really controlled way, targeting the key tissues that we need to be targeted. But the downtime, gosh, you can wear makeup after 24 hours and you're hardly swollen. So this becomes a busy patient's laser.

Kane Rogers 16:32

So if I were to get one I need to have the real expectations that don't expect to see a big difference after just one treatment. But when would I expect to see a difference from a before and after

Dr. Minni Saluja 16:44

Well, the crazy thing is, so I did Pam two weeks ago, and I could see a difference in a week. We both just kept but to set the expectations, I. Would recommend that, after your second treatment, you're gonna, you are gonna see something after the first. It's gonna be subtle and it's gonna build upon itself with each treatment. But it's not to say you're not gonna see, Zero until the third

Kane Rogers 17:06

You'll see improvement over time but when would I like really be able to look at a before and after picture? Would it be like six weeks after my third treatment?

Dr. Minni Saluja 17:15

No, probably about six, six weeks after your second treatment. And even maybe six weeks after your first.

Kane Rogers 17:21

Okay. I just wanna like everybody, have real expectations that it does take a little bit of time. It Even though you may see pretty rapid benefit. Correct.

Dr. Minni Saluja 17:29

Correct. And should we hold off and talk about Smooth Eyes

Kane Rogers 17:33

Yeah, this, it sounds again, this is the Bentley of devices and it sounds like there's a lot

Dr. Minni Saluja 17:40

there's so much.

Kane Rogers 17:42

and I think we should break it up a little bit,

Dr. Minni Saluja 17:44

But I'm in love with this device. You'll see me there on Friday, Saturdays and playing around with it because I just, I love this device. I wanna see all the capabilities. It does things like on a co mycosis, it does, not that I'm gonna be doing fungal nails, but it can do so many things. It does rosacea. It does. Kane, I could be here talking all night long about what it

Kane Rogers 18:03

All right so one more quick one. So does this work on the neck as well? Could you look at this as a non-surgical neck lift as well?

Dr. Minni Saluja 18:10

It does. And if you look you'll see, and we'll post more and more of our own photos too. But I think truly a great treatment is when you do face and neck together. Because I really do think that we have to think about it, but the neck, you can think about it more as a 3D. Because there's no intraoral component for the neck. So it's step two, three, and four, correct?

Kane Rogers 18:30

All right. And when you say we're gonna post photos, that is on

Dr. Minni Saluja 18:33

on our Instagram, it's Saja Laser MD on Instagram. And that's where we'll post photos. And then certainly we'll continue to do these podcasts and cover it a little bit more.

Kane Rogers 18:42

Okay. Alright. Sounds good. Yeah, we're at about the 20 minute mark. And

Dr. Minni Saluja 18:45

Longer than normal.

Kane Rogers 18:46

We're, I think we've run our. Run our course on this one.

Dr. Minni Saluja 18:49

Thank you so much Kane, and we will talk about this later on. Thank you. Bye bye.