Episode #32: T-Runner

Welcome to Just Laser It! In this episode, we're talking about the T-Runner, one of my favorite laser treatments for natural skin tightening. If you've been wondering whether you can improve loose, crepey skin without surgery or significant downtime, this episode is for you. We'll discuss how the T-Runner works, who makes a good candidate, what the treatment feels like, and the realistic results you can expect as your body builds new collagen over time. Let's dive in!

Thank you for your listenership!

Transcript

MIC1 0:19

Hi, everyone. I hope you're doing well. Thank you for joining us for another episode of Just Laser and All Things Cosmetic. Kane, how are you doing? I'm

Dr. Minni Saluja 0:27

I'm doing really well. You always ask me that question every time. I'm doing great, thanks.

MIC1 0:32

well. You always ask me that question every time. I'm doing great. Thank you. Oh, good. I'm glad you're doing well because I need you to be- How am I supposed to-

Dr. Minni Saluja 0:35

Good, I'm glad you don't want to complain to me. What am I supposed to say? If I'm having a bad day, you want me to be honest

MIC1 0:37

No, I just wouldn't do a podcast that day. But anyway, we're here, Kane, because, you know, we're always chasing that magic eraser in clinic. We want that one item that can take away all of our wrinkles in one session with zero downtime, and we're forever chasing that, right?

Dr. Minni Saluja 0:55

Did you find

MIC1 0:56

it? Nope. I haven't found it yet. I'm still, I'm still running, though. I don't think I'll stop until I get there, and I think maybe one day we will get there. But for now, patients often ask, "Dr. Sluja, i want the one that has four to seven day downtime versus two to th- three day downtime." And, and certainly sometimes the deeper you go leads to, to better, wrinkle reduction. I'm talking about resurfacing and other lasers that we're doing on the skin. But it's not always the case. It's not always the

Dr. Minni Saluja 1:24

What's not always the case?

MIC1 1:25

That the longer of a downtime that you have may be better. And I'm gonna talk to you a little bit about something that we've added to our practice-

Dr. Minni Saluja 1:33

does make sense. Like the more aggressive, the better results, but the longer downtime.

MIC1 1:38

But the longer

Dr. Minni Saluja 1:39

just ma- intuitively that

MIC1 1:40

Intuitively, I would think. And I think for the most part, for the most part, that's correct, except there are some exceptions, and that's what we're gonna talk about today.

Dr. Minni Saluja 1:48

Okay, let's talk about it

MIC1 1:49

Okay. So today we're gonna talk about the T Runner and why we brought it into the practice. You've heard me talk a lot about Fotona, and I love my erbium, and I really have loved my CO2 as well. But because my erbium can do everything that CO2 does, but CO2 cannot do everything that erbium does, and case in point is cold microcoring, I love my erbium more.

Dr. Minni Saluja 2:14

Okay. And how does TRunner fit into

MIC1 2:17

into this. Sure. So when we're talking about resurfacing, one of the,

Dr. Minni Saluja 2:20

First of all, I don't... I'm sorry to interrupt you, but I don't know if you know the answer to this, but what is a T-runner? Like, why is it called a

MIC1 2:28

is it called T? So T stands for tightening, and the Runner means that it's a robotically scanned hand piece. And so if I hold that device up, and you'll see a lot of this on our Instagram posts. I've done multiple Instagram posts utilizing the T

Dr. Minni Saluja 2:43

Saluja Laser MD

MIC1 2:44

@salujalaserMD. @salujalaserMD, correct. I basically hold it up, Kane, and it will robotically scan over the skin. If I set it at 11 pulse stacks, which seems to be, and we'll talk about this, the greatest tissue effects-

Dr. Minni Saluja 2:58

I don't know what 11 pole stacks

MIC1 3:00

I don't know what 11 pulse stacks looks like Okay, we'll talk about that. We'll, we'll go into this. But what I'm getting at is that it does it all at the same speed, at the same concise way, because it's all robotically performed

Dr. Minni Saluja 3:11

you're just holding it up and then it's, it's like on automatic?

MIC1 3:15

Correct. And what's great about that, just in general, is that it's very delegatable. Because what if I... In my hands, we'll get the same results as someone else's hands if they're doing things in the way that we do it. And what I mean by that is sometimes we'll stack other things on top of

Dr. Minni Saluja 3:30

Are the settings variable or is it pretty

MIC1 3:33

are. They are. So there's something on the TRunner called an STP, and,, you'll always hear me in clinic to say STP of 84% or STP of 98%. I typically run it at a 84%. That's a surface temperature parameter. What you're feeling on the surface of the skin. And usually that's at a certain set fluence that I use, energy setting that I use to, to stack these pulses. And You'll feel the heat, but it's very tolerable because what I stack it at... Let's talk about this, the pulse stacks., Adrian Gaspar did a study and he looked at, looked at biopsies of tissue to see what makes a difference. Do we stack it at three pulse stacks, where the laser just goes over it over and over three times? Do we stack it at five? Do we stack it at 11? Do we stack... He went all the way to 20, and what he found was the greatest collagen production was at these 11 pulse stacks. So that's what I utilize a lot i- with the TRunner, is using the 11 pulse stacks for

Dr. Minni Saluja 4:33

kind of the sweet spot then. You can go more, but the, the benefit's really not gonna be there

MIC1 4:39

Correct. And when patients sit down in the chair, I tell them, "Okay, you might feel a little bit of heat, kind of you'll feel it, you'll feel a little bit of heat. Okay, it's gradually building, and then it's gonna switch and scan another area." So just as they start to feel a little bit of heat, then it moves and it scans another area. So I can set it at a big square where, let's say, I'm putting down 220 pulses, and it's just scanning over that robotically. And as it gets to 11 pulse stacks, it, it

Dr. Minni Saluja 5:00

So right when it kind of gets to that, uh, uncomfortable spot, ah, you get a little

MIC1 5:05

Correct. Correct. And there is body hand pieces to this. There's face and neck hand pieces.

Dr. Minni Saluja 5:10

So is this, is this an erbium laser? Just, it's just a different handpiece that you're using

MIC1 5:16

an erbium laser, but it's delivered in a different way. So when you think about erbium, you think about ablative. You think about where it's vaporizing the top layer of the skin. We do this all the time with our FS01 handpiece, which vaporizes the top layer of skin. Yes, patients have a little bit of a downtime where they have to use Aquaphor on the skin. We have them prophylactically use Valtrex. But when I'm doing a T-Runner came, we do it in a non-ablative fashion, and that's what's so neat about this particular modality. You know, when we do f- Fotona 4Ds, we go inside of the mouth. That part is also delivered non-ablatively. It's stacked pulses that deliver the energy. It's delivered at an energy setting that's below the ablation threshold, so it's delivering heat into the tissue. With this, it's the same way. It's a series of pulses. It drives the energy down So it's getting down to the reticular dermis to build that architecture. So this is what I was trying to get at, that usually when I'm down that deep, I'm vaporizing tissue down that deep. So that means a long downtime. Instead, what I'm doing, and we call this a, a fractional resurfacing max, I'm going in with my T-Runner, and I'm putting heat down, and I'm building that architecture down deep into the tissue, but I'm not vaporizing the skin. But then I go over it with a resurfacing laser that does vaporize the skin. So I do a two-in-one with it.

Dr. Minni Saluja 6:46

with it So you don't just do the T-runner and then you're done

MIC1 6:49

No, but you could just do the T Runner and be done. Like on the body? On the body when I'm doing arms and when I'm doing abdomen and when I'm doing knees, yes, I just do the T Runner

Dr. Minni Saluja 6:58

So really, I'm gonna... This is all, like, really making my head spin. So let me make sure I'm, like, understanding this at a very basic level. So the T runner is, you're really doing it to tighten. Yes. That, that's, that's what you're doing. And you can do it pri- I mean, I, I see a lot done on the neck, but you can do it on arms and other places on the body. Anywhere that's, anywhere that you wanna tighten your skin.

MIC1 7:23

Anywhere that you wanna tighten your skin. I built it into my 4D now too. Okay. Because it's that dramatic of a, of a tissue tightener. I really, really like the T

Dr. Minni Saluja 7:29

And all it is is a different handpiece

MIC1 7:31

It's a different handpiece, but it's got five laser heads on it. So when I'm holding it and scanning over the tissue, there's five laser heads that are scanning over it. So it would take me five times that time period if I was to do it manually. So it's really-

Dr. Minni Saluja 7:46

it's really efficient

MIC1 7:47

it's efficient. It gets that energy in there. Absolutely.

Dr. Minni Saluja 7:51

Okay. So you use this to tighten, but then I heard you say just a minute ago, you'll oftentimes come back around with a different handpiece, I guess, and, and resurface the skin as

MIC1 8:03

Correct. So I can resurface and really kind of buff up the skin on the surface part where I'm going deep with the T-Runner, and then I'm also gliding over the surface with the resurfacing. I like that combo

Dr. Minni Saluja 8:14

and this combo is achieving what?

MIC1 8:17

It's achieving tissue tightening and rejuvenation of the top layer, so tissue and texture. Okay.

Dr. Minni Saluja 8:22

Okay

MIC1 8:22

So, or tightening and texture, I should say, of the tissue. I started off with my T runner with a series of patients doing what I call T neck, which is this combination of T runner first, followed by an FS01, with settings that have about a three-day downtime of, two to four-day downtime of using Aquaphor on the skin, and then the skin will slightly shed a little bit. But the T runner itself is called Tensor Tight. That's what the company has termed it. And Tensor Tight alone does great. We just wanted to see what we can do to kind of augment the surface texture as well.

Dr. Minni Saluja 9:00

Okay. So I know this is about T-Runner, but this is, like, the most basic question f- for a guy that's not, you know, r- real knowledgeable. When you say texture of the skin, what does that mean?

MIC1 9:14

So it can, it can encompass a lot of things. You're right, it's kind of a broad, term. It means the fine lines and wrinkles, the roughness of the skin. When I talk about rejuvenating the skin or, or giving it a luminescence, that's more of the brightening aspect, but it's more the roughness and the surface texture, kind of the pore size, all of those type of things. When I talk about deeper lines and wrinkles and the architecture of the skin, that's where I'm talking about really going in deep to the reticular dermis. You know, not the papillary, but getting down a little bit deeper to try to resurface the skin or try to deliver energy there that can turn on the fibroblast. And what's interesting about the T-Runner, the study that Adrian Gaspar did, he found that at three weeks, the activated fibroblasts doubled. At three months, they quadrupled.

Dr. Minni Saluja 10:00

What do you mean at three? Like after the procedure?

MIC1 10:03

the procedure, correct. So there was this process that's going on, and it does this because the T-runner

Dr. Minni Saluja 10:09

say that again. After, after you complete a procedure and, and I'm sorry to cut you off, but typically, is it just one procedure?

MIC1 10:16

No, we do a series. You could do one, you could see something with one, but no. To really get the essence of it, I recommend at least three treatments. And when I'm doing the neck, I'm doing a series of three

Dr. Minni Saluja 10:27

And they're spaced, what, four to six weeks apart roughly?

MIC1 10:30

correct. And we did put a photo up on our Instagram that shows where patients are, and I'm gonna try to put more and more post one treatment. You could

Dr. Minni Saluja 10:40

I saw that and I, I don't have a, I don't have a trained eye to see changes, but I could see the change in

MIC1 10:46

good. If you could see the changes,

Dr. Minni Saluja 10:48

Even I could.

MIC1 10:49

I hesitate to put post one up because I know when you see photos, it's not the same as in person, but it was nice to be able to see, and I thought that did translate,

Dr. Minni Saluja 10:58

So you would do typically a series of three, and then after three weeks you see what you were saying?

MIC1 11:04

if you always to look at the histological component that you've turned on these fibroblasts and they're producing collagen, and then at three months they've even quadrupled. So you're getting these cells activated to produce collagen, and it does it in a two format way. So a bimodal way. It, the T runner creates heat at the top layers, so it turns on heat shock proteins, and then it drives energy deep into the tissue to turn on the fibroblasts to create collagen elastin.

Dr. Minni Saluja 11:32

Okay. And I know

MIC1 11:33

thermal effect on deep and superficial

Dr. Minni Saluja 11:36

All right. That actually makes sense to me. So we started off talking about, the more aggressive, the more downtime, the better results, all that sort of stuff isn't necessarily always the case. So what would be an expected downtime for a T runner?

MIC1 11:51

So when I do a neck, about two to three days. But remember, it's because I'm coupling it with a little bit of texture. But otherwise, if I just did the T runner, only the T runner, which is like a busy woman's laser. Busy patients, i should be gender neutral. No downtime. No downtime. I mean, it, because all that energy's delivered down into the tissue. So you could put your makeup on and you could go

Dr. Minni Saluja 12:14

Okay. And when we talk about downtime, what's that? Just like redness, tenderness? What's downtime for two or three days?

MIC1 12:20

I couple it with the resurfacing laser, classic resurfacing laser where they have to wear Aquaphor for two to three days. They might be a little bit rough, and then they might flake a little bit. They can't wear makeup. Typically, when I resurface the skin then I tell them not to wear makeup. Now, if I go deep with my resurfacing, similar to my CO2, then it's about a four-day downtime, but it's still not a seven-day. I've still shaved off some time, and the healing's a lot better. Now, there is some healing. Some patients... Or everybody's so biologically different. I get some patients that say, "Dr. Sluchow, I was barely red. Is this right?" And, "I was only red for two days," or whatever. And others that say, "I was red for seven days." And so everybody's a little different. Swelling's a little different as well. But for the most part, it does save on downtime while still delivering results.

Dr. Minni Saluja 13:06

Okay. So just really high level summary. T-Runner, which is a handpiece for your Photona device,

MIC1 13:12

Five laser heads robotically scanned over the tissue. It delivers deep energy to the tissue, and it also turns on heat shock proteins. Just a wonderful tissue tightening. Now, they also have L runners for lipo, th- for the fat. They also have F runners for fractional as well, so. But this T runner, I can imagine, you know, five

Dr. Minni Saluja 13:30

I might be interested in the L runner for the lipo. Okay. All right. I'll be interested in that.

MIC1 13:36

Interested in the L runner. Okay. All right. I'll be interested in doing that. I can imagine, though, down the road that, hey, it's not my hand that's holding this up. It's a robotic arm off of the laser

Dr. Minni Saluja 13:44

It really is that, that efficient and-

MIC1 13:47

That efficient and- And it's that automated. And I mean, granted, you have to select the patients, you have to select the, the proper settings, but it really is wonderful. It's my time that I get to talk to patients and get to know patients, and boy, do we have interesting patients. Wow.

Dr. Minni Saluja 14:01

Wow. And so, so this is, you're doing this to help tighten, and you can pretty much tighten anywhere Anywhere Um, a neck is a great place, but other places

MIC1 14:10

it on faces and I'm doing abdomens. Stay tuned with that. So just, and I'm doing some arms. We have some, some folks that are wanting to wear dresses, certain dresses, and they want the f- the front of their arms done. So I'm really loving this

Dr. Minni Saluja 14:24

All right. And so just with the T-Runner, really no downtime, but you like to couple it with a a modest resurfacing, and that might give, eh, roughly two or three days

MIC1 14:34

Correct. And you can use it on any skin type too, so

Dr. Minni Saluja 14:39

Right. And you can use it on any skin type, too. Okay. Okay. What else should I be asking that I'm not? I th- I started off, like, not understanding anything that you were saying. Now I think I have a pretty good grasp.

MIC1 14:45

Do I numb for it?

Dr. Minni Saluja 14:47

I now work? Ah, there

MIC1 14:47

And so on the abdomen, no. On the arms, no. So body I don't. I do numb when I do the neck or the face, and the reason is because I couple it with a f- with a fractional laser

Dr. Minni Saluja 15:00

And typically, how long does this take if you're just doing the neck? Let's just say a neck procedure

MIC1 15:04

Yeah, about 30 minutes. It does take a little while. But remember, when, if I'm doing 20 minutes of T-Runner, multiply that by five if I was doing it manually. So it really, I mean, that would be close to an hour and a half of, of lasering. So it, time in the chair is painful sometimes for the patient, but it's cost to the patient. It's cost to the practitioner. So if you can deliver energy settings in an efficient way, and I don't mean just in the delivery of the laser heat, et cetera, but I also mean in a timely fashion, that's a win-win for both of us

Dr. Minni Saluja 15:35

Yeah. No, that makes sense. Efficiency has value

MIC1 15:38

Absolutely. But yeah, I, I'm, I'm loving it. I know patients are like, "Oh, d-," but I'll just say, "Oh my gosh, let me bust this out. Let's put this over here." So, so some patients have, have tried the T-rudder just on their own, but we've done a lot of necks. We've done-- We've added it to a lot of Fotona 4Ds. We're again starting to do abdomens and arms.

Dr. Minni Saluja 15:54

That's really

MIC1 15:55

So stay

Dr. Minni Saluja 15:56

And if you want to see some photos, go @salujalasermd. That's the Instagram,

MIC1 15:59

Laser MD Laser Indeed. You got

Dr. Minni Saluja 16:05

All right,

MIC1 16:05

Thank you so much for tuning in, and we appreciate you all.

Dr. Minni Saluja 16:09

right. Thank you

MIC1 16:10

Bye-bye.