Transcript quadrolase-ppt

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QuadraLASE
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•Fractional
– Second
level & Classical Re-surfacing
• Third level•Surgical Applications
– Fourth level
» Fifth level
QuadraLASE™
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CO2 History
Fractional Resurfacing
Patient Consultation
Pre/Intra/Post Care
Instructions
Treatment Parameters
Device Specifications &
Buttonology
Maintenance
Ablative Resurfacing
Surgical Applications
Indications
• Photo-damage
– Wrinkles
– Dyschromia
• Scarring
• Acne Scarring
• Surgical Applications
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History
Brief History of C02
• Developed in 1964
• 10,600nm wavelength is highly absorbed by
water
• Ablative!!!
• First CO2 lasers were continuous wave
– Surgical purposes: Cutting & Coagulation
• Eventually became “pulsed”
– Resurfacing
Continued History of CO2
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Physician – Patient Handholding
DOWNTIME!!!
High Risk to Benefit Ratio
CO2 resurfacing complications
– Prolonged Downtime
– Infections/Scarring
– Dyschromia
– ALL are unacceptable to patients
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– Second level
The
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Science
What is Fractional Resurfacing?
• Pixilated distribution of laser light
– Scanned pulses are delivered in a NonSequential manner
– Prevents overlap/overheating (RTD)
• Smaller thermal injury areas
– Shorter downtime
– Fewer complications
– Allows for treatment of darker skin types
1540
1540
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CO2
CO2
CO2
Necrosis
Coagulation
QuadraSCAN™
• QuadraSCAN technology allows for better
patient comfort
– Scanning places laser pulses in 2 adjacent spots
in the longest possible intervals
– Limits heat build up that creates patient
discomfort
QuadraSCAN™
• Laser delivers pulses in 4
independent quadrants
– Allows maximum time for
thermal cooling of the tissue,
less pain for the patient and
faster recovery
• Delivers uniform tissue
ablation to the dermis
causing contraction and
tissue tightening
• Thermal injury also
stimulates the production of
new collagen
Delivery of Pulses
• Continuous Wave
– "CW" refers to a laser which produces a continuous
output beam, sometimes referred to as 'free-running'
• SuperPulse
– A very brief, high-power energy laser pulse
• QuadraLASE Fractional
– Is continuous wave that is “chopped” by a fanlike
device and scanned to produce a fractional array of
5-40% coverage (density)
Types of Pulses
Why Shorter Downtime?
• Only a small percentage
(20-40%) of tissue is
ablated (micro thermal
zones - MTZ)
• Remaining epithelium is
undamaged and intact
thus facilitates quicker
healing and shorter
downtime
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In Practice
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QuadraLASE™
• Should ONLY be performed by a Physician
• This is NOT a NO DOWNTIME treatment
Patient Consultation
• Explain entire process to patient
– Will require, at least, 5-10 days of downtime
– Number & Frequency of treatments required
• Set realistic expectations
– Does not replace surgical procedures
• Discuss Contra-indications
Contra-indications
• Cease the use of
Accutane (12 months)
• Tendency to Keloid
• Injectibles/Fillers
– Botox can be injected
post treatment/Fillers two
weeks post final
treatment
• Recent/Planned Sun
Exposure
• Avoid Pregnancy and
Breast feeding
• Active Skin Infections
• Vitaligo
• Unrealistic Patient
Expectations
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Treatment
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Considerations
Pre-Treatment
• Consent form should be obtained from patient
– Note: If sedation is being utilized, patient should sign the day
prior to administration
• Prophylactics
– Anti-viral and Anti-biotic as needed and prior to treatment
– Hydro-quinone (bleaching cream) as needed and recommended
for ALL darker skin types
• Topical Anesthetic/Local or Regional Blocks
• Cleanse area to be treated with soap and water
– No drying cleansers (alcohol)
Intra-Treatment
• Select and Calibrate Appropriate Treatment
Parameters
• Protect Un-treated areas with moist/wet
gauze or towels
• If treating inside the orbital rim, utilize
corneal shields
• Stretch skin with non-dominant hand
• Utilize a smoke evacuator
Clinical Endpoints
• Pixilated Frosting of
the skin
• Erythema
• Edema
Potential Hazards
• Reflective/Metal Objects
– Jewelry
– Mirrors
• “Matted” Instruments
• No Flammable Anesthetics and/or Disinfectants
• Plume may contain viable particulates. The use of
a smoke evacuator is highly recommended
• Protect the Hair!!!
Post-Treatment
• Keep area clean and moist
• Thin layer of petroleum based ointment may
be applied
• Cool Compresses, if necessary
• HYDRATE!!!
• Patients should try to sleep in a semirecumbent position to limit edema
• Sunscreen (30+ SPF)
Transient Side Effects
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Epidermal Bronzing
HSV breakout
Acne flares
Petechiae
Prolonged Edema/Erythema
Post Inflammatory Hyper-pigmentation (PIH)
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Treatment
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Progression
Post-Treatment Progression #1
Post-Treatment Progression #2
Post-Treatment Progression #3
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– Second level Parameters
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Hand Pieces
300µ QS HP
180µ QD HP
Hand Pieces
180µ QD
300µ QS
QS Vs QD
QS Vs QD
• 300µ QS Hand Piece
– Laser pulse is .3 mm in
diameter
– Can be used for both
Fractional and Ablative
resurfacing
• 180µ QD Hand Piece
– Laser pulse is .18 mm
in diameter
– Can ONLY be used for
Fractional resurfacing
**Spot Size must be entered manually. Device will
not recognize attached hand piece**
Exposure Control
• “S” = Single Scanned Pulse
– Activates a single laser scan emission towards the patient.
Emission will stop automatically upon completion of the scan
or when the footswitch is released. To Activate Another
scan, press the footswitch
• “R” = Repeat
– Activates a series of laser scan emissions towards the
patient. There is a fixed pause of 1000msec between each
scan. Emission stops when the footswitch is released.
• “B” = Beam
– When “B” is selected and confirmed, the display returns to
the standard operative screen.
Shape of Treatment Area
QL
Shape Size Scale
• Area of treatment
– 300µm:
• Ranges from 6x6mm to 20x20mm
• Adjusts in increments of 2mm
– 180µm:
• Ranges from 4x4mm to 12x12mm
• Adjusts in increments of 1mm
Density Value (D%)
• Indicates the percentage of area
covered during scanning
• Can be set to the following values:
– 5, 10, 15, 20, 25, 30, 35, 40%
– 100% = Full Ablation
Watts/Pulse Duration
• Watts (Energy)
– Range of 5 - 30 watts
– Higher Watts = Deeper Treatment
• Pulse Duration (Time on Tissue)
– Range of 2.5ms – 16ms
– Longer Pulse Duration = More
coagulation/hemostasis
Treatment Considerations
QS-300µ Hand Piece
Watts
Light
8
Moderate
12
Aggressive
15
Pulse
Duration
3.5
3.5
3.5
Coverage
Depth*
20%
80-160µ
20%
100-200µ
20%
150-250µ
*The above table provides THEORETICAL tissue removal depths for a CO2 laser assuming that the target tissue is 70% water. Actual
results will vary considerably dependant on tissue moisture content and other factors. Drier tissue will yield deeper
penetration/ablation; highly moisturized tissue will yield less. Consequently, do not use harsh drying cleansers prior to treatment.
Test and observe tissue response for each patient at every treatment. Also, multiple passes appear to be additive.
Treatment Considerations
QD-180µ Hand Piece
Watts
Light
8
Moderate
12
Aggressive
15
Pulse
Duration
3.5
3.5
3.5
20%
20%
20%
200-300µ
300-400µ
500-650µ
Coverage
Depth*
*The above table provides THEORETICAL tissue removal depths for a CO2 laser assuming that the target tissue is 70% water.
Actual results will vary considerably dependant on tissue moisture content and other factors. Drier tissue will yield deeper
penetration/ablation; highly moisturized tissue will yield less. Consequently, do not use harsh drying cleansers prior to treatment.
Test and observe tissue response for each patient at every treatment. Also, multiple passes appear to be additive.
Treatment Considerations
• ONLY USE RECOMMENDED PARAMETERS
• Recommend against treating outside
recommended settings
• Recommended settings are within the
SWEET SPOT
Depth of Penetration
• In the beginning….
– How deep could you go?
– Anything over 900µ is trouble
• Current Thinking…
– 450µ - 650µ will get you what you need for
wrinkles
– 300µ QS HP won’t get you there
Aiming Beam
• Fractional Re-surfacing
– Aiming beam is a dotted square
• Ablative Re-surfacing
– Aiming beam is full square
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Specifications
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& Buttonology
Specifications
QuadraLASE Specifications
Laser Type
Wavelength
Maximum Power
Optical Spot Size
Coverage:
Aiming Beam
Scan Pattern
Scan Pattern
C02 (Sealed-off and DC
excited)
10600 nm
30 Watts
300 microns and 180
micron (fractional)
300 micron continuous
5-40% in Fractional Mode;
100% in Traditional Mode
635 nm, intensity adjustable
from screen
Line, Rectangle, Square,
Triangle, Circle and Donut
in Traditional mode
Square in Fractional Mode
6x6 mm to 20x20 mm
in increments of 2mm
Specifications
QuadraLASE Specifications (cont.)
Pulse Duration
Traditional Mode: .1 to .8 ms in
increments of .1 ms
Fractional Mode: 2.5 ms to 16 ms
Operating Modes Continuous:
Single pulse: 50 – 1000msec
Repeat pulse: 50 – 1000mse
Articulated Arm
Maneuverability: 7 axes
Working radius: 130cm
Rotation angle: 340°
Electrical
100 – 240 V AC
50-60 Hz
Dimensions
Width: 35 cm (13.8 in.)
Depth: 24 cm (9.5 in.)
Height: 100 cm (39.4 in.)
Weight: 30 Kg (66 lb.)
User Interface
Pulse Control
Shape/Diameter
PW/D%/Watts
Down
Up
Enter
Ready/Stand-by
User Interface
• Blinking Icon needs to be entered before
moving to the next selection
• REMINDER
– ONLY QL is Fractional
– Other Shapes are True Ablative
Resurfacing
Device Back
Power Cord
Foot Switch
Door Interlock
Stabilizing foot
Device Back
Handle
Scanner Cord
Chopper Cord
Arm Storage Clip
Computer Pattern Generator (CPG)
Chopper
Chopper/CPG
Chopper
CPG
Distance Gauges
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– Second levelMaintenance
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Cleaning/Disinfection
• Device may be wiped down with standard
disinfectant wipes
• Distance Gauges may be cleaned in all
modes, including gas, cold sterilization and
autoclaves
• Lenses should be cleaned with ethyl alcohol
and lens paper
Trouble Shooting
• Tips can be found in the operator’s
manual
Classic Re-surfacing
• Similar Pre-treatment protocols as Fractional
Re-surfacing
• Longer downtime/Greater Wound
Management
Surgical Applications
• Continuous Wave
– Used for Cutting and Coagulation
• SuperPulse
– Limits necrosis of epidermis
• Ablation of:
– SKs
– Skin Tags
Supporting Vendors
• Smoke Evacuators
– Buffalo Filter: www.buffalofilter.com
• Protective Eyewear/Instruments
– NOIR: www.noirlaser.com
– Kentek: www.kentek.com
– Innovative Optics: www.innovativeoptics.com
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– Second level
Thank You
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