Transcript GentleLase

GentleYAG
• Patient Consultation &
•
•
•
the Management of
expectations
Laser Hair Removal
Veins
Skin
Tightening/Wrinkle
Reduction
Patient Consult
• Today’s patient is better educated than
ever thanks to the internet.
– Before any treatment, ALWAYS sit down with
the client to explain the entire process.
– They should know exactly what is expected of
them.
– They should know what to expect as far as
outcomes.
Fitzpatrick Skin Types
• Skin Type is race dependent and DOES
NOT CHANGE.
• Suntan alters the degree of pigmentation
NOT the skin type.
Fitzpatrick Skin Types
Skin Type
Typical Skin Type Definition
Skin Reaction on over exposure to UV light
1
Red-blonde Hair
Blue-green Eyes
Very light Skin
Always Burns
Never Tans
2
Light to Medium Hair
Light to Medium Eyes
Light to Medium Skin
Usually Burns
Seldom Tans
3
Medium Hair
Medium to Dark Eyes
Medium to Olive Skin
Moderate Burns
Usually Tans
4
Dark Hair
Dark Eyes
Dark Olive to Brown Skin
Burns Mildly
Moderate Browning
5
Dark Hair
Dark Eyes
Dark Skin
6
Dark Hair
Dark Eyes
Very Dark Skin
Seldom Burns
Deep Browning
Does Not Burn
No Change in Color
How does the Laser work?
(Hair)
Patient Consult
• Laser Hair Removal –
– Targets the pigment in the hair
follicle.
–Heat is absorbed and destroys the
cells lining the hair follicle
specifically around the bulb, bulge,
and vascular supply.
Permanent Hair Reduction
“long-term stable
reduction in the number
of hairs re-growing after a
treatment regime”
The FDA allows us this definition
IMPORTANT!
• The GentleYAG will NOT treat
white, blonde, or gray hairs!
Patients should be informed
upfront.
Hair Anatomy
Epidermis
Sebaceous
Gland
Follicle
Vascular
Supply
(matrix)
Bulge
Bulb
Bulb / bulge are critical structures
responsible for hair re-growth
Patient Consult
–What are the 3 cycles of hair
growth?
•Anagen: Hair is actively growing
•Catagen: Hair is dormant
•Telagen: Hair is falling out
Hair Biology
Anagen
Catagen
Telogen
Patient Consult
• When do you re-treat?
– Within 7 days of when re-growth is observed.
– Different areas have different percentages of
hair in the Anagen phase.
• Face, Axilla, Bikini are approximately 20-35%
• Trunk and Extremities have approximately 10-20%
Hair Growth Information
Body Area
% Anagen
Hair
% Telogen
Hair
Axillae
30%
70%
Brow and
Ears
10-15%
Beard
Telogen
Duration
Follicles density/cm2
Depth of follicle
3 months
65
3.5-4.5 mm
85-90%
3 months
50
2-2.5 mm
70%
30%
10 weeks
500
2-4 mm
Upper Lip
65%
35%
6 weeks
500
1-2.5 mm
Scalp
80-90%
13%
3-4 months
350
3-5 mm
Trunk
10-20%
80-90%
4 months
70
2-4.5 mm
Pubic Area
20-30%
70%
3 months
70
3.5-4.5 mm
Arms
20%
80%
18 weeks
80
2-4.5 mm
Legs & Thighs
20%
80%
6 months
60
2.5-4 mm
Breast
30%
70%
3 months
65
3-4.5 mm
Patient Consult
• For best results, multiple treatments will
be needed. For most areas 4-6 treatments
are necessary to achieve desired hair
clearance. One may need more or less
than 6 treatments depending on hair type,
previous methods of hair removal, and
skin color. Results will vary from patient to
patient and to various degrees of efficacy.
F.A.Q.
• Can cancer survivors be treated?
– Yes, but if there is concern get clearance from
their treating physician.
• Can children be treated?
– Yes, but more treatments maybe required
later due to hormonal changes.
F.A.Q.
• Can patients use “sunless” tanning
products?
– With the GentleYAG, YES!
• Can you treat a man’s head?
– Yes, but make sure he understands that it is
permanent and signs an informed consent.
F.A.Q.
• What areas of the body can you treat?
– All areas are treatable with the exception of
inside the orbital rim.
• Can treatments be done over implants?
– Yes.
F.A.Q.
• Can treatments be performed over
orthopedic hardware?
– Yes, however some patients may notice more
discomfort in those areas.
• Pacemakers and other cardiac implants?
– Patients with pacemakers may have treatment
once cleared by their physician. Treatments
are not typically performed directly over
implant.
F.A.Q.
• What about braces or other dental work?
- Yes. Frequently gauze is placed between the
cheek and gum for those patients who
experience a “tingling” sensation on their
teeth.
F.A.Q.
• Can treatment be done over injectibles?
- Probably not a good idea to treat directly
over the injectible. Patients can have laser
treatment and injections done...But, in
different areas.
Contraindications
• Accutane
– Most physicians recommend that patients should
cease usage for at least 6 months. However, many
physicians are treating while patient is on medication
provided the primary chromophore is NOT water.
• Sun exposure
– Recent tanning is an absolute contraindication. Skin
with underlying redness is more susceptible to
pigmentary changes.
– AVOID the Sun for at least 1 week prior to a
treatment and 1 week after. The chances of pigment
changes and other “minor” skin irritations are high.
Contraindications
• Pregnancy
– Pregnant practitioners should check with their
physician
– DO NOT TREAT Expecting mothers
– Liability reasons
– Hormones are unstable
Contraindications
• What about Tattoos?
– Tattoos and permanent make-up should be
avoided. While the wavelength can sometime
be used for the removal of tattoos, the
GentleYAG has the WRONG pulse duration to
safely and effectively remove tattoos.
– Areas with permanent make-up should be
covered or avoided.
Patient Consult
• During consultation explain and obtain an
INFORMED CONSENT
• Document, Document, Document.
Remember to chart the treatment
procedure i.e. (Energy, Pulse Duration,
Spot size, DCD)
Patient Consult
• Photo-Document
– It is important to take pictures of the area to
be treated.
– Patients will sometimes forget what they
looked like at the starting point.
– Having before and after photos will allow you
to market to potential clients using your own
photographs.
GentleYAG Treatment
Protocol For Hair Removal
• Pre-Treatment
- Shave hair 24 hours prior to treatment.
- If history of cold sores, an antiviral can
be prescribed.
• Post Treatment
– Aloe vera (with Solarcaine and menthol)
gel may be applied.
- Sunblock of spf 30 if treated area is
exposed to the sun.
Treatment Protocol
– NO Plucking – 6 weeks prior or after
– NO Waxing – 6 weeks prior or after
– NO Tweezing – 6 weeks prior or after
– Patients can only shave.
Treatment Protocol
• 3 Things to ALWAYS remember while
treating
– “FLUSH”
– “PERPENDICULAR”
– NO MORE THAN 30% OVERLAP
Complications
•
complications that can •
occur from laser
•
treatment.
•
• Use of conservative
•
DCD settings are
•
important.
•
• Complications are
•
rare!
•
• There are risks and
Blister
Heat rash
Bruising
Scarring
Infection
Hyperpigmentation
Hypopigmentation
Swelling
Welting
DCD
-Cryogen spray milliseconds before laser pulse
-Cools / protects epidermis from thermal damage
-Protects darker skin types
-Good visibility / does not slow treatment
-No messy gels
Dynamic Cooling
-Short spray of cryogen onto skin milliseconds before
laser pulse
-Rapid, efficient cooling of epidermal layers only
-Does not cool subsurface targeted structures
-Does not impede visibility or treatment speed
Laser Hair Reduction
• Operative Checklist:
– Laser in “ready” mode
and calibrated to
correct energy with
proper hand piece
– “Squeaky Clean” Skin
– Safety goggles or
glasses on clinician
and patient
– No flammable
substances in
operating area
- Written post-operative
instructions given to
the patient
GentleYAG for the
treatment of Leg Veins and
Facial Telangiectasia
Telangectasias or “Spider Veins”
• Sclerotherapy is the
•
•
GOLD STANDARD
GentleYAG can clean
up what
Sclerotherapy does
not
Veins < 3mm in size
are treatable
Special considerations
• Vitamin E, Aspirin, Ibuprofen or other
Blood thinners may increase the likelihood
of bruising. Avoid for several days if
possible, if not, should do test spots
• Diabetic patients should have clearance
from their primary physicians
Pre-Treatment
• Squeaky clean skin!
• No tanned skin!
• No Topical anesthetics
• Measure vessel size
Clinical Endpoints
• Vessel disappears and then comes back
(vasospasm)
• Vessel shrinks in size (vasoconstriction)
• Vessel contents darken
• Vessel looks like a cat’s scratch (Wheal
and flare)
• NO OVERLAPPING!
Post treatment
• Apply pressure to treated area after a few pulses
• May apply aloe vera gel with Solarcaine and
•
•
•
menthol
Encourage sun block 30+ spf
Avoid activities that cause vasodilatation or
increase blood pressure for 3-5 days
Inform the vessel area will gradual fade over
several weeks.
GentleYAG for
Photorejuvenation
Skin Tightening/Wrinkle
Reduction/Scarring/Stretch Marks
Photorejuvenation Consult
• Inform patient that collagen remodeling is
a slow process and that they can continue
to see improvement up to 6 months after
their final treatment
• Inform patient that they will need 4-6
treatments one month apart
Pre-Treatment
• Photo-Document
• Face/Neck should be squeaky clean
• Shave any facial hair
– Facial hair may be reduced. Male patients
should be informed.
• No recently tanned skin
• May use topical anesthetics
Test Spots
• When skin reaction is a concern, always
perform a test spot at a couple of different
lower fluences in an inconspicuous site.
• Untoward skin responses may be noticed
within a day or two.
Post-Treatment
• Mild erythema is clinical endpoint
• May apply aloe vera gel with Solarcaine
and menthol.
• Apply and instruct on daily use of spf 30
• Inform patient fine lines may appear more
enhanced for a few days and their face
may feel tight and dry
• Encourage extra moisturizer
Photorejuvenation
Stretch Marks
Stretch Marks
Photorejuvenation
Leg Veins
Thank You