Transcript Hair Reduction - Dr. Moulton

Rex Moulton-Barrett, MD
Lisa Derita, RN
Alameda & Brentwood, CA
2007
Sciton Profile
Hair Removal
Vessel Reduction
MicroLaserPeel &
Resurfacing
Nd-YAG 1064 nm
Nd-YAG 1064 nm
Er-YAG 2940 nm
Er-YAG 2940 nm
2002
Personalized For Your Practice
ContourTM
2940nm Er:YAG
ThermaScanTM
1319nm Nd:YAG
ClearScanTM
1064nm Nd:YAG
BBLTM
410-1400nm
Intense Pulsed Light
New Modules
Ablative:MLP, resurface
ProFractional: micro-ablative
Non-Ablative: acne, vessels Pro-V
Non-ablative: collagen
Ablative: hair, vessels
Non-ablative: collagen
Ablative: hair, vessels, pigment
Non-ablative collagen, acne
2007
Sciton Profile
Hair Removal
Hair Removal
•
•
•
•
Electrolysis
Creams
Laser
Microwave
Ideally only destroys source
of keratin in hair-bearing skin
Regrowth and Removal With Electrolysis
Patient: Age, Race, Sex
% of Hair Killed
Needle
Tweezer
21 yr. old white female
27 hairs of 46%
19 hairs or 62%
30 yr. old black female
35 hairs or 30%
22 hairs or 56%
40 yr. old white male
23 hairs or 54%
17 hairs or 66%
53 yr. old white female
36 hairs or 38%
18 hairs or 64%
41 yr. old white female
30 hairs or 40%
22 hairs or 56%
Needle = 40%,
Tweezer = 60%
Average Percent Killed:
Laser Hair Reduction
Epidermis: 40 - 150 microns
Dermis: 140 - 400 microns
E & D: 180 >/= 550 microns
1.Papilla: neurovascular tuft
2. Bulge: at Erector Pili
3.Matrix cells:>= 2 mm
Anagen> Catogen> Telogen
Target Isolation
• Can we target over other similar targets?
(Can we seek melanin in hair over skin?)
Selective Photothermolysis
What is the Target ?
• Eumelanin:
brown or black hair
Best absorption of light
• Pheomelanin:
red or blond hair
Poor absorption
• Gray hair:
pigment-free
White hair
No absorption
Hair Removal Lasers
•
•
•
•
•
Nd:YAG
Flashlamp
Diode
Alexandrite
Ruby
1064
575/ 515-1200
800/810
755
694
nm
nm
nm
nm
nm
Relative Absorption of Laser Light
& Competing Chromophores
1064nm
Features
Wavelength:
Power:
Fluence:
Spotsize:
Overlap:
Pulsetime:
Pulse interval:
nm
watts
power/cm2
mm
%
ms
ms or freq
Thermal Containment Time(TCT)
re: The Target
• The specific time for energy to create
reaction without dispersion
too short: will not heat to 70 C
too long: complete dispersion cooling
Determined by pulse width=duration
Thermal Relaxation Time(TRT)
RE: avoid injury to competing chromophores
• Determines the shortest interval between pulses
• The time for 51% of heat reduction by
dispersion and
cooling
• proportional to:
1. the square of spot size
2. pulse duration, providing it is > TCT
Time of the pulse
• Pulse duration should be longer than TCT
•
and
Pulse interval longer than TRT
• This commonly protects other components
with competing chromophores.
Hair Hand Pieces w/cooling
Temperature in the Region Near the
D/E Junction Versus Cooling Time
40
35
Temperature
30
25
0.1 Sec
0.3
20
1
x
15
10
X
5
0
0
100
200
Depth-microns
Skin
Surface
D/E Junction
300
400
3
Skin Cool Technology
Energy Distribution
1
0.8
0.6
Comparison of a 10 mm
diameter Gaussian spot
with a 6.4 mm diameter
square (Top Hat) spot.
The square distribution
delivers useful energy to
a larger spot.
Gaussian
Top Hat
0.4
0.2
0
-6
-4
-2
0
2
4
6
Pulse Stacking: A Problem With Hand
Delivery of Pulses
When pulses are applied next to one another, the epidermis heated by the
first pulse may still be warm when the second pulse arrives. The “double
hit” or “pulse stacking” can result in blisters. The problem will vary with
the amount of overlap, which is not well controlled with hand delivery. A
model of this effect is shown in the next slide.
This is another reason to use a scanner with a large area cooler . With a
small fixed window or plate cooler, there is no cooling of the previous
spot.
Non-sequential scan
• The non-sequential scan extends the time between two
adjacent pulses to four times the interval of a sequential scan.
In combination with the post-pulse cooling, there is adequate
time for epidermal cooling.
Pulse time?
• Treat hair shaft
– TCT 6-10 milliseconds
• Treat hair follicle
– TCT 18-25 milliseconds, ie > 15 ms
– TRT 35-60 milliseconds, ie > 35 ms
Keys for success
•Wavelength: >690 nm (>wavelength=depth)
(shorter -> competing chromophores)
•Spot size: at least 5 millimeters
•Pulse time: 18 or > milliseconds
•Pulse interval of 35 or > milliseconds
When do you treat?
• During Anagen cycle
• Not during telogen
• Cycle time determined by
Richard-Merhag chart
Richards-Merhag
Fitzpatrick Types
OK: Fitzparick IV/VI:
Nd-YAG
non-confluent scanner
>15 ms
Continuous cooling
Consultation
• Patient history
• Any previous hair methods
• Expectations
• Treatment explanation
• Photographs
• Consent
• Periprocedure instructions
Contraindications
• Pregnancy
• Recent sun exposure
• Sun tan
• Suspicious lesions
What about the orbit?
Before Treatment
• Shave 1-3 days before treatment
(stubble)
• Avoid other methods for 30 days
• SPF 15+ for 4-6 weeks
• Avoid tanning creams
• Hydroquinone if necessary
Treatment Safety
• Test cooling plate, check < 5 C
• Test spot: and wait 4 weeks
• No overlap
• Mark landmarks with red pen
• Protect gums with Al foil if over
area
What is the endpoint ?
• Small contact spark/flash
• Smell of burnt hair
• Perifollicular edema
• Sensation of light sunburn
• One in three hairs extrude
Hair Chronology
• Redness: 4-6 hours after treatment
• Hair appears to grow for several days
• Hair falls out: day 10-14
• Hair reappears, next phase: >3-6 weeks
• Treat again: >= 6 weeks later
Complications of Laser Hair Removal
• Blistering
• Hypopigmentation
• Hyperpigmentation
• Scarring
Profile System Features
• Pulse Length: 0.1 to 200 milliseconds
• Wavelength: 1064nm
• Fluence: 20 to 120 Joules/cm2 - Hair
•
•
•
30 to 400
Contact Cooling:
Power Capacity:
Scanning:
Joules/cm2
- Vascular
Pre, During, Post
200 watts
Computer Controlled,
Non-sequential
Profile Clinical Advantages
•
•
•
•
•
•
Maximum Hair Count Reduction Per Treatment
Treats All Skin Types
Minimal Pain
Designed for Safe Operation
Highest Speed
No overlap required: Top hat pattern of injury
Summary of Factors Influencing Success
Versus Safety of Therapy
•Appropriate settings:
fluence ( > 40 J/cm2 ),
spot size ( 5mm or greater ),
pulse duration ( >18msec ) &
pulse interval ( >35msec )
‘top-hat’ non-sequential scanning
•Percentage and density of anagenic hairs
•Fitzpatrick skin type: competing chromophore
•Percentage of Eumelanin versus red, grey or blond hair
•Cooling for at least 3 seconds
•Angle of hair follicle ? 1/15 patients, beware of promises
Patient Instructions
Pretreatment
• • Avoid sun exposure 4-6 weeks prior to laser
• • Avoid bleaching, plucking, waxing for 4-6 weeks
• • Start bleaching regimen 4 weeks prior if tan easily or prone to pigmentation
• • Avoid laser interacting medications for at least 10 days prior to laser ( see list )
At time of Laser
• • Prep and shave skin with hibiclens
• • Protect upper teeth with saline soaked gauze
• • Protective external eye shields is used
• • No oxygen to be used in same room
• • Cooling device is applied to all areas lased: 3 second rule
After Laser
• • Redness to the skin may last a few hours
• • Then resume bleach cream o: 4% hydroquinone with or without sunscreen
• • Makeup may be used
• • Avoid sun exposure for 6 weeks
• • Follow-up and or pretreatment in 4-8 weeks
• • Up to 5 treatments to each site may be necessary for permanent hair removal
Preoperative Laser Safety Check List
Equipment Check
• marking pen
• pattern sheet
• head light
• cooling device to 4 degrees C: no bubbles
Procedure:
• adjust ceiling lights
• confirm laser hazard sign on door light and lock door
• place protective glasses on pt and all in room
• gum protection: moist gauze and Al foil
• move laser with arm in locked position to correct position
• take key to laser and turn on laser
• turn on fan
• place on standby
• dial desired settings
• release arm from lock
• perform procedure: maintaining>= 3 second skin contact with cooling devise
Examples of Clinical Results
Site
Fitzpatrick
Axilla
4
Axilla/bikini 3
Bikini/thigh 2
Bikini
Axilla
4
5
Hair
Color
Quality
black course
black course
dk brown course
black
black
course
course
Settings
Treatments
rate fluence width to satisfaction
5.8
46
35
5
5.9
45
35
5
4.4
60
35
7
3.4
78
35
7
4.6
36
35
5
7.7
30
35
5
Sample Advertisements
400 % variation in local pricing
Anticipated Income
Income:
Low
½ day examples:
95 sideburn
n=10 patients
125 underarms
250 thighs
250 forearms
500 lower legs
75 test patch
105 bikini
250 neck
500 lower legs
75 test patch
½ day collection
$2225
Full day* collection $3560
* n=16 patients
High
400
$5000+
$7120+