Transcript Slide 1

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The
GentleFamily
– Second level
GentleYAG &
• GentleLASE,
Third level
– Fourth level
» Fifth level
GentleMAX
GentleLASE – 755nm
Indications
Laser Hair Removal
Pigmented Lesions
Vascular Lesions
Wrinkle Reduction
GentleYAG – 1064nm
Indications
Laser Hair Removal
Linear Vascular Lesions
Skin Tightening
Best of Both Worlds
GentleMAX
GentleLASE
GentleYAG
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– Second Laser
level
• Third level
– Fourth level
» Fifth level
Hair Removal
Laser Hair Removal
• How does it work?
– 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
The FDA allows us this definition:
“long-term stable reduction in the
number of hairs re-growing after
a treatment regime”
How Effective is it?
• Studies have shown up to 80% reduction in
hair after a series of treatments
• The 755nm & 1064nm wavelengths will
NOT treat white, blonde, or gray hairs!
• Some reds hairs will not achieve desired
efficacy.
• Patients should be informed of all possible
outcomes prior to treatment
Hair Anatomy
Follicle
Epidermis
Sebaceous Gland
Bulge
Vascular Supply
(Matrix)
Bulb
**Bulb/bulge are critical structures responsible for hair re-growth
Cycles of Hair Growth
• 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
How Many Treatments?
• Different areas have different percentages
of hair in the Anagen phase.
– Face, Axilla, Bikini have approximately 2035%
– Trunk and Extremities have approximately 1020%
Time to Retreat?
• As a rule:
– Face/Axilla/Bikini: 4-6 weeks
– Trunk: 8-10 weeks
– Arms & Legs: 10-12 weeks
• Or within 7 days of when regrowth is
observed.
Hair Growth Information
Telogen
Duration
Follicles
Density
/ cm²
Depth of follicle
Body Area
% Anagen
Hair
% Telogen
Hair
Axillae
30%
70%
3 months
65
3.5-4.5 mm
Brow and
Ears
10-15%
85-90%
3 months
50
2-2.5 mm
Beard
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
Bottom Line
• 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 may vary from patient to patient
and to various degrees of efficacy.
Pre-Treatment Instruction
• Before
– Shave hair 24-48 hours prior to treatment
– If the patient has a history of cold sores/fever blisters, an
anti-viral can be prescribed
– If there is concern over pigmentary changes, a
prophylactic bleaching cream can be used weeks prior
to treatment
Pre-Treatment Instruction
– NO Plucking – 6 weeks prior or after
– NO Waxing – 6 weeks prior or after
– NO Tweezing – 6 weeks prior or after
Patients should only shave
Clinical Endpoints
• PFEs
– Perifollicular erythema: The treatment area should
appear red
– Perifollicular edema: There should be swelling around
each hair follicle
• Some patients will experience a hive like response
• Lighter hairs may not respond as significantly
Post-Treatment Instruction
• After
– Cool compresses can be used to reduce patient
discomfort & swelling
– Aloe vera
– Topical Cortisone cream
– Sun block of 30+ SPF
Treatment Technique
• 3 Things to ALWAYS remember while treating:
– FLUSH: The distance gauge should be flat and in
contact with the skin’s surface
– PERPENDICULAR: The hand piece should be 90°
to the skin’s surface
– OVERLAP: Pulses should be overlapped at 2030%. Think of the Olympic Rings
Complications
• There are risks and
complications that can
occur from laser treatment.
• Use of conservative DCD
settings are important.
• Complications are rare!
•
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•
Heat rash
Bruising
Scarring
Infection
Hyper-pigmentation
Hypo-pigmentation
Swelling
Welting
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–Pigmented
Second level
Lesions – 755nm only
• Third level
– Fourth level
» Fifth level
Pigmented Lesions
• A pigmented lesion is caused by an abnormal
production of melanin which makes it visible on
the skins surface
Pigmented Lesions
• The following benign pigmented lesions can be
treated with the 755nm wavelength:
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Mottled or hyperpigmentation
Lentigines
Ephelides (freckles)
Epidermal melasma
Café’ au lait
Pigmented Lesions
• Lentigines:
– Are small, tan to medium brown lesions that are
located on the skins surface
– Usually caused by excessive sun exposure
– Need to be differentiated from the potential skin
cancers. (i.e., have it checked off by a physician)
Lentigines
Pigmented Lesions
• Ephelides:
– Also known as freckles
– Commonly seen on fairer skinned patients
Ephelides
Pigmented Lesions
• Café’ au lait:
– Are typically light tan to pale brown patches that
are seen at birth or soon after.
Café’ Au Lait
Pigmented Lesions
• Remember that this will treat Epidermal
pigmentation issues.
– NOT LIKELY TO RESPOND
• Nevi of Oto or Ito
• Melanocytic Nevi
– Should only be treated by dermatologist
• Blue Nevi
Pigmented Lesions
•
Method of Treatment:
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Treat only on Skin Types I-III (and Asian skin)
No DCD is used.
May require multiple treatments (2 – 3 TX)
For treatment of smaller lesions a small spot
size should be used.
Pigmented Lesions
• Some factors that could possibly trigger a reecurrence of pigmented lesions are:
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Hormonal inbalance
Pregnancy
Medications
Menopause
Sun Exposure
Pigmented Lesions
• Potential Side Effects:
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Discomfort
Bruising
Swelling
Scabs
Hyper-pigmentation
Hypo-pigmentation
– Infection
– Scarring
– Lesion Recurrence
Side effects are quite
rare!
Pigmented Lesions
• Clinical Endpoint
– You may hear a “Snap” while treating.
– The darker the lesion, the louder the “Snap”
– It is not uncommon to see a “Frosting” of the lesion
Single Pulse Only!
Pigmented Lesions
• Clinical Endpoint:
– The lesion will darken within 5 - 10 minutes after
treatment and may remain so until the lesions forms a
micro-crust. Use of an ointment is recommended.
Aquaphor, bacitracin or even vaseline can be used to
keep area moist until the crust falls off. The skin
underneath will be pink. There is a gradual return to
normal skin color over time.
Pigmented Lesions
• Avoidance of direct and indirect sun exposure for at
least 2 weeks before & after the laser treatment is
advisable.
• Sunblock of at least SPF 30 on the treated area
daily. Sun exposure may contribute to
hyperpigmentation in treated area.
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Vascular
& Linear
Telangiectasia
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– Second
level& 1064nm Wavelengths
755nm
• Third level
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Which Does What?
755nm
– Facial Vessels
– Leg Veins
– Hemangiomas
– Resistant PWS
1064nm
– Facial Vessels
– Leg Veins
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Leg Telangectasia or Spider Veins
• Sclerotherapy is the
GOLD STANDARD for
the treatment of leg veins
• The 755nm & 1064nm
wavelengths can clean
up what Sclerotherapy
does not
• Veins < 3mm in size are
treatable
Special Considerations
• Vitamin E, Aspirin, Ibuprofen, Fish Oils or other
Blood thinners may increase the likelihood of
bruising. Avoid for several days if possible, if not,
practitioners should perform test spots
• When treating lower extremities diabetic patients
should have clearance from their primary physicians
• Darker Skin Types should only be treated with the
1064nm wavelength
Pre-Treatment
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Squeaky clean skin!
No tanned skin!
No Topical anesthetics
Topical Alpha-hydroxy
– Can be used for 1-2 weeks prior to treatment
• Measure vessel size
Clinical Endpoints – 755nm
• Facial Vessels & Leg Veins
– Structure will vaso-spasm or darken
– Peri-vascular erythema is normal
• Hemangiomas
– Transient purpura
• Resistant PWS
– Transient gray color that evolves into deep
purpura
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Clinical Endpoints – 1064nm
• Facial Vessels
– ONLY the 1.5mm spot size should be used on
the face
– Vessels should disappear and erythema the end
result
• Leg Veins
– Vessels should disappear
– Wheal & Flare or Cat Scratch appearance after
about 5minutes
45
Post treatment
• Apply pressure to treated area after a few
pulses
• Cool Compresses
• Topical Cortisone Cream
• Encourage sun block 30+ SPF
• Avoid activities that cause vasodilatation or
increase blood pressure for 3-5 days
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– SecondReduction
level
Wrinkle
& Skin Tightening
• Third level
– Fourth level
» Fifth level
What’s The Difference?
755nm
– Thermal Injury
stimulates the
body’s response to
create collagen
1064nm
– Bulk deposition of
heat can cause both
collagen contraction
& collagen
stimulation
48
Use of 755nm
• Treatment of skin types I-IV
• Requires a series of treatments performed
once a month
• Technique is similar to LHR
• Clinical endpoints are slight edema &
erythema
49
Use of 1064nm
• Treatments can be performed on all skin
types
• Requires a series of treatments performed
once a month
• Several techniques to choose from
• Clinical endpoint is achieving a surface skin
temperature of 40-43º C
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1064nm for Skin Tightening
• Three different techniques
– *New Taylor
• 18mm, 50ms, 18 J/cm² with the DCD turned off – 3 Passes
– Keys
• 10mm, 50ms, 20 J/cm², DCD off, Double Pulse/3 Passes
– Painting
• 8-10mm, .25-.5ms, 12 J/cm², DCD off, 5-7Hz
• All deliver bulk heating into the dermal layer of skin
Clinical Endpoint?
• The use of an Infra-Red
Thermometer allows us to
achieve a surface temp of
40°-44° C
• This translates to an
approximate dermal temp
of 65° C
• This is the temperature
that can cause collagen
contracture
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GentleMAX User Interface
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text
styles
•HowMaster
to choose
wavelength
– Second •How
level to adjust parameters
• Third level
•Using the Guided Mode
– Fourth level
» Fifth level
Warning During Warm-Up
Standard Alex Screen
Standard Alex Screen Self Adjust
• Able to adjust all
parameters
– Fluence (J/cm2)
– Pulse duration
(Candela recommends
3ms exclusively)
– Able to adjust DCD
Alexandrite Applications
Alex-Guided Mode Selection
ALEX - Guided Mode Treatment Selection
ALEX - Guided Mode Parameter Selection
ALEX - Guided Mode Calculation
ALEX - Guided Mode Calculated
Parameters
ALEX - Guided Mode Final Screen
ALEX - Guided Mode Warning Screen
Switch to YAG
• Simply press YAG
wavelength
Standard YAG Screen
YAG Applications
YAG Guided Mode
YAG - Guided Mode Treatment Selection
YAG - Guided Mode Parameter Selection
Switch to Alex
• Simply press Alex
wavelength
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– Second level
Thank You
• Third level
– Fourth level
» Fifth level