Download Titan Mobile Treatment Technique

Titan
Mobile
Advanced
Technique
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Indications

The Cutera Titan handpiece is US FDA-cleared for topical
heating for the purpose of elevating tissue temperature for
temporary increase in local circulation where applied

Titan’s wavelength range is 1100-1800nm

Titan is appropriate for all skin types
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Spot Size & Cooling

Spot Size: size of treatment window
– Titan S and Titan V: 1.5 cm x 1 cm
– Titan XL: 3 cm x 1 cm

Treatment window maintained at 20º C for
epidermal cooling
Titan S
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Titan V
Titan XL
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General Considerations

The decision to treat with light therapy should be
based upon appropriate diagnostic evaluation and
consideration of all patient factors.

The Titan handpiece should only be operated by
qualified practitioners who have received
appropriate training and have thoroughly read the
operator manual.

Please consult the Titan Treatment Guidelines and
the Operator Manual for additional information
including indications for use, contraindications,
possible adverse effects, safety warnings and
features, and system operation.

Appropriate parameters will vary. Always observe
tissue reaction during treatment.
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General Considerations

Proper patient screening, parameter
selection, treatment technique, epidermal
cooling, and tissue observation are
important to achieve the desired outcome
without unwanted side effects.

It is important to observe tissue reaction
during treatment. Excessive heating of the
skin can increase the risk of blistering,
burns, erosion, hyperpigmentation, and
hypopigmentation; some of which may
result in scarring.
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Contraindications
Contraindications include:

Patients who are pregnant

Patients who are undergoing treatment for skin
cancer

Refer to Operator Manual for a full listing of
Contraindications, warnings and precautions
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Pre-Op – Medical History

The following conditions are not contraindications
but should be considered before treating:
– Current medications (both routine and occasional use)
• Accutane – do not treat if taken in the last 6 months
• Aspirin, ibuprofen, herbs (such as St. John’s Wort), vitamins, and
anticoagulants
– The above examples may increase risk of purpura or bruising
• Gold Therapy
– May cause blue-gray discoloration
• Photosensitizing drugs (Tetracyclines, etc.)
– Be aware that you may have to adjust the treatment parameters
according to clinical response from test area(s)
– History of vitiligo
• Heat from the treatment could induce a flare-up in patients with preexisting vitiligo
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Pre-Op – Medical History
Continued
– History of Herpes
• Pre-treatment with an antiviral may be indicated
– History of Coagulopathies
– Diabetes
• May impede wound healing
– Autoimmune disease
– Wound Infections
– History of Keloids or Hypertrophic Scarring
– Tattoos, including permanent make-up, in treatment
area
• Do not treat over tattoos
– Pacemaker or defibrillator (consult cardiologist)
– Implants or surgeries in treatment area
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Pre-Op – Patient Consent

Patient Consent
– Provides treatment
information
– Informs of expected and
unexpected side effects
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Patient Prep – Clean

Remove all make-up, sunscreen, topical
anesthetics, etc.
– Any creams or products left on the skin can interact with
the light and increase the risk of unwanted side effects.
– Skin products and/or chemicals (i.e., depilatories, sunless
tanners, etc.) normally tolerated by a patient may cause
an adverse skin reaction with pulsed light treatment.
Avoid using these products at least 24 hours before and
after treatment.
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Pre-Op – Photos

Pre-op photos are highly recommended. You only
have one chance to obtain good pre-op photos.
• Document baseline condition
• Use for comparison purposes later on in treatment
• Consistent technique is important for useful, comparable
photos
– Matched patient positioning
– Camera settings
– Room lighting
• Side views often show the best results
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Patient Prep – Shave

Shave the treatment site
– Remove all hair from the surface of the skin to allow for
complete contact with the cooling device
– Hair in the treatment area may not allow full contact of
the handpiece with the skin
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Eye Safety

Safety eyewear must be worn by ALL people in
the treatment room
Example Operator Eyewear
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Patient Eyewear
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Patient Prep – Patient Comfort

These treatments, if performed properly should
be tolerated without anesthesia

Anesthetics are not recommended
– The use of anesthetics is not recommended as patient
feedback is important in determining treatment settings
and to help prevent adverse events
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Advanced Guidelines for Mobile
Technique
Skin Type
I-VI
Including tanned skin

Fluence
Fluence
Face
Neck
40-46 J/cm2
38-44 J/cm2
Passes
3-6
Common approach for treating:
– Fluence can be adjusted outside the given ranges as needed
• Patient should be able to tolerate the treatment with no more than a
moderate level of discomfort
– 3 to 5 treatments with an average of 4 week intervals
– The number of exposures (pulses) required can vary significantly
from patient to patient based on the size of the area to be treated
*These parameters are based on physician feedback and provided as a guide only. Observe clinical response,
patient discomfort and, area being treated to determine appropriate settings for each patient. See the Titan
Treatment Guidelines for more information.
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Mobile Technique

Allows for a significant increase in fluence compared to stationary
method
– Example: Stationary method – 36 J/cm2
Mobile technique – 46 J/cm2

Move the handpiece in a small circular motion (approximately 20%
of the crystal dimension) in all directions
– Do NOT move the entire width of the crystal
– The movement should be continuous throughout the entire pulse

Crystal should be placed adjacent to prior placement as performed
with the original stamp method (crystal edge to edge without
overlap)
– Crystal motion will overlap adjacent treated areas during treatment
exposure
– See treatment video for example

Clinical endpoint
– Reach patient pain tolerance limit by end of third pass (note: tolerance
assumes no anesthetic)
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Mobile Technique

Move about 20% all directions
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Mobile Technique

Move about 20% all directions
Pulse 1
Pulse 2

Crystal should be placed adjacent to prior
placement as performed with the original stamp
method (crystal edge to edge without overlap)

Crystal motion will overlap adjacent treated areas
during treatment exposure
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Treatment Technique – Key Points

Apply a thick (1 - 3 mm) layer of clear, no-color
ultrasound gel
– May use chilled gel

Always make sure to keep entire window in
contact with the skin

Reduce fluence over sensitive or bony areas

Do not stack individual treatment pulses

Do not lift the handpiece until treatment pulse is
complete
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Treatment Technique

Divide face and neck into
smaller sections

Treat each area with a
minimum of 3-6 passes
before moving to next area

Place pulses adjacent to each
other

Movement speed of crystal
during treatment can vary
according to patient tolerance

Do not stack pulses on one
spot
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Titan

Results may be subtle and/or delayed
– Do not promise immediate results

Pictures are necessary
– Patients forget what they looked like

Length of results vary
– Factors that may diminish outcome or length of efficacy
•
•
•
•
Health of patient including skin health
Sun damage – past and future
Age
Smoking
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