Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Titan Mobile Advanced Technique D0777 Rev. B November, 2013 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 D0777 Rev. B November, 2013 2 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 D0777 Rev. B November, 2013 Titan V Titan XL 3 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. D0777 Rev. B November, 2013 4 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. D0777 Rev. B November, 2013 5 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 D0777 Rev. B November, 2013 6 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 D0777 Rev. B November, 2013 7 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 D0777 Rev. B November, 2013 8 Pre-Op – Patient Consent Patient Consent – Provides treatment information – Informs of expected and unexpected side effects D0777 Rev. B November, 2013 9 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. D0777 Rev. B November, 2013 10 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 D0777 Rev. B November, 2013 11 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 D0777 Rev. B November, 2013 12 Eye Safety Safety eyewear must be worn by ALL people in the treatment room Example Operator Eyewear D0777 Rev. B November, 2013 Patient Eyewear 13 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 D0777 Rev. B November, 2013 14 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. D0777 Rev. B November, 2013 15 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) D0777 Rev. B November, 2013 16 Mobile Technique Move about 20% all directions D0777 Rev. B November, 2013 17 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 D0777 Rev. B November, 2013 18 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 D0777 Rev. B November, 2013 19 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 D0777 Rev. B November, 2013 20 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 D0777 Rev. B November, 2013 21 D0777 Rev. B November, 2013 22