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Click to edit Master title style QuadraLASE • Click to edit Master text styles •Fractional – Second level & Classical Re-surfacing • Third level•Surgical Applications – Fourth level » Fifth level QuadraLASE™ • • • • • • • • • CO2 History Fractional Resurfacing Patient Consultation Pre/Intra/Post Care Instructions Treatment Parameters Device Specifications & Buttonology Maintenance Ablative Resurfacing Surgical Applications Indications • Photo-damage – Wrinkles – Dyschromia • Scarring • Acne Scarring • Surgical Applications Click to edit Master title style • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level History Brief History of C02 • Developed in 1964 • 10,600nm wavelength is highly absorbed by water • Ablative!!! • First CO2 lasers were continuous wave – Surgical purposes: Cutting & Coagulation • Eventually became “pulsed” – Resurfacing Continued History of CO2 • • • • Physician – Patient Handholding DOWNTIME!!! High Risk to Benefit Ratio CO2 resurfacing complications – Prolonged Downtime – Infections/Scarring – Dyschromia – ALL are unacceptable to patients Click to edit Master title style • Click to edit Master text styles – Second level The • Third level – Fourth level » Fifth level Science What is Fractional Resurfacing? • Pixilated distribution of laser light – Scanned pulses are delivered in a NonSequential manner – Prevents overlap/overheating (RTD) • Smaller thermal injury areas – Shorter downtime – Fewer complications – Allows for treatment of darker skin types 1540 1540 1540 CO2 CO2 CO2 Necrosis Coagulation QuadraSCAN™ • QuadraSCAN technology allows for better patient comfort – Scanning places laser pulses in 2 adjacent spots in the longest possible intervals – Limits heat build up that creates patient discomfort QuadraSCAN™ • Laser delivers pulses in 4 independent quadrants – Allows maximum time for thermal cooling of the tissue, less pain for the patient and faster recovery • Delivers uniform tissue ablation to the dermis causing contraction and tissue tightening • Thermal injury also stimulates the production of new collagen Delivery of Pulses • Continuous Wave – "CW" refers to a laser which produces a continuous output beam, sometimes referred to as 'free-running' • SuperPulse – A very brief, high-power energy laser pulse • QuadraLASE Fractional – Is continuous wave that is “chopped” by a fanlike device and scanned to produce a fractional array of 5-40% coverage (density) Types of Pulses Why Shorter Downtime? • Only a small percentage (20-40%) of tissue is ablated (micro thermal zones - MTZ) • Remaining epithelium is undamaged and intact thus facilitates quicker healing and shorter downtime Click to edit Master title style • Click to edit Master text styles – Second level In Practice • Third level – Fourth level » Fifth level QuadraLASE™ • Should ONLY be performed by a Physician • This is NOT a NO DOWNTIME treatment Patient Consultation • Explain entire process to patient – Will require, at least, 5-10 days of downtime – Number & Frequency of treatments required • Set realistic expectations – Does not replace surgical procedures • Discuss Contra-indications Contra-indications • Cease the use of Accutane (12 months) • Tendency to Keloid • Injectibles/Fillers – Botox can be injected post treatment/Fillers two weeks post final treatment • Recent/Planned Sun Exposure • Avoid Pregnancy and Breast feeding • Active Skin Infections • Vitaligo • Unrealistic Patient Expectations Click to edit Master title style • Click to edit Master text styles – Second level Treatment • Third level – Fourth level » Fifth level Considerations Pre-Treatment • Consent form should be obtained from patient – Note: If sedation is being utilized, patient should sign the day prior to administration • Prophylactics – Anti-viral and Anti-biotic as needed and prior to treatment – Hydro-quinone (bleaching cream) as needed and recommended for ALL darker skin types • Topical Anesthetic/Local or Regional Blocks • Cleanse area to be treated with soap and water – No drying cleansers (alcohol) Intra-Treatment • Select and Calibrate Appropriate Treatment Parameters • Protect Un-treated areas with moist/wet gauze or towels • If treating inside the orbital rim, utilize corneal shields • Stretch skin with non-dominant hand • Utilize a smoke evacuator Clinical Endpoints • Pixilated Frosting of the skin • Erythema • Edema Potential Hazards • Reflective/Metal Objects – Jewelry – Mirrors • “Matted” Instruments • No Flammable Anesthetics and/or Disinfectants • Plume may contain viable particulates. The use of a smoke evacuator is highly recommended • Protect the Hair!!! Post-Treatment • Keep area clean and moist • Thin layer of petroleum based ointment may be applied • Cool Compresses, if necessary • HYDRATE!!! • Patients should try to sleep in a semirecumbent position to limit edema • Sunscreen (30+ SPF) Transient Side Effects • • • • • • Epidermal Bronzing HSV breakout Acne flares Petechiae Prolonged Edema/Erythema Post Inflammatory Hyper-pigmentation (PIH) Click to edit Master title style • Click to edit Master text styles – Second Postlevel Treatment • Third level – Fourth level » Fifth level Progression Post-Treatment Progression #1 Post-Treatment Progression #2 Post-Treatment Progression #3 Click to edit Master title style • Click to edit Master text styles – Second level Parameters • Third level – Fourth level » Fifth level Hand Pieces 300µ QS HP 180µ QD HP Hand Pieces 180µ QD 300µ QS QS Vs QD QS Vs QD • 300µ QS Hand Piece – Laser pulse is .3 mm in diameter – Can be used for both Fractional and Ablative resurfacing • 180µ QD Hand Piece – Laser pulse is .18 mm in diameter – Can ONLY be used for Fractional resurfacing **Spot Size must be entered manually. Device will not recognize attached hand piece** Exposure Control • “S” = Single Scanned Pulse – Activates a single laser scan emission towards the patient. Emission will stop automatically upon completion of the scan or when the footswitch is released. To Activate Another scan, press the footswitch • “R” = Repeat – Activates a series of laser scan emissions towards the patient. There is a fixed pause of 1000msec between each scan. Emission stops when the footswitch is released. • “B” = Beam – When “B” is selected and confirmed, the display returns to the standard operative screen. Shape of Treatment Area QL Shape Size Scale • Area of treatment – 300µm: • Ranges from 6x6mm to 20x20mm • Adjusts in increments of 2mm – 180µm: • Ranges from 4x4mm to 12x12mm • Adjusts in increments of 1mm Density Value (D%) • Indicates the percentage of area covered during scanning • Can be set to the following values: – 5, 10, 15, 20, 25, 30, 35, 40% – 100% = Full Ablation Watts/Pulse Duration • Watts (Energy) – Range of 5 - 30 watts – Higher Watts = Deeper Treatment • Pulse Duration (Time on Tissue) – Range of 2.5ms – 16ms – Longer Pulse Duration = More coagulation/hemostasis Treatment Considerations QS-300µ Hand Piece Watts Light 8 Moderate 12 Aggressive 15 Pulse Duration 3.5 3.5 3.5 Coverage Depth* 20% 80-160µ 20% 100-200µ 20% 150-250µ *The above table provides THEORETICAL tissue removal depths for a CO2 laser assuming that the target tissue is 70% water. Actual results will vary considerably dependant on tissue moisture content and other factors. Drier tissue will yield deeper penetration/ablation; highly moisturized tissue will yield less. Consequently, do not use harsh drying cleansers prior to treatment. Test and observe tissue response for each patient at every treatment. Also, multiple passes appear to be additive. Treatment Considerations QD-180µ Hand Piece Watts Light 8 Moderate 12 Aggressive 15 Pulse Duration 3.5 3.5 3.5 20% 20% 20% 200-300µ 300-400µ 500-650µ Coverage Depth* *The above table provides THEORETICAL tissue removal depths for a CO2 laser assuming that the target tissue is 70% water. Actual results will vary considerably dependant on tissue moisture content and other factors. Drier tissue will yield deeper penetration/ablation; highly moisturized tissue will yield less. Consequently, do not use harsh drying cleansers prior to treatment. Test and observe tissue response for each patient at every treatment. Also, multiple passes appear to be additive. Treatment Considerations • ONLY USE RECOMMENDED PARAMETERS • Recommend against treating outside recommended settings • Recommended settings are within the SWEET SPOT Depth of Penetration • In the beginning…. – How deep could you go? – Anything over 900µ is trouble • Current Thinking… – 450µ - 650µ will get you what you need for wrinkles – 300µ QS HP won’t get you there Aiming Beam • Fractional Re-surfacing – Aiming beam is a dotted square • Ablative Re-surfacing – Aiming beam is full square Click to edit Master title style • Click to edit Master text styles – Second level Specifications • Third level – Fourth level » Fifth level & Buttonology Specifications QuadraLASE Specifications Laser Type Wavelength Maximum Power Optical Spot Size Coverage: Aiming Beam Scan Pattern Scan Pattern C02 (Sealed-off and DC excited) 10600 nm 30 Watts 300 microns and 180 micron (fractional) 300 micron continuous 5-40% in Fractional Mode; 100% in Traditional Mode 635 nm, intensity adjustable from screen Line, Rectangle, Square, Triangle, Circle and Donut in Traditional mode Square in Fractional Mode 6x6 mm to 20x20 mm in increments of 2mm Specifications QuadraLASE Specifications (cont.) Pulse Duration Traditional Mode: .1 to .8 ms in increments of .1 ms Fractional Mode: 2.5 ms to 16 ms Operating Modes Continuous: Single pulse: 50 – 1000msec Repeat pulse: 50 – 1000mse Articulated Arm Maneuverability: 7 axes Working radius: 130cm Rotation angle: 340° Electrical 100 – 240 V AC 50-60 Hz Dimensions Width: 35 cm (13.8 in.) Depth: 24 cm (9.5 in.) Height: 100 cm (39.4 in.) Weight: 30 Kg (66 lb.) User Interface Pulse Control Shape/Diameter PW/D%/Watts Down Up Enter Ready/Stand-by User Interface • Blinking Icon needs to be entered before moving to the next selection • REMINDER – ONLY QL is Fractional – Other Shapes are True Ablative Resurfacing Device Back Power Cord Foot Switch Door Interlock Stabilizing foot Device Back Handle Scanner Cord Chopper Cord Arm Storage Clip Computer Pattern Generator (CPG) Chopper Chopper/CPG Chopper CPG Distance Gauges Click to edit Master title style • Click to edit Master text styles – Second levelMaintenance • Third level – Fourth level » Fifth level Cleaning/Disinfection • Device may be wiped down with standard disinfectant wipes • Distance Gauges may be cleaned in all modes, including gas, cold sterilization and autoclaves • Lenses should be cleaned with ethyl alcohol and lens paper Trouble Shooting • Tips can be found in the operator’s manual Classic Re-surfacing • Similar Pre-treatment protocols as Fractional Re-surfacing • Longer downtime/Greater Wound Management Surgical Applications • Continuous Wave – Used for Cutting and Coagulation • SuperPulse – Limits necrosis of epidermis • Ablation of: – SKs – Skin Tags Supporting Vendors • Smoke Evacuators – Buffalo Filter: www.buffalofilter.com • Protective Eyewear/Instruments – NOIR: www.noirlaser.com – Kentek: www.kentek.com – Innovative Optics: www.innovativeoptics.com Click to edit Master title style • Click to edit Master text styles – Second level Thank You • Third level – Fourth level » Fifth level