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Click to edit Master title style • Click to edit Master text styles 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 Click to edit Master title style • Click to edit Master text styles – 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! • • • • • • • • Heat rash Bruising Scarring Infection Hyper-pigmentation Hypo-pigmentation Swelling Welting Click to edit Master title style • Click to edit Master text styles –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: – – – – – 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: – – – – 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: – – – – – Hormonal inbalance Pregnancy Medications Menopause Sun Exposure Pigmented Lesions • Potential Side Effects: – – – – – – 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. Click to edit Master title style Vascular & Linear Telangiectasia • Click to Lesions edit Master text styles – Second level& 1064nm Wavelengths 755nm • Third level – Fourth level » Fifth level Which Does What? 755nm – Facial Vessels – Leg Veins – Hemangiomas – Resistant PWS 1064nm – Facial Vessels – Leg Veins 40 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 • • • • 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 44 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 Click to edit Master title style • Click to edit Master text styles – 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 50 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 Click to edit Master title style GentleMAX User Interface • Click to edit 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 Click to edit Master title style • Click to edit Master text styles – Second level Thank You • Third level – Fourth level » Fifth level