GentleFamily. GentleLASE, GentleYAG, GentleMAX & Pro Series. Banubeautylaser.com.au

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1 GentleFamily GentleLASE, GentleYAG, GentleMAX & Pro Series Banubeautylaser.com.au

2 Alexandrite 755nm Laser Hair Reduction Pigmented Lesions Vascular Lesions Wrinkle Reduction

3 Nd:YAG 1064nm Laser Hair Reduction Vascular Lesions Skin Tightening

4 Best of Both Worlds GentleMax Alexandrite Nd:YAG

5 Laser Hair Reduction Rev A

6 LHR 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.

7 Permanent Hair Reduction The FDA allows us this definition: long-term stable reduction in the number of hairs re-growing after a treatment regime

8 How Effective is it? Studies have shown up to 80% reduction in hair after a series of treatments The GentleLASE 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

9 Hair Anatomy Follicle Epidermis Sebaceous Gland Bulge Vascular Supply (Matrix) Bulb **Bulb/bulge are critical structures responsible for hair re-growth

10 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

11 Hair Biology Anagen Catagen Telogen

12 How Many Treatments? Different areas have different percentages of hair in the Anagen phase. Face, Axilla, Bikini have approximately 20-35% Trunk and Extremities have approximately 10-20%

13 As a rule: Time to Retreat? Face/Axilla/Bikini: 4-6 weeks Trunk: 8-10 weeks Arms & Legs: weeks Or within 7 days of when re-growth is observed.

14 Hair Growth Information Body Site % Telogen % Anagen Duration of telogen (months) Duration of Anagen (months) Scalp Eyebrows Upper Lip Beard Axillae Chest N/A Back N/A N/A Arms Legs Pubic Area Note: N/A, not available Chart taken from Principles and Practices in Cutaneous Laser Surgery, Christine Dierickx, M.D.

15 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.

16 Before Pre-Treatment Instruction Shave hair 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

17 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 and with a new razor

18 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

19 Post-Treatment Instruction After Cool compresses can be used to reduce patient discomfort & swelling Aloe vera Topical Cortisone cream Sun block of 30+ SPF

surface PERPENDICULAR: The hand piece should be 90 to the skin s

20 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 20-30%. Think of the Olympic Rings

21 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

22 Pigmented Lesions 755nm Only

23 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

24 Pigmented Lesions A pigmented lesion is caused by an abnormal production of melanin which makes it visible on the skins surface Benign Pigmented Lesion

25 How does it work? Long pulsed laser light delivery (3ms) closely matches the Thermal Relaxation Time (TRT) of melanocytes Heating of the melanocytes in benign pigmented lesions can cause thermal damage sufficient enough to remove these types of lesions

26 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)

27 Lentigines

28 Pigmented Lesions Ephelides: Also known as freckles Commonly seen on fairer skinned patients

29 Ephelides

30 Pigmented Lesions Café au lait: Are typically light tan to pale brown patches that are seen at birth or soon after.

31 Café Au Lait

32 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

33 Pigmented Lesions Method of Treatment: Treat only on Skin Types I-IV (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.

34 Pigmented Lesions Some factors that could possibly trigger a recurrence of pigmented lesions are: Hormonal imbalance Pregnancy Medications Menopause Sun Exposure

35 Pigmented Lesions Potential Side Effects: Discomfort Bruising Swelling Scabs Hyper-pigmentation Hypo-pigmentation Infection Scarring Lesion Recurrence Side effects are quite rare!

36 Clinical Endpoint Pigmented Lesions 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 The lesion will darken within 5-10 minutes after treatment and may remain so until the lesions forms a micro-crust. Single Pulse Only!

37 Pigmented Lesions Post Treatment Care: 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.

38 Pigmented Lesions Post Treatment Care 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.

39 Vascular Lesions & Linear Telangiectasia

40 Which Does What? 755nm Facial Vessels Leg Veins Hemangiomas Resistant PWS 1064nm Facial Vessels Leg Veins

41 Vascular Treatment Mechanisms 755nm wavelength targets hemoglobin Oxyhemoglobin in red vessels Deoxyhemoglobin in blue vessels Heat transfers to the vessel wall For effective damage to transpire the entire vessel wall must receive sufficient heating

42 Vascular Treatment Mechanisms Thermal Relaxation Time (TRT) Defined as the time necessary for 50% or more of the energy absorbed to diffuse into the surrounding tissue. To effectively heat a targeted structure, longer pulse durations may be required and may be longer than the calculated TRT

43 Vascular Treatment Mechanisms Thermal Damage Time (TDT) Defined as the time necessary to heat the targeted structure to the damaging temperature The TDT may be significantly longer than the TRT

44 Leg Telangiectasia or Spider Veins Sclerotherapy is the GOLD STANDARD for the treatment of leg veins The 755nm wavelength can clean up what Sclerotherapy does not Veins < 2mm in size respond best

45 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 not be treated with the 755nm wavelength

46 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

47 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

48 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

49 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

50 Wrinkle Reduction & Skin Tightening

51 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

52 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

53 Wrinkle Reduction Non-ablative Photorejuvenation Requires multiple treatments 4-6 treatments On Average Treatments performed monthly Benefits: Lack of wound care No Down time Reduced cost

54 How does it work? Thermal Injury stimulates the body s wound healing response Depth of Thermal Injury is dependent on Wavelength Heat Energy will cause collagen injury and possible contraction

55 How does it work? One belief is that the thermal injury will activate and recruit fibroblast activity

56 How does it work? Another belief is that inflammatory cytokines influence creation of Type I Collagen These cytokines permeate from capillary walls following the thermal damage This signals wound healing mechanisms

57 How does it work? Also, skin enzymes such as collagenase (MMP-1) are also created Up side Can remove older collagen structures Down side May degrade the newly created collagen

58 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

59 Wrinkle Reduction

60 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

61 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

62 Clinical Endpoint? The use of an Infra-Red Thermometer allows us to achieve a surface temp of C This translates to an approximate dermal temp of 65 C This is the temperature that can cause collagen contracture

BBLs BroadBand Light. Daryl Mossburg, RN BSN Clinical Specialist Sciton, Inc. All rights reserved.

BBLs BroadBand Light. Daryl Mossburg, RN BSN Clinical Specialist Sciton, Inc. All rights reserved. BBLs BroadBand Light Daryl Mossburg, RN BSN Clinical Specialist 1 2009 Sciton, Inc. All rights reserved. BBL - BroadBand Light BBL module incorporated into JOULE BBLs Standalone System 2 2009 Sciton, Inc.