RightLight TM Technology Enhanced Dye Wavelengths WHITE PAPER Synchro VasQ
DEKA White Paper SYNCHRO VASQ February 2013 RightLight TM Technology Enhanced Dye Wavelengths Prof. P. Campolmi, Prof. G.Cannarozzo, Prof. P. Bonan, Italian Group of Laser Dematology - Dermatological Clinic University of Florence (Italy) Prof. A. Pacifici - Clinical Laser (Perugia - Italy) Vascular Lesions of the Face Superficial vascular lesions of the face have been effectively treated, using light sources with both visible (500-800 nm) and near infrared (800-1300 nm) wavelengths. The most widespread systems used to treat vascular anomalies were KTP (532 nm), copper vapour laser (511/578 nm), Alexandrite (755 nm), Diode laser (800/810/930 nm), before current systems, such as Dye laser, Nd:Yag laser and Pulsed Light systems were identified. As of today, Dye laser represents the established standard for treating superficial vascular lesions. The Figure 1. Absorption spectrum of the main skin chromophores. target of vascular lesion treatment is, in fact, the oxyhemoglobin, which presents three wavelength absorption peaks: 418, 542 and 577 nm (Fig.1). After a first analysis, the most effective therapeutic wavelength must be chosen by identifying the highest absorption of the vascular chromophore. However, vascular lesion anatomy implies that wavelength penetration depth must also be taken into account. In particular, a higher wavelength allows for deeper penetration to reach the level of the dermis where the vascular lesion is located. The current Dye lasers, which use rhodamine as the active medium, allow producing wavelengths ranging between 585 and 600 nm. These wavelengths allow obtaining deeper penetration into the tissues to treat even lesions morphologically distributed in-depth, whilst maintaining high haemoglobin selectivity (Fig.1). The undisputed therapeutic advantage of these wavelengths, linked to the haemoglobin absorption selectivity, which makes Dye laser the gold standard in vascular lesion treatment, can, however, create some discomfort in the treatment of aesthetic disorders because of the possible formation of purple bruises. Nd:YAG laser is another system of undisputed therapeutic value, which allow for near-infrared emissions with a wavelength of 1064 nm. The thermal effect on the vascular component has a rationale similar to that of Dye laser, despite not having its high haemoglobin absorption peaks with the visible Figure 2. A) Telangiectasias on the face. B) After 2 Tx with RightLight TM handpiece. (Photo under polarised light courtesy of Prof. P. Campolmi, Prof. G.Cannarozzo, Prof. P. Bonan, Florence, Italy 1
DEKA White Paper SYNCHRO VASQ wavelength, which require a larger amount of energy. Its deeper penetration allows treating vascular anomalies through emissions corresponding to the thermal relaxation time of the vessels, thereby sparing the surrounding tissue without the formation of purple bruises. In addition to the laser systems described up until now, technological innovation has introduced pulsed light systems, which allow for broadband emissions, with a spectrum of wavelengths ranging between 500 and 1200 nm. The advantage of pulsed light systems lies in the fact that they allow hitting the target of the vascular component over several wavelengths, exploiting both the components of the laser systems described up until now and other wavelengths that fall within their emission spectrum. The use of pulse cooling and handling systems has made pulsed light a valid system to treat superficial February 2013 vascular lesions, as it allows managing the emission whilst maintaining the integrity of the adjacent structures that are not involved in the treatment. Though featuring lower performance than Dye laser and Nd:YAG because of its nonspecificity, pulsed light has allowed reducing the side effects described above and treating wide tissue areas, thanks to the larger size of the waveguides compared to the laser system spot size. The largest limit of pulsed light in vascular treatment is linked to its constructive technology, which leads to higher energy emission in the infrared, leaving a lower percentage of light energy in the visible emission, where both the haemoglobin absorption peaks and typical wavelengths of Dye laser systems are located. Moreover, the emission over the entire visible spectrum involves the pigmentary component in the skin tissue, which covers the entire visible spectrum with greater selectivity for increasingly shorter wavelengths (Fig.1). Figure 3. A) Telangiectasias on the face. B) After 2 Tx with RightLight TM handpiece. (Photo under polarised light courtesy of Prof. A. Pacifici Perugia, Italy) Figure 4. A) Telangiectasias on the face. B) Immediately after Tx with RightLight TM handpiece. (courtesy of Prof. A. Pacifici, Perugia, Italy) 2
DEKA White Paper SYNCHRO VASQ February 2013 Figure 5. RightLightTM Technology handpiece. Figure 5. Post-treatment erythema in Split Face: A) Traditional IPL, B) RightLight TM handpiece. (Courtesy of Prof. A.Pacifici, Perugia, Italy) RightLight TM Technology but only interactions over the pigmentary component and it is usually eliminated in traditional pulsed light systems by using filters. T he RightLight TM technology handpiece, on the SynchroVasQ platform, is a pulsed light system that allows enhancing emission performance in the wavelength range between 550 and 650 nm, in order to obtain pulsed light performance closer to Dye laser s, thereby creating an effective and more comfortable treatment (Fig.5). The system uses rhodamine as a fluorescent substance that can absorb the wavelengths in the UV spectrum up to 550 nm and emit them again in fluorescence within a range between 550-650 nm, with a rhodamine peak around 570 nm, without losing energy during this transformation (Fig.6). This system of shifting the emission band via fluorescence can also allow exploiting the component closest to ultraviolet (between 450 and 500 nm), not selected for vascular treatment. This range of wavelengths between 450 and 500 nm of the lamp would not produce therapeutic effects Figure 6. Moving emission frequencies using rhodamine with 100% efficiency. This system aims at not eliminating an important amount of energy and, rather, transferring it to a vascular frequency range, as in the case of Dye laser Figure 7. A) Telangiectasias on the nose. B) After 1 Tx with RightLight TM handpiece. (Photo under natural [l-h] and polarised light [r-h] (courtesy of Prof. P. Campolmi, Prof. G. Cannarozzo, Prof. P. Bonan, Florence, Italy) 3
DEKA White Paper SYNCHRO VASQ February 2013 Figure 8. A) Spider nevus. B) After 1 Tx with RightLight TM handpiece. (Photo under polarised light courtesy of Prof. P. Campolmi, Prof. G.Cannarozzo, Prof. P. Bonan, Florence, Italy) specifications, to increase both energy efficiency and its performance on the haemoglobin chromophore (Fig. 2, 3, 4, 7, 8, 10, 11 e 12). All this allows obtaining an amount of energy that falls within the range between 550-650 nm greater than traditional pulsed light systems, which translates into higher performance on vascular lesions (Fig.9). The use of waveguides, which transfers the energy generated by the lamp and subsequently optimised on the tissue, allows moving the mechanics of the lamp away from the skin to increase visibility of the treatment area (Fig.5). Moreover, greater visibility and reduced treatment area allow adapting the handpiece to every area of the face to effectively reach those that are most difficult to access, such as the wing of the nose (Fig.7). Finally, optimised cooling of the waveguide allows protecting the epidermis against pulsed light radiation, thereby maintaining the integrity of the surrounding tissues. Figure 9. Increase in vascular performance. In addition, cooling is also used to generate a local anaesthetic effect over the radiated area, making the treatment more comfortable. Figure 10. A) Rosacea. B) After 1 Tx with RightLightTM handpiece. (Courtesy of Prof. P. Campolmi, Prof. G. Cannarozzo, Prof. P. Bonan,Florence, Italy) 4
DEKA White Paper SYNCHRO VASQ February 2013 Figure 11. A) Rosacea. B) After 2 Tx with RightLight TM handpiece. (Photo under polarised light courtesy of Prof. A.Pacifici, Perugia, Italy) Figure 12. A) Telangiectasias on the face. B) After 1 Tx with RightLight TM handpiece. (Photo under polarised light courtesy of Prof. P. Campolmi, Prof. G. Cannarozzo, Prof. P. Bonan, Florence, Italy) Conclusion References I J Cosmet Laser Ther. 2007 Jun; 9(2):113-24. n conclusion, as clinically proven, the RightLight TM technology handpiece enhances the performance in the working range of Dye laser systems, thereby allowing dispensing larger amounts of energy in the wavelengths for treating vascular lesions with reduced side effects. Vascular lasers and IPLS: guidelines for care from the European Society for LaserDermatology (ESLD). Adamic M, Troilius A, Adatto M, Drosner M, Dahmane R. 5
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