Daryl Mossburg, BSN RN Clinical Specialist Sciton, Inc.

Daryl Mossburg, BSN RN Clinical Specialist Sciton, Inc.

What is Halo? Indications for Use Physics/Science Patient Selection & Contraindications Treatment Overview & Guidelines Halo Technology/System Overview Treatment Techniques Post Treatment and Follow-up Safety Overview

What is the Halo? Available only from Sciton, Halo is the world s first hybrid fractional laser that can sequentially utilize two wavelengths in its delivery. Best of both worlds in a single pass. No need to go as deep, to get a global response. Halo offers the best of both worlds Ablative Fractional Results Non-Ablative Downtime Achieve Results in Fewer Treatments Very Comfortable Treatment with Little to No Downtime

Halo Hybrid Wavelength Characteristics 1470nm wavelength is for non-ablative coagulation Ideal for non-ablation of soft tissue and creating controlled zones of coagulation to chosen depths into the dermis. Tunable between 200 700 microns to optimally target epidermal and dermal pigmented lesions. Treatment with the 1470 nm laser alone produces non-ablative channels and is a delegatable option. 2940nm wavelength is for intraepidermal ablation Erbium s high absorption in water results in precision ablation as desired in the epidermis. Tunable from 0 100 microns to target intraepidermal tissue. Precisely vaporizes tissue 1470nm alone does not vaporize tissue.

Hybridized 1470nm / 2940nm Laser HALO & HALO PRO LASER PHYSICS

Absorption Spectrum for Water 2940 nm wavelength selectively targets epidermal tissue. Er:YAG is 12 18 times better absorbed than C02. 1470nm targets dermal tissue containing water and hemoglobin It does not cause water in the tissue to vaporize. 6 2012 Sciton, Inc. All rights reserved.

Why 1470nm? 150 112.5 75 Spectrum 1927 1550 1470 Pigment exists in the epidermis, up to 100 microns deep Most of the textural damage exists in the papillary dermis, the upper portion of the dermis, up to 500 microns deep 1927 nm 100 to 150 microns depth Can only treat pigment in the epidermis 1550 nm 500 to 1300 microns depth Too Deep! Treating deeper than is necessary only adds pain and longer downtimes to the treatment with no added benefit 1470 nm 100 to 700 microns depth Perfect depth for treating both pigment and texture. 37.5 0 1250 1438 1625 1813 2000

Clinical Research Why 1470? Use of fractional resurfacing to achieve transdermal elimination of dermal content - MENDS First report of a non-ablative laser-induced transport mechanism by which dermal content can be predictably extruded through the epidermis. Achieved by the creation of microscopic treatment zones (MTZs) The necrotic dermal tissue is incorporated into microscopic epidermal necrotic debris (MENDS) and shuttled up to the epidermis to be exfoliated through the stratum corneum.

Non-Ablative Healing Process Summary < 1 hour Tissue within MTZs is destroyed and becomes non-viable Collagen is thermally altered / denatured 1 day Within 1 day, the epidermis is repaired and MENDs form Dermal tissue is still non-viable and collagen is still thermally altered Days 2 7 MENDs become trapped in Stratum Corneum Dermal tissue becomes more viable each day 9

Clinical Research Why 2940nm? Study demonstrated marked changes in both the epidermal and dermal structure after superficial fractionated Er:YAG resurfacing. BACKGROUND: Various minimally invasive treatments enhance the skin's appearance. Little is known about the molecular mechanisms whereby treatments working at the epidermal level might alter the dermis. OBJECTIVE: We sought to quantify the molecular changes that result from erbium:yttrium-aluminium-garnet (Er:YAG) laser microablative resurfacing. METHODS: We performed biochemical analyses after intraepidermal Er:YAG laser resurfacing of 10 patients. Immunohistochemical analysis and polymerase chain reaction technology were utilized to measure key biomarkers. RESULTS: The basement membrane remained intact after intraepidermal microablation, as demonstrated by laminin γ2 immunostaining. Epidermal injury was demonstrated with acute up-regulation of keratin 16. An inflammatory response ensued as indicated by increases in cytokines interleukin 1 beta (IL-1β) and IL-8 as well as a substantial neutrophil infiltrate. Levels of cjun and JunB proteins, components of the transcription factor AP-1 complex, were also elevated. Up-regulation of extracellular matrix degrading proteinases matrix metalloproteinase 1 (MMP-1), MMP-3, and MMP-9 was noted. A transient increase in keratinocyte proliferation, as indicated by staining for Ki67, was observed. Increased expression of type I and type III procollagen was demonstrated. LIMITATIONS: The data presented are those that resulted from a single treatment session. CONCLUSIONS: Although microablation was confined to the uppermost epidermis, marked changes in epidermal and dermal structure and function were demonstrated after Er:YAG laser microablative resurfacing. We demonstrated substantial dermal matrix remodeling, including a degree of collagen production that compares favorably with some more invasive interventions. Dermal remodeling and stimulation of collagen production are associated with wrinkle reduction. Thus these results suggest that the skin's appearance may be enhanced by creating dermal changes through the use of superficially acting treatments. Dermal remodeling and collagen stimulation associated with wrinkle reduction and improvement in skin s appearance.

Day 1 Post with Ablation Halo Pro At day 1, we can see the MENDs begin to form 11

Day 2 Post with Ablation Halo Pro At Day 2 we can see the MENDs are at the surface 12

Day 3 with Ablation Halo Pro At day 3 we can see that almost all of the MENDS have been removed from the skin 13

Day 4 with Ablation Halo Pro At day 4, all MENDs have been released and the skin appears normal and healthy 14

Day 5 with Ablation Halo Pro We can see a slight amount of erythema as the collagen is remodeling 15

Day 1 vs Day 5 Halo Pro Day 1 Day 5 16

HALO & HALO PRO PATIENT SELECTION & CONTRAINDICATIONS

Contraindications Contraindications: Patients who are intolerant to anesthetic based agents Patients with an infectious disease Patient with propensity for keloid formations Patients who are immunocompromised Patients who are on long-standing systemic steroids Patients who are pregnant Patients who have used isotretinoins within the past year Patients with a medical condition that may affect wound healing

Prolonged erythema Swelling Blistering Infection Pigment Changes Herpetic reactivation Acne outbreak Potential side effects

Hybridized 1470nm / 2940nm Laser HALO PRO TREATMENT OVERVIEW

Halo Pro User Mode Halo Pro Ablative and Non-Ablative Hybridized Near Simultaneous 1470nm / 2940nm wavelengths

1470/2940 Halo Pro User s Screen

1470nm / 2940nm Halo Pro Safe Start Protocols Halo Pro Independent Wavelength Selection Control Application Skin Type 1470 nm Depth µm (non-ablative) Density % 2940 nm Depth µm (ablative) Density % Facial Pigment/ Texture/tone Facial Texture/ Remodeling scars Body Pigment/ Texture/tone Body texture/ Remodeling scars I-III 250 350 5 30 0 20 5 20 IV-VI 250 350 5 15 0 20 5-15 I-III 300 400 5 30 0 40 5 20 IV-VI 300 400 5 15 0 40 5-15 I-III 200 300 5 20 0 20 5 20 IV-VI 200 300 5 10 0 20 5 10 I-III 250 350 5 20 0 40 5 20 IV-VI 250 350 5 10 0 40 5-10

Before and After Halo Pro Before After 1tx: 1470@300u, 20% 2940@20u, 22%

Before and After Halo Pro Before After 1tx: 1470@300u, 20% 2940@20u, 22%

Healing Post and Day 1 Halo Pro

Healing Days 2 and 3 Halo Pro

Halo Pro Body Option

HYBRID FRACTIONAL LASER HALO TECHNOLOGY SYSTEM OVERVIEW

Integrated Cooling and Suction

Integrated Cooling and Suction Motion Sensor Attachment for Zimmer Chiller Attachment for Buffalo Tubing

Precision Controlled

DTO Ensures Consistent Treatment Without DTO, as skin temperature warms or cools the size of the MTZ will change leading to overtreatment or undertreatment. DTO continually measures the temperature of the skin and automatically changes the energy density to ensure uniform and predictable treatments.

Halo & Halo Pro User Modes Halo Non-Ablative 1470nm Wavelength Only Halo Pro Ablative and Non-Ablative Hybridized Near Simultaneous 1470nm / 2940nm wavelengths

HYBRID FRACTIONAL LASER HALO & HALO PRO TREATMENT TECHNIQUES

Treatment Basics If oral medications are prescribed, they should be given at least 30 minutes prior to procedure. Note: All prescribed medication follow practitioner s recommendation.

1470/2940 Halo Pro User s Screen

Halo and Halo Pro - Treatment Basics Measure Face or Area 5 Zone Face area measuring data screen Fixed area measuring data screen Press Save after each measured treatment area. To clear data, tap on footswitch

Halo and Halo Pro - Treatment Basics To activate the Halo measuring feature, the foot pedal is depressed simultaneously as the roller closest to the illuminated red light of the device is in constant contact with the skin being measured. Begin rolling the device at the start of a zone from one arrow direction to the next to measure length, the measurement will be populated in the screen, then measure the width. This measurement will calculate each treatment zone areas in cm 2. Repeat until all areas are completed. For the fixed area, measure in the same method above, length and width. Press Save after each measured treatment area. To clear data, tap on footswitch

Halo and Halo Pro - Treatment Basics The Halo scanner must be held perpendicular and in full contact with the skin, with the rollers in constant communication with the device and with red light visible. To navigate the zone being treated, gently roll the scanner starting in a single pass technique. Roller with red light is the roller being tracked.

Halo Cross-Hatch Treatment Technique 1 Begin in vertical passes within cosmetic unit Roll Halo as arrows indicate and lay down pass Lift halo and begin again at start position Repeat another pass 2 Next move to adjacent row and repeat 3 Next repeat process until this cosmetic unit has been treated with 2 vertical passes 4 After vertical passes given alternate with horizontal passes within cosmetic unit Roll Halo as arrows indicate and lay down pass Lift halo and begin again at start position Repeat another pass 5 Next move to adjacent row and repeat 6 Next repeat process until this cosmetic unit has been treated with 2 horizontal passes 7 Continue cross hatching alternating vertical and horizontal until recommended energy is reached indicated by accumulated energy bar and audible sound

Halo Motion Scanning Completely Even Treatment Over Multiple Passes

Post Treatment Observations erythema localized edema sun burn sensation tightness of skin Bronzing and sand paper texture to the skin MENDS (microscopic epidermal necrotic debris) begins at day 2-3 and will be almost clear by day 4-5 (depending on aggressiveness of treatment and whether ablation versus coagulation alone).

My Halo Pro experience Days 1-2 no texture change, light moisturizer 1470@ 400u,30% 2940@ 20u,20% On June 27 Day 3 needed heavier balm Day 3 Day 4 Day 5 Day 6 Days 4-6 sand paper feeling lessened each day 44 2009 Sciton, Inc. All rights reserved.

Conclusion Adding ablation to a non-ablative resurfacing treatment allows better and faster healing and therefore more aggressive treatments given a specific range of downtime This allows the practitioner to provide to patients a better quality treatment without the need for a prolonged healing process normally associated with more aggressive treatments. 45