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2002

Rex Moulton-Barrett, MD Lisa Derita, RN Alameda & Brentwood, CA Sciton Profile Hair Removal Nd-YAG 1064 nm Vessel Reduction Nd-YAG 1064 nm MicroLaserPeel & Er-YAG 2940 nm Resurfacing Er-YAG 2940 nm. 2007. 2002. Personalized For Your Practice. Ablative :MLP, resurface.

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2002

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  1. Rex Moulton-Barrett, MD Lisa Derita, RNAlameda & Brentwood, CAScitonProfileHair Removal Nd-YAG 1064 nm Vessel Reduction Nd-YAG 1064 nm MicroLaserPeel & Er-YAG 2940 nmResurfacing Er-YAG 2940 nm 2007 2002

  2. Personalized For Your Practice Ablative:MLP, resurface 2007 ContourTM 2940nm Er:YAG ProFractional: micro-ablative Non-Ablative: acne, vessels Pro-V ThermaScanTM 1319nm Nd:YAG Non-ablative: collagen Ablative: hair, vessels ClearScanTM 1064nm Nd:YAG Non-ablative: collagen BBLTM 410-1400nm Intense Pulsed Light Ablative: hair, vessels, pigment Non-ablative collagen, acne New Modules

  3. ScitonProfile Hair Removal

  4. Hair Removal • Electrolysis • Creams • Laser • Microwave Ideally only destroys source of keratin in hair-bearing skin

  5. Regrowth and Removal With Electrolysis Patient: Age, Race, Sex % of Hair Killed Needle Tweezer 21 yr. old white female 30 yr. old black female 40 yr. old white male 53 yr. old white female 41 yr. old white female 27 hairs of 46% 35 hairs or 30% 23 hairs or 54% 36 hairs or 38% 30 hairs or 40% 19 hairs or 62% 22 hairs or 56% 17 hairs or 66% 18 hairs or 64% 22 hairs or 56% Average Percent Killed: Needle = 40%, Tweezer = 60%

  6. Laser Hair Reduction Epidermis: 40 - 150 microns Dermis: 140 - 400 microns E & D: 180 >/= 550 microns 1.Papilla: neurovascular tuft 2. Bulge: at Erector Pili 3.Matrix cells:>= 2 mm Anagen> Catogen> Telogen

  7. Target Isolation • Can we target over other similar targets? (Can we seek melanin in hair over skin?) Selective Photothermolysis

  8. What is the Target ? • Eumelanin: brown or black hair Best absorption of light • Pheomelanin: red or blond hair Poor absorption • Gray hair: pigment-free White hair No absorption

  9. Hair Removal Lasers • Nd:YAG 1064 nm • Flashlamp 575/ 515-1200 nm • Diode 800/810 nm • Alexandrite 755 nm • Ruby 694 nm

  10. Relative Absorption of Laser Light & Competing Chromophores 1064nm

  11. FeaturesWavelength: nmPower: wattsFluence: power/cm2Spotsize: mmOverlap: %Pulsetime: msPulse interval: ms or freq

  12. Thermal Containment Time(TCT) re: The Target • The specific time for energy to create reaction without dispersion too short: will not heat to 70 C too long: complete dispersion cooling Determined by pulse width=duration

  13. Thermal Relaxation Time(TRT)RE: avoid injury to competing chromophores • Determines the shortest interval between pulses • The time for 51% of heat reduction by dispersion and cooling • proportional to: 1. the square of spot size 2. pulse duration, providing it is > TCT

  14. Time of the pulse • Pulse duration should be longer than TCT and • Pulse interval longer than TRT • This commonly protects other components with competing chromophores.

  15. Hair Hand Pieces w/cooling

  16. Temperature in the Region Near the D/E Junction Versus Cooling Time x X Skin Surface D/E Junction

  17. Skin Cool Technology

  18. Energy Distribution Comparison of a 10 mm diameter Gaussian spot with a 6.4 mm diameter square (Top Hat) spot. The square distribution delivers useful energy to a larger spot.

  19. Pulse Stacking: A Problem With Hand Delivery of Pulses When pulses are applied next to one another, the epidermis heated by the first pulse may still be warm when the second pulse arrives. The “double hit” or “pulse stacking” can result in blisters. The problem will vary with the amount of overlap, which is not well controlled with hand delivery. A model of this effect is shown in the next slide. This is another reason to use a scanner with a large area cooler . With a small fixed window or plate cooler, there is no cooling of the previous spot.

  20. Non-sequential scan • The non-sequential scan extends the time between two adjacent pulses to four times the interval of a sequential scan. In combination with the post-pulse cooling, there is adequate time for epidermal cooling.

  21. Pulse time? • Treat hair shaft • TCT 6-10 milliseconds • Treat hair follicle • TCT 18-25 milliseconds, ie > 15 ms • TRT 35-60 milliseconds, ie > 35 ms

  22. Keys for success • Wavelength: >690 nm (>wavelength=depth) • (shorter -> competing chromophores) • Spot size: at least 5 millimeters • Pulse time: 18 or > milliseconds • Pulse interval of 35 or > milliseconds

  23. When do you treat? • During Anagen cycle • Not during telogen • Cycle time determined by Richard-Merhag chart

  24. Richards-Merhag

  25. Fitzpatrick Types OK: Fitzparick IV/VI: Nd-YAG non-confluent scanner >15 ms Continuous cooling

  26. Consultation • Patient history • Any previous hair methods • Expectations • Treatment explanation • Photographs • Consent • Periprocedure instructions

  27. Contraindications • Pregnancy • Recent sun exposure • Sun tan • Suspicious lesions What about the orbit?

  28. Before Treatment • Shave 1-3 days before treatment (stubble) • Avoid other methods for 30 days • SPF 15+ for 4-6 weeks • Avoid tanning creams • Hydroquinone if necessary

  29. Treatment Safety • Test cooling plate, check < 5 C • Test spot: and wait 4 weeks • No overlap • Mark landmarks with red pen • Protect gums with Al foil if over area

  30. What is the endpoint ? • Small contact spark/flash • Smell of burnt hair • Perifollicular edema • Sensation of light sunburn • One in three hairs extrude

  31. Hair Chronology • Redness: 4-6 hours after treatment • Hair appears to grow for several days • Hair falls out: day 10-14 • Hair reappears, next phase: >3-6 weeks • Treat again: >= 6 weeks later

  32. Complications of Laser Hair Removal • Blistering • Hypopigmentation • Hyperpigmentation • Scarring

  33. Profile System Features • Pulse Length: 0.1 to 200 milliseconds • Wavelength: 1064nm • Fluence: 20 to 120 Joules/cm2 - Hair 30 to 400 Joules/cm2 - Vascular • Contact Cooling: Pre, During, Post • Power Capacity: 200 watts • Scanning: Computer Controlled, Non-sequential

  34. Profile Clinical Advantages • Maximum Hair Count Reduction Per Treatment • Treats All Skin Types • Minimal Pain • Designed for Safe Operation • Highest Speed • No overlap required: Top hat pattern of injury

  35. Summary of Factors Influencing Success Versus Safety of Therapy Appropriate settings: fluence ( > 40 J/cm2 ), spot size ( 5mm or greater ), pulse duration ( >18msec ) & pulse interval ( >35msec ) ‘top-hat’ non-sequential scanning Percentage and density of anagenic hairs Fitzpatrick skin type: competing chromophore Percentage of Eumelanin versus red, grey or blond hair Cooling for at least 3 seconds Angle of hair follicle ? 1/15 patients, beware of promises

  36. Patient Instructions Pretreatment • • Avoid sun exposure 4-6 weeks prior to laser • • Avoid bleaching, plucking, waxing for 4-6 weeks • • Start bleaching regimen 4 weeks prior if tan easily or prone to pigmentation • • Avoid laser interacting medications for at least 10 days prior to laser ( see list ) At time of Laser • • Prep and shave skin with hibiclens • • Protect upper teeth with saline soaked gauze • • Protective external eye shields is used • • No oxygen to be used in same room • • Cooling device is applied to all areas lased: 3 second rule After Laser • • Redness to the skin may last a few hours • • Then resume bleach cream o: 4% hydroquinone with or without sunscreen • • Makeup may be used • • Avoid sun exposure for 6 weeks • • Follow-up and or pretreatment in 4-8 weeks • • Up to 5 treatments to each site may be necessary for permanent hair removal

  37. Preoperative Laser Safety Check List Equipment Check • marking pen • pattern sheet • head light • cooling device to 4 degrees C: no bubbles Procedure: • adjust ceiling lights • confirm laser hazard sign on door light and lock door • place protective glasses on pt and all in room • gum protection: moist gauze and Al foil • move laser with arm in locked position to correct position • take key to laser and turn on laser • turn on fan • place on standby • dial desired settings • release arm from lock • perform procedure: maintaining>= 3 second skin contact with cooling devise

  38. Examples of Clinical Results Site Fitzpatrick Hair Settings Treatments Color Quality rate fluence width to satisfaction Axilla 4 black course 5.8 46 35 5 Axilla/bikini 3 black course 5.9 45 35 5 Bikini/thigh 2 dk brown course 4.4 60 35 7 3.4 78 35 7 Bikini 4 black course 4.6 36 35 5 Axilla 5 black course 7.7 30 35 5

  39. Sample Advertisements 400 % variation in local pricing

  40. Anticipated Income Income: Low High ½ day examples: 95 sideburn 125 underarms 250 thighs 250 forearms 500 lower legs n=10 patients 75 test patch 105 bikini 400 250 neck 500 lower legs 75 test patch ½ day collection $2225 $5000+ Full day* collection $3560$7120+ * n=16 patients

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