GentleYAG

1. GentleYAG • Patient Consultation & the Management of expectations • Laser Hair Removal • Veins • Skin Tightening/Wrinkle Reduction

2. Patient Consult • Today’s patient is better educated than ever thanks to the internet. • Before any treatment, ALWAYS sit down with the client to explain the entire process. • They should know exactly what is expected of them. • They should know what to expect as far as outcomes.

3. Fitzpatrick Skin Types • Skin Type is race dependent and DOES NOT CHANGE. • Suntan alters the degree of pigmentation NOT the skin type.

4. Fitzpatrick Skin Types

5. How does the Laser work? (Hair)

6. Patient Consult • Laser Hair Removal – • 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 “long-term stable reduction in the number of hairs re-growing after a treatment regime” The FDA allows us this definition

8. IMPORTANT!Write This Down • The GentleYAG will NOT treat white, blonde, or gray hairs! Patients should be informed upfront.

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

10. Patient Consult • 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. Patient Consult • When do you re-treat? • Within 7 days of when re-growth is observed. • Different areas have different percentages of hair in the Anagen phase. • Face, Axilla, Bikini are approximately 20-35% • Trunk and Extremities have approximately 10-20%

13. Hair Growth Information

14. Patient Consult • 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 will vary from patient to patient and to various degrees of efficacy.

15. F.A.Q. • Can cancer survivors be treated? • Yes, but if there is concern get clearance from their treating physician. • Can children be treated? • Yes, but more treatments maybe required later due to hormonal changes.

16. F.A.Q. • Can patients use “sunless” tanning products? • With the GentleYAG, YES! • Can you treat a man’s head? • Yes, but make sure he understands that it is permanent and signs an informed consent.

17. F.A.Q. • What areas of the body can you treat? • All areas are treatable with the exception of inside the orbital rim. • Can treatments be done over implants? • Yes.

18. F.A.Q. • Can treatments be performed over orthopedic hardware? • Yes, however some patients may notice more discomfort in those areas. • Pacemakers and other cardiac implants? • Patients with pacemakers may have treatment once cleared by their physician. Treatments are not typically performed directly over implant.

19. F.A.Q. • What about braces or other dental work? • Yes. Frequently gauze is placed between the cheek and gum for those patients who experience a “tingling” sensation on their teeth.

20. F.A.Q. • Can treatment be done over injectibles? • Probably not a good idea to treat directly over the injectible. Patients can have laser treatment and injections done...But, in different areas.

21. Contraindications • Accutane • Most physicians recommend that patients should cease usage for at least 6 months. However, many physicians are treating while patient is on medication provided the primary chromophore is NOT water. • Sun exposure • Recent tanning is an absolute contraindication. Skin with underlying redness is more susceptible to pigmentary changes. • AVOID the Sun for at least 1 week prior to a treatment and 1 week after. The chances of pigment changes and other “minor” skin irritations are high.

22. Contraindications • Pregnancy • Pregnant practitioners should check with their physician • DO NOT TREAT Expecting mothers • Liability reasons • Hormones are “out of whack”

23. Contraindications • What about Tattoos? • Tattoos and permanent make-up should be avoided. While the wavelength can sometime be used for the removal of tattoos, the GentleYAG has the WRONG pulse duration to safely and effectively remove tattoos. • Areas with permanent make-up should be covered or avoided.

24. Patient Consult • During consultation explain and obtain an INFORMED CONSENT • Document, Document, Document. Remember to chart the treatment procedure i.e. (Energy, Pulse Duration, Spot size, DCD)

25. Patient Consult • Photo-Document • It is important to take pictures of the area to be treated. • Patients will sometimes forget what they looked like at the starting point. • Having before and after photos will allow you to market to potential clients using your own photographs.

26. GentleYAG Treatment Protocol For Hair Removal • Pre-Treatment - Shave hair 24 hours prior to treatment. - If history of cold sores, an antiviral can be prescribed. • Post Treatment • Aloe vera (with Solarcaine and menthol) gel may be applied. - Sunblock of spf 30 if treated area is exposed to the sun.

27. Treatment Protocol • NO Plucking – 6 weeks prior or after • NO Waxing – 6 weeks prior or after • NO Tweezing – 6 weeks prior or after • Patients can only shave.

28. Treatment Protocol • 3 Things to ALWAYS remember while treating • “FLUSH” • “PERPENDICULAR” • NO MORE THAN 30% OVERLAP Say it with me…..”FLUSH, PERPENDICULAR, NO MORE THAN 30% OVERLAP”

29. There are risks and complications that can occur from laser treatment. Use of conservative DCD settings are important. Complications are rare! Blister Heat rash Bruising Scarring Infection Hyperpigmentation Hypopigmentation Swelling Welting Complications

30. DCD -Cryogen spray milliseconds before laser pulse -Cools / protects epidermis from thermal damage -Protects darker skin types -Good visibility / does not slow treatment -No messy gels

31. Dynamic Cooling -Short spray of cryogen onto skin milliseconds before laser pulse -Rapid, efficient cooling of epidermal layers only -Does not cool subsurface targeted structures -Does not impede visibility or treatment speed

32. Operative Checklist: Laser in “ready” mode and calibrated to correct energy with proper hand piece “Squeaky Clean” Skin Safety goggles or glasses on clinician and patient No flammable substances in operating area - Written post-operative instructions given to the patient Laser Hair Reduction

33. GentleYAG for the treatment of Leg Veins and Facial Telangiectasia

34. Telangectasias or “Spider Veins” • Sclerotherapy is the GOLD STANDARD • GentleYAG can clean up what Sclerotherapy does not • Veins < 3mm in size are treatable

35. Special considerations • Vitamin E, Aspirin, Ibuprofen or other Blood thinners may increase the likelyhood of bruising. Avoid for several days if possible, if not, should do test spots • Diabetic patients should have clearance from their primary physicians

36. Pre-Treatment • Squeaky clean skin! • No tanned skin! • No Topical anesthetics • Measure vessel size

37. Clinical Endpoints • Vessel disappears and then comes back (vasospasm) • Vessel shrinks in size (vasoconstriction) • Vessel contents darken • Vessel looks like a cat’s scratch (Wheal and flare) • NO OVERLAPPING!

38. Post treatment • Apply pressure to treated area after a few pulses • May apply aloe vera gel with Solarcaine and menthol • Encourage sun block 30+ spf • Avoid activities that cause vasodilatation or increase blood pressure for 3-5 days • Inform the vessel area will gradual fade over several weeks.

39. GentleYAG for Photorejuvenation Skin Tightening/Wrinkle Reduction/Scarring/Stretch Marks

40. Photorejuvenation Consult • Inform patient that collagen remodeling is a slow process and that they can continue to see improvement up to 6 months after their final treatment • Inform patient that they will need 4-6 treatments one month apart

41. Special Considerations • Please refer to Clinical Bulletin #8 created by Dr. Mark Taylor for treatment photos, parameters and technique.

42. Pre-Treatment • Photo-Document • Face/Neck should be squeaky clean • Shave any facial hair • Facial hair may be reduced. Male patients should be informed. • No recently tanned skin • May use topical anesthetics

43. Test Spots • When skin reaction is a concern, always perform a test spot at a couple of different lower fluences in an inconspicuous site. • Untoward skin responses may be noticed within a day or two.

44. Post-Treatment • Mild erythema is clinical endpoint • May apply aloe vera gel with Solarcaine and menthol. • Apply and instruct on daily use of spf 30 • Inform patient fine lines may appear more enhanced for a few days and their face may feel tight and dry • Encourage extra moisturizer

45. Photorejuvenation

46. Stretch Marks

47. Stretch Marks

48. Photorejuvenation

49. Leg Veins

50. Maintenance Refer to section 6 of the operator’s manual • User verification tests • Policy for the cleaning of distance gauges and lenses.