GentleLASE

1. GentleLASE • Patient Consultation & the Management of expectations • Laser Hair Removal • Benign Pigmented Lesions • Wrinkle Reduction • Vascular Lesions

2. PatientConsult • Today’s patient is better educated than ever thanks to the internet. • Before any treatment, ALWAYS review 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 Gentlelase will NOT treat white, blonde, or gray hairs! Patients should be informed upfront. • Some reds hairs will not achieve desired efficacy. 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 regrowth 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 may 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 GentleLASE, NO! Remember pigment is pigment. • 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 • Tanning is an absolute contraindication • AVOID the Sun for at least 2 weeks prior to a treatment and 2 weeks after. The chances of pigment changes and other “minor” skin irritations are high. • This included tanning sprays and lotions. Remember “Pigment is pigment”

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 GentleLASE 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, 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. Gentlelase 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! Heat rash Bruising Scarring Infection Hyper-pigmentation Hypo-pigmentation 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. GentleLase for the Treatment of Pigmented Lesions The Next Chapter

34. Pigmented Lesions • A pigmented lesion is caused by an abnormal production of melanin which makes it visible on the skins surface

35. Pigmented Lesions • The following benign pigmented lesions can be treated with the GentleLase: • Mottled or hyperpigmentation • Lentigines • Ephelides (freckles) • Epidermal melasma • Café’ au lait

36. 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)

37. Lentigines

38. Pigmented Lesions • Ephelides: • Also known as freckles • Commonly seen on fairer skinned patients

39. Ephelides

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

41. Café’ Au Lait

42. 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

43. Pigmented Lesions • Method of Treatment: • Treat only on Skin Types I-III (and 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.

44. Some factors that could trigger re-occurrence of pigmented lesions are: Hormonal Imbalance Pregnancy Medications Menopause Sun Exposure Pigmented Lesions

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

46. Pigmented Lesions • Clinical Endpoint • 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 • Single Pulse Only!

47. Pigmented Lesions • Clinical Endpoint: • The lesion will darken within 5 - 10 minutes after treatment and may remain so until the lesions forms a micro-crust. 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.

48. Pigmented Lesions • Avoidance of direct and indirect sun exposure for at least 2 weeks 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.

49. Operative Checklist: Put 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 Hair protected with headband Written post-operative instructions given to the patient Pigmented Lesions

50. 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 occur if there is sun exposure within 1-2 days of treatment.