Ellman Sandstone Cheveux™in Progress

Report
Ellman Sandstone Cheveux™
Permanent Hair Reduction
810 Diode Laser
From Razor to Laser
• Methods of hair removal
– Shaving
– Waxing / plucking
– Depilatories and creams (bleaches)
– Electrolysis / electrothermolysis
– Laser/light-based hair removal
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Benefits of Laser Hair Removal
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Treats a large area quickly
Low risk of side-effects
Temporary hair reduction for all hair types
Long-term growth delay
Permanent hair reduction
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Absorption Spectrum of Major Chromophores
in Skin
Cheveux™ Diode Laser
How Laser Hair Removal Works
• Laser energy is selectively
absorbed by the melanin
in the hair follicle and
converted to heat, injuring
the follicle.
• Most hair is permanently
removed. Hair that does
regrow is finer and lighter
than before.
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Appropriate Pulse Durations
• Pulse duration: key in destroying the follicle without
excessive damage to the epidermis
– With a pulse duration and energy chosen properly for a
particular skin type, the follicle can be destroyed with
minimal heat damage to the epidermis (selective
photothermolysis).
• The larger the target, the longer the thermal relaxation time
(defined as the time required for an object to cool to 50% of
the temperature achieved immediately following laser
exposure).
– Finer hair has shorter TRT.
– Coarser hair has longer TRT.
• Longer pulses allow heat to safely spread from the
epidermis, especially important with darker skin types (e.g.
100ms, 400ms).
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Who is a Candidate?
• The Cheveux™ is safe and effective on all
skin types and tanned skin
• Works best on darker hair
– Red or light brown hair may take more treatments
to be effective
– Blonde, gray and white hair do not contain
melanin so treatments are not recommended
• Can treat any area of the body
– For safety avoid treating within ocular socket/orbit
or on mucous membrane
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Number of Treatments
• Three phases of normal hair growth:
– Anagen (active)
– Catagen (regression)
– Telogen (resting)
• Follicle most susceptible during anagen phase
• 1/3 to 2/3 of hair is in Anagen phase at any time
• Hair has most melanin in the bulb during Anagen phase and absorbs the
most energy to disable stem cells
• Multiple treatments required 4 to 6 weeks apart
– 3-6 treatments for lighter skin patients
– 4-8 treatments for darker skin patients
– During initial treatment, only 1/3-2/3 hair will be effected
• Permanent reduction typically 50-90% following
multiple treatments
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Pre-Treatment
• Pt. cannot wax, pluck or undergo electrolysis for
6 weeks beforehand
– Can shave or trim
• Avoid active tanning in area to be treated for 4
weeks prior to treatment
• No self-tanning products 2 weeks prior to
treatment
• Obtain photographs
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Pre-Treatment
• Patient selection
– Gray or blond hair not good candidates
– Avoid treating if history of pronounced keloids
– Avoid treating over tattoos or permanent make-up
– History of herpes simplex virus (HSV) - pretreat with
antiviral medication
– Stop Accutane for at least 6 months
– Caution if patient on photosensitizing medications
– Caution if history of hyper- or hypopigmentation
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Eye Safety
• Can cause severe retinal injury
• No treatment within bony orbit of eye (outer
canthus). Treatment of eyebrows not
recommended.
• Ocular Hazard Zone:
– 164 feet / 50 m
• Use occlusive goggles when treating the face
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Safety
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Enclosed room, windows covered
Laser safety sign posted outside door
Laser in standby when not actively used
Key removed when not in use
Laser beam directed only at target or calibration
port
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Safety
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Footswitch clean and out of way when not in use
Do not treat over paper or cloth
Do not store flammables in the room
Available fire extinguisher
Follow ANSI standards for Class IV laser
– Contact Laser Institute of America (LIA)
(800) 34LASER for current ANSI and OSHA standards
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Laser Hair Removal Technique
• Treatment is simple and straightforward
– Set patient expectations
– Obtain health history
– Informed consent signed
– Area clean and shaved prior to treatment
– If desired, topical anesthetic cream applied
30-60 minutes before treatment
• Caution if lidocaine allergy
– Settings chosen based on skin type and hair
density
– Look for the presence of a tan
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– Test spotting recommended
Fitzpatrick Skin Type Classification Scale
Skin Type
Skin Color
Characteristics
I
White; very fair; red or blond hair; blue
eyes; freckles
Always burns, never tans
II
White; fair; red or blond hair; blue,
hazel, or green eyes
Usually burns, tans with
difficulty
III
Cream white; fair with any eye or hair
color; very common
Sometimes mild burn,
gradually tans
IV
Brown; typical Mediterranean Caucasian
skin
Rarely burns, tans with ease
V
Dark Brown; mid-eastern skin types
Very rarely burns, tans very
easily
VI
Black
Never burns, tans very easily
Suggested Treatment Parameters
Fitzpatrick Skin
Type
Starting Fluences (Test Spots)
I
35J/cm2
Wait at least 15-30 minutes.
Observe epidermal response,
increase or decrease by 2-5 J/cm2.
II
350J/cm2
Wait at least 15-30 minutes.
Observe epidermal response,
increase or decrease by 2-5 J/cm2.
III
25J/cm2
Wait at least 15-30 minutes.
Observe epidermal response,
increase or decrease by 2-5 J/cm2.
Tolerated Fluences
Pulse Width
15-60 J/cm2
Auto
30 ms – high
hair density areas
15-60 J/cm2
Auto
30 ms – high
hair density areas
10-45 J/cm2
Auto – finer hair
30 ms – coarser hair or
high hair density areas
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Suggested Treatment Parameters
Fitzpatrick
Skin Type
IV
Tolerated
Fluences
Pulse Width
20 J/cm2 for 100 ms
10-45 J/cm2
30 ms – finer hair
100 ms – coarser hair or
high hair density areas
1-10 J/cm2 for 400 ms
1-10 J/cm2
100 ms for coarse hair
Starting Fluences (Test Spots)
Wait at least 15-30 minutes.
Observe epidermal response,
increase or decrease by 2-3 J/cm2.
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Suggested Treatment Parameters
Fitzpatrick
Skin Type
V
VI
Starting Fluences (Test Spots)
Tolerated
Fluences
Pulse Duration
15-20 J/cm2 for 100 ms
1-35 J/cm2
100 ms
1-10 J/cm2 for 400 ms
1-10J/cm2
400 ms
10-20 J/cm2 for 100 ms
10-20 J/cm2
100 ms
1-10 J/cm2 for 400 ms
1-10J/cm2
400 ms
Wait at least 48-72 hours.
Observe epidermal response,
increase or decrease by 1-2 J/cm2.
Wait at least 48-72 hours.
Observe epidermal response,
increase or decrease by 1-2 J/cm2.
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Suggested Treatment Parameters
Fitzpatrick Skin
Type
Starting Fluences (Test Spots)
Tolerated
Fluences
Pulse Duration
All Skin Types –
Tanned Skin
Use low range of fluences recommended
for one skin type darker than patient’s
skin type (e.g. treat tanned skin type III as
skin type IV).
Perform test spots on areas with same
degree of tan as area to be treated.
n/a
100 ms
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Operator Technique
•Secure wrist strap!
•Apply water-based gel on area to be treated (this may be
kept refrigerated)
•Apply gel in no bigger than 12 inch square area as it tends to
dry out
•Spot size is 9mmX9mm – laser spreads under skin
•Overlap 10%
•Larger spot sizes – deeper penetration in skin
•Apply slight compression
•Keep chilled tip flat on the skin surface at a 90o angle
-Surface skin is cooled by chilled tip (4° C)
to minimize heating of skin
•Inspect and clean tip frequently during treatment!
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•Caution if treating over moles or suspicious lesions
Expected Sequelae and Tips
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Observe skin for unwanted effects such as excessive
erythema, blistering
Perifollicular edema is to be expected – resolves in 2 hours
Perform a test spot behind ear to ensure safety to skin – wait
24 hours
Do not overlap over 10% or treat area twice
Make sure tip is always in contact with skin when treating
Place wet gauze under lip when treating
Do not try to sculpt eyebrows
Never treat inside orbital rim
Use goggles when treating glabellar area to protect eyes
Place cotton ball in ears when treating tregus
Place white sponge behind ear when treating pinna
Stop treatment If greying or separation
Positive Clinical Endpoints
• Perifollicular erythema and edema
- Bumps around follicle several minutes after
treatment
- Less pronounced on darker skin types
Courtesy C. Dierickx M.D.
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Post-Treatment
• Sunburn sensation is normal
• Takes 2 weeks for hair to shed
• If desired, cold compress, aloe or hydrocortisone
cream applied after treatment
• Gently clean area twice daily
• Stop glycolics, retinoids etc
• Sunscreen for 6 weeks over the area
• Describe singed hair and shedding process
• Patient returns in 4-8 weeks for next treatment
• After completion of initial treatment touch-up
treatments at 6 month intervals may be required to
disable resistant hairs in treatment area
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Potential Risks
• Perifollicular edema/erythema
– Favorable post-treatment response
– Usually resolves w/in 24 hours
• Local blisters - too high fluence, dark skin
• Hyper/Hypopigmentation
– Transient, should clear within 6-12 months,
– Fluence and skin type dependent
• Scarring – Extremely rare
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Ideas For Getting Started
Promote
• Good idea to treat staff so they can speak
knowledgeably about procedure
• Mention availability to patients
• Brochures
• Posters in waiting room, office bathrooms, exam
rooms
• On-hold message introducing laser
• Phone staff should be able to answer basic
questions
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