Hair Removal Solution Cutera’s multiple wavelength hair removal solution includes Alexandrite, Diode and Nd:YAG treatment modes making it the most versatile and fastest solution for all skin types.

Overview

Why Provide Hair Removal? Number 1 performed laser procedure Number 3 non-surgical aesthetic procedure

Hair Removal Solution Advantages Faster, more effective solutions Better ease of use Greater versatility Broader patient population than diode, IPL, or Alexandrite based solution More patients and revenue

Selective Photothermolysis Light Based Hair Removal Melanin is in the epidermis & hair The more melanin, the more heat Epidermal safety is determined by the amount of melanin & laser parameters Skin type & tan Wavelength Fluence Cooling Melanin

Hair Growth Phases Lasers only reduce hair in the active growth phase Phase durations vary by body location Number of treatments and interval are based on hair phases www.lahairmd.com

Hair depth chart?

Target, Safety and Depth Wavelength Target, Safety and Depth

Absorption by Wavelength Important for hair removal and epidermal safety 100 Melanin 10 Hemoglobin Important for vascular treatments 1 532 585 694 755 810 1064 Wavelength (nm) FD Nd:YAG Ruby Alex Diode Nd:YAG Pulsed Dye

Melanin Absorption by Wavelength Too much Absorption in Epidermis Limits Safe Fluence Important for penetrating safely through the epidermis Hair and deep veins 100 10 1 532 585 694 755 810 1064 Wavelength (nm) Ruby Alex Diode Nd:YAG FD Nd:YAG Pulsed Dye

Wavelength - Depth of Penetration Wavelength affects depth of penetration. Shorter wavelengths experience more scattering. Longer wavelengths reach deeper targets Water absorption limits depth of longer wavelengths Wavelength (nm): 532 585 694 755 810 1,064 2790 2940 10600 Laser Type: FD Nd:YAG PDL Ruby Alex Diode Nd:YAG YSGG Erbium CO2

Selectively Heating the Target Pulse Duration Selectively Heating the Target

Thermal Relaxation Time Pulse duration controls efficacy Hot objects give away heat to surroundings Speed of heat escape is proportional to the size of the target Short pulses are effective because energy is delivered faster than it can escape Long pulses protect the epidermis because heat can escape preventing heat rise How do you provide epidermal protection with efficacy?

Thermal Relaxation Time The time necessary for the target to cool down 50%, through the transfer of its heat to surrounding tissue via thermal diffusion. Time 100% 1 2 3 4 5 6 7 8 9 1 0 Heat / Energy 50%

Ideal Range for Laser Hair Removal Ideal Treatment Range > Hair Follicle Thermal Relaxation Time Ineffective Treatment 0 10 20 30 40 50 60 70 80 90 100 time in milliseconds Epidermal Thermal Relaxation Epidermal Damage

Pulse Duration Tip If uncertain of effective parameters: Shave several hairs. Pick the pulse duration and fluence you want to use and shoot the hair. The hair should jump / twist / deform from the pulse. If not, play with duration and fluence. Extreme response indicates too much fluence Decrease duration and increase fluence to be more aggressive Best setting is the longest pulse duration that does not require increasing energy to achieve the same response

Will it work on light hair? As long as there is melanin in the hair Yes for light brown, fine hair No for blond, white, grey, red Will need to adjust parameters Shorter pulse, higher fluence

Treatment Tips Decrease fluence over bony prominences, epidermis becomes easily overheated in some instances = epidermal injury Decrease fluence and/or increase pulse duration where hair is very thick or dark (commonly on the chin, upper lip and/or sideburn area).

Maximizing Epidermal Safety Cooling Maximizing Epidermal Safety

Cooling Helps protect the epidermis by decreasing epidermal temperature Pre, Parallel and Post Cooling Pre-cooling is the most significant cooling factor Decreases starting temperature – increasing safety Parallel cooling Post-cooling removes any final heat and helps prevent heat bloom from lower targets Beneficial when treating skin types V-VI 50 °C (Blister) 37 °C With pre-cooling

Cooling Copper Sapphire Cryogen spray Cools fastest and can be used for pre post and bulk cooling Sapphire Cools sufficiently well, but less efficiently than copper Delivers pre, post and parallel cooling Blocks direct visualization Cryogen spray Sprays liquid cryogen on the skin – very limited depth Hyper cools (-30 to -400 C) and requires the laser pulse to reheat the skin to prevent pigmentary complications from cold Increased risk on dark skin Cannot provide significant bulk or post cooling Problematic for dark skin

Clinical References Hair Removal (Nd:YAG) Grossman M, Kilmer S, Edward M, Geronemus R. Hair removal for tanned patients & wide range of skin types with the Cutera Nd:YAG CoolGlide laser, November 2000. White paper. Kilmer S. Summary of 15 month clinical results using the CoolGlide long-pulse Nd:YAG laser for hair removal, June 2000. White paper. Kilmer S. 3 month clinical results using the CoolGlide long-pulse Nd:YAG laser for hair removal, 1999 (note: current version says 2002). White paper. Tanzi E, Alster T. Long-pulsed 1064-nm Nd:YAG laser-assisted hair removal in all skin types, June 2000. White paper. Tanzi E, Alster T. Long-pulsed 1064-nm Nd:YAG laser-assisted hair removal in all skin types. Dermatol Surg 2004;30:13-17. Mittal R, Sriram S, Sandhu K. Evaluation of long-pulsed 1064 nm Nd:YAG laser assisted hair removal vs multiple treatment sessions and different hair types in Indian patients. J Cutan Aesthet Surg 2008;1:2:75-79. Garrett AB. Laser hair removal: Appropriate device, careful patient selection will prevent complications. By Louise Gagnon, Dermatology Times, September 2009. Lukish J, Kindelan T, Marmon L, Pennington M, Norwood C. Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Ped Surg 2009;44:282-285.

Clinical References Hair Removal (ProWave 770) Lee M. Infrared, programmable wavelength light source for permanent hair reduction in skin types I-V, February 2006. White paper. Davenport S, Shine R. A Novel infrared programmable wavelength light source for permanent hair reduction, January 2006. White paper. Negishi, K, Nagao, K, Wakamatsu, S. Hair removal in Japanese skin: Evaluating the safety and efficacy of the ProWave 770 infrared-light device, April 2007. White paper. Calkin J. Permanent hair reduction using the ProWave 770 programmable wavelength infrared flashlamp device, April 2008. White paper. Garrett AB. Laser hair removal: Appropriate device, careful patient selection will prevent complications. By Louise Gagnon, Dermatology Times, September 2009.

CoolGlide 1064nm Long-Pulse Nd:YAG

CoolGlide Positioning The CoolGlide is the first laser cleared for permanent hair reduction in all skin types and is endorsed by physicians worldwide

Clinical Value Ability to safely treat all skin types Pseudo-folliculitis Barbae (PSB) Inflamed ingrown hair common with coarse dark curly hair Significant problem for darker skin types (clinical problem) Nd:YAG is the best solution for dark skin Nd:YAG can equally effectively treat light and dark skin It is a common misconception that it can only treat dark skin Other technologies cannot treat dark skin with the same safety and efficacy as Nd:YAG

Cutera - Bulk Contact Cooling Gold-plated copper cooling head has more than 10X the thermal conductivity of sapphire windows ClearViewTM hand-piece provides an unobstructed view of the target No consumables Effective cooling keeps treated area below background skin temperature, many seconds after treatment 55J/cm2, 20ms

Clinical Guidelines: Nd:YAG

Nd:YAG Laser Hair Removal Before After Skin Type V Photos courtesy of Eliot F. Battle, Jr., MD

Nd:YAG Laser Hair Removal Skin Type V Before After Photos courtesy of Eliot F. Battle, Jr., MD

Nd:YAG Laser Hair Removal Pseudofolliculitis Barbae Before After Photos courtesy of Samuel Lederman, MD

Nd:YAG Laser Hair Removal Before After Photos courtesy of Samuel Lederman, MD

Nd:YAG Laser Hair Removal Before 8 Weeks After 3rd Treatment Photos courtesy of Greg Waslen, MD

Nd:YAG Laser Hair Removal Skin Type IV (Indian) Before After 4th Treatment Photos courtesy of Kevin Smith, MD

Nd:YAG Laser Hair Removal Fine Hair – upper lip Before After Photos courtesy of Kevin Smith, MD

Nd:YAG Laser Hair Removal Before After 3rd Treatment

Nd:YAG Laser Hair Removal Before After Photos courtesy of Samuel Lederman, MD

Nd:YAG Laser Hair Removal Before After Photos courtesy of Samuel Lederman, MD

ProWave

ProWave Positioning ProWave’s multiple wavelength technology switches modes from Alexandrite to Diode to near Nd:YAG. With unrivaled versatility and speed, ProWave achieves maximum results, safety and repeatability.

ProWave’s custom designed lamp and power supply make this possible. ProWave 770 Versatility Visible Infrared 400 500 600 700 800 900 1000 1100 Alex Diode Nd:YAG Unique Infrared Programmable System Program Mode A B C Comparable Laser Alexandrite Diode Diode / YAG Skin Types I-III III-IV IV-V Programmable wavelength selection provides maximum efficacy, speed and flexibility. ProWave’s custom designed lamp and power supply make this possible.

Greatest efficacy with the fewest treatments Prowave 82% reduction after 3 treatments Alexandrite 72% reduction after a mean of 3.6 treatment1 Diode + RF = 75% after 3 treatments2 IPL 76% reduction after a mean of 3.7 treatments3 Alma Soprano (not pain free) 87.6% reduction after 5 treatments 1. 2. 3.

ProWave Results > 80% hair reduction after only 3 treatments Christine Lee, MD study (USA) Kei Negishi, MD study (Japan)

Unrivaled Speed and Efficacy Extremely fast – 30 seconds per underarm – see videos Treatment speed of 3 cm2 per second at clinical settings A man’s back is ~ 2750 cm2 ~15 minutes - 2750cm2 / 3 = 915 seconds = 15 minutes

Clinical Guidelines: Prowave

ProWave Study 90% Reduction 6 months post 3 Tx

ProWave 770 Hair Removal Before 6 Months After 3rd Treatment Leg, Skin Type IV, 22-26 J/cm2 , Program A Photos courtesy of Kei Negishi, MD Tokyo Women’s Medical University Aoyama, Institute of Women’s Medical Clinic

ProWave 770 Hair Removal Before 6 Months After 3rd Treatment Axilla, Tx1 30 J/cm2, 18 pulses; Tx2 35 J/cm2, 16 pulses; Tx3 35 J/cm2, 19 pulses All treatments used Mode A, Snowflake Photos courtesy of Jacqueline Calkin, MD

ProWave 770 Hair Removal Before 6 Months After 3rd Treatment Axilla, Tx1 30 J/cm2, 16 pulses; Tx2 34 J/cm2, 14 pulses; Tx3 35 J/cm2, 20 pulses All treatments used Mode A, Snowflake Photos courtesy of Jacqueline Calkin, MD

ProWave 770 Hair Removal Study >80% reduction 6 months post 3 Tx Before 6 Months After 3rd Treatment Leg, Skin Type IV, 22-26 J/cm2 , Program A Photos courtesy of Kei Negishi, MD Tokyo Women’s Medical University Aoyama, Institute of Women’s Medical Clinic

ProWave 770 Hair Removal Before 6 Months After 3rd Treatment Axilla, Tx1 30 J/cm2, 21 pulses; Tx2 35 J/cm2, 18 pulses; Tx3 35 J/cm2, 20 pulses All treatments used Mode A, Snowflake Photos courtesy of Jacqueline Calkin, MD

ProWave 770 Hair Removal Before 6 Months After 3rd Treatment Photos courtesy of M. Christine Lee, MD

ProWave 770 Hair Removal Before 6 Months After 3rd Treatment Tx1 30 J/cm2, 33 pulses; Tx2 35 J/cm2, 44 pulses; Tx3 35 J/cm2, 45 pulses All treatments used Mode A, Snowflake. Photos courtesy of Jacqueline Calkin, MD

ProWave 770 Hair Removal Lower Back Before After Back, Tx1 31 J/cm2, 250 pulses; Tx2 34 J/cm2, 272 pulses; Tx3 35 J/cm2, 219 pulses All treatments used Mode B, Snowflake Photos courtesy of Jacqueline Calkin, MD

Summary The Cutera Hair Removal Solution delivers an optimal combination of proven efficacy, speed and versatility on all skin types Ability to treat all skin types, year-round with one of the fastest solutions on the market increases revenue potential Not all technologies can be used during summer months Efficacy and safety for any hair reduction device are proven by studies with hair counts 6-month post last treatment

Testimonials A unique advantage of my 1064 Nd:YAG is the ability to deliver very high power and eliminate resistant individual hairs…including those fine, light brown hairs which cannot be treated successfully with other lasers Kevin Smith, MD

Testimonials The greatest advantage of the ProWave 770 is the ability to “shift-on-the-fly” from output spectrum to spectrum. By simply pushing a button, one can select the optimal wavelength range for specific skin types E. Victor Ross, MD