GentleLASE, GentleYAG & GentleMAX The GentleFamily GentleLASE, GentleYAG & GentleMAX

GentleLASE – 755nm

GentleYAG – 1064nm

Best of Both Worlds

Laser Hair Removal

Laser Hair Removal How does it work? 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.

Permanent Hair Reduction The FDA allows us this definition: “long-term stable reduction in the number of hairs re-growing after a treatment regime” This is the FDA’s definition of “Permanent Hair Reduction.” Electrolysis is the only methodology that can claim “Permanent Hair Removal” although those who wrote the regulations do not differentiate between the two terms. Setting patient expectations is the key, as “Permanent Hair Reduction” or “Removal” does not mean 100% elimination of hair forever.

How Effective is it? Studies have shown up to 80% reduction in hair after a series of treatments The 755nm & 1064nm wavelengths will NOT treat white, blonde, or gray hairs! Some reds hairs will not achieve desired efficacy. Patients should be informed of all possible outcomes prior to treatment

**Bulb/bulge are critical structures responsible for hair re-growth Hair Anatomy Follicle Epidermis Sebaceous Gland Bulge Vascular Supply (Matrix) Bulb Still, these lasers are primarily hair removal lasers and should be purchased on the basis of their hair removal capabilities. So how does laser hair removal work? Current research suggests the two critical areas of the hair follicle that need to be destroyed to demonstrate permanent hair reduction are the the bulge area (located 1-1.5 mm deep in the skin) and the bulb/vascular supply area of the hair follicle (located 3-5 mm deep within the skin). **Bulb/bulge are critical structures responsible for hair re-growth

What are the 3 cycles of hair growth? Anagen: Hair is actively growing Catagen: Hair is dormant Telagen: Hair is falling out

Hair Biology Anagen Catagen Telogen

How Many Treatments? Different areas have different percentages of hair in the Anagen phase. Face, Axilla, Bikini have approximately 20-35% Trunk and Extremities have approximately 10-20%

Time to Retreat? As a rule: Face/Axilla/Bikini: 4-6 weeks Trunk: 8-10 weeks Arms & Legs: 10-12 weeks Or within 7 days of when regrowth is observed.

Hair Growth Information Body Area % Anagen Hair % Telogen Hair Telogen Duration Follicles Density / cm² Depth of follicle Axillae 30% 70% 3 months 65 3.5-4.5 mm Brow and Ears 10-15% 85-90% 50 2-2.5 mm Beard 10 weeks 500 2-4 mm Upper Lip 65% 35% 6 weeks 1-2.5 mm Scalp 80-90% 13% 3-4 months 350 3-5 mm Trunk 10-20% 4 months 70 2-4.5 mm Pubic Area 20-30% Arms 20% 80% 18 weeks 80 Legs & Thighs 6 months 60 2.5-4 mm Breast 3-4.5 mm

Bottom Line 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.

Pre-Treatment Instruction Before Shave hair 24-48 hours prior to treatment If the patient has a history of cold sores/fever blisters, an anti-viral can be prescribed If there is concern over pigmentary changes, a prophylactic bleaching cream can be used weeks prior to treatment

Pre-Treatment Instruction NO Plucking – 6 weeks prior or after NO Waxing – 6 weeks prior or after NO Tweezing – 6 weeks prior or after Patients should only shave

Clinical Endpoints PFEs Perifollicular erythema: The treatment area should appear red Perifollicular edema: There should be swelling around each hair follicle Some patients will experience a hive like response Lighter hairs may not respond as significantly

Post-Treatment Instruction After Cool compresses can be used to reduce patient discomfort & swelling Aloe vera Topical Cortisone cream Sun block of 30+ SPF

Treatment Technique 3 Things to ALWAYS remember while treating: FLUSH: The distance gauge should be flat and in contact with the skin’s surface PERPENDICULAR: The hand piece should be 90° to the skin’s surface OVERLAP: Pulses should be overlapped at 20-30%. Think of the Olympic Rings

Complications 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

Pigmented Lesions – 755nm only

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

Pigmented Lesions The following benign pigmented lesions can be treated with the 755nm wavelength: Mottled or hyperpigmentation Lentigines Ephelides (freckles) Epidermal melasma Café’ au lait

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)

Lentigines

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

Ephelides

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

Café’ Au Lait

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

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.

Pigmented Lesions Some factors that could possibly trigger a re-ecurrence of pigmented lesions are: Hormonal inbalance Pregnancy Medications Menopause Sun Exposure

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

Pigmented Lesions Clinical Endpoint Single Pulse Only! 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!

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.

Pigmented Lesions Avoidance of direct and indirect sun exposure for at least 2 weeks before & 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.

Vascular Lesions & Linear Telangiectasia 755nm & 1064nm Wavelengths

Which Does What? 755nm 1064nm Facial Vessels Leg Veins Hemangiomas Resistant PWS 1064nm Facial Vessels Leg Veins 40

Leg Telangectasia or Spider Veins Sclerotherapy is the GOLD STANDARD for the treatment of leg veins The 755nm & 1064nm wavelengths can clean up what Sclerotherapy does not Veins < 3mm in size are treatable

Special Considerations Vitamin E, Aspirin, Ibuprofen, Fish Oils or other Blood thinners may increase the likelihood of bruising. Avoid for several days if possible, if not, practitioners should perform test spots When treating lower extremities diabetic patients should have clearance from their primary physicians Darker Skin Types should only be treated with the 1064nm wavelength 42

Pre-Treatment Squeaky clean skin! No tanned skin! No Topical anesthetics Topical Alpha-hydroxy Can be used for 1-2 weeks prior to treatment Measure vessel size Tanned skin and high fluences DO NOT MIX……..may scab/blister/hypopigment. 43

Clinical Endpoints – 755nm Facial Vessels & Leg Veins Structure will vaso-spasm or darken Peri-vascular erythema is normal Hemangiomas Transient purpura Resistant PWS Transient gray color that evolves into deep purpura 44

Clinical Endpoints – 1064nm Facial Vessels ONLY the 1.5mm spot size should be used on the face Vessels should disappear and erythema the end result Leg Veins Vessels should disappear Wheal & Flare or Cat Scratch appearance after about 5minutes 45

Post treatment Apply pressure to treated area after a few pulses Cool Compresses Topical Cortisone Cream Encourage sun block 30+ SPF Avoid activities that cause vasodilatation or increase blood pressure for 3-5 days

Wrinkle Reduction & Skin Tightening

What’s The Difference? 755nm 1064nm Thermal Injury stimulates the body’s response to create collagen 1064nm Bulk deposition of heat can cause both collagen contraction & collagen stimulation 48

Use of 755nm Treatment of skin types I-IV Requires a series of treatments performed once a month Technique is similar to LHR Clinical endpoints are slight edema & erythema 49

Use of 1064nm Treatments can be performed on all skin types Requires a series of treatments performed once a month Several techniques to choose from Clinical endpoint is achieving a surface skin temperature of 40-43º C 50

1064nm for Skin Tightening Three different techniques *New Taylor 18mm, 50ms, 18 J/cm² with the DCD turned off – 3 Passes Keys 10mm, 50ms, 20 J/cm², DCD off, Double Pulse/3 Passes Painting 8-10mm, .25-.5ms, 12 J/cm², DCD off, 5-7Hz All deliver bulk heating into the dermal layer of skin

Clinical Endpoint? The use of an Infra-Red Thermometer allows us to achieve a surface temp of 40°-44° C This translates to an approximate dermal temp of 65° C This is the temperature that can cause collagen contracture

GentleMAX User Interface How to choose wavelength How to adjust parameters Using the Guided Mode

Warning During Warm-Up

Standard Alex Screen

Standard Alex Screen Self Adjust Able to adjust all parameters Fluence (J/cm2) Pulse duration (Candela recommends 3ms exclusively) Able to adjust DCD

Alexandrite Applications

Alex-Guided Mode Selection

ALEX - Guided Mode Treatment Selection

ALEX - Guided Mode Parameter Selection

ALEX - Guided Mode Calculation

ALEX - Guided Mode Calculated Parameters

ALEX - Guided Mode Final Screen

ALEX - Guided Mode Warning Screen

Switch to YAG Simply press YAG wavelength

Standard YAG Screen

YAG Applications

YAG Guided Mode

YAG - Guided Mode Treatment Selection

YAG - Guided Mode Parameter Selection

Switch to Alex Simply press Alex wavelength

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