1. 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.

2. Overview

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

4. 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

5. 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

6. 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

7. Hair depth chart?

8. Target, Safety and Depth
Wavelength
Target, Safety and Depth

9. 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

10. 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

11. 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): ,
Laser Type: FD Nd:YAG PDL Ruby Alex Diode Nd:YAG YSGG Erbium CO2

12. Selectively Heating the Target
Pulse Duration
Selectively Heating the Target

13. 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?

14. 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%
Heat / Energy
50%

15. Ideal Range for Laser Hair Removal
Ideal Treatment
Range
> Hair Follicle Thermal Relaxation Time
Ineffective Treatment
time in milliseconds
Epidermal
Thermal Relaxation
Epidermal Damage

16. 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

17. 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

18. 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).

19. Maximizing Epidermal Safety
Cooling
Maximizing Epidermal Safety

20. 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

21. 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

22. 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 White paper.
Kilmer S. Summary of 15 month clinical results using the CoolGlide long-pulse Nd:YAG laser for hair removal, June 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 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:

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

24. CoolGlide
1064nm Long-Pulse Nd:YAG

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

26. 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

27. 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

28. Clinical Guidelines: Nd:YAG

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

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

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

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

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

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

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

36. Nd:YAG Laser Hair Removal
Before
After 3rd
Treatment

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

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

39. ProWave

40. 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.

41. ProWave’s custom designed lamp and power supply make this possible.
ProWave 770 Versatility
Visible
Infrared
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.

42. 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.

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

44. 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 cm2 / 3 = 915 seconds = 15 minutes

45. Clinical Guidelines: Prowave

46. ProWave Study 90% Reduction 6 months post 3 Tx

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

48. 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

49. 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

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

51. 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

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

53. 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

54. 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

55. 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

56. 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

57. 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