1. Michael J. Tomcik, M.D.

2. MiXto sx ® Microfractional CO2 Laser at the Advanced Laser and Skin Care Center Michael J. Tomcik, MD William Ting, MD Michael J. Tomcik, MD William Ting, MD

3. WHY CO 2 Gold standard for smoothing, tightening and resurfacing. Ablative > Non-Ablative CO2 > Erbium > Near Infrared Heats the dermis greater than all other wavelengths.

4. Laser Feature Mixto SX® Lasering Encore® Lumenis Pixel® Alma Laser Lux 1540 Palomar Affirm® Cynosure Fraxel® Reliant Wavelength10.600 nm 2940 nm1540 nm1440 nm1550nm Type of EmissionContinuous\PulsedPulse Continuous Beam Spot size0.3 mm1.3 mm0.7 mm0.2-0.3mmN.A. Scanned area20x20 mm14x14 mm11x11 mm10-15 mm10 mmN/A ScannerYes NoYesNoYes ModeAblative Nonablative

5. NecrosisCoagulation 154015401540 CO 2

6. Why MiXto sx ® Microfractional CO 2 Innovative Computerized Pattern Generator –Microspot - 300u –Covers 20% of the surface on each pass –Algorythm avoids heat build-up

7. MiXto sx ® after 24 hours

8. Why MiXto sx ® Microfractional CO 2 Innovative Computerized Pattern Generator –Microspot - 300u –Covers 20% of the surface on each pass –Algorythm avoids heat build-up

9. Video

10. Why MiXto sx® Microfractional CO 2 Price Two Year Warranty Results

11. Two Controls Depth of heating (sx) Tissue ablation (power)

12. Choosing your settings Baseline*- 8 sx, 8 power Face* - may do multiple passes –Acne/Chicken Pox - 6 sx, 11 power –Tightening - 5 sx, 10 power Neck, Décolletage, Hands and Arms* - generally one pass –6 sx, 10 power *These are only recommended as guidelines, each patient needs to be evaluated individually.

13. Benefits of MiXto sx ® Versatile (Face, Neck, Décolletage, Hands and Arms) Easy and fast –Face (20 – 40 minutes) –Neck (15 - 30 minutes) –Chest (20 – 30 minutes) –Each Hand (10-15 minutes) Topical anesthetic –BLT (20%, 6%, 4%) TLC Pharmacy, Hermosa Beach - 310-798-5400 All skin types

14. Benefits of MiXto sx ® (cont.) Minimal Discomfort –Moderate Sunburn sensation – 30 minutes – 3 hours –Erythema and Edema – 1 – 3 days –Tightening and Itching – 7 days Minimal Risks for: –Hypo/Hyper Pigmentation –Scarring Minimal downtime –Face – 3-6 days –Neck and Hands – 7-10 Days –Chest – 10 – 21 Days

15. Progression Photo’s

16. Before

17. Post Op - Day 2

18. Post Op - Day 3

19. Post Op - Day 9

20. Progression #1 BEFORE DAY 2DAY 3DAY 9

21. Before

22. Post Op - Day 3

23. Post Op - Day 6

24. Post Op - Day 12

25. Progression #2 BEFORE DAY 3DAY 6DAY12

26. Before

27. Post Op – 10 Minutes

28. Post Op - 24 Hours

29. Post Op - 3 Days

30. Post Op - 8 Days

31. Progression #3

32. Progression #4 Type III – 52 Yrs – Face 2 Passes (Sx 6/Pwr 10) Neck 1 Pass (Sx 6/Pwr 10) 6 Days – Post Op 30 Days – Post Op

33. Before/After Photo’s

34. Type II – 2 passes Sx 6/Pwr 10

35. Before/After Photo’s Type II – 36 Yrs. – 2 passes Sx 6/Pwr 10

36. Before/After Photo’s Type IV – 44 Yrs – 3 Passes Sx 6/Pwr 10

37. Before/After Photo’s Type I – 56 Yrs. – 2 Passes Sx 6/Pwr 10

38. Before/After Photo’s Type IV – 58 Yrs. – 3-4 Passes Sx 6/Pwr 10

39. Patient Selection 1.Realistic Expectations 2. Medical History Herpes Simplex Keloids Pregnant/Breast Feeding Accutane within 12 months Committed to Sunscreen – 45 or higher

40. Pre-Operative No Asprin or Anti-Inflamatory Drugs – 3 days prior/post Famvir – 500 mg – T.I.D. – 10 days Keflex – 500 mg – T.I.D. – 7 days TriLuma Cream – 4 weeks prior to treatment every second to third day for skin types II, III, IV.

41. Post-Op Immediate –Hydrating Gel ( Cicalfate - Avene, Aloe Vera Gel, etc.) –Sunscreen - SPF 45 or higher –Fan 7 Days –Hydrate – Luke Warm Shower – 5 X a day –Lubricate Elta M.D. Aquaphor –Sunscreen - SPF 45 or higher General –No financial decisions for 24 hours –Avoid Sun Exposure Sunscreen, Broad Brim Hat, Scarf –Avoid Strenuous Exercise 3 – 7 days –Call office for any pain greater than a mild sunburn

42. Physician Recommendations Proceed cautiously Use Eye Protection Be less aggressive on neck, chest, hands, arms Gradually increase power Gradually decrease SX Remember – Ablative lasers CAN scar