1. Accolade QS Alexandrite 755 nm
Benign Pigmented Lesions and Tattoo Removal

2. Market Size and Incidence
Epidermal Lesions- Superficial
30% of population has solar lentigines
10% of population has café-aulait
60% have freckles
Dermal Lesions
Nevus of Ota and Ito (Acquired Dermal Melanocytosis)
0.014%-0.034% of Asian population
% of people of Japanese and Korean descent
Cosmetic, Medical, Body Art Tattoo
Permanent makeup tattoos
Reconstructive medical tattoos after mastectomy and surgery
Cosmetic tattoos to cover up scars and other skin imperfections
Body Art Tattoos

3. Treatment Market Size Benign Pigmented Lesion Removal Tattoo Removal
Global treatment size $2.50 Billion to $6.48 Billion
2008 expected US market size $38 M at CAGR 12%*
Tattoo Removal
2008 expected US market size $120 M at CAGR 17%*
International market estimated $45 M
In 2005, pigmented lesion removal laser systems generated revenues of merely $27.0
million in the US (see Exhibit 7-1), representing a 12.5% increase from 2004.
Contributing to this modest growth is the US population’s desire for youthful looking
skin and the growing demand for supplementary treatment offerings in aesthetic
laser practices.
Pigmented lesions are generally a secondary concern to patients, who
are most often concerned with hair removal or wrinkles, so it is often performed as
an adjunct procedure or included in skin rejuvenation. This leads to cannibalization
of the pigmented lesion removal laser market and limits growth. The market for
pigmented lesion removal lasers will grow slower than the overall aesthetic laser
market, rising to $48.2 million in 2010 at a CAGR of 12.1% over the forecast period.
Pigmented lesions are created by a concentration of melanocytes in a particular area
of the skin. The melanin (the biological pigment that gives skin and hair its color)
produced by melanocytes in the dermis is normally distributed uniformly throughout
the body; however, the high concentration of melanocytes in pigmented lesions leads
to discoloration on the skin. Examples of pigmented lesions include brown age spots
(lentigines), freckles (ephileds), melasma, and moles (nevi).
Prior to the advent of laser pigmented lesion removal, pigmented lesions had to be
covered with makeup, or removed using painful dermabrasion or cryosurgery. Even
if a pigmented lesion is removed with dermabrasion or cryosurgery, it is likely that a
scar or a visibly lighter area of skin will remain after the procedure.
Lasers remove pigmented lesions through a process that is known as
photothermolysis. The distinct color of the pigmented lesion absorbs light more
intensely than the surrounding tissue. As the laser targets and rapidly heats the
pigmented lesion, the melanin is fractured. The fractured melanin is then eliminated
by the patient’s immune system. As a result of this rapid heating and fracturing, the
process of pigmented lesion removal is moderately painful and the treatment feels
akin to being struck with specks of hot grease or being snapped with a rubber band.
*Source: Millennium Research Group

4. Nano vs microsecond Pulse Width
Effectively destroys melanosomes and tattoo pigments
Ultra-short pulse widths required to shatter melanosome/ pigments by photoacoustic effect
Power
Equal amounts of energy
Nanosecond
Pulse Width
Microsecond
Courtesy of:
Dr. Wang Hongwei
Peking Union Medical College Hospital
Time

5. Benign Pigmented Lesions
Discoloration caused by high concentration of melanocytes in a particular area
Treatments include cover up with makeup, or painful removal by dermabrasion or cryosurgery
Mostly for pediatric treatments or as an adjunct procedure in skin rejuvenation for adults
Lasers remove pigmented lesions through photoaccoustic effects
Melanin absorbs laser energy more intensely than the surrounding tissue which leads to fracturing of the pigment and melanocyte cell death
Fractured melanin/melanocyte is removed by the immune system

6. Nevus of Ota First described in 1861
Bluish hyperpigmentation along the first or second branches of trigeminal nerve
Most patients have no family history
Age of onset- perinatal period or puberty
Significant predominance among women
Male to female ratio 1:4.8
Female hormones suggested as potent stimuli
Other stimuli include infection, trauma, or ultraviolet light exposure
Source: Chan and Kono et al Nevus of Ota: Clinical Aspects & Management, SKINmed, 2003

7. Nevus of Ito, Mongolian spots & Other conditions
Variant of Nevus of Ota.
Skin pigmentation occurs is more diffuse and less mottled in the acromioclavicular region
Mongolian spot
Sacrococcygeal region
Usually regresses and disappears during childhood.
The spot is found in almost all newborn Chinese, Japanese and Mongolian children, as well as some white and black children.
Becker Nevus and Henry Nevus

8. Treatment of Pigmented Lesions

9. Treatment of Pigmented Lesions

10. Incidence – Tattoos
Sixth fastest-growing retail business in the United States in recent years
80% of tattoo customers are upper middle-class white suburban females
15-20% of US teens and young adults have tattoos (40M Americans)
23% of college students have tattoos
50% of everyone receiving a tattoo, wants it removed (ASDS)
“In the 90’s I did five laser treatments a month… now I do that in one day” Elizabeth McBurney, MD
Source: The Pulse, Hofstra University and ASDS- American Society of Dermatologic Surgery

11. Treatment of Tattoos

12. Treatment of Tattoos

13. The Accolade Q-Switched Alexandrite Laser Removes Pigmented Lesions
The Speed of Alex
The Spot Size of Ruby
Removes Pigmented Lesions
Removes Black, Blue, Brown and Green Tattoos

14. Correct Wavelength for Specific Treatment
Kai-lou-jai-xing
Alexandrite 755 nm

15. Effective Wavelengths
1320nm Nd:YAG
Accolade
755nm
Absorbed by most pigments
Greater depth of penetration for treating deeper structures
50-70 ns pulse width
Disrupts melansomes and tattoo pigments

16. Accolade Specs Wavelength 755 nm Spot Size 2.0 mm
(Max Fluence 18 J/cm2)
3.0 mm
(Max Fluence 10 J/cm2)
4.0 mm
(Max Fluence 5 J/cm2)
5.0 mm
(Max Fluence 2.8 J/cm2)
Pulse Width
Short Pulse: Min 50 nsec Long Pulse: 150 μsec
Pulse Rate
1, 2, 5, 10 Hz
Beam Delivery
Optical Fiber

17. Accolade Improved Design
Faster than other competing systems
2x spot size of other Alex
More than 10x the speed of Ruby
Faster Treatments and Faster Clearance
Larger Spot and Higher Repetition rate give the fastest treatment possible
Larger Spot means deeper penetration for faster clearance

18. Accolade Treatments Characteristics
Accolade treatments are gentler
Less painful especially for the face
Greater specificity towards target chromophore
Reduces damage to peripheral tissue
Minimum pinpoint bleeding
Decreases incidence of scarring

19. Accolade Features and Benefits

20. Weakness of Other Lasers

21. Comparison of Different Lasers

22. Clinical Results: Nevus of Ota
BEFORE
AFTER

23. Nevus of Ota Before & After
4 treatments
Courtesy of:
Dr. Wang Hongwei
Peking Union Medical College Hospital

24. Nevus of Ota Before & After
Courtesy of:
Dr. Wang Hongwei
Peking Union Medical College Hospital
7 treatments

25. Pigmented Lesion Before & After
3 treatments
Courtesy of:
Dr. Wang Hongwei
Peking Union Medical College Hospital

26. Freckles Before & After
1 treatment
Courtesy of:
Dr. Wang Hongwei
Peking Union Medical College Hospital

27. After 2 treatments (5.8-8.6 J/cm2) Dr. Lu Zhong Huashan Hospital
Tattoo Treatment Before & After
Eyebrow Tattoo
BEFORE
AFTER
After 2 treatments ( J/cm2)
Courtesy of:
Dr. Lu Zhong Huashan Hospital
Caution: Spot test first. Tattoo pigments with iron may turn jet black with laser; continue treatment for black

28. Tattoo Treatment Before & After
After 3 treatments ( J/cm2)
Courtesy of:
Dr. Lu Zhong Huashan Hospital