2. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level GentleYAG

3. GentleYAG – 1064nm Indications Laser Hair Removal Linear Vascular Lesions Skin Tightening

4. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Laser Hair Removal

5. 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.

6. Permanent Hair Reduction The FDA allows us this definition: “long-term stable reduction in the number of hairs re-growing after a treatment regime”

7. How Effective is it? Studies have shown up to 80% reduction in hair after a series of treatments The 1064nm wavelength 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

8. Hair Anatomy Epidermis Sebaceous Gland Bulb **Bulb/bulge are critical structures responsible for hair re-growth Follicle Bulge Vascular Supply (Matrix)

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

10. Hair Biology AnagenTelogenCatagen

11. 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%

12. 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.

13. Hair Growth Information Body Area % Anagen Hair % Telogen Hair Telogen Duration Follicles Density / cm²Depth of follicle Axillae30%70%3 months653.5-4.5 mm Brow and Ears10-15%85-90%3 months502-2.5 mm Beard70%30%10 weeks5002-4 mm Upper Lip65%35%6 weeks5001-2.5 mm Scalp80-90%13%3-4 months3503-5 mm Trunk10-20%80-90%4 months702-4.5 mm Pubic Area20-30%70%3 months703.5-4.5 mm Arms20%80%18 weeks802-4.5 mm Legs & Thighs20%80%6 months602.5-4 mm Breast30%70%3 months653-4.5 mm

14. 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.

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Vascular Lesions & Linear Telangiectasia 1064nm Wavelength

22. GentleYAG does what? 1064nm –Facial Vessels –Leg Veins 22

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

24. 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

25. 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

26. 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 26

27. 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

28. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Wrinkle Reduction & Skin Tightening

29. How does it work? 1064nm –Bulk deposition of heat can cause both collagen contraction & collagen stimulation 29

30. 3 Techniques for Skin Tightening 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, 7-10 Hz All deliver bulk heating into the dermal layer of skin

31. 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

32. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Thank You