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

3. GentleLASE – 755nm Indications Laser Hair Removal Pigmented Lesions Vascular Lesions Wrinkle Reduction

4. 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.

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

6. How Effective is it? Studies have shown up to 80% reduction in hair after a series of treatments The GentleLASE 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

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

8. 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

9. Hair Biology AnagenTelogenCatagen

10. 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%

11. 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.

12. 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

13. 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.

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Pigmented Lesions

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

22. 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

23. 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)

24. Lentigines

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

26. Ephelides

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

28. Café’ Au Lait

29. 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

30. 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.

31. Pigmented Lesions Some factors that could possibly trigger a recurrence of pigmented lesions are: –Hormonal imbalance –Pregnancy –Medications –Menopause –Sun Exposure

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

33. Pigmented Lesions Clinical Endpoint –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!

34. 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.

35. 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.

36. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Vascular Lesions & Linear Telangiectasia 755nm Wavelength

37. GentleLASE Does What? Vascular Lesions –Facial Vessels –Leg Veins –Hemangiomas –Resistant PWS 37

38. Leg Telangectasia or Spider Veins Sclerotherapy is the GOLD STANDARD for the treatment of leg veins The 755nm wavelength can clean up what Sclerotherapy does not Veins < 2mm in size are treatable

39. 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 not be treated with the 755nm wavelength

40. 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

41. 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 41

42. 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

43. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Wrinkle Reduction

44. How does it work? 755nm –Thermal Injury stimulates the body’s response to create collagen 44

45. 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 45

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