The GentleFamily

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The GentleFamily

• GentleLASE, GentleYAG GentleMAX

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GentleLASE 755nm
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GentleYAG 1064nm
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Best of Both Worlds
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Laser Hair Removal
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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.

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Permanent Hair Reduction
The FDA allows us this definition long-term
stable reduction in the number of hairs
re-growing after a treatment regime
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How Effective is it?

• Studies have shown up to 80 reduction in hair
  after a series of treatments
• The 755nm 1064nm wavelengths 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

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

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Hair Biology

Anagen
Telogen
Catagen
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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

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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.

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Hair Growth Information
Body Area Anagen Hair Telogen Hair Telogen Duration Follicles Density / cm² Depth of follicle
Axillae 30 70 3 months 65 3.5-4.5 mm
Brow and Ears 10-15 85-90 3 months 50 2-2.5 mm
Beard 70 30 10 weeks 500 2-4 mm
Upper Lip 65 35 6 weeks 500 1-2.5 mm
Scalp 80-90 13 3-4 months 350 3-5 mm
Trunk 10-20 80-90 4 months 70 2-4.5 mm
Pubic Area 20-30 70 3 months 70 3.5-4.5 mm
Arms 20 80 18 weeks 80 2-4.5 mm
Legs Thighs 20 80 6 months 60 2.5-4 mm
Breast 30 70 3 months 65 3-4.5 mm
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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.

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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

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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

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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

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Post-Treatment Instruction

• After
• Cool compresses can be used to reduce patient
  discomfort swelling
• Aloe vera
• Topical Cortisone cream
• Sun block of 30 SPF

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Treatment Technique

• 3 Things to ALWAYS remember while treating
• FLUSH The distance gauge should be flat and in
  contact with the skins surface
• PERPENDICULAR The hand piece should be 90 to
  the skins surface
• OVERLAP Pulses should be overlapped at 20-30.
  Think of the Olympic Rings

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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

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Pigmented Lesions 755nm only
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Pigmented Lesions

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

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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

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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)

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Lentigines
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Pigmented Lesions

• Ephelides
• Also known as freckles
• Commonly seen on fairer skinned patients

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Ephelides
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Pigmented Lesions

• Café au lait
• Are typically light tan to pale brown patches
  that are seen at birth or soon after.

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Café Au Lait
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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

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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.

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Pigmented Lesions

• Some factors that could possibly trigger a
  re-ecurrence of pigmented lesions are
• Hormonal inbalance
• Pregnancy
• Medications
• Menopause
• Sun Exposure

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Pigmented Lesions

• Infection
• Scarring
• Lesion Recurrence
• Side effects are quite rare!

• Potential Side Effects
• Discomfort
• Bruising
• Swelling
• Scabs
• Hyper-pigmentation
• Hypo-pigmentation

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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!

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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.

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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.

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Vascular Lesions Linear Telangiectasia

• 755nm 1064nm Wavelengths

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Which Does What?

• 1064nm
• Facial Vessels
• Leg Veins

• 755nm
• Facial Vessels
• Leg Veins
• Hemangiomas
• Resistant PWS

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Leg Telangectasia or Spider Veins

• Sclerotherapy is the GOLD STANDARD for the
  treatment of leg veins
• The 755nm 1064nm wavelengths can clean up what
  Sclerotherapy does not
• Veins lt 3mm in size are treatable

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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

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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

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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

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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

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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

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Wrinkle Reduction Skin Tightening
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Whats The Difference?

• 755nm
• Thermal Injury stimulates the bodys response to
  create collagen

• 1064nm
• Bulk deposition of heat can cause both collagen
  contraction collagen stimulation

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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

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Use of 1064nm

• Treatments can be performed on all skin types
• Requires a series of treatments performed once a
  month
• Several techniques to choose from
• Clinical endpoint is achieving a surface skin
  temperature of 40-43º C

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1064nm for Skin Tightening

• Three different techniques
• 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, 5-7Hz
• All deliver bulk heating into the dermal layer of
  skin

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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

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GentleMAX User Interface

• How to choose wavelength
• How to adjust parameters
• Using the Guided Mode

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Warning During Warm-Up
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Standard Alex Screen
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Standard Alex Screen Self Adjust

• Able to adjust all parameters
• Fluence (J/cm2)
• Pulse duration (Candela recommends 3ms
  exclusively)
• Able to adjust DCD

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Alexandrite Applications
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Alex-Guided Mode Selection
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ALEX - Guided Mode Treatment Selection
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ALEX - Guided Mode Parameter Selection
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ALEX - Guided Mode Calculation
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ALEX - Guided Mode Calculated Parameters
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ALEX - Guided Mode Final Screen
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ALEX - Guided Mode Warning Screen
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Switch to YAG

• Simply press YAG wavelength

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Standard YAG Screen
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YAG Applications
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YAG Guided Mode
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YAG - Guided Mode Treatment Selection
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YAG - Guided Mode Parameter Selection
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Switch to Alex

• Simply press Alex wavelength

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Thank You