RevLite SI Q-Switched Laser Technology 1
Q-Switch Lasers 5 Nanosecond Pulse Duration Extremely Selective Peak energy is dispersed throughout the epidermis faster than the relaxation time of the healthy tissue Energy confined to target, minimizing damage to surrounding tissue Long pulse lasers have photo- thermal pulse Heat energy is transferred to tissue surrounding target Cooling necessary to limit collateral tissue damage 500nsec 2
RevLite SI Q-Switched lasers to address: Tattoo removal, pigmentation and skin revitalization Four wavelengths: 1064 nm, 532 nm, 585 nm and 650 nm, for more treatments on all skin types Photo Acoustic energy: High peak power and short pulse duration, shatters the target molecule tattoo ink, pigments or stimulates collagen without harming the surrounding skin 3
Revlite SI Advantage Unparalleled reliability Lasers have excellent service records Unparalleled consistent clinical results Uniform beam mode Faster heating Deeper penetration into tissue Faster clearing of pigment Stability High power short pulse Uniform beam mode flat top True Q-switching High quality components Attention to detail Consistent improvement Emphasis on quality Laser platforms known as Workhorse of an Aesthetic Practice Treatments are VERY fast Multiple indications 4
Treatment Indications Common Treatment Names: Tattoo removal full color spectrum Pigmented lesion removal Dermal lesion treatment Nevus of Ota Skin revitalization Sun damage Anti-aging maintenance Wrinkle reduction Laser peel Acne scar reduction Intended for: Black, Dark Blue, Sky Blue, Green and Red Ink Tattoo Removal Epidermal and Dermal Pigmented Lesion Removal Non-ablative Skin Resurfacing Including Wrinkles and Acne Scars 5
Laser Wavelengths 1064 nm Nd:YAG The most widely used wavelength in tattoo removal today 1064 nm wavelength is able to increase dermal penetration and decrease melanin absorption Removes almost all colors of ink Safe for skin types I-VI 585 nm (optional) Targets difficult colors including: sky blue and purple 650 nm (optional) Treats green ink 532 nm Treats red, brown, orange and purple inks Absorbed by melanin and hemoglobin Shallower penetration ideal for superficial pigmented lesions Safe for skin types I- IV 6
PhotoAcoustic Technology Hallmark of the MedLite and RevLite SI Q-Switched Nd:YAG lasers The high-speed light energy is released in a series of nanosecond pulses, causing it to acoustically vibrate and shatter the targeted molecule (ink or pigment) deep within the skin The laser also stimulating new collagen growth to replenish the collagen we lose as we age 7
Selective Photothermolysis 585nm Dye Oxyhemoglobin Absorption Melanin Absorption 532nm YAG 650nm Dye 1064nm YAG 500 600 700 800 900 1000 8
RevLite SI PTP PhotoAcoustic Technology Pulse (PTP) A unique pulse dispersion proven more effective and more comfortable than single Q-switched pulse for skin revitalization and skin toning, using a 6 or 8 mm spot size Converts PhotoAcoustic MOA to PhotoThermal causing non-ablative skin revitalization Dual pulse lowers the peak power creating Subtle thermal injury Higher energy with more comfort Allows for large spot size treatments Safer and more effective for revitalization 9
Single vs. PTP Pulse Single pulse short high peak Single Pulse PTP Pulse PTP pulse two consecutive pulses making the pulse wider and lower in peak power 10
RevLite SI 11
RevLite SI Laser recognizes the spot size on the handpiece is set Dye HP pulse count will be monitored The display warns when handpiece is close to being depleted Pulse count can be found in Options menu on the screen Dye HPs have no aiming beam Aiming beam diameter matches the selected spot size of 532 nm beam Aiming beam diameter will be slightly smaller than the selected spot size of 1064 nm beam 12
RevLite SI Current software for RevLite SI is revision H3 1064nm: Maximum fluence is 30J/cm2 585nm and 650nm: Optimized consistency in fixed 2mm spot size in dye mode produces increased tissue response Includes 4 adjustable fluence settings Defaults to lowest setting for safety 532nm: Performs 532nm auto-peak automatically 13
RevLite SI Maximum fluence for 532/1064nm RevLite SI 1064 532 Mode J/cm 2 J/cm 2 Single-pulse 30 22 PTP 30 22 14
RevLite SI Optimized 532nm peaking mode 532 RevLite SI Mode J/cm 2 Single-pulse 22 PTP 22 15
RevLite SI PTP mode can be used for the following spot size selections 1064 PTP Mode Spot Size J/cm2 532 PTP Mode Spot Size J/cm2 8.5mm 2.7 8mm 3.1 6mm 5.5 6mm 1.6 4mm 12.0 4mm 3.7 3mm 22.0 3mm 6.5 2mm 15 16
RevLite SI 4 fluence settings for dye modes (585nm and 650nm) RevLite SI 585nm 650nm J/cm 2 8.6 6.5 4.3 2.2 5.5 4.1 2.7 1.4 17
RevLite SI 532nm Auto Peak When the laser can obtain the requested fluence: Ready indicator flashes and beeps (within 2 seconds), indicating is has obtained the requested fluence When the laser can t obtain the requested fluence: 5 seconds after requesting fluence (during which time the Ready indicator flashes) the laser performs an automatic 532nm peak During the peak operation, the laser beeps and displays Peak 532 with a countdown timer 18
RevLite SI 532nm Auto Peak: When peaking is complete one of the following will occur: 1. If enough energy is present to obtain the requested fluence, the find energy process is repeated-the Ready indicator flashes and a beep sounds within 2 seconds 2. If there is usable energy but not enough to obtain the originally requested fluence, the fluence is reduced to what can be delivered, flashing the reduced fluence and beeping for 3 seconds and then the find energy process is performed with the reduced fluence (if the reduced fluence can t be obtained an Er20 Energy Error is issued) 3. If energy is too low, an Er20( Energy Error) is issued 19
532Lite Handpiece Low fluence, small spot size treatments, ideal for pigment For the 532Lite Handpiece do not deliver more than 2.4 J/cm2 as displayed on the control panel Aiming beam is equal to the laser beam spot size 20
Skin Anatomy Pigment is held primarily in the dermis Some pigment may be evident in the subcutaneous layer Shattered pigment is released through the lymphatic system 21
RevLite SI Treatments 22
Tattoo Removal 23
History of Tattoo Removal Salabrasion The oldest method of tattoo removal Water and salt peels away upper layers of skin to destroy tissue Diminishes appearance of tattoo; rarely removes tattoo entirely High incidence of scarring Dermabrasion Mechanical tissue destruction Skin is frozen to create a hard surface Abrasive tool used to get down through the layers of the skin Wire brush or sanding disk Deeper ink is more difficult to remove High incidence of scarring Excision This method is the only way to remove a tattoo when a person is diagnosed with a ink allergy Cutting out the tattoo Skin graft may be necessary Very high incidence of scarring 24
History of Tattoo Removal Laser tattoo removal Considered the best way of removing a tattoo today Highest chance of success with minimal risks for side effects Lasers produces short pulses that pass through the skin Pigments absorb pulses through Selective Photothermolysis Laser energy breaks pigment into smaller particles Particles are removed by the bodies lymphatic system Wavelengths are specific to the color of pigment 25
Wavelengths Four Wavelengths 1064 nm All dark ink Dermal and epidermal pigment 532 nm Light color ink Red Orange, some yellows 585 nm dye handpiece Sky blue ink Purple ink 650 nm dye handpiece Light green ink 26
Laser Tattoo Removal Factors Skin Color: Skin types I-IV respond faster to treatment Location of Tattoo: Closer to the heart, the quicker the response Lower extremity tattoos take slightly longer to clear Ink Color: Black is the easiest color to remove Red and orange are second easiest to remove Blue and green are more difficult to remove 27
Patient Consultation and Selection Skin Types (Fitzpatrick) Medical history Contraindications Expectations Consent forms Pre and post treatment protocols Treatment guidelines Documentation 28
Skin Types and Characteristics Type I Always burns, never tans, light color hair and eyes Type II Usually burns, tans with difficulty, light skin, light colored hair Type III Sometimes burns, but usually tans, darker eyes, slight coloring to the skin Type IV Rarely burns, tans easily, dark eye color, definitive darkening skin color Type V Very rarely burns, dark hair and eye color Type VI Very dark skin color, dark coarse hair, dark eyes 29
Medical History Medications Photosensitivity Systemic disease Skin cancer Pregnancy Previous skin treatments 30
Contraindications Ink allergies Red ink allergy is most common Tattoo may be itchy, red and swollen since tattoo application Can develop symptoms after their first laser treatment Medication that is known to increase sensitivity to sunlight Accutane in past 6 months Anticoagulants Gold therapy present or past treatment Antibiotics tetracycline, etc. Other herbal medications i.e. St. Johns Wort 31
Contraindications cont. Immuno-compromised medical conditions Seizure disorders triggered by light/light sensitivity Suspicious pigmented lesions Pregnancy Cosmetic ink (relative contraindication), white and pink ink Treating these inks can lead to paradoxical ink darkening History of Keloids Sun exposure 32
Realistic Expectations Expectations should be discussed with the patient Factors affecting treatment Skin color Location Ink color Previous scarring Cover up tattoos Compromised immune system Amateur vs. professional tattoos Age of the tattoo Age of the client 33
Treatment Timeframe Realistic time frame, number and frequency of treatments Professional tattoos usually require more treatments than amateur tattoos Tattoo treatments should be every 6-12 weeks Tattoos will continue to break down and get lighter in between treatments Recently acquired tattoos should not be treated for at least 6 weeks to prevent scarring 34
Pretreatment Protocol No sun exposure or spray tanning 2 weeks prior to treatment for Nd:YAG and at least 4 weeks for 532, 585 and 640 Area to be treated should be shaved Clean treatment area with alcohol to remove makeup, lotion, etc. Photos are recommended before every treatment to document course of treatment 35
Post Treatment Care Apply Aloe Vera and ice pack immediately after treatment Apply ice pack for the first day No more than 3-5 minutes at a time! If tattoos treated on extremities, extremities should be elevated No physical activities for 24-48 hours Apply Vaseline or Aquaphor to keep area moist for 5-10 days or until healed Bandage may be applied if blistering or scabs occur 36
Treatment Guidelines Larger spot size = faster clearance Larger spot size results in deeper penetration Smaller spot size provides superficial penetration 30-50% Overlap Look and listen for clinical endpoint Frosting Light skin vs. dark skin settings Treat dark skin types conservatively with 1064 nm for several treatments before treating with different wavelengths 37
Guidelines cont. Incorporating additional wavelengths All colors of ink should be treated with 1064 nm for 3-5 treatments before using the 532nm, 585nm, or 650nm Treatments with shorter wavelengths (532, 585, 650) may blister due to high hemoglobin and melanin absorption Use additional wavelengths after the 4th treatment depending on pigment changes Handpiece position should be perpendicular to the skin Treat tattoos on extremities and thin skinned areas conservatively 38
Tattoo Treatment Chart Please refer to clinical manual for parameters 39
Complications Hyperpigmentation/Hypopigmentation Skin types IV- VI are at a higher risk for this due to increased native melanin Corrected with daily use of lightening cream and time Pigment will return to normal usually within 4-6 weeks Scarring Permanent texture changes and scarring very rarely occur Transient Skin Changes 25% of patients experience transient skin changes Usually resolves within 6-12 months; rarely permanent Blisters Infection Extremely rare; typically result of poor aftercare Swimming pool/hot tub, pedicures (for tattoos on feet, ankles and lower legs) should be avoided for a week after treatment Icing the area for more than 5 minutes at a time should be avoided Signs of infection are fever, green puss from area, red streaks near area treated, foul odor 40
Points to Remember Realistic Expectations More energy doesn t necessarily mean faster clearance Education, Education, Education Non-compliance with aftercare instructions is #1 reason for complications Before and After Photos! 41
Courtesy of M. Gold, MD Tattoo Results Before After 13 Tx 42
Courtesy of R. Anderson, MD and S. Kilmer, MD Tattoo Results Before After 11 Tx* *11 treatments with 532 nm and 1064 nm 43
Dermal and Epidermal Pigments Skin Revitalization and Scarring 44
RevLite SI RevLite SI can be used to treat and improve a variety of skin conditions: Epidermal and dermal pigmented lesions - Lentigines, age/sun spots, café-au-lait and dermal melanocytosis Sun damage Skin tone and texture Fine lines and wrinkles Acne scarring See clinical guide for treatment parameters 45
Pigment Treatments PhotoAcoustic energy targets individual spots and gently breaks up pigment into tiny particles Treat pigment with 1064 nm or 532 nm Treat skin types IV-VI with smaller spot sizes to prevent pigmentation changes Smaller spot sizes provide energy more superficially and reduce pigmentary changes Use smaller spot sizes for epidermal lentigines Dermal lentigines require larger spot sizes 46
Pigment Treatments cont. Spots will turn dark and slough off in 1-2 weeks Generally 1-3 treatments is needed; administered once a month Treatment endpoint should be a slight frosting Aiming beam may be used 2-5 Hz is recommended for treating epidermal and dermal pigmented lesions with the 532 nm 47
Courtesy of C.W. Trey, MD Dermal Pigmented Lesions Before After 4 Tx* *4 treatments, 6 mo post op, 1064 nm at 4 mm, 10 Hz, 6.6 7.6 J/cm 2 48
Courtesy of D. McDaniel, MD Pigmented Lesion Treatment Before After 1 Tx* *1 treatments, 30 days post tx, 532 nm 49
Courtesy of D. McDaniel, MD Pigmented Lesion Treatment After 1 tx* Before After 1 Tx* *1 treatments, 30 days post tx, 532 nm 50
Courtesy of N. Polnikorn, KAC Epidermal Pigment/Photoaging Before After 4 Tx* 1 yr maintenance tx *4 treatments, with MedLite C6S 51
532 nm Laser Peel Laser Peel treatments improve skin tone, texture, pore size and remove skin lentigines Treatment should only be performed on skin types I-II First treatment should be at low conservative settings. Settings determined by the amount of pigmentation damage is present Full face treatment will be 45 min to 1 hour Clinical endpoint is darkening of sun spots and erythema 52
Laser Peel cont. Thoroughly cleanse face with alcohol before treatment Use eye shields Apply Ice immediately after treatment Patients should expect to have a sun-burned appearance for 3-5 days Spots may get darker and slough off after 1-2 weeks 1-4 treatments depending on how much pigmentation damage they have Treatments should be done no sooner than every 4 weeks Test spots should always be done first 53
Laser Peel Parameters Type of Treatment Wavelength Spot Size Fluence Laser Peel Skin Types I & II 532 nm 6mm 0.7-1.3 j at 2 Hz 54
Skin Revitalization PhotoAcoustic lasers are an excellent choice for skin revitalization, acne scarring and striae SmootherTexture while stimulating on going collagen growth Treatment recommendations Skin revitalization: 6-10 treatments every 1-4 weeks Acne scarring/striae: 4-6 treatment sessions for best results 55
1064 nm Laser Facial Build collagen, smooth fine lines, decrease the breakdown of tissue, helps with acne scarring and improves skin tone and texture RevLite SI s PTP mode can be used to allow more power and energy with 6 mm spot size Safe for all skin types. Treat skin types V-VI conservatively Thoroughly cleanse face with alcohol before treatment 56
Laser Facial Overview cont. Full face should take 5-15 minutes Treatment can be performed on the face, neck, chest and hands Do 2-5 passes with a 50% overlap Clinical endpoint will be moderate redness or erythema. If petechiae, pinpoint bleeding or hives occur, lower energy Do not apply anything cool to area after treated. Sun screen may be applied Little to no downtime Treatment results Smaller pore size, more even skin tone, reduction in fine lines and wrinkles and a refreshed appearance 57
Courtesy of B. Saal, MD Skin Revitalization Before After Tx series* *Treatment series between 5-8 tx, 1064 nm, 6 mm spot, 3.5 J/cm 2, 10 Hz 58
Courtesy of B. Saal, MD Skin Pigment Revitalization Before *Treatment series between 5-8 tx, 1064 nm, 6 mm spot, 3.5 J/cm 2, 10 Hz After Tx series* 59
Laser Peel vs Laser Facial Laser Facial 1064 nm Used for: tone and texture, pore size, fine lines, collagen, pigmented lesions, acne No down time All skin types 2-5 passes 6-10 treatments needed Can be done once a week PTP mode with RevLite SI Laser Peel 532 nm Used for: pigmented lesions, tone and texture, fine lines, sun damage, fine lines 2-3 days downtime 1 pass vertical and horizontal 1-3 treatments needed Skin types I-II only Only treat once a month 60
RevLite SI Thank you! Questions please? 61