Casnigo, 21 December 2010 OPERATIVE PROTOCOLS FOR IPL STARLITE Name of the machine: StarLite Manufacturer: Elettronica Valseriana Srl Reference: Prof. Beniamino Palmieri, Modena, Italy; Dr. Alberto Bazzoni, Darfo, BS, Italy INTRODUCTION AND TECHNICAL SPECIFICATIONS The object of the following report is to provide the IPL operators with a protocol to correctly use the technology for all the application it is able to carry out and does not expect to be the absolute truth, but a constant point of reference that, with the help of our world-wide collaborators net, can be constantly improved. StarLite is an IPL Intense Pulsed Light with maximum energy for single shot equal to maximum 100J; the main technical specifications are summarized in the following chart: - Wavelength range: 590-1200 nm - Fluence max: 10J/ cm 2 spot 20x50 mm - Pulse repetition rate: 0,5 0,25 Hz (according to the energy settings) - Pulse width: 5 ms - Delay: 20 ms - Skin cooling type: optional skin cooling system @ -5 C - Internal cooling system: air-water sailed circuit StarLite permits to adjust both the number of trains in the burs and the fluence, in order to always achieve the best results limiting the undesired effect. OPERATIVE SUGGESTIONS BEFORE APPLICATION Carefully clean the application area and remove completely the make up if any; the hair must be completely trimmed (to the level of the epidermis). In order to avoid a dishomogeneous grow during the treatment, the use of depilatory creams or waxes is unadvisable. Cool the area down (3/4 seconds) and afterwards provide the pulsed light flash. This application must be repeated every time, alternating the use of the handpieces of the two equipments; don't exceed in the cooling in order not to cause burns. The crystal to touch the skin shall be absolutely clean, every minimal residue could provoke an excessive concentration of heat on the skin besides a damage to the filter itself because of the light reflection and absorption caused by the dirty surface.
The IPL handpiece shall be in contact with the skin, a mild pressure is also suggested. This system of optical connection between the two dishomogeneous means eliminates the oxygen between the two parts, thus avoiding the combustion on the surface; this application increases the degree of penetration of the light ray and therefore its effectiveness, reducing the side effects as well. The chilled handpiece allows to avoid the use of expensive gels generally applied between the handpiece and the epidermis. The use of the gel should be justified by a good conductibility of the light and by a cooling and protective effect for the epidermis. The opposite, some of the molecules it contains increase the reflection of the light creating further dispersion. For particularly wide zones it is advisable to delimit the perimeters with a cosmetic pencil (white), in order to visualize their borders and the parts already treated. AFTER APPLICATION: At the end of each IPL session (photo-rejuvenation as well) clients can immediately resume their activities, without post-treatment courses: may we recommend to avoid sun baths for a week and, absolutely, any exposure to the sun in the 24 hours following the treatment, during which a protective total shield cream shall be used. May we suggest after the treatment not to take baths with very warm water and not to rub the treated zone. EVALUTATION OF RESULTS AFTER FIRST SESSION: As already mentioned, may we suggest, in order to achieve the best results, to shave completely (to the level of the epidermis) the hairs of the area to be treated. The pulsed light beam releases the energy to the stem of the hair that carries the heat to the dermal papilla, causing a micro explosion and the hair destruction.
This process happens only in phase Anagen, with the hair connected to the papilla. This energy doesn't harm the surface of the epidermis thanks to the chilled handpiece. The hairs hit in this phase will be then expelled from the follicle, while if dermal papilla is still active, they will grow again maybe thinner and lighter. A medium reduction of 10 to 20% of the hair density for every session is to be considered, with results more evident session after session, as IPL causes a permanent and progressive reduction of the hair growth. Reduction of hair density depends of course on the percentage of the hair in Anagen phase in the treatment area that statistically varies from 5 to 40% according to person and body areas. Underarm, Bikini Area, Groin, are usually the area with results faster to get, while legs, arms and face it often means a hormonal disorder we cannot cure with IPL are usually slower. MEDICAL DISORDERS AND MEDICINES: If client suffers from one of the following dysfunctions, with specific assumption of medicines, operator shall be informed about. May we suggest to ask client to sign that no results are guaranteed (disclaimer). - Allergy - Psoriasis - Epilepsy - Acne - Asthma - Hypertension - Vitiligo - Diabetic arthritis - Heart troubles - Herpes simplex - Depression - Hyperthyroidism - Skin cancer - Immunodeficiency Besides, we recommend to avoid any type of treatment during pregnancy, not because it would be harmful but because of the particular hormonal situation of the woman in such a period.
THE ADVANTAGES OF IPL Wide areas treated in a few minutes Very safe and painless applications with chilled handpiece Suitable for every body area Visible results after a few sessions Where not to use IPL: Skin-type V and VI When sensitive or damaged skin When tanned skin When blond hairs no acceptable results When white hairs no results (no target) On nevus Where to use IPL: Any skin-type II and III, carefully skin type IV Any dark hair type Any wide area to be treated application with IPL is very fast Medical! Any superficial vascular lesions Medical! Dark pigmented lesions TROUBLES DURING APPLICATIONS The sensations of heat should always result highly tolerable; should the subject be hypersensitive to the application, may we suggest to cool for longer time the area and use lower fluence and longer pulse width especially for the first shot. SIDE EFFECTS: No permanent side effect have actually been observed on about 5000 cases treated.
THE APPLICATION CHARTS How to read the charts: The following charts are an indication based on about 5000 cases treated by our medical staff. It was noted that human body is use to respond very well to IPL energy but that it is very complicated to indicate parameters valid for most of the clients. May we suggest to consider the following numbers as a very good beginning that will bring you to make your own charts thru your personal experience. Parameters: - HR: Hair removal - PR: Photorejuvenation - Fluence: density of energy per cm 2 - Spot: dimensions of the application area - Pulses: number of pulses (single burst up to 5) Applications: 1. Hair removal 2. Photo-rejuvenation and pigmented lesions (medical!) 3. Vascular lesions (medical!) 4. Active acne clearance (maybe medical) Warning: Please always check and keep in mind the local regulation about aesthetic or medical application. If medical, beauty therapist MUST not use IPL for that application. If any doubt, please ask the local dealer or the Government Health Department.
HAIR REMOVAL: Target molecule is the hair melanine. For skin type IV may we suggest to use always the 5 shots in the burst mode and to lower the fluence, about 20%, for an application more gentle. Cooler: ALWAYS Hair: Area: Skin-type: Fluence: Pulses: Thick dark Upper lip/face/neck II - III 5-6 3 Groin/bikini line II - III 5-6 3 Chest/back II - III 6-7 4/5 Legs/arms II - III 6-7 4/5 Upper lip/face/neck IV 6-7 4 Groin/bikini line IV 6-7 4 Chest/back IV 6-7 4/5 Legs/arms IV 6-7 4/5 Thin dark Upper lip/face/neck II - III 6-7 4 Groin/bikini line II - III 6-7 4 Chest/back II - III 7-8 4/5 Legs/arms II - III 7-8 4/5 Upper lip/face/neck IV 7-8 4/5 Groin/bikini line IV 7-8 4/5 Chest/back IV 7-9 5 Legs/arms IV 7-9 5 Brown Upper lip/face/neck II - III 8-9 4 Groin/bikini line II - III 8-9 5 Chest/back II - III 8-10 5 Legs/arms II - III 8-10 5 Upper lip/face/neck IV 8-10 4/5 Groin/bikini line IV 8-10 4/5 Chest/back IV 9-10 4/5 Legs/arms IV 9-10 4/5
PHOTO-REJUVENATION: Multiple factors can cause skin damage such as pigmented and vascular lesions. IPL, light source absorbed by the target molecules melanine, haemoglobin and water, is the non-aggressive solution for such a problem, without skin layer removal and so no side effects. The use of IPL makes the skin smoother and brighter improving as well the texture, especially the parts of body subjected to the atmospheric agents, sun, wind, very high or very low temperature can seriously damage the skin causing a precocious aging. May we suggest to use IPL for photo-rejuvenation applications with a reticular procedure, horizontal and then vertical so to better stimulate all parts of the treatment area. Pigmented lesions are caused by a proliferation of the skin melanocytes, the cells that produce melanine, the dark pigment of the skin. Pigmented lesions include lentigo, age and sun spots. Right after the treatment lesions gets darker, since the superficial melanine has been targeted; then in two weeks time the natural peel off of the skin will cause a very visible improvement. The heat, generated by the interaction of the light with the chromophore, stimulates the collagen production or reshaping; this means a very visible improvement of the skin looking, brighter and smoother besides a reduction of the thin wrinkles especially in the mouth contour. PHOTO-REJUVENATION (GENERIC APPLICATION) Operative suggestions: Use burst. Cooler: NEVER Area: Skin-type: Fluence: Pulses: Face/neck II 03 05 4/5 Hands II 04 06 5 Face/neck III 04 05 4/5 Hands III 04 05 5 Face/neck IV 03 04 4/5 Hands IV 03 04 4/5
PIGMENTED LESIONS (Maybe medical) Operative suggestions: Cooler: ALWAYS. Area: Skin-type: Fluence: Pulses: Face/neck II Max. 5 Hands II Max. 5 Face/neck III Max. 5 Hands III Max. 5 Face/neck IV 07-08 5 Hands IV 07-08 5 VASCULAR LESIONS (Maybe medical) Those pathologies (port wine stains, teleangectasias, spider veins, ruby angiomas) are caused by the degeneration of the superficial capillaries; superficial vessels are thermo-coagulated (closed) by the ray of light. Operative suggestions: Cooler: ALWAYS 5 seconds before each shot. Pathology: Skin-type: Fluence: Pulses: Couperose II III Max 5 Capillaries II III Max 5 Rosacea Wide Small II III 09 10 09 10 5 Port wine stains II III 07 08 5
ACTIVE ACNE Operative suggestions: Cooler: NEVER. Pathology: Skin-type: Fluence: Pulses: Acne II III 08 10 5 FURTHER INFORMATION AND DETAILS Our staff is at your complete disposal for any further information or details you may need. info@evlaser.com medest@evlaser.com +39035726301