Casnigo, 10 th of July, 2012 OPERATIVE PROTOCOLS FOR IPL APOLLO SUPERCHARGED Name of the machine: Apollo SuperCharged Multifilter 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. Apollo SuperCharged is an IPL Intense Pulsed Light with maximum energy for single shot equal to maximum 150J, according to the different models; the main technical specifications are summarized in the following chart: - Wavelength standard range: 585-1100 nm - Wavelength options: 415, 530, 640 1100 nm PLUG IN - Fluence max: 26J/ cm 2 spot 15x50 mm - Pulse repetition rate: 0,50,25 Hz (according to the energy settings) - Pulse width 1: adjustable single, 8-13 ms 2: adjustable burst, 2-18 ms Delay, 5-50 ms - Skin cooling type: built-in high purity sapphire glass - Cooling system: air-water sailed circuit Apollo SuperCharged permits to adjust both the single shot width and the burst, besides the delay, also independently, 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 chilled crystal 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. Apollo SuperCharged 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: - Filter cut - 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) - T1: time of the first shot of burst (or single shot) - T2: time of the shots from 2 to 5 burst mode - P: delay between one shot and following - Cooler: cooling level 1, 2, 3 from minimum to maximum Applications: 1. Hair removal 2. Photo-rejuvenation and pigmented lesions (medical!) 3. Vascular lesions (medical!) 4. Active acne clearance 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. T1 and T2: always use burst according to the following indications. T1/T2 width and delay: time shall be set according to the skin and hair type. Skin types II and III allow to use shorter pulse width about 5ms For skin type IV may we suggest to use longer T1 and shorter T2 besides delay around 20 ms so to make application more gentle. Cooler: step 3 Filter cut: skin type II & III: 585 1200 / skin type IV: 640-1200 Hair: Area: Skin-type: Fluence: Pulses: Thick dark Upper lip/face/neck II - III 15-18 3 Groin/bikini line II - III 15-21 3 Chest/back II - III 18 23 4/5 Legs/arms II - III 18 23 4/5 Upper lip/face/neck IV 13 15 4 Groin/bikini line IV 13 15 4 Chest/back IV 18 23 4/5 Legs/arms IV 18-23 4/5 Thin dark Upper lip/face/neck II - III 15 21 4 Groin/bikini line II - III 18 21 4 Chest/back II - III 21 23 4/5 Legs/arms II - III 21-26 4/5 Upper lip/face/neck IV 13 15 4/5 Groin/bikini line IV 13 15 4/5 Chest/back IV 13 15 5 Legs/arms IV 15 18 5 Brown Upper lip/face/neck II - III 18 21 4 Groin/bikini line II - III 21 23 5 Chest/back II - III 21 23 5 Legs/arms II - III 21 23 5 Upper lip/face/neck IV 13 15 4/5 Groin/bikini line IV 15-18 4/5 Chest/back IV 15 18 4/5 Legs/arms IV 15-18 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; T1 and T2 medium long (skin type IV); delay 20 ms. Cooler: step 1 Filter cut: 530-1200 Area: Skin-type: Fluence: Pulses: Face/neck II 08 10 4/5 Hands II 10 12 5 Face/neck III 08 10 4/5 Hands III 10 12 5 Face/neck IV 06 08 4/5 Hands IV 06 08 4/5
PIGMENTED LESIONS (Maybe medical) Operative suggestions: Use burst; T1 and T2 longest, delay 30 ms. Cooler: step 1. Filter cut: 585-1200 Area: Skin-type: Fluence: Pulses: Face/neck II 21-24 5 Hands II 21-26 5 Face/neck III 18 21 5 Hands III 21 24 5 Face/neck IV 15 18 5 Hands IV 18-21 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: Use single pulse with longest pulse width. Cooler: step 3. Filter cut: 530-1200 Pathology: Skin-type: Fluence: Pulse/time: Couperose II III Max 1/Max Capillaries II III Max 1/Max Rosacea Wide Small II III 21 26 21 26 1/Max Port wine stains II III 21 26 1/Max
ACTIVE ACNE Operative suggestions: Use single pulse with shortest pulse width. Cooler: step 3. Filter cut: 415-1200 Pathology: Skin-type: Fluence: Pulse/Time Acne II III 10 16 Single/Minimum 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