Advanced Treatment Pearls Laser

Palomar Confidential - Not for DistPalomar Confidential - Not for Distributionribution

Palomar MedicalPalomar Medical

StarLux StarLux

Advanced Advanced

Treatment PearlsTreatment Pearls

Rich BankowskiRich Bankowski

Field Clinical DirectorField Clinical Director


StarLuxStarLux

Active Contact CoolingActive Contact Cooling

Smooth Pulse DesignSmooth Pulse Design

Optimized spectrum IPL and laser hand pieces allow a Optimized spectrum IPL and laser hand pieces allow a variety of conditions to be treated without compromise variety of conditions to be treated without compromise in resultsin results


ApplicationApplication TargetTarget

Hair RemovalHair Removal MelaninMelanin

Pigmented LesionsPigmented Lesions MelaninMelanin

Vascular LesionsVascular Lesions HemoglobinHemoglobin

Skin RejuvenationSkin Rejuvenation HemoglobinHemoglobin

AcneAcne Porphyrins, hemoglobin, and Porphyrins, hemoglobin, and waterwater

StarLux SystemStarLux System

Applications: Target Applications: Target (Chromophore)(Chromophore)



Optimized Spectrum for Optimized Spectrum for Precise TargetingPrecise Targeting


Treatment GuidesTreatment Guides New Treatment guides for StarLux – series I & New Treatment guides for StarLux – series I &

series II hand piecesseries II hand pieces Guides are designed to give a safe and effective Guides are designed to give a safe and effective

range of treatment parametersrange of treatment parameters Guides are designed with all levels of users in Guides are designed with all levels of users in

mindmind Experienced users should try to use the high Experienced users should try to use the high

end of the end of the rangerange of suggested settings – this of suggested settings – this does not mean put in on the highest setting and does not mean put in on the highest setting and fire. Perform a test pulse to gauge effect – watch fire. Perform a test pulse to gauge effect – watch for signs of over-treatmentfor signs of over-treatment


The most common error in treatment strategy is The most common error in treatment strategy is skin typing and determining if tan is present – skin typing and determining if tan is present – the guides give a little room for error at the lower the guides give a little room for error at the lower end of the suggested treatment rangeend of the suggested treatment range

When working at the higher end of the When working at the higher end of the suggested treatment range, be sure of the skin suggested treatment range, be sure of the skin type and whether or not tan is presenttype and whether or not tan is present


Vascular Vascular

Lux G – Series II Hand piecesLux G – Series II Hand pieces– Benefit of much higher fluences at both short Benefit of much higher fluences at both short

and long pulse durationand long pulse duration At 5 ms increased to 20 j/cmAt 5 ms increased to 20 j/cm22

At 10 ms increased to 36 j/cmAt 10 ms increased to 36 j/cm22



All Vascular lesions are treated with Lux GAll Vascular lesions are treated with Lux G


Wavelength:Wavelength: 500 - 670 nm & 870 - 1400 nm500 - 670 nm & 870 - 1400 nm

Spot Size:Spot Size: 10 x 15 mm10 x 15 mm

Maximum Fluence:Maximum Fluence: 60 J/cm60 J/cm22

Pulsewidth:Pulsewidth: 1 - 400 ms1 - 400 ms

Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)

Applications

• RejuveLux™ Photofacials

• Pigmented Lesions

• Vascular Lesions


LuxGLuxG™™ Pulsed Light Handpiece Pulsed Light Handpiece



LuxG Effect on BloodLuxG Effect on Blood


Vascular – Treatment of Small Vascular – Treatment of Small VesselsVessels

Small Vessels issues – defined as vessels Small Vessels issues – defined as vessels <0.3 mm commonly seen in skin type I-III<0.3 mm commonly seen in skin type I-III– Use 10 ms pulse duration 30-34 j/cmUse 10 ms pulse duration 30-34 j/cm22

Start at 30 j/cmStart at 30 j/cm22 and increase fluence based on and increase fluence based on skin reaction skin reaction

Vessels should close (vasoconstriction) Vessels should close (vasoconstriction) If darkening occurs, pulse duration may be too If darkening occurs, pulse duration may be too

short (may need 20 ms)short (may need 20 ms) Caution should be used treating above 34 j/cmCaution should be used treating above 34 j/cm22 – a – a

few cases of mild purpura have been reported at few cases of mild purpura have been reported at the higher settings on thinner skin surrounding the the higher settings on thinner skin surrounding the periorbital areaperiorbital area


SMALL VESSELSMALL VESSEL


Vascular – Treatment of Average Vascular – Treatment of Average VesselsVessels

Average vessel issues – defined as vessels >0.3 mm to 1.0 mm commonly Average vessel issues – defined as vessels >0.3 mm to 1.0 mm commonly seen in skin types I-IIIseen in skin types I-III

– Use 20 ms pulse duration 36-44 j/cmUse 20 ms pulse duration 36-44 j/cm22

Start at 36 j/cmStart at 36 j/cm22 and increase fluence based on skin reaction and increase fluence based on skin reaction Vessels should close (vasoconstriction) Vessels should close (vasoconstriction) If only spasm (blurring) occurs, pulse duration may be too long (may If only spasm (blurring) occurs, pulse duration may be too long (may

need 10 ms)need 10 ms) If darkening occurs (methemoglobin), pulse duration may be too If darkening occurs (methemoglobin), pulse duration may be too

short – yet good results are obtainable with this endpoint (consider short – yet good results are obtainable with this endpoint (consider longer pulse duration to constrict the vessel)longer pulse duration to constrict the vessel)

Caution should be used treating above 40 j/cmCaution should be used treating above 40 j/cm22 – usually reserve 42- – usually reserve 42-44 j/cm44 j/cm22 for resistant vessels in very sebaceous areas (nose) for resistant vessels in very sebaceous areas (nose)


AVERAGE VESSELAVERAGE VESSEL


Vascular – Treatment of Large Vascular – Treatment of Large VesselsVessels

Large vessel issues – defined as vessels >1.0mm Large vessel issues – defined as vessels >1.0mm commonly seen in skin types I-III primarily in alar area commonly seen in skin types I-III primarily in alar area and also malar area (can also be purple or blue in color)and also malar area (can also be purple or blue in color)

– Use 100 ms pulse duration 50-60 j/cmUse 100 ms pulse duration 50-60 j/cm22

Start at 50 j/cmStart at 50 j/cm22 and increase fluence based on and increase fluence based on skin reaction skin reaction

Vessels should close (complete vasoconstriction) Vessels should close (complete vasoconstriction) If vessel is reduced in diameter and not completely If vessel is reduced in diameter and not completely

closed, follow with a 20 ms pulse at maximum safe closed, follow with a 20 ms pulse at maximum safe fluence to complete constrictionfluence to complete constriction


LARGE VESSELLARGE VESSEL


Vascular – Strategy for Cherry Vascular – Strategy for Cherry AngiomasAngiomas

Isolate lesion with templateIsolate lesion with template Treat at 20 ms 38-40 j/cmTreat at 20 ms 38-40 j/cm22

Lesion should turn light greyLesion should turn light grey Some thicker angiomas may Some thicker angiomas may

require an additional pulserequire an additional pulse Larger angiomas may need Larger angiomas may need

more than one treatment to more than one treatment to completely clearcompletely clear


Vascular – Treatment for Spider Vascular – Treatment for Spider AngiomasAngiomas

Isolate lesion if smaller than spot Isolate lesion if smaller than spot sizesize

2 pulse approach –2 pulse approach –– 11stst pulse –slight compression to shut pulse –slight compression to shut

down feederdown feeder– 22ndnd pulse –light contact to affect pulse –light contact to affect

superficial vesselssuperficial vessels Primarily done at 20 ms, Primarily done at 20 ms,

however if very fine 10 ms may however if very fine 10 ms may be usedbe used

36-42 j/cm36-42 j/cm22 at 20 ms, 30-34j/cm at 20 ms, 30-34j/cm22 at 10 ms– location may limit at 10 ms– location may limit fluence used (periorbital area)fluence used (periorbital area)


Vascular – Treatment for Rosacea Vascular – Treatment for Rosacea (Couperose)(Couperose)

Treat using 10 ms pulse Treat using 10 ms pulse duration at 30-34 j/cmduration at 30-34 j/cm22

Follow up with a 5 ms 20 j/cmFollow up with a 5 ms 20 j/cm22 second pass over areas that second pass over areas that are predominantly flush (malar are predominantly flush (malar into cheek, nose & chin)into cheek, nose & chin)

Do this only if it appears the Do this only if it appears the skin can tolerate a a second skin can tolerate a a second passpass

Higher fluences may be used Higher fluences may be used but there is a risk of mild but there is a risk of mild purpura (34-36 j/cmpurpura (34-36 j/cm22 at 10 ms) at 10 ms)


Vascular – Treatment for Vascular – Treatment for Poikloderma of CivatePoikloderma of Civate

This a usually a mix of vascular and This a usually a mix of vascular and pigmentpigment

Lux G will address both Lux G will address both chromophores simultaneouslychromophores simultaneously

34-38 j/cm34-38 j/cm22 at 20 ms or 28-34 j/cm at 20 ms or 28-34 j/cm22 at 10 msat 10 ms

Significant clearing in a single Significant clearing in a single treatment treatment

Diffuse erythema and constriction of Diffuse erythema and constriction of small vessels and/or slight small vessels and/or slight darkening of pigment are good darkening of pigment are good endpointsendpoints

Fluence selection will depend on Fluence selection will depend on quantity of dyschromia (pigment & quantity of dyschromia (pigment & vascular) vascular)


Vascular – Treatment for PWSVascular – Treatment for PWS Several considerations (color, Several considerations (color,

thickness, location, etc.)thickness, location, etc.) 10 ms pulse duration may be 10 ms pulse duration may be

optimal (30-36 j/cmoptimal (30-36 j/cm22)) 5 ms pulse duration may be added 5 ms pulse duration may be added

as a second pass (18-20 j/cmas a second pass (18-20 j/cm22)) Some lesion may respond to 20 ms Some lesion may respond to 20 ms

pulse duration (different sized pulse duration (different sized vessels)vessels)

Approach may be to change pulse Approach may be to change pulse duration in subsequent treatments duration in subsequent treatments (i.e. start at 20 ms for tx 1, then 10 (i.e. start at 20 ms for tx 1, then 10 & 5 ms for treatments 2+)& 5 ms for treatments 2+)


Considerations for TreatmentConsiderations for Treatment Have a signed consent formHave a signed consent form Keep a log/record of treatment settings used Keep a log/record of treatment settings used Pre-treatment photos Pre-treatment photos Use Lux-lotion or Humatrix to couple light energy to Use Lux-lotion or Humatrix to couple light energy to

the skinthe skin Rosacea patients typically swell after treatmentRosacea patients typically swell after treatment Poikloderma patients tend to have a good amount Poikloderma patients tend to have a good amount

of tissue reaction – dual chromophoresof tissue reaction – dual chromophores If patients are on blood thinners (Coumadin, If patients are on blood thinners (Coumadin,

aspirin, etc) there is an increased risk of purpura aspirin, etc) there is an increased risk of purpura (bruising) (bruising)


Vascular – Post Treatment Vascular – Post Treatment ConsiderationsConsiderations

Ice! – Ice! – get the heat out of the skinIce! – Ice! – get the heat out of the skin Topical steroid CREAM– some Drs. prefer to use post tx Topical steroid CREAM– some Drs. prefer to use post tx

to calm down skin and make the patient more to calm down skin and make the patient more comfortable comfortable – Suggest a strong steroid for the first day only (2-3 applications) Suggest a strong steroid for the first day only (2-3 applications)

Important to use if you feel there has been an over treatment – can Important to use if you feel there has been an over treatment – can minimize side effects and complicationsminimize side effects and complications

– Some non-physicians use OTC steroid creams for a couple of Some non-physicians use OTC steroid creams for a couple of days days

– Some people suggest using nothingSome people suggest using nothing If treating full face or near the peri-orbital rim, advise If treating full face or near the peri-orbital rim, advise

patient that there may be swelling (especially if there is patient that there may be swelling (especially if there is lax skin) – suggest sleeping with their head elevated for lax skin) – suggest sleeping with their head elevated for 2-3 nights2-3 nights


PigmentPigment Lux G – Series II Hand PieceLux G – Series II Hand Piece

– Benefit of much higher fluences at both short and long pulse Benefit of much higher fluences at both short and long pulse durationduration At 10 ms increased to 36 j/cmAt 10 ms increased to 36 j/cm22, at 20 ms to 44 j/cm, at 20 ms to 44 j/cm22

LuxG at 20 ms for smaller (area) moderate to dark lesions, 10 ms for LuxG at 20 ms for smaller (area) moderate to dark lesions, 10 ms for lighter pigment.lighter pigment.

Lux Y – Series II Hand PieceLux Y – Series II Hand Piece– Addition of 15 ms pulse duration (series I &II)Addition of 15 ms pulse duration (series I &II)

At 15 ms – 27 j/cmAt 15 ms – 27 j/cm22, at 20 ms -31 j/cm, at 20 ms -31 j/cm22 (series II) (series II)

– Lux Y for moderate to dark pigmented lesions on large surface Lux Y for moderate to dark pigmented lesions on large surface areasareas

Lux V Hand PieceLux V Hand Piece– Single joule increments for more flexibility in treatmentSingle joule increments for more flexibility in treatment– Lux V for resistant pigment (lighter and diffuse bronzing) on skin Lux V for resistant pigment (lighter and diffuse bronzing) on skin

types I-IV without tantypes I-IV without tan







Applications





LuxGLuxG™™ Pulsed Light Handpiece Pulsed Light Handpiece


Wavelength:Wavelength: 525 - 1200 nm 525 - 1200 nm


Maximum Fluence:Maximum Fluence: 4040 J/cm J/cm22



15cm15cm22 /sec (Coverage Rate) /sec (Coverage Rate)

Applications

• Permanent Hair Reduction




LuxYLuxY™™ Pulsed Light Handpiece Pulsed Light Handpiece







15cm15cm22 /sec (Coverage Rate /sec (Coverage Rate))

Applications

• Acne



LuxVLuxV™™ Pulsed Light Handpiece Pulsed Light Handpiece


Pigment - MechanismPigment - Mechanism

Short pulse ( Q-switched Short pulse ( Q-switched Nd:YAG, RD 1200):Nd:YAG, RD 1200):– exploding of melanosomesexploding of melanosomes– thermomechanical damage thermomechanical damage

of melanocytesof melanocytes

Long pulse (Lux Products): Long pulse (Lux Products): – heating of melanocytes by heating of melanocytes by

thermal diffusion from thermal diffusion from melanosomesmelanosomes

– thermal injury of thermal injury of melanocytes melanocytes (photothermal)(photothermal)


Pigment – Pigment – Treatment for Solar Lentigenes Treatment for Solar Lentigenes on Handson Hands

Medium to Dark LentigenesMedium to Dark Lentigenes Skin Type I-IIISkin Type I-III

– Lux Y 15ms 25-27j/cmLux Y 15ms 25-27j/cm22

– Lux G 20ms 34-38j/cmLux G 20ms 34-38j/cm22

Skin Type IVSkin Type IV– Lux Y 20 ms 25-31 j/cmLux Y 20 ms 25-31 j/cm22 – Lux G 20-40 ms 22-36 j/cmLux G 20-40 ms 22-36 j/cm2 2

Very Light to Light LentigenesVery Light to Light Lentigenes Skin Type I-IIISkin Type I-III

– Lux G 20ms 36-38 j/cmLux G 20ms 36-38 j/cm22

10ms 28-34 j/cm10ms 28-34 j/cm22

– Lux V 40ms 15-20 j/cmLux V 40ms 15-20 j/cm22

Skin Type IVSkin Type IV– Lux G 20 ms 22-28 j/cmLux G 20 ms 22-28 j/cm22

– Lux V 100 ms 10-15 j/cmLux V 100 ms 10-15 j/cm22

When possible, isolate lesion with mask especially if there is concern about the When possible, isolate lesion with mask especially if there is concern about the skin color (or tan) surrounding the lesion – this is not always practical if there skin color (or tan) surrounding the lesion – this is not always practical if there is bronzing mixed with the distinct lentigenes is bronzing mixed with the distinct lentigenes

Skin on the extremities is less “resilient” than skin on the face – pigment takes Skin on the extremities is less “resilient” than skin on the face – pigment takes longer to clear and over-treatment will take longer to heallonger to clear and over-treatment will take longer to heal


Pigment – Pigment – Treatment for Solar Lentigenes Treatment for Solar Lentigenes on Face &Bodyon Face &Body

Medium to Dark LentigenesMedium to Dark Lentigenes Skin Type I-IIISkin Type I-III

– Lux G 20ms 34-38j/cmLux G 20ms 34-38j/cm22

Skin Type IVSkin Type IV– Lux G 20 ms 26-32 j/cmLux G 20 ms 26-32 j/cm22 or 40 ms 30-38 j/cm or 40 ms 30-38 j/cm22

Very Light to Light LentigenesVery Light to Light Lentigenes Skin Type I-IIISkin Type I-III

– Lux G 20ms 36-40 j/cmLux G 20ms 36-40 j/cm22

10 ms 30-34 j/cm10 ms 30-34 j/cm22


On very Light skin (I & II) can try 20 ms at 14-18 j/cmOn very Light skin (I & II) can try 20 ms at 14-18 j/cm22

Skin Type IVSkin Type IV– Lux G 20 ms 28-34 j/cmLux G 20 ms 28-34 j/cm22

10 ms 24-28 j/cm10 ms 24-28 j/cm22


When possible, isolate lesion with mask especially if there is concern When possible, isolate lesion with mask especially if there is concern about the skin color (or tan) surrounding the lesion – this is not about the skin color (or tan) surrounding the lesion – this is not always practical if there is bronzing mixed with the distinct lentigenes always practical if there is bronzing mixed with the distinct lentigenes


Pigment – Treatment for Actinic Pigment – Treatment for Actinic Bronzing - FaceBronzing - Face

FaceFace– Skin Type I-IIISkin Type I-III

Lux G 20ms 36-40 j/cmLux G 20ms 36-40 j/cm2 2 –– Average BronzingAverage Bronzing Lux V 40ms 15-20 j/cmLux V 40ms 15-20 j/cm22 – Light or Resistant Bronzing – Light or Resistant Bronzing

– Lux V on very light skin patients with very light bronzing can be used Lux V on very light skin patients with very light bronzing can be used at 20ms 14-18 j/cmat 20ms 14-18 j/cm22

– Skin Type IVSkin Type IV Lux G 20 ms 28-34 j/cmLux G 20 ms 28-34 j/cm22 or 40 ms 32-36 j/cm or 40 ms 32-36 j/cm2 2 - Average - Average Bronzing Bronzing

– More or dense pigment use 40 ms pulse durationMore or dense pigment use 40 ms pulse duration Lux V 100 ms 10-15 j/cmLux V 100 ms 10-15 j/cm22 – Light Bronzing – Light Bronzing


Pigment – Treatment for Actinic Pigment – Treatment for Actinic Bronzing - ChestBronzing - Chest

ChestChest– Skin Type I-IIISkin Type I-III

Lux Y 15ms 23-27 j/cmLux Y 15ms 23-27 j/cm2 2 –– Average BronzingAverage Bronzing Lux V 40ms 15-20 j/cmLux V 40ms 15-20 j/cm22 – Light or Resistant Bronzing – Light or Resistant Bronzing

– Lux V on very light skin patients with very light bronzing can be used at Lux V on very light skin patients with very light bronzing can be used at 20ms 12-18 j/cm20ms 12-18 j/cm22

– Skin Type IVSkin Type IV Lux Y 15 ms 19-25 j/cmLux Y 15 ms 19-25 j/cm22 or 20 ms 25-31 j/cm or 20 ms 25-31 j/cm2 2 - Average - Average

– More or dense pigment use 20 ms pulse durationMore or dense pigment use 20 ms pulse duration

Lux V 100 ms 10-15 j/cmLux V 100 ms 10-15 j/cm22 – Light Bronzing – Light Bronzing


Pigment - MelasmaPigment - Melasma Melanocytes produce more pigment in Melanocytes produce more pigment in

response to multiple factors including UV, response to multiple factors including UV, genetic predisposition, and hormonal genetic predisposition, and hormonal influencesinfluences

Advise that these patients need to be pre-treated with Advise that these patients need to be pre-treated with bleaching agents several weeks before treatment, off bleaching agents several weeks before treatment, off the bleaching agent for 2 weeks and then put back on the bleaching agent for 2 weeks and then put back on the bleaching agent once desquamation clears post the bleaching agent once desquamation clears post treatment. Treat at less frequent intervals, and treatment. Treat at less frequent intervals, and religiously use sunscreens.religiously use sunscreens.

Results can be achieved with this protocol but rapid Results can be achieved with this protocol but rapid regression can occur with just a single day without UV regression can occur with just a single day without UV protection – patient compliance is critical and even protection – patient compliance is critical and even then there are people that do not respond wellthen there are people that do not respond well


Pigment – Treatment Pigment – Treatment ConsiderationsConsiderations

Have a signed consent formHave a signed consent form Keep a log/record of treatment settings used Keep a log/record of treatment settings used Pre-treatment photos – if possiblePre-treatment photos – if possible Use Lux-lotion or Humatrix to couple light energy to the skinUse Lux-lotion or Humatrix to couple light energy to the skin Place hand piece on skin and fire immediately – do not dwell on the skin Place hand piece on skin and fire immediately – do not dwell on the skin

prior to firing – sapphire is very efficient in cooling the skin (extracting prior to firing – sapphire is very efficient in cooling the skin (extracting heat)heat)

Isolate lesion or use long pulse duration (100 ms+ caution) if forced to Isolate lesion or use long pulse duration (100 ms+ caution) if forced to treat tanned or darker skin typestreat tanned or darker skin types

For darker skin consider testing with Lux Rs handpiece (start with hair For darker skin consider testing with Lux Rs handpiece (start with hair removal settings)removal settings)

Pigmentation will darken 1-2 shades when treated – desirable endpointPigmentation will darken 1-2 shades when treated – desirable endpoint If mild response occurs, consider a second pass on that area before If mild response occurs, consider a second pass on that area before

increasing fluence – then increase fluence for the next area to achieve increasing fluence – then increase fluence for the next area to achieve endpoint in a single passendpoint in a single pass

If using pulse durations > 20 ms be sure to wait at least 5-10 minutes to If using pulse durations > 20 ms be sure to wait at least 5-10 minutes to observe true endpoint -delayedobserve true endpoint -delayed

Pigment on the face will clear fastest – hands, arms, and legs the Pigment on the face will clear fastest – hands, arms, and legs the longestlongest


Pigment – Post Treatment Pigment – Post Treatment ConsiderationsConsiderations

Ice! – Ice! – get the heat out of the skinIce! – Ice! – get the heat out of the skin Topical steroid CREAM– some Drs. prefer to use post tx Topical steroid CREAM– some Drs. prefer to use post tx

to calm down skin and make the patient more to calm down skin and make the patient more comfortable comfortable – Suggest a strong steroid for the first day only (2-3 applications) Suggest a strong steroid for the first day only (2-3 applications)

Important to use if you feel there has been an over treatment – can Important to use if you feel there has been an over treatment – can minimize side effects and complicationsminimize side effects and complications

– Some non-physicians use OTC steroid creams for a couple of Some non-physicians use OTC steroid creams for a couple of days days

– Some people suggest using nothingSome people suggest using nothing If treating full face or near the peri-orbital rim, advise If treating full face or near the peri-orbital rim, advise

patient that there may be swelling (especially if there is patient that there may be swelling (especially if there is lax skin) – suggest sleeping with their head elevated for lax skin) – suggest sleeping with their head elevated for 2-3 nights2-3 nights

Treat post tx crusting with Aquaphor or polysporin Treat post tx crusting with Aquaphor or polysporin ointment – day 2 until healedointment – day 2 until healed







15cm15cm22 /sec (Coverage Rate /sec (Coverage Rate))

Applications

• Acne



LuxVLuxV™™ Pulsed Light Handpiece Pulsed Light Handpiece


Treatment of AcneTreatment of Acne

Acne Therapy with Lux V is beginning to revolutionize the Acne Therapy with Lux V is beginning to revolutionize the treatment of acne (white paper by Robert S. Berger MD-he treatment of acne (white paper by Robert S. Berger MD-he has administrated more the 4,500 tx)has administrated more the 4,500 tx)

The treatment of acne is as varied as the clinical The treatment of acne is as varied as the clinical presentationspresentations

Topical retinoids are essential for the successful treatment Topical retinoids are essential for the successful treatment of acneof acne

All types of acne(mild-conglobate) and all skin types(I-VI)All types of acne(mild-conglobate) and all skin types(I-VI) Only side effect is heat which can result in burn/blisterOnly side effect is heat which can result in burn/blister Generally treat in 2 week intervals with average of 5 Generally treat in 2 week intervals with average of 5

sessions in initial treatment periodsessions in initial treatment period After evaluation may extend intervals by 2 wks,4 wks, 6wks After evaluation may extend intervals by 2 wks,4 wks, 6wks

then 8wks etc. Once at 8-12wks patients calls as neededthen 8wks etc. Once at 8-12wks patients calls as needed


Acne-StarLuxAcne-StarLux 11stst pass start with 100ms 10-12j/cm2 2 pass start with 100ms 10-12j/cm2 2ndnd pass 20ms 8- pass 20ms 8-

10j/cm2 10j/cm2 Second treatment- 1Second treatment- 1stst pass 100ms 13-15j/cm2 2 pass 100ms 13-15j/cm2 2ndnd pass pass

20ms 10-12j/cm2 (220ms 10-12j/cm2 (2ndnd pass is important) pass is important) Best result at 100ms 18-20j/cm2 and 20ms 15-18j/cm2 Best result at 100ms 18-20j/cm2 and 20ms 15-18j/cm2

(skin types I-II)(skin types I-II) Skin Types IV-VI and dark III rarely go over 13-15j/cm2 at Skin Types IV-VI and dark III rarely go over 13-15j/cm2 at

100ms and 10-12 j/cm2 at 20ms (despite lower fluence, the 100ms and 10-12 j/cm2 at 20ms (despite lower fluence, the darker skins types improve as welldarker skins types improve as well

Most improvement in the 5-6 treatment rangeMost improvement in the 5-6 treatment range If you do not increase the power settings to 100ms If you do not increase the power settings to 100ms

18-20j/cm2,20ms 15-18j/cm2 the patients do not improve, 18-20j/cm2,20ms 15-18j/cm2 the patients do not improve, and there is some evidence they may worsen.and there is some evidence they may worsen.


Wavelength:Wavelength: 525 - 1200 nm 525 - 1200 nm





15cm15cm22 /sec (Coverage Rate) /sec (Coverage Rate)

Applications





LuxYLuxY™™ Pulsed Light HandpiecePulsed Light Handpiece



LuxRLuxR™™ & LuxRs & LuxRs™™ Pulsed Light Handpieces Pulsed Light Handpieces

Applications


Wavelength:Wavelength: 650 - 1200 nm650 - 1200 nm





Wavelength:Wavelength: 650 - 1200 nm650 - 1200 nm





15cm15cm2 2 /sec (Coverage Rate)/sec (Coverage Rate)


Optimal Hair Removal TreatmentOptimal Hair Removal Treatment

The StarLux Treatment Guide is a very good source The StarLux Treatment Guide is a very good source of settings for hair removalof settings for hair removal

Always work towards the higher end of the range if Always work towards the higher end of the range if tolerated and the user is confident with skin typingtolerated and the user is confident with skin typing

To achieve the greatest amount of permanency use To achieve the greatest amount of permanency use 100 ms – to show the best short term clearing and 100 ms – to show the best short term clearing and “WOW” effect use 20 ms – if treating a smaller area “WOW” effect use 20 ms – if treating a smaller area do a 100 ms pass followed by a 20 ms – it is very do a 100 ms pass followed by a 20 ms – it is very rare that the skin cannot tolerate 2 passesrare that the skin cannot tolerate 2 passes

To treat lighter hair (light brown, dirty blonde) use To treat lighter hair (light brown, dirty blonde) use Lux Y at shorter pulse (15- 20 ms) at maximum Lux Y at shorter pulse (15- 20 ms) at maximum tolerated fluencetolerated fluence

Be sure to tell the client that if you are treating tan Be sure to tell the client that if you are treating tan or dark skin you would usually perform a test dose or dark skin you would usually perform a test dose to maximize the fluence and wait 24-48 hrs.to maximize the fluence and wait 24-48 hrs.


Hair Removal - Suggested Hair Removal - Suggested Treatment ParametersTreatment Parameters

Lux YLux Y– Large surface areas and Large surface areas and

lighter/finer hairlighter/finer hair I-II 20 ms 27-31 j/cmI-II 20 ms 27-31 j/cm22

– 100 ms 30-40 j/cm100 ms 30-40 j/cm22

III 20 ms 23-27 j/cmIII 20 ms 23-27 j/cm22

– 100 ms 25-35 j/cm100 ms 25-35 j/cm22

IV 20 ms 17-21 j/cmIV 20 ms 17-21 j/cm22

– 100 ms 20-30 j/cm100 ms 20-30 j/cm22

Lux RsLux Rs– Dark hair and/or darker Dark hair and/or darker

skin & tanskin & tan I-III 20 ms 35-40 j/cmI-III 20 ms 35-40 j/cm22

– 100 ms 50-70 j/cm100 ms 50-70 j/cm22

IV 20 ms 26-30 j/cmIV 20 ms 26-30 j/cm22

– 100 ms 30-40 j/cm100 ms 30-40 j/cm22

V* 20 ms 18-26 j/cmV* 20 ms 18-26 j/cm22

– 100 ms 20-35 j/cm100 ms 20-35 j/cm22

VI* 20 ms 8-16 j/cmVI* 20 ms 8-16 j/cm22

– 100 ms 20-30 j/cm100 ms 20-30 j/cm22

– *Longer pulse durations *Longer pulse durations are always safer on dark are always safer on dark skin – new tan may skin – new tan may require lower fluencesrequire lower fluences


Hair Removal – End pointsHair Removal – End points Common endpoint is perifollicular edema Common endpoint is perifollicular edema If using longer pulse durations, this may not occur but results should If using longer pulse durations, this may not occur but results should

be goodbe good Mild to moderate erythema and perifollicular edema – in lighter hair Mild to moderate erythema and perifollicular edema – in lighter hair

this may be harder to achievethis may be harder to achieve The reality is that longer pulses will not show both of these The reality is that longer pulses will not show both of these

commonly recognized end points – typically only mild to moderate commonly recognized end points – typically only mild to moderate erythema is observed – yet longer pulses will show very good erythema is observed – yet longer pulses will show very good permanencypermanency

A treatment may requires 4-6 weeks to show the result – explain to A treatment may requires 4-6 weeks to show the result – explain to the client that long pulse durations are very effective, however they the client that long pulse durations are very effective, however they will see more of an immediate effect from the shorter pulse will see more of an immediate effect from the shorter pulse durations (if treating a small area consider a pass of each)durations (if treating a small area consider a pass of each)


Perifollicular Edema Perifollicular Edema Skin Type II MaleSkin Type II Male


Hair – Considerations & Post TxHair – Considerations & Post Tx Have a signed consent formHave a signed consent form Keep a log/record of treatment settings used Keep a log/record of treatment settings used Pre-treatment photos – if possiblePre-treatment photos – if possible Shave the hair prior to treatmentShave the hair prior to treatment Use Lux-lotion to couple light energy to the skinUse Lux-lotion to couple light energy to the skin Ice post treatment (10-15 minutes)Ice post treatment (10-15 minutes) Steroids are helpful but not necessary unless Steroids are helpful but not necessary unless

there is a concern about over treatment - also there is a concern about over treatment - also helps the itchiness that patients may helps the itchiness that patients may experience after treatmentexperience after treatment


Before 6 Mo Post Tx 7Before 6 Mo Post Tx 7

Lux Rs



Lux1064Lux1064™™ Nd:YAG Laser Nd:YAG Laser

HandpieceHandpieceWavelength:Wavelength: 1064 nm1064 nm

Spot Size:Spot Size: 1.5, 3, 6, & 9 mm1.5, 3, 6, & 9 mm




Applications

• Leg Veins



Leg Veins - TreatmentLeg Veins - Treatment Use a consent form, record settings and take Use a consent form, record settings and take

pre-treatment photos pre-treatment photos When treating lateral thigh area for treatmentWhen treating lateral thigh area for treatment

– This area rarely has underlying vascular issuesThis area rarely has underlying vascular issues– Usually has 1 mm purple vessels and 1-2 mm Usually has 1 mm purple vessels and 1-2 mm

reticular (blue) vessels– use 3mm spotreticular (blue) vessels– use 3mm spot When treating small red vessels around the When treating small red vessels around the

ankleankle– These are typically very difficult and painful to treat These are typically very difficult and painful to treat

with sclero – use 1.5 mm spotwith sclero – use 1.5 mm spot Be cautious about vessels that branch from Be cautious about vessels that branch from

behind the knee – reflux may be presentbehind the knee – reflux may be present Avoid treating varicose veinsAvoid treating varicose veins


Leg Veins – Suggested Leg Veins – Suggested ParametersParameters

Vessel SizeVessel Size Spot SizeSpot Size ParametersParameters

0.1 to .5 mm0.1 to .5 mm 1.5 mm1.5 mm3.0 mm3.0 mm

10-20 ms @ 350 to 500 j/cm210-20 ms @ 350 to 500 j/cm220-40 ms @ 300 to 350 j/cm220-40 ms @ 300 to 350 j/cm2

.5 to 1.0 mm.5 to 1.0 mm 3 mm3 mm 20-40 ms @ 250 to 300j/cm220-40 ms @ 250 to 300j/cm2

1.5 to 2.0 mm1.5 to 2.0 mm 3 mm3 mm6 mm6 mm

30-50 ms @ 200-275 j/cm230-50 ms @ 200-275 j/cm230-50 ms @ 90-140 j/cm230-50 ms @ 90-140 j/cm2

2.0 to 4 mm2.0 to 4 mm 3.0 mm 3.0 mm 6 mm6 mm

40-80 ms @ 150-300 j/cm240-80 ms @ 150-300 j/cm230-50 ms @ 90-140 j/cm230-50 ms @ 90-140 j/cm2


Leg Veins – Treatment PearlsLeg Veins – Treatment Pearls

Have patient lay back -not sitting to reduce pressure on the leg vessels Have patient lay back -not sitting to reduce pressure on the leg vessels during treatment. With legs slightly above the heart – Trendelenburgduring treatment. With legs slightly above the heart – Trendelenburg

Always use Humatrix during treatment for adequate coupling to protect the Always use Humatrix during treatment for adequate coupling to protect the epidermis. 15 pulses with then add more cold humatrix.epidermis. 15 pulses with then add more cold humatrix.

Skin type needs to be a factor…..no less than 20ms for skin type I-III and Skin type needs to be a factor…..no less than 20ms for skin type I-III and test spot skin type IV – dark III and IV may require additional cooling with test spot skin type IV – dark III and IV may require additional cooling with the cool roller for added epidermal protectionthe cool roller for added epidermal protection

The deeper vessel will be cloudy and bluish in color, these vessels need The deeper vessel will be cloudy and bluish in color, these vessels need 40ms for deeper penetration. 40ms for deeper penetration.

Use 40ms pulse width on any vessel larger than 1mm-1.5mmUse 40ms pulse width on any vessel larger than 1mm-1.5mm A lot of pre cooling with darker skin type IV (Tan) & V is required, there is a A lot of pre cooling with darker skin type IV (Tan) & V is required, there is a

higher risk of pigmentation post treatment with these skin types. Use the higher risk of pigmentation post treatment with these skin types. Use the Cool roller over the vessel immediately before and after pulse.Cool roller over the vessel immediately before and after pulse.

Roll or ice with pressure immediately post….pressure helps keep vessel Roll or ice with pressure immediately post….pressure helps keep vessel collapsedcollapsed

Allow 1 minute after firing a few pulses- your endpoint will be delayed. Not Allow 1 minute after firing a few pulses- your endpoint will be delayed. Not waiting could result in crusting, scabs and ulcers.waiting could result in crusting, scabs and ulcers.


Leg Veins – Treatment PearlsLeg Veins – Treatment Pearls DO NOT DOUBLE PULSEDO NOT DOUBLE PULSE Do not apply pressure on vessels with handpiece when treating, Do not apply pressure on vessels with handpiece when treating,

have light contact. NOTE: too light a contact will be more painful. Be have light contact. NOTE: too light a contact will be more painful. Be sure to be in contactsure to be in contact

Treat the vessel from Treat the vessel from distal to proximal. distal to proximal. If you are at the distal end If you are at the distal end you will see clearing with 1st pulse. you will see clearing with 1st pulse.

Use maximum fluence when treating larger vessels to avoid Use maximum fluence when treating larger vessels to avoid thrombosis thrombosis

The larger the spot size the more spacing between pulses…..1-2x The larger the spot size the more spacing between pulses…..1-2x the spot size is recommended. For 6mm use full spot size distance the spot size is recommended. For 6mm use full spot size distance between pulses. For 3mm use ½ spot size distance between pulses. between pulses. For 3mm use ½ spot size distance between pulses. Adjust the spot size to be larger than the vessel size, adjust pulse Adjust the spot size to be larger than the vessel size, adjust pulse width to accommodate vessel depth and diameterwidth to accommodate vessel depth and diameter

Clinical endpoint for the bluer vessels will be a spasm or movement Clinical endpoint for the bluer vessels will be a spasm or movement of vessel. The margins of the vessel appear less defined – as if you of vessel. The margins of the vessel appear less defined – as if you were looking at the vessel through a puddle of water For the tiny red were looking at the vessel through a puddle of water For the tiny red vessels - they will often disappear (vasoconstriction) vessels - they will often disappear (vasoconstriction)


Leg Veins – Treatment PearlsLeg Veins – Treatment Pearls 1064 has a lot of absorption of water and is less safe for 1064 has a lot of absorption of water and is less safe for

sebaceous tissue like the nose, this area is higher risk for sebaceous tissue like the nose, this area is higher risk for blisters and potential linear depressionsblisters and potential linear depressions

Treatment locations: medial/lateral thigh is easy to clear Treatment locations: medial/lateral thigh is easy to clear up to 1.5mm vessel and not too painful, ankle clears well up to 1.5mm vessel and not too painful, ankle clears well but is more painful, shin is more painful, calf is well but is more painful, shin is more painful, calf is well tolerated, back of the knee is tender.tolerated, back of the knee is tender.

Bruising……none with telangiectasias, more common with Bruising……none with telangiectasias, more common with reticular vesselsreticular vessels

All vessels treated should have a urticarial effect post All vessels treated should have a urticarial effect post treatment-(cat scratch appearance) treatment-(cat scratch appearance)

For hemociterin staining consider trying the Lux YFor hemociterin staining consider trying the Lux Y


Leg Veins – Post TxLeg Veins – Post Tx ICE (freeze 4x4 gauze and give to take home)ICE (freeze 4x4 gauze and give to take home) Steroid creamsSteroid creams compression stockings will help get the best results out of a single compression stockings will help get the best results out of a single

treatmenttreatment Elevate leg up to 24hrs post treatmentElevate leg up to 24hrs post treatment Wear compression hose for 5 days post laser and 7 days for larger Wear compression hose for 5 days post laser and 7 days for larger

vessels(3 weeks post sclero)vessels(3 weeks post sclero) Venous matte-under high pressure, purplish and you can palpate a lot of Venous matte-under high pressure, purplish and you can palpate a lot of

them-this needs to be wrapped or compression stockings 20-30mm them-this needs to be wrapped or compression stockings 20-30mm medical grade or 17-21 daily wear compression hose, thigh high and medical grade or 17-21 daily wear compression hose, thigh high and wear for 5 days.wear for 5 days.

Get out walkingGet out walking Running with compression hose after 3 days for blue reticular vesselsRunning with compression hose after 3 days for blue reticular vessels No No hothot baths, baths, hothot showers, no mountain climbing and high aerobics for 2 showers, no mountain climbing and high aerobics for 2

weeks (minimum 3 days)weeks (minimum 3 days) Treatments 8-12 weeks apartTreatments 8-12 weeks apart Use 18gauge needle to relieve clot if necessary.Use 18gauge needle to relieve clot if necessary. At 2-3 weeks, vessels may appear to return to baseline but then have a At 2-3 weeks, vessels may appear to return to baseline but then have a

tendency to resolve over the next 6-8 weekstendency to resolve over the next 6-8 weeks


Thank youThank you

For more information contact your trainer or Palomar Medical1-800-Palomar

1553-0076-A

Advanced Treatment Pearls Laser

Documents

Transcript of Advanced Treatment Pearls Laser