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The GentleFamily

GentleLASE, GentleYAG & GentleMAX

GentleLASE – 755nmIndications

Laser Hair Removal

Pigmented Lesions

Vascular Lesions

Wrinkle Reduction

GentleYAG – 1064nm

Indications

Laser Hair Removal

Linear Vascular Lesions

Skin Tightening

Best of Both Worlds

GentleMAX

GentleLASE GentleYAG

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Laser Hair Removal

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.

Permanent Hair Reduction

The FDA allows us this definition:

“long-term stable reduction in the number of hairs re-growing after a treatment regime”

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

Hair Anatomy

EpidermisSebaceous Gland

Bulb

**Bulb/bulge are critical structures responsible for hair re-growth

Follicle

Bulge

Vascular Supply (Matrix)

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

Hair Biology

Anagen TelogenCatagen

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%

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.

Hair Growth Information

Body Area% Anagen

Hair% Telogen

HairTelogen

Duration

FolliclesDensity

/ 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

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.

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

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

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

Post-Treatment Instruction• After

– Cool compresses can be used to reduce patient discomfort & swelling

– Aloe vera– Topical Cortisone cream– Sun block of 30+ SPF

Treatment Technique• 3 Things to ALWAYS remember while treating:

– FLUSH: The distance gauge should be flat and in contact with the skin’s surface

– PERPENDICULAR: The hand piece should be 90° to the skin’s surface

– OVERLAP: Pulses should be overlapped at 20-30%. Think of the Olympic Rings

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

Pigmented Lesions

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

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

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)

Lentigines

Pigmented Lesions• Ephelides:

– Also known as freckles– Commonly seen on fairer skinned patients

Ephelides

Pigmented Lesions

• Café’ au lait:– Are typically light tan to pale brown patches that

are seen at birth or soon after.

Café’ Au Lait

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

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.

Pigmented Lesions• Some factors that could possibly trigger a re-

ecurrence of pigmented lesions are:– Hormonal inbalance– Pregnancy– Medications– Menopause– Sun Exposure

Pigmented Lesions• Potential Side Effects:

– Discomfort– Bruising– Swelling– Scabs– Hyper-pigmentation– Hypo-pigmentation

– Infection– Scarring– Lesion Recurrence

Side effects are quite rare!

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!

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.

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 Telangiectasia755nm & 1064nm Wavelengths

Which Does What?

1064nm– Facial Vessels– Leg Veins

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

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 < 3mm in size are treatable

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

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

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

What’s The Difference?

755nm– Thermal Injury

stimulates the body’s 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

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

Warning During Warm-Up

Standard Alex Screen

Standard Alex Screen Self Adjust

• Able to adjust all parameters– Fluence (J/cm2)– Pulse duration

(Candela recommends 3ms exclusively)

– Able to adjust DCD

Alexandrite Applications

Alex-Guided Mode Selection

ALEX - Guided Mode Treatment Selection

ALEX - Guided Mode Parameter Selection

ALEX - Guided Mode Calculation

ALEX - Guided Mode Calculated Parameters

ALEX - Guided Mode Final Screen

ALEX - Guided Mode Warning Screen

Switch to YAG

• Simply press YAG wavelength

Standard YAG Screen

YAG Applications

YAG Guided Mode

YAG - Guided Mode Treatment Selection

YAG - Guided Mode Parameter Selection

Switch to Alex

• Simply press Alex wavelength

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Thank You