Michael J. Tomcik, M.D.Michael J. Tomcik, M.D.
MiXto sx®
Microfractional CO2 Laser
at the Advanced Laser and Skin Care Center
MiXto sx®
Microfractional CO2 Laser
at the Advanced Laser and Skin Care Center
Michael J. Tomcik, MD
William Ting, MD
Michael J. Tomcik, MD
William Ting, MD
WHY CO2
• Gold standard for smoothing, tightening and resurfacing.
• Ablative > Non-Ablative
• CO2 > Erbium > Near Infrared
• Heats the dermis greater than all other wavelengths.
Laser Feature
Mixto SX® Lasering
Encore®Lumenis
Pixel®Alma Laser
Lux 1540Palomar
Affirm®Cynosure
Fraxel®Reliant
Wavelength 10.600 nm 10.600 nm 2940 nm 1540 nm 1440 nm 1550nm
Type of Emission Continuous\
PulsedPulse Pulse Pulse Pulse Continuous
Beam Spot size 0.3 mm 1.3 mm 0.7 mm 0.2-0.3mm N.A. N.A.
Scanned area 20x20 mm 14x14 mm 11x11 mm 10-15 mm 10 mm N/A
Scanner Yes Yes No Yes No Yes
Mode Ablative Ablative Ablative Nonablative Nonablative Nonablative
NecrosisNecrosis
CoagulationCoagulation
15401540 15401540 15401540 COCO22COCO22
COCO22
Why MiXto sx® Microfractional CO2
• Innovative Computerized Pattern Generator
– Microspot - 300u
– Covers 20% of the surface on each pass
– Algorythm avoids heat build-up
MiXto sx® after 24 hours
Why MiXto sx® Microfractional CO2
• Innovative Computerized Pattern Generator
– Microspot - 300u
– Covers 20% of the surface on each pass
– Algorythm avoids heat build-up
Video
Why MiXto sx® Microfractional CO2
• Price
• Two Year Warranty
• Results
Two Controls
• Depth of heating (sx)
• Tissue ablation (power)
Choosing your settings• Baseline*- 8 sx, 8 power
• Face* - may do multiple passes
– Acne/Chicken Pox - 6 sx, 11 power– Tightening - 5 sx, 10 power
• Neck, Décolletage, Hands and Arms* - generally one pass – 6 sx, 10 power
*These are only recommended as guidelines, each patient needs to be evaluated individually.
Benefits of MiXto sx®
• Versatile (Face, Neck, Décolletage, Hands and Arms)
• Easy and fast– Face (20 – 40 minutes)– Neck (15 - 30 minutes)– Chest (20 – 30 minutes)– Each Hand (10-15 minutes)
• Topical anesthetic– BLT (20%, 6%, 4%)
• TLC Pharmacy, Hermosa Beach - 310-798-5400
• All skin types
Benefits of MiXto sx® (cont.)• Minimal Discomfort
– Moderate Sunburn sensation – 30 minutes – 3 hours– Erythema and Edema – 1 – 3 days– Tightening and Itching – 7 days
• Minimal Risks for:– Hypo/Hyper Pigmentation– Scarring
• Minimal downtime– Face – 3-6 days– Neck and Hands – 7-10 Days– Chest – 10 – 21 Days
Progression Photo’sProgression Photo’s
Before
Post Op - Day 2
Post Op - Day 3
Post Op - Day 9
Progression #1
BEFORE DAY 2 DAY 3 DAY 9
Before
Post Op - Day 3
Post Op - Day 6
Post Op - Day 12
Progression #2
BEFORE DAY 3 DAY 6 DAY12
Before
Post Op – 10 Minutes
Post Op - 24 Hours
Post Op - 3 Days
Post Op - 8 Days
Progression #3
Progression #4Type III – 52 Yrs – Face 2 Passes (Sx 6/Pwr 10)
Neck 1 Pass (Sx 6/Pwr 10)
6 Days – Post Op 30 Days – Post Op
Before/After Photo’sBefore/After Photo’s
Before/After Photo’sType II – 2 passes
Sx 6/Pwr 10
Before/After Photo’sType II – 36 Yrs. – 2 passes
Sx 6/Pwr 10
Before/After Photo’sType IV – 44 Yrs – 3 Passes
Sx 6/Pwr 10
Before/After Photo’sType I – 56 Yrs. – 2 Passes
Sx 6/Pwr 10
Before/After Photo’sType IV – 58 Yrs. – 3-4 Passes
Sx 6/Pwr 10
Patient Selection
1. Realistic Expectations
2. Medical History• Herpes Simplex• Keloids• Pregnant/Breast Feeding• Accutane within 12 months• Committed to Sunscreen – 45 or higher
Pre-Operative
• No Asprin or Anti-Inflamatory Drugs – 3 days prior/post
• Famvir – 500 mg – T.I.D. – 10 days
• Keflex – 500 mg – T.I.D. – 7 days
• TriLuma Cream – 4 weeks prior to treatment every second to third day for skin types II, III, IV.
Post-Op• Immediate
– Hydrating Gel (Cicalfate - Avene, Aloe Vera Gel, etc.)– Sunscreen - SPF 45 or higher– Fan
• 7 Days– Hydrate – Luke Warm Shower – 5 X a day– Lubricate
• Elta M.D.• Aquaphor
– Sunscreen - SPF 45 or higher• General
– No financial decisions for 24 hours– Avoid Sun Exposure
• Sunscreen, Broad Brim Hat, Scarf– Avoid Strenuous Exercise 3 – 7 days – Call office for any pain greater than a mild sunburn
Physician Recommendations
• Proceed cautiously
• Use Eye Protection
• Be less aggressive on neck, chest, hands, arms
• Gradually increase power
• Gradually decrease SX
• Remember – Ablative lasers CAN scar