1.Intense Pulsed Light (IPL) Benefits & Drawbacks Dr. Patrick Treacy MD Ailesbury Clinics Ltd. Professional Beauty Dublin Oct 2012

2. MEDICAL DISCLOSURE: Dr. Patrick J. Treacy is a Cosmetic Doctor presently on the Specialist Register in the UK & Ireland. Specialist Dermatologist. Previously worked in United States., United Kingdom, Australia, New Zealand, South Africa and Gibraltar. No financial interest or stock in Lumenis nor do I receive any additional remuneration for giving this IPL lecture. 3. Agenda IPL Skin Treatments Using Photorejuvenation The Science Behind IPL What IPL Can Do Skin Treatments Using Photorejuvenation Type I Type II Type III (pending FDA clearance) Technologies Available on IPL Platforms Unwanted Veins Tattoo Removal Treatment of Wrinkles and Skin Laxity Treatment Considerations Complications of IPL Whats New in IPL technology 4. Before and After Female with facial veins Before and after 3 IPL treatments Courtesy of Jerry Darms, MD, Lake Oswego, Oregon Before After 5. Before and After Female with facial veins Before and after 3 IPL treatments Courtesy of Jerry Darms, MD, Lake Oswego, Oregon Before After Telangiectasia 6. Before and After Female with ruddy complexion Before and after 3 IPL treatments Courtesy of Robert Weiss, MD, Hunt Valley, Maryland Before After 7. Before and After Female with ruddy complexion Before and after 3 IPL treatments Courtesy of Robert Weiss, MD, Hunt Valley, Maryland Before After Rosacea 8. Before and After Female with sun damage Before and after 3 IPL treatments Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado Before AfterLentiges 9. Before and After Female with sun damage Before and after 3 IPL treatments Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado Before AfterSun Damage 10. Before and After Female with sun damage Before and after 3 IPL treatments Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado Before After Sun Damage 11. Before and After Female with poikiloderma Before and after 3 IPL treatments Courtesy of Mary Grey, MD, Auckland, New Zealand Before After 12. Before and After Female with poikiloderma Before and after 3 IPL treatments Courtesy of Mary Grey, MD, Auckland, New Zealand Before After Poikiloderma 13. Before and After Female with age spots (sun-induced freckles) Before and after 1 IPL treatment Courtesy of Franklin Johnson, MD, Mineola, New York Before After Age Spots 14. Before and After Male with vascular changes Before and after 3 IPL treatments Courtesy of Gayle Rothenberg, MD, Houston, Texas Before After Vascular Changes 15. Before and After AfterBefore Histology 16. The Science Behind IPL 17. What is IPL? IPL = Intense Pulsed Light Visible and near infra-red light, 500-1200 nm Efficacious Flexible Safe Elora, IPL Quantum and Lumenis One 18. How IPL Works: Selective Photothermolysis Selective Specially selected wavelengths of light penetrate the skin, reaching the target (hemoglobin, melanin) with minimal epidermal/dermal absorption Photothermo- The light is converted to heat in the target -Lysis Heat coagulates the proteins in the target and is conducted to the cells around, causing mechanical damage Clearance by immune system cells 19. How IPL Works: Selective Photothermolysis 1. Specially selected wavelengths of light penetrate the skin 2. Target (haemoglobin, melanin) absorbs the light with minimal epidermal/dermal absorption 3. Light is converted to heat, destroying the vessel or lesion 4. Damaged tissue is removed by the body 20. Quick Rule 1: Different objects preferentially absorb different wavelengths of light. (selective absorption) 21. Quick Rule 2 The right wavelength can selectively destroy the object without affecting the surrounding tissue. (selective photothermolysis) 22. Spectral Selectivity 23. Laser Types x-rays cosmic rays Microwaves TV and radio waves Excimer KTP Nd:YAG Er:YAG 190-390 488-514 532 577-630 755 694 1064 2940 10600 UV VISIBLE INFRARED 400 nm 700 nm Holmium 2100 24. Selective Photothermolysis 25. Properties of Laser Light Collimated: Minimal divergence of light bundle Monochromatic: Only one wavelength Coherent: Defined phase relation White light (Divergent) White light (Complete visible spectrum) Laser Light Laser Light Laser Light White light (Incoherent) 26. IPL vs. Laser Single wavelength targets single peak of melanin and hemoglobins absorption spectra to destroy target Wavelength cannot be adjusted for individualized treatment Multiple wavelengths target multiple peaks of melanin and hemoglobins absorption spectra to destroy target Wavelengths can be optimized to individuals skin types and conditions, using filters Minimal ocular hazard No down-time, non- ablative procedure with minimal side-effects Laser IPL 27. During the pulses, light energy is delivered During the delays, the tissue cools More energy can be be safely delivered to the target IPLs Efficacy: Multiple Synchronized Pulsing Pulse 1 Pulse 2 Pulse 3 Delay 1 Delay 2 28. Technologies Available on IPL Platforms 29. Two heads are better than one Nd:YAG Module 2 Spot Sizes (2 x 4 mm and 6 mm) to ensure precision treatment with computer- enabled recognition Continuous contact cooling with SapphireCool Light Guides to measurably increase patient comfort and enhance Light Guide durability 30. What IPL Can Do IPL is the gold-standard for photorejuvenation Treats redness and rosacea symptoms Treats brown pigmentation and age spots Leaves the skin soft and smooth Treats the full face, neck, chest, and hands Requires no downtime 31. What IPL Can Do Type I Skin Treatments Using Photorejuvenation: Erythema/Flushing Rosacea symptoms Telangiectasia Hyperpigmentation Melasma Photoaging 32. Why treat pigmentary conditions? 75% of the Irish population between the ages of 35 and 65 have some type of treatable pigmented lesion. What IPL Can Do Pigmentary Conditions 33. Treatment options for pigmentary conditions: IPL Lasers Liquid nitrogen Chemical peels (Micro-) Dermabrasion Surgery Topicals, including bleaching Prescription drugs No treatment What IPL Can Do Pigmentary Conditions 34. What IPL Can Do Pigmentary Conditions 35. What IPL Can Do Vascular Conditions Treatment options for vascular conditions: IPL Lasers Sclerotherapy Compression stockings Combination No treatment 36. What IPL Can Do Vascular Conditions Why treat Vascular Conditions? 1 million Irish people suffer from benign vascular condition such as: Spider veins and other telangiectasia Haemangiomas Port wine stains and other vascular malformations - 3 in 1000 births Rosacea - estimates of 150,000 Irish people, many who go untreated 37. What IPL Can Do Vascular Conditions 38. What IPL Can Do Type II Skin Treatments Using Photorejuvenation Dermal and epidermal structural changes Elastotic changes Wrinkles 39. What IPL Can Do Type II : Clinical Research 40. Before 6 Months After 5-ALA therapy followed by IPL treatment What IPL Can Do Type III : Photodynamic Photos courtesy of Mitchel Goldman, MD Pending FDA Clearance 41. Before 6 Months After 5-ALA therapy followed by IPL treatment What IPL Can Do Type III : Photodynamic Photos courtesy of Mitchel Goldman, MD Pending FDA Clearance 42. Procedure Acetone scrub 5-ALA therapy with 30 minute incubation Lumenis IPL at 30 J/cm2 Before After What IPL Can Do Type III : Photodynamic Photos courtesy of Dore Gilbert, MD Pending FDA Clearance 43. What IPL Can Do Unwanted Hair 44. Before Female with hair on the chin Before and 6 months after 3 IPL treatments Courtesy of Robert Weiss, MD, Hunt Valley, Maryland After What IPL Can Do Unwanted Hair 45. Before Female with spider veins Before and 2 months after 4 IPL treatments Courtesy of Marc Troxler, MD, Arlesheim, Switzerland After What IPL Can Do Unwanted Veins 46. Why treat leg veins and deep vascular lesions? Varicose veins are present in approximately 50% of women and 20% of men before the age of 60. 50% of people with varicose veins are bothered by symptoms. Almost all are bothered by appearance. What IPL Can Do Unwanted Veins 47. Treatment Considerations Parameter selection Easy presets for novices Customizable parameters for advanced users 48. Treatment Considerations Contraindications Malignancy Prolonged sun exposure or tanning within four weeks pre- or post-treatment Photosensitizing drugs Relative contraindications Diabetes History of keloid scarring Pregnancy 49. IPL Photorejuvenation Complications / Adverse Effects Dissatisfaction Ecchymosis (purpura) Tiger Stripes Leopard Spots Burns No scars to date Hyperpigmentation Hypopigmentation Epidermal Crusting Adverse reactions can spoil everything - for the patient, for the dr, for all the drs Photos: R Weiss MD pre 1 day post 3 weeks post 50. Problems 51. Problems 52. Problems 53. Problems 54. Causes for Burns Fluence too high Filter wavelength too short Pulse duration too short Pulse delay too short Insufficient quantity of gel NO TRAINING! 55. Photorejuvenation 56. Photorejuvenation 57. Whats new in IPL? 58. OPT Optimal Pulse Technology Square Off the pulse Typical IPL pulses have energy peaks, followed by decline Lumenis One and M22 have the ability to control the pulse shape, each of them individually OPT: squares off and equalizes the pulses, delivering consistent, homogeneous energy over the duration of the pulse Even more important with a train of pulses 59. OPT Optimal Pulse Technology Safety Eliminating the energy peak at the beginning of the pulse Efficacy Current Pulse Shape Addition of energy to the ineffective decline at the end of the pulse New Pulse Shape Reproducibility Homogeneous squared off energy distribution 60. Accessories M22 Cart 61. Just what you need, when you need it The new Multi-Application platform Grows with your business Allows add-ons Expands to treatment needs Adapts to future applications as they emerge 62. Technology & Applications 63. A single head with many ideas One Treatment Head Change Filters instead of hand piece Saves time, storage space and purchase of multiple, expensive treatment heads 6x Expert Filters: (515, 560, 590, 615, 640, 695 nm) 2x SapphireCool Light Guides (15 x 35mm; 8 x 15mm) 64. Cut off Filters Treatment of following skin conditions with just one Head: 65. Cut off Filters 66. Pigmented Lesions 67. Clinical Indications What can we treat? 68. Pigmented Lesions 69. Lentigines Solar Age," "sun" or "liver" spots Commonly appear as medium to dark brown Hands, face, forearms and chest Senile Most fair-skinned people in middle age Flat, round or oval-shaped, and have a slightly irregular border. 70. Solar Keratosis Warning sign you are prone to sun damage and skin cancer Red, flattish, scaling dry skin that may sting if scratched Appear on areas of skin most often exposed to the sun, like hands and face Most common in people over forty years. Keratosis 71. Caf-au-lait Most often present at birth Determined by color of coffee and milk 50 % chance of reoccurrence Treat with IPL or Q- Switch 72. Haemosiderin Brownish pigment containing iron May make the skin appear brown or orange after a bruise or other injury heals. Post injury that causes red blood cells to leak i.e. sclerotherapy 73. Becker nevus Skin disorder predominantly affecting males Nevus first appears as an irregular pigmentation On the torso or upper arm, and gradually enlarges irregularly, becoming thickened and often hairy 74. Ota Nevus Blue to dark brown pigmentation Dermal - Usually at birth The nevus of Ota is usually located in the region of the eye and maxillary division of the trigeminal nerve Treat with IPL or Q-Switch 75. Ito Nevus The nevus of Ito is usually located on the shoulder, side of neck, and supraclavicular areas 76. Hyperpigmentation Excess skin pigmentation Can be the symptom of a severe disease In certain conditions melanocytes can become abnormal and cause an excessive amount of darkening in the color of the skin Treatment combination IPL and Hydroquinone (bleaching cream) 77. VASCULAR LESIONS 78. PWS Port Wine Stain Child Present at birth Pink to dark or bluish red, abnormal blood vessels Do not change color when gently pressed and do not disappear over time Adult May become darker and may bleed 79. After 4 TreatmentsBefore Female, Skin Type II, Port Wine Stain ARM and SHOULDER Universal IPL treatment head and Nd:YAG IPL: Triple pulse, 3/20/3/20/3, 590 nm filter, 20-29 J/cm2 Nd:YAG: Single pulse, 14 ms, 110 J/cm2 Basmat Zamir, MD 80. Port Wine Stain After 4 TreatmentsBefore Female, Skin Type II, Port Wine Stain ARM and SHOULDER Universal IPL treatment head and Nd:YAG IPL: Triple pulse, 3/20/3/20/3, 590 nm filter, 20-29 J/cm2 Nd:YAG: Single pulse, 14 ms, 110 J/cm2 Basmat Zamir, MD 81. Facial Dilated superficial blood vessels Red, pink or purple, they will absorb more of the laser light than the surrounding normal skin IPL effective, may reoccur 82. Telangiectasias Facial Dilated superficial blood vessels Red, pink or purple, they will absorb more of the laser light than the surrounding normal skin IPL effective, may reoccur 83. Truncal Thin skin secondary to long-term steroid use or aging, collagen vascular disease, and hormonal variation (particularly estrogen) 84. Hemangioma Nodular Raised, flesh-colored nodule, which often has a bluish hue or an overlying telangiectatic patch Regular Bright red, flat area resembling a port-wine stain Upper layers of skin 85. IPL SKIN TREATMENTS 86. Rosacea Progressive Stages of Rosacea Stage One Flushing skin Stage Two Persistent redness and inflammation Unexplained bumps and pimples Not painful 87. Rosacea Stage Three Visible blood vessels Painful to the touch Thickening on the nose or cheeks Blood pooling under the skin : bruising Stage Four: Full-Blown Eye irritation Burning or stinging, crusty, scaly, with persistent pain Combination of topical, antibiotic medication , and IPL 88. Uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. Associated with the female hormones estrogen and progesterone Treatment with IPL can be difficult Treatment combination with hydroquinone Avoid sun exposure 89. Melasma Uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face) Associated with the female hormones estrogen and progesterone Treatment with IPL can be difficult Combination with hydroquinone Avoid sun exposure 90. Poikiloderma Reddish-brown colour Erythema and mottled pigmentation seen on the sides of the neck Most commonly seen in women Photosensitizing chemicals in perfumes or cosmetics Avoid sun exposure 91. Age Spots/ Telangiectasias (M) Mild Over exposure to the sun (S) Severe Dense pigmentation and enlarge capillaries (N-F) Non-Facial Hands, arms, chest exposed to sun Use lower energy