Post on 01-Dec-2014
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Palomar MedicalPalomar Medical
StarLux StarLux
Advanced Advanced
Treatment PearlsTreatment Pearls
Rich BankowskiRich Bankowski
Field Clinical DirectorField Clinical Director
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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
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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)
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StarLux SystemStarLux System
Optimized Spectrum for Optimized Spectrum for Precise TargetingPrecise Targeting
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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
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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
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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
At 20 ms increased to 46 j/cmAt 20 ms increased to 46 j/cm22
At 100 ms increased to 60 j/cmAt 100 ms increased to 60 j/cm22
All Vascular lesions are treated with Lux GAll Vascular lesions are treated with Lux G
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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
StarLux SystemStarLux System
LuxGLuxG™™ Pulsed Light Handpiece Pulsed Light Handpiece
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StarLux SystemStarLux System
LuxG Effect on BloodLuxG Effect on Blood
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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
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SMALL VESSELSMALL VESSEL
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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)
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AVERAGE VESSELAVERAGE VESSEL
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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
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LARGE VESSELLARGE VESSEL
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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
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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)
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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)
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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)
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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+)
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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)
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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
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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
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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
StarLux SystemStarLux System
LuxGLuxG™™ Pulsed Light Handpiece Pulsed Light Handpiece
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Wavelength:Wavelength: 525 - 1200 nm 525 - 1200 nm
Spot Size:Spot Size: 16 x 46 mm16 x 46 mm
Maximum Fluence:Maximum Fluence: 4040 J/cm J/cm22
Pulsewidth:Pulsewidth: 1 - 400 ms1 - 400 ms
Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)
15cm15cm22 /sec (Coverage Rate) /sec (Coverage Rate)
Applications
• Permanent Hair Reduction
• RejuveLux™ Photofacials
• Pigmented Lesions
StarLux SystemStarLux System
LuxYLuxY™™ Pulsed Light Handpiece Pulsed Light Handpiece
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Wavelength:Wavelength: 400 - 700 nm & 870 - 1200 nm400 - 700 nm & 870 - 1200 nm
Spot Size:Spot Size: 16 x 46 mm16 x 46 mm
Maximum Fluence:Maximum Fluence: 25 J/cm25 J/cm22
Pulsewidth:Pulsewidth: 1 - 400 ms1 - 400 ms
Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)
15cm15cm22 /sec (Coverage Rate /sec (Coverage Rate))
Applications
• Acne
• Pigmented Lesions
StarLux SystemStarLux System
LuxVLuxV™™ Pulsed Light Handpiece Pulsed Light Handpiece
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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)
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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
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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
– Lux V 40ms 15-20 j/cmLux V 40ms 15-20 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
– Lux V 100ms 10-15 j/cmLux V 100ms 10-15 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
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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
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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
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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
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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
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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
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Wavelength:Wavelength: 400 - 700 nm & 870 - 1200 nm400 - 700 nm & 870 - 1200 nm
Spot Size:Spot Size: 16 x 46 mm16 x 46 mm
Maximum Fluence:Maximum Fluence: 25 J/cm25 J/cm22
Pulsewidth:Pulsewidth: 1 - 400 ms1 - 400 ms
Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)
15cm15cm22 /sec (Coverage Rate /sec (Coverage Rate))
Applications
• Acne
• Pigmented Lesions
StarLux SystemStarLux System
LuxVLuxV™™ Pulsed Light Handpiece Pulsed Light Handpiece
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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
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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.
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Wavelength:Wavelength: 525 - 1200 nm 525 - 1200 nm
Spot Size:Spot Size: 16 x 46 mm16 x 46 mm
Maximum Fluence:Maximum Fluence: 40 J/cm40 J/cm22
Pulsewidth:Pulsewidth: 1 - 400 ms1 - 400 ms
Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)
15cm15cm22 /sec (Coverage Rate) /sec (Coverage Rate)
Applications
• Permanent Hair Reduction
• RejuveLux™ Photofacials
• Pigmented Lesions
StarLux SystemStarLux System
LuxYLuxY™™ Pulsed Light HandpiecePulsed Light Handpiece
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StarLux SystemStarLux System
LuxRLuxR™™ & LuxRs & LuxRs™™ Pulsed Light Handpieces Pulsed Light Handpieces
Applications
• Permanent Hair Reduction
Wavelength:Wavelength: 650 - 1200 nm650 - 1200 nm
Spot Size:Spot Size: 12 x 28 mm12 x 28 mm
Maximum Fluence:Maximum Fluence: 7070 J/cm J/cm22
Pulsewidth:Pulsewidth: 5 - 400 ms5 - 400 ms
Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)
Wavelength:Wavelength: 650 - 1200 nm650 - 1200 nm
Spot Size:Spot Size: 16 x 46 mm16 x 46 mm
Maximum Fluence:Maximum Fluence: 4545 J/cm J/cm22
Pulsewidth:Pulsewidth: 5 - 400 ms5 - 400 ms
Maximum Speed:Maximum Speed: 2 Hz (Pulse Rate)2 Hz (Pulse Rate)
15cm15cm2 2 /sec (Coverage Rate)/sec (Coverage Rate)
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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.
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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
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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)
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Perifollicular Edema Perifollicular Edema Skin Type II MaleSkin Type II Male
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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
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Before 6 Mo Post Tx 7Before 6 Mo Post Tx 7
Lux Rs
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StarLux SystemStarLux System
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
Maximum Fluence:Maximum Fluence: 700 J/cm700 J/cm22
Pulsewidth:Pulsewidth: 5 - 100 ms5 - 100 ms
Maximum Speed:Maximum Speed: 1 Hz (Pulse Rate)1 Hz (Pulse Rate)
Applications
• Leg Veins
• Vascular Lesions
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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
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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
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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.
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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)
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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
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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
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Thank youThank you
For more information contact your trainer or Palomar Medical1-800-Palomar
1553-0076-A