AccoladeAccolade

QS Alexandrite 755 nmBenign Pigmented Lesions and Tattoo Removal

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Market Size and Incidence

• Epidermal Lesions- Superficial

• 30% of population has solar lentigines

• 10% of population has café-aulait

• 60% have freckles• Dermal Lesions

• Nevus of Ota and Ito (Acquired Dermal Melanocytosis)

– 0.014%-0.034% of Asian population

– 0.4-0.8% of people of Japanese and Korean descent • Cosmetic, Medical, Body Art Tattoo

• Permanent makeup tattoos

• Reconstructive medical tattoos after mastectomy and surgery

• Cosmetic tattoos to cover up scars and other skin imperfections

• Body Art Tattoos

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Treatment Market Size

• Benign Pigmented Lesion Removal• Global treatment size $2.50 Billion to $6.48 Billion

• 2008 expected US market size $38 M at CAGR 12%*

• Tattoo Removal• 2008 expected US market size $120 M at CAGR 17%*

• International market estimated $45 M

*Source: Millennium Research Group

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Nano vs microsecondPulse Width

Time

Power

Equal amounts of energy

NanosecondPulse Width

MicrosecondPulse Width

Courtesy of:

Dr. Wang Hongwei

Peking Union Medical College Hospital

• Effectively destroys melanosomes and tattoo pigments

• Ultra-short pulse widths required to shatter melanosome/ pigments by photoacoustic effect

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Benign Pigmented Lesions

• Discoloration caused by high concentration of melanocytes in a particular area

• Treatments include cover up with makeup, or painful removal by dermabrasion or cryosurgery

• Mostly for pediatric treatments or as an adjunct procedure in skin rejuvenation for adults

• Lasers remove pigmented lesions through photoaccoustic effects

• Melanin absorbs laser energy more intensely than the surrounding tissue which leads to fracturing of the pigment and melanocyte cell death

• Fractured melanin/melanocyte is removed by the immune system

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Nevus of Ota

• First described in 1861• Bluish hyperpigmentation along the first or

second branches of trigeminal nerve• Most patients have no family history• Age of onset- perinatal period or puberty• Significant predominance among women

• Male to female ratio 1:4.8

• Female hormones suggested as potent stimuli

• Other stimuli include infection, trauma, or ultraviolet light exposure

Source: Chan and Kono et al Nevus of Ota: Clinical Aspects & Management, SKINmed, 2003

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Nevus of Ito, Mongolian spots & Other conditions

Nevus of Ito • Variant of Nevus of Ota. • Skin pigmentation occurs is more diffuse and

less mottled in the acromioclavicular region

Mongolian spot • Sacrococcygeal region • Usually regresses and disappears during

childhood. • The spot is found in almost all newborn Chinese,

Japanese and Mongolian children, as well as some white and black children.

Becker Nevus and Henry Nevus

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Treatment of Pigmented Lesions

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Treatment of Pigmented Lesions

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Incidence – Tattoos

• Sixth fastest-growing retail business in the United States in recent years

• 80% of tattoo customers are upper middle-class white suburban females

• 15-20% of US teens and young adults have tattoos (40M Americans)

• 23% of college students have tattoos

• 50% of everyone receiving a tattoo, wants it removed (ASDS)

“In the 90’s I did five laser treatments a month… now I do that in one day” Elizabeth McBurney, MD

Source: The Pulse, Hofstra University and ASDS- American Society of Dermatologic Surgery

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Treatment of Tattoos

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Treatment of Tattoos

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The Accolade

• Q-Switched Alexandrite Laser

• The Speed of Alex

• The Spot Size of Ruby

• Removes Pigmented Lesions

• Removes Black, Blue, Brown

and Green Tattoos

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Correct Wavelength for Specific Treatment

Alexandrite 755 nm

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Effective Wavelengths

Accolade• 755nm

• Absorbed by most pigments

• Greater depth of penetration for treating deeper structures

• 50-70 ns pulse width• Disrupts

melansomes and tattoo pigments

1320nm Nd:YAG

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Accolade Specs

Wavelength 755 nm

Spot Size

2.0 mm(Max Fluence 18 J/cm2)

3.0 mm (Max Fluence 10 J/cm2)4.0 mm(Max Fluence 5 J/cm2)

5.0 mm (Max Fluence 2.8 J/cm2)

Pulse WidthShort Pulse: Min 50 nsec Long Pulse: 150 μsec

Pulse Rate 1, 2, 5, 10 Hz

Beam Delivery Optical Fiber

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Accolade Improved Design

• Faster than other competing systems• 2x spot size of other Alex

• More than 10x the speed of Ruby

• Faster Treatments and Faster Clearance• Larger Spot and Higher Repetition rate

give the fastest treatment possible• Larger Spot means deeper penetration for

faster clearance

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Accolade Treatments Characteristics

• Accolade treatments are gentler

• Less painful especially for the face

• Greater specificity towards target chromophore

• Reduces damage to peripheral tissue

• Minimum pinpoint bleeding

• Decreases incidence of scarring

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AccoladeFeatures and Benefits

Features Benefits Wavelength: 755 nm Target absorption by tattoo pigments

Treats Black, Blue, Green colors Target absorption by melanin Reduces damage to surrounding tissues

Short pulse: minimum 50 ns Intense high peak energy targeting: Tattoo pigments Melanosomes (cell structures with melanin) No cooling needed (optional)

Long pulse: 150 μs Superficial vascular lesions Persistent epidermal lesions

Spot/ Fluence: 2 mm; min10 to max18 J/cm2 Short Pulse; treats deeper skin levels 3 mm; min5 to max10 J/cm2 Short Pulse; most commonly used; deeper 4 mm; min3 to max5 J/cm2 Short Pulse; treats large areas faster 5 mm; min1.6 to max2.8 J/cm2 Short Pulse; treats larger areas faster Rep Rates: 1, 2, 5, 10 Hz Better treatment control

Faster treatment with higher rep rates Lower rep rates prevent treatment overlap

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Weakness of Other Lasers

Other Suppliers Features Weakness Supplier C QS Alexandrite

QS Alexandrite 755 nm with QS 1064nm & 532nm

Laser Pump Laser Low QS 1064/532 Fluence Max 5 Hz Rep Rate

Highly unstable Internal machine is the QS Alexandrite laser 1064/532 driven by handpiececs Inadequate energy for any treatment with 1064/532 Slower treatment

Supplier H QS ND:YAG

QS ND:YAG 1064 nm & 532 nm Two hand pieces- 585 nm &

650 nm (dye polymer) Claims to do a lot of functions

with one box

More side effects from pinpoint bleeding due to non-specific absorption by hemoglobin & water

Low energy hand pieces not effective Expensive hand pieces More painful treatments than the Alexandrite laser

Other Nd YAG Low price Small size

Unstable pulse width High variability & quality

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Comparison of Different Lasers

Affinity AccoladeSystem TypeWavelength 532nm 532 585 650 532 1064Pulse Width 150 µsec 140 µsec*Max Fluence per Spot Size 8 mm * * * 8 mm 2 J/cm2 * * *

6mm 3 J/cm2 1.5 J/cm2 5mm 6mm 3.0 1.4 J/cm2 * * 5mm 4 J/cm2 1 J/cm2 2 J/cm24 mm 7.0 3.0 4mm 4 mm 6.0 3.0 * * 4mm 6 J/cm23mm 12.0 6.0 3mm 3 mm 12.0 4.0 3.5 J/cm2 2.1 J/cm2 3mm 11 J/cm2 3 J/cm2 6 J/cm22mm 28.0 14.0 2mm 2 mm * 5.0 8.0 4.5 2mm 25 J/cm2 6 J/cm2 13 J/cm2

Max Rep RateAiming BeamElectrical RequirmentsSize (HxWxD)

Price

MedLiteTM C6 AlexTriVantageNd:YAG QS QS Alexandrite Nd:YAG & Dye Impregnated Polymers QS Alex & QS nd: YAG

755nm6 nsec min 50 ns 5–20 ns 50 nsec

1064nm 755nm 1064

*

2.8 J/cm25 J/cm2

10 J/cm218 J/cm2

1, 2, 5, 10 Hz 10 Hz 1, 2, 5 &10 1, 2, 3, 5 HzRed LED Red Diode Laser Red aiming beam Ring Style

32"x10" X 27" 41"x15"x25" 28.5" X 12" X 31.8" 43"x16"x30"200/220 VAC/15A 220 Vac/20A, 50/60Hz, single 220 V, Single Phase, 8 Amps or 110 V, 15 Amps

(109cmx40cmX76cm)$95,500 $95,500 $85,000

(81cmx26cmx69cm) (104cmx38cm64cm) (81cmX30.5cmX72.5cm)

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Clinical Results: Nevus of Ota

BEFORE AFTER

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Nevus of Ota Before & After

Courtesy of:

Dr. Wang Hongwei

Peking Union Medical College Hospital

4 treatments

BEFORE AFTER

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Nevus of Ota Before & After

7 treatments

BEFORE AFTER

Courtesy of:

Dr. Wang Hongwei

Peking Union Medical College Hospital

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Pigmented Lesion Before & After

3 treatments

BEFORE AFTER

Courtesy of:

Dr. Wang Hongwei

Peking Union Medical College Hospital

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Freckles Before & After

1 treatment

BEFORE AFTER

Courtesy of:

Dr. Wang Hongwei

Peking Union Medical College Hospital

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Tattoo Treatment Before & After

After 2 treatments (5.8-8.6 J/cm2)

Eyebrow Tattoo

Caution: Spot test first. Tattoo pigments with iron may turn jet black with laser; continue treatment for black

Courtesy of:

Dr. Lu Zhong Huashan Hospital

BEFORE AFTER

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Tattoo Treatment Before & After

Courtesy of:

Dr. Lu Zhong Huashan Hospital

After 3 treatments (5.8-8.6 J/cm2)

BEFORE AFTER