Ellman Sandstone Cheveux™ Permanent Hair Reduction 810 Diode Laser.

Ellman Sandstone Cheveux™

Permanent Hair Reduction

810 Diode Laser

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From Razor to Laser

• Methods of hair removal– Shaving– Waxing / plucking– Depilatories and creams (bleaches)– Electrolysis / electrothermolysis– Laser/light-based hair removal

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Benefits of Laser Hair Removal

• Treats a large area quickly• Low risk of side-effects• Temporary hair reduction for all hair types• Long-term growth delay• Permanent hair reduction

Cheveux™ Diode Laser

Absorption Spectrum of Major Chromophores in Skin

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How Laser Hair Removal Works

• Laser energy is selectively absorbed by the melanin in the hair follicle and converted to heat, injuring the follicle.

• Most hair is permanently removed. Hair that does regrow is finer and lighter than before.

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Appropriate Pulse Durations• Pulse duration: key in destroying the follicle without

excessive damage to the epidermis– With a pulse duration and energy chosen properly for a

particular skin type, the follicle can be destroyed with minimal heat damage to the epidermis (selective photothermolysis).

• The larger the target, the longer the thermal relaxation time (defined as the time required for an object to cool to 50% of the temperature achieved immediately following laser exposure). – Finer hair has shorter TRT. – Coarser hair has longer TRT.

• Longer pulses allow heat to safely spread from the epidermis, especially important with darker skin types (e.g. 100ms, 400ms).

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Who is a Candidate?

• The Cheveux™ is safe and effective on all skin types and tanned skin

• Works best on darker hair– Red or light brown hair may take more treatments

to be effective– Blonde, gray and white hair do not contain

melanin so treatments are not recommended

• Can treat any area of the body– For safety avoid treating within ocular socket/orbit

or on mucous membrane

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Number of Treatments

• Three phases of normal hair growth: – Anagen (active)

– Catagen (regression)

– Telogen (resting)

• Follicle most susceptible during anagen phase• 1/3 to 2/3 of hair is in Anagen phase at any time• Hair has most melanin in the bulb during Anagen phase and absorbs the

most energy to disable stem cells

• Multiple treatments required 4 to 6 weeks apart

– 3-6 treatments for lighter skin patients

– 4-8 treatments for darker skin patients

– During initial treatment, only 1/3-2/3 hair will be effected

• Permanent reduction typically 50-90% following

multiple treatments

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Pre-Treatment

• Pt. cannot wax, pluck or undergo electrolysis for 6 weeks beforehand – Can shave or trim

• Avoid active tanning in area to be treated for 4 weeks prior to treatment

• No self-tanning products 2 weeks prior to treatment

• Obtain photographs

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Pre-Treatment

• Patient selection– Gray or blond hair not good candidates– Avoid treating if history of pronounced keloids– Avoid treating over tattoos or permanent make-up– History of herpes simplex virus (HSV) - pretreat with

antiviral medication– Stop Accutane for at least 6 months– Caution if patient on photosensitizing medications– Caution if history of hyper- or hypopigmentation

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Eye Safety

• Can cause severe retinal injury• No treatment within bony orbit of eye (outer

canthus). Treatment of eyebrows not recommended.

• Ocular Hazard Zone:– 164 feet / 50 m• Use occlusive goggles when treating the face

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Safety

• Enclosed room, windows covered• Laser safety sign posted outside door• Laser in standby when not actively used• Key removed when not in use• Laser beam directed only at target or calibration

port

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Safety

• Footswitch clean and out of way when not in use• Do not treat over paper or cloth• Do not store flammables in the room• Available fire extinguisher• Follow ANSI standards for Class IV laser

– Contact Laser Institute of America (LIA) (800) 34LASER for current ANSI and OSHA standards

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Laser Hair Removal Technique

• Treatment is simple and straightforward– Set patient expectations – Obtain health history– Informed consent signed– Area clean and shaved prior to treatment– If desired, topical anesthetic cream applied

30-60 minutes before treatment• Caution if lidocaine allergy

– Settings chosen based on skin type and hair density

– Look for the presence of a tan– Test spotting recommended

Skin Type Skin Color Characteristics

I White; very fair; red or blond hair; blue eyes; freckles Always burns, never tans

II White; fair; red or blond hair; blue, hazel, or green eyes

Usually burns, tans with difficulty

III Cream white; fair with any eye or hair color; very common

Sometimes mild burn, gradually tans

IV Brown; typical Mediterranean Caucasian skin Rarely burns, tans with ease

V Dark Brown; mid-eastern skin types Very rarely burns, tans very easily

VI Black Never burns, tans very easily

Fitzpatrick Skin Type Classification Scale

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Suggested Treatment Parameters

Fitzpatrick Skin Type Starting Fluences (Test Spots) Tolerated Fluences Pulse Width

I

35J/cm2

Wait at least 15-30 minutes.Observe epidermal response,

increase or decrease by 2-5 J/cm2.

15-60 J/cm2 Auto

30 ms – highhair density areas

II

350J/cm2



15-60 J/cm2 Auto

30 ms – highhair density areas

III

25J/cm2



10-45 J/cm2 Auto – finer hair

30 ms – coarser hair or high hair density areas

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Fitzpatrick Skin Type Starting Fluences (Test Spots) Tolerated

Fluences Pulse Width

IV

20 J/cm2 for 100 ms 10-45 J/cm2 30 ms – finer hair

100 ms – coarser hair or high hair density areas

1-10 J/cm2 for 400 ms 1-10 J/cm2 100 ms for coarse hair



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Fluences Pulse Duration

V

15-20 J/cm2 for 100 ms 1-35 J/cm2 100 ms

1-10 J/cm2 for 400 ms 1-10J/cm2 400 ms

Wait at least 48-72 hours.Observe epidermal response,


VI

10-20 J/cm2 for 100 ms 10-20 J/cm2 100 ms

1-10 J/cm2 for 400 ms 1-10J/cm2 400 ms

Wait at least 48-72 hours.Observe epidermal response,


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Fluences Pulse Duration

All Skin Types – Tanned Skin

Use low range of fluences recommended for one skin type darker than patient’s

skin type (e.g. treat tanned skin type III as skin type IV).

Perform test spots on areas with same degree of tan as area to be treated.

n/a 100 ms

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Operator Technique

•Secure wrist strap!• Apply water-based gel on area to be treated (this may be kept

refrigerated)• Apply gel in no bigger than 12 inch square area as it tends to

dry out• Spot size is 9mmX9mm – laser spreads under skin• Overlap 10%• Larger spot sizes – deeper penetration in skin

•Apply slight compression•Keep chilled tip flat on the skin surface at a 90o angle

-Surface skin is cooled by chilled tip (4° C) to minimize heating of skin

•Inspect and clean tip frequently during treatment!•Caution if treating over moles or suspicious lesions

• Observe skin for unwanted effects such as excessive erythema, blistering

• Perifollicular edema is to be expected – resolves in 2 hours• Perform a test spot behind ear to ensure safety to skin – wait

24 hours• Do not overlap over 10% or treat area twice• Make sure tip is always in contact with skin when treating• Place wet gauze under lip when treating• Do not try to sculpt eyebrows• Never treat inside orbital rim• Use goggles when treating glabellar area to protect eyes• Place cotton ball in ears when treating tregus• Place white sponge behind ear when treating pinna• Stop treatment If greying or separation

Expected Sequelae and Tips

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Positive Clinical Endpoints

Courtesy C. Dierickx M.D.

• Perifollicular erythema and edema- Bumps around follicle several minutes after

treatment- Less pronounced on darker skin types

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Post-Treatment

• Sunburn sensation is normal• Takes 2 weeks for hair to shed• If desired, cold compress, aloe or hydrocortisone

cream applied after treatment• Gently clean area twice daily• Stop glycolics, retinoids etc• Sunscreen for 6 weeks over the area• Describe singed hair and shedding process• Patient returns in 4-8 weeks for next treatment• After completion of initial treatment touch-up

treatments at 6 month intervals may be required to disable resistant hairs in treatment area

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Potential Risks

• Perifollicular edema/erythema – Favorable post-treatment response– Usually resolves w/in 24 hours

• Local blisters - too high fluence, dark skin• Hyper/Hypopigmentation

– Transient, should clear within 6-12 months, – Fluence and skin type dependent

• Scarring – Extremely rare

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Ideas For Getting Started

Promote• Good idea to treat staff so they can speak

knowledgeably about procedure• Mention availability to patients • Brochures • Posters in waiting room, office bathrooms, exam

rooms• On-hold message introducing laser• Phone staff should be able to answer basic

questions

Ellman Sandstone Cheveux™ Permanent Hair Reduction 810 Diode Laser.

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