Titan Mobile Presentation-QuickRef

8/3/2019 Titan Mobile Presentation-QuickRef

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December, 2008 - D0777_Rev. A - Titan Mobile Technique

IndicationsIndicationsIndications

The Cutera Titan handpiece is US FDA-cleared fheating for the purpose of elevating tissue temptemporary increase in local circulation where ap

The Cutera Titan Handpiece is EU CE marked fotreatment of wrinkles

Histologic evidence following Titan exposure shcontraction

– Zelickson B, Ross V, Kist D, Counters J, Davenport S, SUltrastructural Effects of an Infrared Handpiece on ForeAbdominal Skin. Dermatologic Surgery 2006;32:897-90

The wavelength is 1100-1800nm

Appropriate for all skin types




Spot SizeSpot SizeSpot Size

Spot Size: size of treatment window – Titan S and Titan V: 1.5 cm x 1 cm

– Titan XL: 3 cm x 1 cm

– Treatment window maintained at 20º C for cooling

Titan S Titan V Tit




General ConsiderationsGeneral ConsiderationsGeneral Considerations

The decision to treat with light therapy based upon appropriate diagnostic evalconsideration of all patient factors.

The Titan Handpiece should only be opequalified practitioners who have receiveappropriate training and have thoroughoperator manual.

Please consult the Titan Treatment Guidthe Operator Manual for additional infoincluding indications for use, contraindipossible adverse effects, safety warning

features, and system operation.

Appropriate parameters will vary. Alwaytissue reaction during treatment.




General ConsiderationsGeneral ConsiderationsGeneral Considerations

Proper patient screening, parameterselection, treatment technique, epidercooling, and tissue observation areimportant to achieve the desired outcowithout unwanted side effects.

It is important to observe tissue reactduring treatment. Excessive heating oskin can increase the risk of blisteringburns, erosion, hyperpigmentation, an

hypopigmentation; some of which maresult in scarring.




ContraindicationsContraindicationsContraindications

Pregnant Patients

Treatment of Skin Cancer




Pre-Op – Medical HistoryPrePre--OpOp –– Medical HistoryMedical History

The following conditions are not contraibut should be considered before treatin

– Current medications (both routine and occas• Accutane – do not treat if taken in the last 6 month

• Aspirin, ibuprofen, herbs (such as St. John’s Wort), anticoagulants

– The above examples may increase risk of purpu

• Gold Therapy

– May cause blue-gray discoloration

• Photosensitizing drugs (Tetracyclines, etc.)

– Be aware that you may have to adjust the treaaccording to clinical response from test area(s)

– History of vitiligo• Heat from the treatment could induce a flare-up in

existing vitiligo.




Pre-Op – Medical HistoryContinuedPrePre--OpOp –– Medical HistoryMedical History

ContinuedContinued

– History of Herpes• Pre-treatment with an antiviral may be i

– History of Coagulopathies

– Diabetes

• May impede wound healing

– Autoimmune diseases

– Wound Infections

– History of Keloids or Hypertrophic Scarring

– Tattoos, including permanent make-up, in tarea

• Do not treat over tattoos.

–Pacemaker or defibrillator (consult cardiolog

– Implants or surgeries in treatment area




Patient Prep – CleanPatient PrepPatient Prep –– CleanClean

Remove all make-up, sunscreen, topicaanesthetics, etc.

– Any creams or products left on the skin canthe light and increase the risk of unwanted

– Skin products and/or chemicals (i.e., depila

tanners, etc.) normally tolerated by a patiean adverse skin reaction with pulsed light tAvoid using these products at least 24 hourafter treatment.




Pre-op photos are your MOST valuable protection. You only have one chance togood pre-op photos.

• Document baseline condition

• Use for comparison purposes later on in t

• Consistent technique is important for usephotos.

– Matched patient positioning

– Camera settings

– Room lighting

• Side views often show the best results

Pre-Op – PhotosPrePre--OpOp –– PhotosPhotos




Patient Prep – ShavePatient PrepPatient Prep –– ShaveShave

Shave the treatment site.

– Remove all hair from the surface of the skincomplete contact with the cooling device.

– Hair in the treatment area may not allow fulthe handpiece with the skin.




Eye SafetyEye SafetyEye Safety

Safety eyewear must be worn by ALL the treatment room.

Example Operator Eyewear Patient Eyew




These treatments, if performed propertolerated without anesthesia.

Anesthetics may be used, but are not

recommended.

– The use of anesthetics is not recommendedfeedback is important in determining treatm

– If used, topical anesthetic must be completprior to treatment.

• CAUTION: Toxicity may result with overuse anesthesia. Consult the manufacturer's labe

Patient Prep – Patient ComfortPatient PrepPatient Prep –– Patient ComfortPatient Comfort




Advanced Guidelines for MobileTechniqueAdvancedAdvanced GuidelinesGuidelines for Mobilefor Mobile

TechniqueTechnique

Common approach for treating: – Fluence can be adjusted outside the given ranges

• Patient should be able to tolerate the treatment withmoderate level of discomfort.

– 3 to 5 treatments with an average of 4 week inter

– The number of exposures (pulses) required can vafrom patient to patient based on the size of the ar

*These parameters are based on physician feedback and provided as a guide only. Obpatient discom fort and, area being treated to determine appropriate settings for eachTreatment Guidelines for more information.

38-44 J/cm2

FluenceNeck

40-46 J/cm2I-VI

Including tanned skin

FluenceFace

Skin Type




Mobile TechniqueMobile TechniqueMobile Technique

Allows for a significant increase in fluence compstationary method

– Example: Stationary technique – 36 J/cm2

Mobile technique – 46 J/cm2

Move the handpiece in a small circular motion (20% of the crystal dimension) in all directions

– Do NOT move the entire width of the crystal

– The movement should be continuous throughout

Crystal should be placed adjacent to prior placeperformed with the original stationary method to edge without overlap)

– Crystal motion will overlap adjacent treated areatreatment exposure

– See following animated placement slides

Clinical endpoint

– Reach patient pain tolerance limit by end of last tolerance assumes no anesthetic)





Move about 20% all directions





Move about 20% all directions

Crystal should be placed adjacent to priplacement as performed with the originamethod (crystal edge to edge without o

Crystal motion will overlap adjacent treaduring treatment exposure

Pulse 1 Pulse 2




Treatment Technique – Key PointTreatment TechniqueTreatment Technique –– Key PointKey Point

Apply a thick (1 - 3 mm) layer of clearultrasound gel.

– May use chilled gel

Always make sure to keep entire wind

contact with the skin.

Reduce fluence over sensitive or bony

Do not stack individual treatment puls

Do not lift the handpiece until treatme

complete.




Treatment Technique ATreatment Technique ATreatment Technique A

Divide face into smallersections

Treat one area with 3-6passes before moving tonext area

–Repeat for each area onthe face

– Move to neck and treat inthe same manner

Place pulses adjacent toeach other

Do not stack pulses on onespot

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TitanTitanTitan

Results may be subtle and/or delayed

– Collagen remodeling takes 3-6 months

– Do not promise immediate results

Pictures are necessary

– Patients forget what they looked like

Length of results vary

– Results are permanent (new collagen) but pcontinue to age and lose collagen

• Not like injectables that “go away”

– Factors that may diminish outcome or lengt

• Health of patient including skin health• Sun damage – past and future

• Age

• Smoking



Titan Mobile TreatmentQuick Reference Sheet

This Quick Reference Sheet is not intended to be a complete set of guidelines. Refer toaccompanying PowerPoint presentation for guidance on performing the Titan Mobiletechnique. Consult Titan Clinical CD for complete treatment information.

PARAMETER SELECTION

Skin Type FluenceFace

FluenceNeck

Passes

I-VI

Including tanned skin40-46 J/cm2 38-44 J/cm2 3-6

Common approach for treating: Fluence can be adjusted outside the given ranges as needed.

Patient should be able to tolerate the treatment with no more than amoderate level of discomfort

3 to 5 treatments with an average of 4 week intervals The number of exposures (pulses) required can vary significantly from

patient to patient based on the size of the area to be treated. These parameters are based on physician feedback and provided as a guide

only. Observe clinical response, patient discomfort and, area being treated todetermine appropriate settings for each patient. See the Titan TreatmentGuidelines for more information.

TREATMENT TECHNIQUE Allows for a significant increase in fluence compared to stationary method.

Example:o Stationary method – 36J/cm2 o Mobile technique – 46 J/cm2

Move the handpiece in a small circular motion (approximately 20% of the crystaldimension) in all directions

o Do NOT move the entire width of the crystal Crystal should be placed adjacent to prior placement as performed with the original

stationary method (crystal edge to edge without overlap)o Crystal motion will overlap adjacent treated areas during treatment exposureo See animated slides on Titan Mobile Technique presentation or Titan Mobile

Technique video for example Clinical Endpoint is reached when patient reaches pain tolerance limit by the end of

third pass (note: tolerance assumes no anesthetic)

Titan Mobile Presentation-QuickRef

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