2. GentleLASE, GentleYAG & GentleMAX
The GentleFamily
GentleLASE, GentleYAG & GentleMAX

3. GentleLASE – 755nm

4. GentleYAG – 1064nm

5. Best of Both Worlds

6. Laser Hair Removal

7. Laser Hair Removal How does it work?
Targets the pigment in the hair follicle.
Heat is absorbed and destroys the cells lining the hair follicle specifically around the bulb, bulge, and vascular supply.

8. Permanent Hair Reduction
The FDA allows us this definition:
“long-term stable reduction in the number of hairs re-growing after a treatment regime”
This is the FDA’s definition of “Permanent Hair Reduction.” Electrolysis is the only methodology that can claim “Permanent Hair Removal” although those who wrote the regulations do not differentiate between the two terms. Setting patient expectations is the key, as “Permanent Hair Reduction” or “Removal” does not mean 100% elimination of hair forever.

9. How Effective is it?
Studies have shown up to 80% reduction in hair after a series of treatments
The 755nm & 1064nm wavelengths will NOT treat white, blonde, or gray hairs!
Some reds hairs will not achieve desired efficacy.
Patients should be informed of all possible outcomes prior to treatment

10. **Bulb/bulge are critical structures responsible for hair re-growth
Hair Anatomy
Follicle
Epidermis
Sebaceous Gland
Bulge
Vascular Supply (Matrix)
Bulb
Still, these lasers are primarily hair removal lasers and should be purchased on the basis of their hair removal capabilities.
So how does laser hair removal work? Current research suggests the two critical areas of the hair follicle that need to be destroyed to demonstrate permanent hair reduction are the the bulge area (located mm deep in the skin) and the bulb/vascular supply area of the hair follicle (located 3-5 mm deep within the skin).
**Bulb/bulge are critical structures responsible for hair re-growth

11. What are the 3 cycles of hair growth?
Anagen: Hair is actively growing
Catagen: Hair is dormant
Telagen: Hair is falling out

12. Hair Biology
Anagen
Catagen
Telogen

13. How Many Treatments?
Different areas have different percentages of hair in the Anagen phase.
Face, Axilla, Bikini have approximately 20-35%
Trunk and Extremities have approximately 10-20%

14. Time to Retreat? As a rule:
Face/Axilla/Bikini: 4-6 weeks
Trunk: 8-10 weeks
Arms & Legs: weeks
Or within 7 days of when regrowth is observed.

15. Hair Growth Information
Body Area
% Anagen Hair
% Telogen Hair
Telogen Duration
Follicles
Density
/ cm²
Depth of follicle
Axillae
30%
70%
3 months 65 mm
Brow and Ears
10-15%
85-90% 50
2-2.5 mm
Beard
10 weeks
500
2-4 mm
Upper Lip
65%
35%
6 weeks
1-2.5 mm
Scalp
80-90%
13%
3-4 months
350
3-5 mm
Trunk
10-20%
4 months 70
2-4.5 mm
Pubic Area
20-30%
Arms
20%
80%
18 weeks 80
Legs & Thighs
6 months 60
2.5-4 mm
Breast
3-4.5 mm

16. Bottom Line For best results, multiple treatments will be needed.
For most areas 4-6 treatments are necessary to achieve desired hair clearance.
One may need more or less than 6 treatments depending on hair type, previous methods of hair removal, and skin color.
Results may vary from patient to patient and to various degrees of efficacy.

17. Pre-Treatment Instruction
Before
Shave hair hours prior to treatment
If the patient has a history of cold sores/fever blisters, an anti-viral can be prescribed
If there is concern over pigmentary changes, a prophylactic bleaching cream can be used weeks prior to treatment

18. Pre-Treatment Instruction
NO Plucking – 6 weeks prior or after
NO Waxing – 6 weeks prior or after
NO Tweezing – 6 weeks prior or after
Patients should only shave

19. Clinical Endpoints PFEs
Perifollicular erythema: The treatment area should appear red
Perifollicular edema: There should be swelling around each hair follicle
Some patients will experience a hive like response
Lighter hairs may not respond as significantly

20. Post-Treatment Instruction
After
Cool compresses can be used to reduce patient discomfort & swelling
Aloe vera
Topical Cortisone cream
Sun block of 30+ SPF

21. Treatment Technique 3 Things to ALWAYS remember while treating:
FLUSH: The distance gauge should be flat and in contact with the skin’s surface
PERPENDICULAR: The hand piece should be 90° to the skin’s surface
OVERLAP: Pulses should be overlapped at 20-30%. Think of the Olympic Rings

22. Complications
There are risks and complications that can occur from laser treatment.
Use of conservative DCD settings are important.
Complications are rare!
Heat rash
Bruising
Scarring
Infection
Hyper-pigmentation
Hypo-pigmentation
Swelling
Welting

23. Pigmented Lesions – 755nm only

24. Pigmented Lesions
A pigmented lesion is caused by an abnormal production of melanin which makes it visible on the skins surface

25. Pigmented Lesions
The following benign pigmented lesions can be treated with the 755nm wavelength:
Mottled or hyperpigmentation
Lentigines
Ephelides (freckles)
Epidermal melasma
Café’ au lait

26. Pigmented Lesions Lentigines:
Are small, tan to medium brown lesions that are located on the skins surface
Usually caused by excessive sun exposure
Need to be differentiated from the potential skin cancers. (i.e., have it checked off by a physician)

27. Lentigines

28. Pigmented Lesions Ephelides: Also known as freckles
Commonly seen on fairer skinned patients

29. Ephelides

30. Pigmented Lesions Café’ au lait:
Are typically light tan to pale brown patches that are seen at birth or soon after.

31. Café’ Au Lait

32. Pigmented Lesions
Remember that this will treat Epidermal pigmentation issues.
NOT LIKELY TO RESPOND
Nevi of Oto or Ito
Melanocytic Nevi
Should only be treated by dermatologist
Blue Nevi

33. Pigmented Lesions Method of Treatment:
Treat only on Skin Types I-III (and Asian skin)
No DCD is used.
May require multiple treatments (2 – 3 TX)
For treatment of smaller lesions a small spot size should be used.

34. Pigmented Lesions
Some factors that could possibly trigger a re-ecurrence of pigmented lesions are:
Hormonal inbalance
Pregnancy
Medications
Menopause
Sun Exposure

35. Pigmented Lesions Potential Side Effects: Infection Scarring
Lesion Recurrence
Side effects are quite rare!
Potential Side Effects:
Discomfort
Bruising
Swelling
Scabs
Hyper-pigmentation
Hypo-pigmentation

36. Pigmented Lesions Clinical Endpoint Single Pulse Only!
You may hear a “Snap” while treating.
The darker the lesion, the louder the “Snap”
It is not uncommon to see a “Frosting” of the lesion
Single Pulse Only!

37. Pigmented Lesions Clinical Endpoint:
The lesion will darken within minutes after treatment and may remain so until the lesions forms a micro-crust. Use of an ointment is recommended. Aquaphor, bacitracin or even vaseline can be used to keep area moist until the crust falls off. The skin underneath will be pink. There is a gradual return to normal skin color over time.

38. Pigmented Lesions
Avoidance of direct and indirect sun exposure for at least 2 weeks before & after the laser treatment is advisable.
Sunblock of at least SPF 30 on the treated area daily. Sun exposure may contribute to hyperpigmentation in treated area.

39. Vascular Lesions & Linear Telangiectasia
755nm & 1064nm Wavelengths

40. Which Does What? 755nm 1064nm Facial Vessels Leg Veins Hemangiomas
Resistant PWS
1064nm
Facial Vessels
Leg Veins 40

41. Leg Telangectasia or Spider Veins
Sclerotherapy is the GOLD STANDARD for the treatment of leg veins
The 755nm & 1064nm wavelengths can clean up what Sclerotherapy does not
Veins < 3mm in size are treatable

42. Special Considerations
Vitamin E, Aspirin, Ibuprofen, Fish Oils or other Blood thinners may increase the likelihood of bruising. Avoid for several days if possible, if not, practitioners should perform test spots
When treating lower extremities diabetic patients should have clearance from their primary physicians
Darker Skin Types should only be treated with the 1064nm wavelength 42

43. Pre-Treatment Squeaky clean skin! No tanned skin!
No Topical anesthetics
Topical Alpha-hydroxy
Can be used for 1-2 weeks prior to treatment
Measure vessel size
Tanned skin and high fluences DO NOT MIX……..may scab/blister/hypopigment. 43

44. Clinical Endpoints – 755nm
Facial Vessels & Leg Veins
Structure will vaso-spasm or darken
Peri-vascular erythema is normal
Hemangiomas
Transient purpura
Resistant PWS
Transient gray color that evolves into deep purpura 44

45. Clinical Endpoints – 1064nm
Facial Vessels
ONLY the 1.5mm spot size should be used on the face
Vessels should disappear and erythema the end result
Leg Veins
Vessels should disappear
Wheal & Flare or Cat Scratch appearance after about 5minutes 45

46. Post treatment Apply pressure to treated area after a few pulses
Cool Compresses
Topical Cortisone Cream
Encourage sun block 30+ SPF
Avoid activities that cause vasodilatation or increase blood pressure for 3-5 days

47. Wrinkle Reduction & Skin Tightening

48. What’s The Difference? 755nm 1064nm
Thermal Injury stimulates the body’s response to create collagen
1064nm
Bulk deposition of heat can cause both collagen contraction & collagen stimulation 48

49. Use of 755nm Treatment of skin types I-IV
Requires a series of treatments performed once a month
Technique is similar to LHR
Clinical endpoints are slight edema & erythema 49

50. Use of 1064nm Treatments can be performed on all skin types
Requires a series of treatments performed once a month
Several techniques to choose from
Clinical endpoint is achieving a surface skin temperature of 40-43º C 50

51. 1064nm for Skin Tightening Three different techniques
*New Taylor
18mm, 50ms, 18 J/cm² with the DCD turned off – 3 Passes
Keys
10mm, 50ms, 20 J/cm², DCD off, Double Pulse/3 Passes
Painting
8-10mm, ms, 12 J/cm², DCD off, 5-7Hz
All deliver bulk heating into the dermal layer of skin

52. Clinical Endpoint?
The use of an Infra-Red Thermometer allows us to achieve a surface temp of 40°-44° C
This translates to an approximate dermal temp of 65° C
This is the temperature that can cause collagen contracture

53. GentleMAX User Interface
How to choose wavelength
How to adjust parameters
Using the Guided Mode

54. Warning During Warm-Up

55. Standard Alex Screen

56. Standard Alex Screen Self Adjust
Able to adjust all parameters
Fluence (J/cm2)
Pulse duration (Candela recommends 3ms exclusively)
Able to adjust DCD

57. Alexandrite Applications

58. Alex-Guided Mode Selection

59. ALEX - Guided Mode Treatment Selection

60. ALEX - Guided Mode Parameter Selection

61. ALEX - Guided Mode Calculation

62. ALEX - Guided Mode Calculated Parameters

63. ALEX - Guided Mode Final Screen

64. ALEX - Guided Mode Warning Screen

65. Switch to YAG
Simply press YAG wavelength

66. Standard YAG Screen

67. YAG Applications

68. YAG Guided Mode

69. YAG - Guided Mode Treatment Selection

70. YAG - Guided Mode Parameter Selection

71. Switch to Alex
Simply press Alex wavelength

72. Thank You