1. Ellman Sandstone Cheveux™
Permanent Hair Reduction 810 Diode Laser

2. From Razor to Laser Methods of hair removal Shaving Waxing / plucking
Depilatories and creams (bleaches)
Electrolysis / electrothermolysis
Laser/light-based hair removal

3. 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

4. Absorption Spectrum of Major Chromophores in Skin
Cheveux™ Diode Laser

5. 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.

6. 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).

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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 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

15. Fitzpatrick Skin Type Classification Scale
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
The Fitzpatrick Classification Scale was developed by Harvard Medical School dermatologist, Thomas Fitzpatrick, MD, PhD. This scale classifies a person's complexion and their tolerance of sunlight. It is used by many practitioners to determine how someone will respond or react to facial treatments.

16. Suggested Treatment Parameters
Fitzpatrick Skin Type
Starting Fluences (Test Spots)
Tolerated Fluences
Pulse Width I
35J/cm2
Wait at least minutes.
Observe epidermal response,
increase or decrease by 2-5 J/cm2.
15-60 J/cm2
Auto
30 ms – high
hair density areas II
350J/cm2
III
25J/cm2
10-45 J/cm2
Auto – finer hair
30 ms – coarser hair or high hair density areas

17. Suggested Treatment Parameters
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
Wait at least minutes.
Observe epidermal response,
increase or decrease by 2-3 J/cm2.

18. Suggested Treatment Parameters
Fitzpatrick Skin Type
Starting Fluences (Test Spots)
Tolerated 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 hours.
Observe epidermal response,
increase or decrease by 1-2 J/cm2. VI
10-20 J/cm2 for 100 ms
10-20 J/cm2

19. Suggested Treatment Parameters
Fitzpatrick Skin Type
Starting Fluences (Test Spots)
Tolerated 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

20. 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
Operator Technique

21. Expected Sequelae and Tips
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

22. Positive Clinical Endpoints
Perifollicular erythema and edema
Bumps around follicle several minutes after treatment
Less pronounced on darker skin types
Courtesy C. Dierickx M.D.

23. 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

24. 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

25. 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