1. GentleYAG Patient Consultation & the Management of expectations
Laser Hair Removal
Veins
Skin Tightening/Wrinkle Reduction
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2. Patient Consult
Today’s patient is better educated than ever thanks to the internet.
Before any treatment, ALWAYS sit down with the client to explain the entire process.
They should know exactly what is expected of them.
They should know what to expect as far as outcomes.
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3. Fitzpatrick Skin Types
Skin Type is race dependent and DOES NOT CHANGE.
Suntan alters the degree of pigmentation NOT the skin type.
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4. Fitzpatrick Skin Types
Typical Skin Type Definition
Skin Reaction on over exposure to UV light 1
Red-blonde Hair Blue-green Eyes Very light Skin
Always Burns Never Tans 2
Light to Medium Hair Light to Medium Eyes Light to Medium Skin
Usually Burns Seldom Tans 3
Medium Hair Medium to Dark Eyes Medium to Olive Skin
Moderate Burns Usually Tans 4
Dark Hair Dark Eyes Dark Olive to Brown Skin
Burns Mildly Moderate Browning 5
Dark Hair Dark Eyes Dark Skin
Seldom Burns Deep Browning 6
Dark Hair Dark Eyes Very Dark Skin
Does Not Burn No Change in Color
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5. How does the Laser work?
(Hair)
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6. Patient Consult Laser Hair Removal –
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.
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7. Permanent Hair Reduction
“long-term stable reduction in the number of hairs re-growing after a treatment regime”
The FDA allows us this definition
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.
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8. IMPORTANT! Write This Down
The GentleYAG will NOT treat white, blonde, or gray hairs! Patients should be informed upfront.
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9. Bulb / bulge are critical structures responsible for hair re-growth
Hair Anatomy
Epidermis
Sebaceous Gland
Bulge
Follicle
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
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10. Patient Consult What are the 3 cycles of hair growth?
Anagen: Hair is actively growing
Catagen: Hair is dormant
Telagen: Hair is falling out
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11. Hair Biology
Anagen
Catagen
Telogen
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12. Patient Consult When do you re-treat?
Within 7 days of when re-growth is observed.
Different areas have different percentages of hair in the Anagen phase.
Face, Axilla, Bikini are approximately 20-35%
Trunk and Extremities have approximately 10-20%
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13. 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
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14. Patient Consult
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 will vary from patient to patient and to various degrees of efficacy.
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15. F.A.Q. Can cancer survivors be treated? Can children be treated?
Yes, but if there is concern get clearance from their treating physician.
Can children be treated?
Yes, but more treatments maybe required later due to hormonal changes.
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16. F.A.Q. Can patients use “sunless” tanning products?
With the GentleYAG, YES!
Can you treat a man’s head?
Yes, but make sure he understands that it is permanent and signs an informed consent.
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17. F.A.Q. What areas of the body can you treat?
All areas are treatable with the exception of inside the orbital rim.
Can treatments be done over implants?
Yes.
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18. F.A.Q. Can treatments be performed over orthopedic hardware?
Yes, however some patients may notice more discomfort in those areas.
Pacemakers and other cardiac implants?
Patients with pacemakers may have treatment once cleared by their physician. Treatments are not typically performed directly over implant.
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19. F.A.Q. What about braces or other dental work?
Yes. Frequently gauze is placed between the cheek and gum for those patients who experience a “tingling” sensation on their teeth.
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20. F.A.Q. Can treatment be done over injectibles?
Probably not a good idea to treat directly over the injectible. Patients can have laser treatment and injections done...But, in different areas.
This slide is to prompt discussion.
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21. Contraindications Accutane Sun exposure
Most physicians recommend that patients should cease usage for at least 6 months. However, many physicians are treating while patient is on medication provided the primary chromophore is NOT water.
Sun exposure
Recent tanning is an absolute contraindication. Skin with underlying redness is more susceptible to pigmentary changes.
AVOID the Sun for at least 1 week prior to a treatment and 1 week after. The chances of pigment changes and other “minor” skin irritations are high.
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22. Contraindications Pregnancy
Pregnant practitioners should check with their physician
DO NOT TREAT Expecting mothers
Liability reasons
Hormones are “out of whack”
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23. Contraindications What about Tattoos?
Tattoos and permanent make-up should be avoided. While the wavelength can sometime be used for the removal of tattoos, the GentleYAG has the WRONG pulse duration to safely and effectively remove tattoos.
Areas with permanent make-up should be covered or avoided.
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24. Patient Consult
During consultation explain and obtain an INFORMED CONSENT
Document, Document, Document. Remember to chart the treatment procedure i.e. (Energy, Pulse Duration, Spot size, DCD)
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25. Patient Consult Photo-Document
It is important to take pictures of the area to be treated.
Patients will sometimes forget what they looked like at the starting point.
Having before and after photos will allow you to market to potential clients using your own photographs.
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26. GentleYAG Treatment Protocol For Hair Removal
Pre-Treatment
- Shave hair 24 hours prior to treatment.
- If history of cold sores, an antiviral can be prescribed.
Post Treatment
Aloe vera (with Solarcaine and menthol) gel may be applied.
- Sunblock of spf 30 if treated area is exposed to the sun.
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27. Treatment Protocol NO Plucking – 6 weeks prior or after
NO Waxing – 6 weeks prior or after
NO Tweezing – 6 weeks prior or after
Patients can only shave.
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28. Treatment Protocol 3 Things to ALWAYS remember while treating “FLUSH”
“PERPENDICULAR”
NO MORE THAN 30% OVERLAP
Say it with me…..”FLUSH, PERPENDICULAR, NO MORE THAN 30% OVERLAP”
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29. Complications
There are risks and complications that can occur from laser treatment.
Use of conservative DCD settings are important.
Complications are rare!
Blister
Heat rash
Bruising
Scarring
Infection
Hyperpigmentation
Hypopigmentation
Swelling
Welting
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30. DCD -Cryogen spray milliseconds before laser pulse
The real difference between lasers is in their ability to protect the skin from “collateral epidermal damage.” GentleLASE’s unique, integrated and patented Dynamic Cooling Device (DCD) selectively cools the epidermis during low and high fluence laser treatments. DCD delivers a short, pre-determined and re-producible burst of non-toxic cryogen spray onto the top of the patient’s skin milliseconds before the laser pulse, independent of operator technique or involvement. This evaporative coolant protects the epidermis without cooling the underlying targeted hair follicle or leg vein, providing maximum protection of the patient’s skin while ensuring maximum thermal energy is delivered to the targeted structure. Furthermore, DCD eliminate the need for cooling gels used with most other laser systems, allowing for increased visibility as well as faster treatment times. All of these DCD advantages further contribute to overall operator ease-of-use.
-Cryogen spray milliseconds before laser pulse
-Cools / protects epidermis from thermal damage
-Protects darker skin types
-Good visibility / does not slow treatment
-No messy gels
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31. Dynamic Cooling
Pictorially, the laser energy is delivered to the targeted structure through the patient’s epidermis, where any heat being generated from the absorption of that laser energy by competing epidermal melanin is cooled and effectively neutralized by DCD cryogen spray. This importance of skin cooling cannot be overstated, as laser energy is constant The consistency and constancy of your epidermal cooling must match the consistency and constancy of the energy being delivered. Insufficient cooling will result in epidermal damage (burns, hyper & hypo pigmentation) while TOO MUCH skin cooling will actually result in the targeted hair follicle or blood vessel being cooled, therefore reducing treatment efficacy, as is often the case with “contact cooling”.
-Short spray of cryogen onto skin milliseconds before laser pulse
-Rapid, efficient cooling of epidermal layers only
-Does not cool subsurface targeted structures
-Does not impede visibility or treatment speed
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32. Laser Hair Reduction Operative Checklist:
Laser in “ready” mode and calibrated to correct energy with proper hand piece
“Squeaky Clean” Skin
Safety goggles or glasses on clinician and patient
No flammable substances in operating area
- Written post-operative instructions given to the patient
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33. GentleYAG for the treatment of Leg Veins and Facial Telangiectasia
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34. Telangectasias or “Spider Veins”
Sclerotherapy is the GOLD STANDARD
GentleYAG can clean up what Sclerotherapy does not
Veins < 3mm in size are treatable
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35. Special considerations
Vitamin E, Aspirin, Ibuprofen or other Blood thinners may increase the likelyhood of bruising. Avoid for several days if possible, if not, should do test spots
Diabetic patients should have clearance from their primary physicians
Younger “healthy” diabetics should be okay. Older or more ill diabetics may have neuropathy which may inhibit their true tolerance to the treatment. Should a complication arise from the treatment with someone who has diabetic neuropathy, this may lead to delays in treatment of the complication.
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36. Pre-Treatment Squeaky clean skin! No tanned skin!
No Topical anesthetics
Measure vessel size
Tanned skin and high fluences DO NOT MIX……..may scab/blister/hypopigment.
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37. Clinical Endpoints Vessel disappears and then comes back (vasospasm)
Vessel shrinks in size (vasoconstriction)
Vessel contents darken
Vessel looks like a cat’s scratch (Wheal and flare)
NO OVERLAPPING!
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38. Post treatment Apply pressure to treated area after a few pulses
May apply aloe vera gel with Solarcaine and menthol
Encourage sun block 30+ spf
Avoid activities that cause vasodilatation or increase blood pressure for 3-5 days
Inform the vessel area will gradual fade over several weeks.
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39. GentleYAG for Photorejuvenation
Skin Tightening/Wrinkle Reduction/Scarring
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40. Photorejuvenation Consult
Inform patient that collagen remodeling is a slow process and that they can continue to see improvement up to 6 months after their final treatment
Inform patient that they will need 4-6 treatments one month apart
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41. Special Considerations
Please refer to Clinical Bulletin #8 created by Dr. Mark Taylor for treatment photos, parameters and technique.
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42. Pre-Treatment Photo-Document Face/Neck should be squeaky clean
Shave any facial hair
Facial hair may be reduced. Male patients should be informed.
No recently tanned skin
May use topical anesthetics
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43. Test Spots
When skin reaction is a concern, always perform a test spot at a couple of different lower fluences in an inconspicuous site.
Untoward skin responses may be noticed within a day or two.
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44. Post-Treatment Mild erythema is clinical endpoint
May apply aloe vera gel with Solarcaine and menthol.
Apply and instruct on daily use of spf 30
Inform patient fine lines may appear more enhanced for a few days and their face may feel tight and dry
Encourage extra moisturizer
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45. Photorejuvenation
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46. Stretch Marks
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47. Stretch Marks
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48. Photorejuvenation
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49. Leg Veins
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50. Maintenance Refer to section 6 of the operator’s manual
User verification tests
Policy for the cleaning of distance gauges and lenses.
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51. Thank You
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