1. MedArt ® 450 CO 2 laser

2. Table of contents CO 2 CO 2 vs alternatives Considerations in CO 2 treatments Summary The MedArt ® 450 The MedArt ® 456 Recommended reading

3. CO2 Principle: The laser works on the principle of selective photothermolysis. The specific wavelength targets one or more chromophores in the tissue. The chromophore will be heated and the controlled dosis of laser light will produce the desired treatment result (based on the principle of thermal relaxation time). Wavelength: 10,600 nm targets water. Water in the tissue will be heated and thus ablate up to 30 microns of epidermal tissue. The heat diffusion will however mean that an additional up to 1 mm epidermal tissue is coagulated.

4. CO 2 treatments Skin resurfacings Full face Perioral area Periorbital area Glabellar area Cheek area Benign skin lesions Acne scars, xanthelasma, verrucae seborrhoica, etc. etc.

5. CO2 vs. alternatives Er:YAG At 2940 nm this ablative laser can basically do the same treatments as the CO 2 but: More passes are needed to produce the same result as with the co2. Bleeding = risk of infection IPL Non-ablative technique to reverse photoaging. Only limited rhytide reduction. Not applicable for other skin lesion types.

6. Considerations in co2 treatment The patient Comfort and safety Skin type Anaesthesia Clinical aspects Power Pulse delivery Spot shape Functionality Power distribution Clinical working conditions Economy - Investment - Running costs

7. The patient Comfort and safety: No bleeding Shorter procedure time Controlled energy distribution Skin type: Classic Fitzpatrick – skin type I-III Darker skin types treatable but with considerably higher risk of dyspigmentation postop. Anaesthesia: For full skin resurfacing: General anaesthesia is recommended. For all other treatments: Local anaesthesia by injection or EMLA creme.

8. Clinical aspects Power Pulse delivery Spot shape

9. Power Power output is measured in Watt. The indicated treatments are done with very low power output. Since power output is low it has to be very stable. Stable power output is the key to safe and efficient ablative treatments Power can be delivered as pulses or continuous wave MedArt ® 450 has less than 10% power deviation

10. Pulse delivery Focus mode: Focal point irradiation achieves evaporation of tissue This technique is e.g. used for skin resurfacing with the help of a scanner. Defocus mode: A defocusing of the irradiation achieves coagulation of tissue The treated area will peel off within 2-10 days (ideal for e.g. wart removal)

11. Spot shape MedArt ® 450 secures even distribution of energy Important to secure even distribution of energy into the tissue to secure a good treatment result. Beam profile: Crystaline profileTraditional CO 2 profile Scanning patterns: MedArt® 456 scanning patternTraditional CO 2 scanning patterns

12. Functionality Power distribution Clinical working conditions Economy investment running costs

13. Power distribution Articulated arm: Based on adjustable mirrors Vulnerable to vibrations Not movable Requires regular maintenance Flexible fibre: Silver crystaline Freedom of movement for the operator Can be used with scanner No maintenance Portable MedArt ® 450

14. Clinical working conditions Scanning technology: Important in terms of skin resurfacings or treatment on larger body areas. Scanning patterns Feathering Smoke extraction: An external smoke extraction tube can be easily attached to the scanner.

15. Economy Investment Ideal tool for the smaller private practice with a wish to treat skin lesions and/or do skin resurfacings Running costs No consumables We recommend a general service checkup every two years.

16. Summary MedArt ® 450 – a cost efficient safe and versatile treatment tool The patient Skin type Anaesthesia The technology Wavelength: 10,600 nm Power: 0,1 to 10 Watt Flexible fibre system Energy delivery: Focused/defocused Scanner system Pulse width 5-999 msec.

17. MedArt ® 450 laser technology Flexible fibre delivery system compact, easily movable in/between facilities. No extra running costs No consumables (dye, filters, liquid, filling, lamps) No regular requirements for adjustments and calibration No need for regular service calls

18. Recommended reading Principles of CO2/Erbium Laser Safety (411) Darrell J. Fader, MD and Désirée Ratner, MD Dermatol Surg 2000;26:235-239 Studies on the Transmission of Viral Disease via the CO 2 Laser Plume and Ejecta (35) Peter M. Wisniewski, M, Michael J. Warhol, MD, et al. The Journal of Reproductive Medicine, vol. 35, No. 12, December 1990 Treatment of Xanthelasma Palperarum with the Carbon Dioxide Laser (23) David B. Apfelberg, MD, Morton R. Maser, MD, Harvey Lash, MD, David N. White, MD J. Dermatol. Surg. Oncol. 13:2 February 1987 Benefits of the CO 2 laser for verruca resistant to other modalities of treatment (27) David B. Apfelberg, MD, David Druker, MD, Morton R. Maser, MD, et al. J. Dermatol. Surg. Oncol. 15:4 April 1989 Anesthesia for the Dermatologic Surgeon (400) Dwight Scarborough, MD, Emil Bisaccia, MD, Wendy Schuen, MD, Rick Swensen, CRNA International Journal of Dermatology, December 1989 Vol. 28.