capa asks… laser 101- treating redness to wrinkles...faesthetic derm treatments: acne treatment,...
TRANSCRIPT
9/28/2011
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CAPA ASKS…
1. Where were you in 1976?
Born May 25, 1976
2. Was medicine on your radar then?
2, 4, 6, 9, 12 month well baby exams/vaccination
3. What is your career vision for 2026?Derm, derm, derm
LASER 101-TREATING REDNESS TO WRINKLES
Lindsay Miller, MS, PA‐C
MAGDA THE SUN MAGNET I THINK I JUST NEED A LITTLE LASER
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WHAT IS LASER?
Laser is an acronym
Light Amplification by Stimulated Emission of Radiation
In 1917, Albert Einstein established and published the theoretic foundations for the laser and the maser conceptually based upon probability coefficients called Einstein coefficients.
In 1959 the term LASER was first published by Columbia University doctoral student Gordon Gould. His thesis studied the energy levels of excited thallium.
ENERGY PRINCIPLEProcess: excitation of molecules of a medium, which release a photon of light as it returns to a stable state.
Each medium produces a specific wavelength of light, may be within the visible spectrum (violet 400 through to red 700nm) or infrared spectrum (> 700 nm).
1. Gas‐ argon, krypton, carbon dioxide
2. Liquid‐ dye
3. Solid‐ ruby, neodymium: yttrium‐aluminum‐garnet (Nd:YAG), alexandrite
LASER APPLICATION
Medicine: Surgery, kidney stone treatment, opthalmology (L.A.S.I.K.), dentistryIndustry: Cutting, welding, material heat treatmentMilitary: Marking targets, guiding munitions, missile defense, electro‐optical countermeasures (EOCM), alternative to radar.Research: Spectroscopy, laser ablation, fluorescence microscopy.Product development/commercial: laser printers, optical discs (e.g. CDs), barcode scanners, thermometers, laser pointers, hologramsAesthetic derm treatments: acne treatment, cellulite and striae reduction, laser vein treatment, and laser hair removal.
DERM APPLICATION: REDNESS TO WRINKLES
*The light energy is converted to heat energy. The heat energy is used to destroy the target while protecting the surrounding tissues and structures
Vascular
Dyschromia
Hair Removal
Wrinkle reduction/resurfacing
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SELECTING A TECHNOLOGY
What are you attempting to treat (which chromophore)?
Determines base technology
How deep is your target?
Determines spot size (mm)
What size is your target?
Determines pulse duration (m/s)
How much energy is required?
Determines fluence (J/cm2)
**MUST HAVE ALL 4 SIMULTANEOUSLY TO BE EFFECTIVE
VASCULAR CONDITIONSShallow to Deep
SELECTING A TECHNOLOGY: VASCULAR
What are you attempting to treat?Blood in the vessel
How deep is the target?Facial telangectasias‐superficial
Peri‐ocular veins‐moderate
Reticular leg veins – deep
What size is the target?Small facial veins
Large leg veins
How much energy is required?Depends on the technology/device
HEMOGLOBIN ABSORPTION BY WAVELENGTH
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SELECTING A WAVELENGTH: VASCULAR
Visible: (KTP, PDL, IPL)
Very high hemoglobin absorption
Strength: low energy treats small targets
Challenge: treating large of deep targets
Infrared: (940, 980,1064nm)
Lower hemoglobin absorption
Strength: can treat large and deep targets
Challenge: requires higher fluence for small targets
PULSE DYE LASER
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SELECTING A TECHNOLOGY: DYSCHROMIA
Ephilides, lentigines, melasma, hyperpigmentation
1. What are you attempting to treat?Pigment in the epidermis‐Melanin
2. How deep is the target?Superficial
3. What size is the target?Small ephilidesMedium lentiginesLarge patches of melasma
4. How much energy required?Depends on the technology
MELANIN ABSORPTION BY WAVELENGTH
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WAVELENGTH OPTIONS: DYSCHROMIA
Target melanocytes in epidermis
Best approach is visible light range (500‐700 nm)
532‐ KTP
585‐ PDL
694‐ Ruby755‐Alexandrite
OR Ablative/Fractional technology
IPL
FRACTIONAL CO2 TO TREAT DYSCHROMIASELECTING A TECHNOLOGY:
HAIR REMOVAL1. What are you attempting to treat?
Pigment in the hair follicle‐melanin
2. How deep is your target?
2‐4 mm
3. What size is the target?
Fine vs. Coarse hair
4. How much energy is required?
Depends on technology and color of hair
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TECHNOLOGY: HAIR REMOVAL
Alexandrite (755 nm)
High melanin absorption – lower fluence
Typically skin types 1‐III
Diode (810 nm)
Moderate melanin absorption‐moderate fluence
Typically skin types 1‐VI
Nd: YAG (1064 nm)
Lower melanin absorption – higher fluence
Skin types 1‐VI
IPL
SELECTING A TECHNOLOGY: RESURFACING
1. What are you attempting to target
Water in the epidermis and dermis
2. What are you treating
Photo damage/deep damage – FRACTIONAL COVERAGE
Diffuse sun damage/fine wrinkles –CONFLUENT COVERAGE
3.How deep is your target
Ablate to necessary depth
Directly controlled by energy
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RESURFACING OVERVIEW
Ablative laser treatments treat the epidermis
Non‐ablative treatments target dermal collagen (mid‐layer of skin)
Fractional laser treatments target the epidermis and dermis
A laser beam is divided into thousands of tiny, deep columns of treatment into the skin called micro thermal treatment zones (MTZs).
Within each MTZ dermis causes a reaction that leads to collagen remodeling and new collagen formation.
By using MTZs, treatment is intensive within the zone while surrounding healthy tissue remain intact and unaffected.
Fractional300 micron diameter micro columns ablate tissue deep in the dermis
• Thermal coagulation provides hemostasis
• Lateral zone of residual thermal damage promotes long‐term collagen
stimulation
• Minimal thermal overlap reduces risk of complications
WATER ABSORPTION BY WAVELENGTH COLLAGEN REMODELING
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TREATING WRINKLES WITH TOXIN
First used in 1980 to treat strabismus in children
Neurotoxin A
Botox, Dysport, Myobloc, and Xeomin
Ideal for treating dynamic wrinkles
Crows feet, frown lines, forehead lines
Mechanism of action:
Prevents the release of acetylcholine
Muscle contraction prevented
Lasts about 3‐4 months
MECHANISM OF ACTION
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BOTOX BEFORE AND AFTER TREATING WRINKLES WITH FILLER
Hyaluronic Acid:Perlane, Restylane, Juvederm, Juvederm Ultra PlusLasts 9‐12 monthsIdeal for minimal volume loss in MLF, tear trough, lips
Calcium Hydroxylapatite:RadiesseLasts 12‐15 monthsVery volumizing, collagen stimulatingIdeal for moderate to severe volume loss in MLF, pre‐jowl, and mid face augmentation
MLF, LIPS, PHILTRUM RADIESSE TREATMENT OF MLF
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PEARLS
Not everything can be treated with laserThere are limitations to current technology
Experience and technology matterSafest, most effective outcomes combine both
Thank You!
Email: [email protected]