Laser Tissue Laser Tissue Laser Tissue Laser Tissue Interaction Interaction ––Interaction Interaction ––
Technology Technology Technology Technology meets medicinemeets medicinemeets medicinemeets medicine
Aesthetic Laser Aesthetic Laser Aesthetic Laser Aesthetic Laser IndustryIndustryIndustryIndustry
Why the excitement?
Laser Aesthetic Market GrowthLaser Aesthetic Market GrowthLaser Aesthetic Market GrowthLaser Aesthetic Market Growth
71% of patients who have cosmetic
Affordabilitywho have cosmetic surgery earn less than $60,000 per Year*
AcceptanceAll ages and incomes consider cosmetic procedures**
$60,000 per Year
34.8 million light-based equipment procedures performed in 2006***
procedures**
in 2006***
More than $17.24 billion spent in 2006 on aesthetic procedures
Market
3
worldwide***
Sources: * People Magazine, June 2008. **American Society for Aesthetic Plastic Surgery, 2006; Forbes 2006. ***Medical Insights, 2006.
The media is fueling the antiThe media is fueling the anti--aging buzzaging buzzThe media is fueling the antiThe media is fueling the anti--aging buzzaging buzz
More?
The Latest Breakthroughs inReducing the Signs of Aging
Lunchtime Facelifts AreThe Newest Skin Treatment
4
g g g g
Procedure volume for light based skin Procedure volume for light based skin procedures continues to growprocedures continues to growProcedure volume for light based skin Procedure volume for light based skin procedures continues to growprocedures continues to grow
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Industry InformationIndustry InformationIndustry InformationIndustry Information
Cutera Websitet– www.cutera.com
American Society of Aesthetic Plastic Surgery (ASAPS)(ASAPS)– www.surgery.org
American Academy of Dermatology (AAD)American Academy of Dermatology (AAD)– www.aad.org
American Academy of Ophthalmology (AAO)y p gy ( )– www.aao.org
American Society for Laser Medicine and Surgery
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(ASLMS)– www.aslms.org
Industry CompetitionIndustry CompetitionIndustry CompetitionIndustry Competition
Highly competitive Market
Many competitors in this industry – the following are several major competitors– Cutera– Cutera– Lumenis– Sciton– Syneron– Alma– PalomarPalomar– Cynosure– Candela
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Laser Tissue Laser Tissue Laser Tissue Laser Tissue InteractionInteractionInteractionInteraction
Goal of Lasers in Aesthetics / Goal of Lasers in Aesthetics / MedicineMedicineGoal of Lasers in Aesthetics / Goal of Lasers in Aesthetics / MedicineMedicine
Target specific structures without damaging surrounding tissuesurrounding tissue
Enable less invasive procedures with lower risk of complicationcomplication– Lentigines– Glaucoma
Dermatology and Ophthalmology– Accessibility
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Anatomy of the SkinAnatomy of the Skin
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Normal Skin HistologyNormal Skin HistologyNormal Skin HistologyNormal Skin Histology
A
BC
Epidermis (5 Primary Layers)– Stratum Corneum at top– Varies in thickness by body
D
part
Dermis (2 Primary Layers)– Papillary Dermis
s
Papillary Dermis– Reticular Dermis– ~2mm thick (varies)
H d i b l D i
Hypodermis below Dermis– Adipose tissue / connective
tissue0 30 h k
11
E – 10-30mm thick
Skin Histology Cont.Skin Histology Cont.Skin Histology Cont.Skin Histology Cont.
12http://www.lab.anhb.uwa.edu.au/mb140/corepages/integumentary/Images/skthick0021he.jpg
http://upload.wikimedia.org/wikipedia/commons/2/20/Skinlayers.png
Mechanisms of Laser InteractionMechanisms of Laser InteractionMechanisms of Laser InteractionMechanisms of Laser Interaction
Photo Chemical– Acne – PDT (Photo Dynamic
Therapy)
Photo Thermal– Vascular (Face and Leg
Veins– Rejuvenation
(Wrinkles, texture, age spots)Resurfacing – Resurfacing
– Hair Removal, etc.
Photo Acoustic
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– Tattoo
Photochemical ActionPhotochemical ActionPhotochemical ActionPhotochemical Action
Light induced chemical reaction
Uses Endogenous or Exogenous ChromophoresUses Endogenous or Exogenous Chromophores
PDT (Photo Dynamic Therapy)Spectral absorption curve determines optimal light – Spectral absorption curve determines optimal light sources
– Typical action is a chemical reaction that releases a free radical oxygenradical oxygen
– Free radical oxygen is highly volatile
Used for Acne (one example)Used for Acne (one example)– P.Acne Bacteria also has an absorption spectrum with a
photochemical reactionP t f th t d t l ft ti t
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– Part of the reason acne tends to clear up after time at the beach
Photo AcousticPhoto AcousticPhoto AcousticPhoto Acoustic
Uses shockwaves to destroy tissue or target structures
Dermatology examples:– Q-switched lasers (~50ns pulse duration)
• Little to no thermal damage• Target ink particles in the upper dermis
– Tattoo Removal Tattoo Removal • Targeting requires wavelengths that absorb in ink colors• Typically requires 3 distinct wavelengths (multiple color
tattoos)tattoos)– YAG, Ruby, KTP
Ophthalmology examples
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– Secondary Cataracts (Q-YAG)– Vision correction (Excimer laser)
Photo ThermalPhoto ThermalPhoto ThermalPhoto Thermal
Most common application of lasers in Dermatology and Ophthalmology (retinal)Dermatology and Ophthalmology (retinal)
Very dependant upon the use of the Theory of Selective PhotothermolysisSelective Photothermolysis
Lasers and Light used typically range from ~400nm to 10,600 nm,
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Theory of Selective PhotothermolysisTheory of Selective PhotothermolysisTheory of Selective PhotothermolysisTheory of Selective Photothermolysis
Photothermolysis (Greek)
– Photo meaning light
– Thermo meaning heat
– Lysis meaning destruction.Lysis meaning destruction.
Translation: Selective PhotothermolysisTranslation: Selective Photothermolysis
– Using light to selectively heat an object, resulting in its destruction, while preserving surrounding tissue
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Goal of PhotoGoal of Photo--Thermal TreatmentsThermal TreatmentsGoal of PhotoGoal of Photo--Thermal TreatmentsThermal Treatments
Regardless of IPL (Intense Pulsed Light) or Laser, the goal is to:to:– Heat the desired targets …
• In the case of hair and vessels, to the point of destruction
ith t i h ti d d t di ti– …without excessive heating, and damage, to surrounding tissue
Selective Photothermolysis requires the right combination of ALL of the following parameters safety and consistently achieve the desired target response.
– Wavelength
– Pulse Duration
– Power
– Spot Size
– Cooling (consistent safety)
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g ( y)
– … all selected to treat a specific patient and condition
Primary Chromophores for Primary Chromophores for Thermal TxThermal TxPrimary Chromophores for Primary Chromophores for Thermal TxThermal Tx
Reduced & Oxy-hemoglobin– vascular lesions
Melanin– pigmented lesions, hair– Primarily in hair and epidermis
• some dermal pigmentsome dermal pigment
Water– General tissue incision excision ablation volumetric General tissue incision, excision, ablation, volumetric
heating– Water exists in every cell
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Light Sources: Lasers and LampsLight Sources: Lasers and LampsLight Sources: Lasers and LampsLight Sources: Lasers and Lamps
LaserLampRange of Wavelengths
Single Wavelength or “Color”
Controllable beam: Can be delivered via fiber
g g
Highly divergent light: Lamp placed near target tissue
Fixed treatment areaAdjustable Spot Sizes
Typically smaller treatment area
Fixed treatment area(based on size of window)
Typically, large treatment areaSkiarea Skin
Lamp
Skin
Laser Handpiece
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Selective PhotothermolysisSelective PhotothermolysisSelective PhotothermolysisSelective Photothermolysis
Desired Response:
1. Sufficient light reaches targetReflection
2. Light absorbed by target (chromophore)
3. Absorbed light converts to heatTarget
Scatter
3. Absorbed light converts to heat
4. Temperature rise in target sufficient toprovide desired effect
Transmission
Absorption
provide desired effect
5. Minimal heating of surrounding tissue
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Key Parameters of Light SourcesKey Parameters of Light SourcesKey Parameters of Light SourcesKey Parameters of Light Sources
Wavelength– What is the absorbing target?
Spot SizeSpot Size– How large and how deep is the
target?
Pulse DurationPulse Duration– What is the size of the target?
FluenceHow much energy is necessary – How much energy is necessary to thermally treat the target?
Cooling– Can enough energy be delivered – Can enough energy be delivered
to the target while protecting the epidermis
Selective Photothermolysis requires
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Selective Photothermolysis requiresthe right combination of parametersfor safe and effective treatments.
Absorption Absorption (Melanin and Hemoglobin)(Melanin and Hemoglobin)Absorption Absorption (Melanin and Hemoglobin)(Melanin and Hemoglobin)
Absorption Spectrum(Logarithmic)
1000
Different Targets are absorbed differently according to wavelength
1000
100
tion
(1/c
m)
HemoglobinMelanin
10Abs
orp
1
500 550 600 650 700 750 800 850 900 950 1000
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500 550 600 650 700 750 800 850 900 950 1000
Wavelength (nm)532 KTP 585 Pulsed Dye 755
Alexandrite694
Ruby
808Diode
1064YAG
940Diode
AbsorptionAbsorption(Melanin, Hemoglobin, and Water)(Melanin, Hemoglobin, and Water)AbsorptionAbsorption(Melanin, Hemoglobin, and Water)(Melanin, Hemoglobin, and Water)
Absorption Spectra
10001000
100
1/cm
)
Hemoglobin
10
Abs
orpt
ion
(
Deoxy HemoglobinWaterMelanin
1500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000
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0.1
Wavelength
Absorption (Water)Absorption (Water)Absorption (Water)Absorption (Water)
Water Absorption by WavelengthWater Absorption by Wavelength
10000
100000
10
100
1000
n (1
/cm
)
0.1
1
10
500 2500 4500 6500 8500 10500
Abs
orpt
ion
0.0001
0.001
0.01
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Wavelength (nm)
Wavelength: Effect on Depth of Wavelength: Effect on Depth of PenetrationPenetrationWavelength: Effect on Depth of Wavelength: Effect on Depth of PenetrationPenetration
Wavelength and depth of penetration (given comparable fluence)– In visible to near IR, depth of penetration increases with wavelength
over the range absorbed by melanin and hemoglobin.over the range absorbed by melanin and hemoglobin.• Shorter wavelengths experience more scattering.• More of the longer wavelengths reach deeper targets.
– Water absorption limits depth of longer wavelengths Wavelength (nm): 532 585 694 755 810 1,064 2790 2940 10600
Laser Type: FD Nd:YAG PDL Ruby Alex Diode Nd:YAG YSGG Erbium CO2
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Visible Infrared
Selection of Spot SizeSelection of Spot SizeSelection of Spot SizeSelection of Spot Size
Smaller spot sizes reduce penetration at a given wavelength, due to increased i f impact of scatter.
Large Spot Sizes for:D T t– Deep Targets
• Hair removal, deep reticular veins
– Large Area Coverage• Epidermal melanin
Large Spot Sizep
• Bulk dermal heating
Small Spot Sizes for:ll h ll– Small, shallow targets
– Where high fluences are required (such as telangiestasia)
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Small Spot Size
Selection of Pulse DurationSelection of Pulse DurationSelection of Pulse DurationSelection of Pulse Duration
Thermal Relaxation Time (TRT)
The time it takes for an object to cool to 50% of h h d d l f lthe temperature achieved immediately after laser
exposure
Thermal relaxation time also affects the time that it takes for an object to heat it takes for an object to heat. – Short thermal relaxation times cool and heat rapidly– Long thermal relaxation times cool and heat slowly
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“The Goal” When Selecting a Pulse Duration (Width)“The Goal” When Selecting a Pulse Duration (Width)“The Goal” When Selecting a Pulse Duration (Width)“The Goal” When Selecting a Pulse Duration (Width)
Utilize a pulse width short enough to confine heating to the desired target without excessive heating to the desired target without excessive heating of adjacent tissue (pulse width shorter than the target’s TRT)
YET
long enough to minimize epidermal heating g g p g(pulse width longer than epidermal TRT)
Nominal pulse duration = ½ TRT to TRT
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Selection of Pulse DurationSelection of Pulse DurationSelection of Pulse DurationSelection of Pulse Duration
Target ObjectLight
OnPulse Duration
Light
TimeOff
Prior to the light exposure, the target is approximately the same temperature as the surrounding tissue.
Light
The target object is heated during the pulse of light.– As light is absorbed, the temperature of the target increases.
As the target becomes hotter than the surrounding tissue As the target becomes hotter than the surrounding tissue, heat will begin to flow from the target to the surrounding skin. (Conduction)
Light
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Selection of Pulse DurationSelection of Pulse DurationSelection of Pulse DurationSelection of Pulse Duration
Small objects in the skin cool off faster than large objects.
– Greater surface area relative to absorption area
Lightarea
– Tea cup vs. large pot of hot water. • Tea cup cools off much faster, but also heats up
much faster• Tea cup has a short thermal relaxation time
Small objects lose heat more rapidly, so optimal pulse duration will be p
relative to a large pot of water
For maximum heating efficiency, heating should occur rapidly enough so that most of the heat is confined to the target. Light
shorter.
the heat is confined to the target.
In order to provide efficient heating of the target, the optimal pulse duration for a small object is usually shorter than for a l bj t
Large objects lose heat more slowly, so pulse duration can be longer.
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large object. be longer.
Commonly Used Laser Pulse Durations Commonly Used Laser Pulse Durations by Applicationby ApplicationCommonly Used Laser Pulse Durations Commonly Used Laser Pulse Durations by Applicationby Application
The pulse durations listed below are short enough to efficiently heat the target but long enough to provide minimal heating of the epidermis
• Microvasculature (capillary loops, blush) Laser Genesis procedure: 0.3 ms
– Estimates (each hair, vein, etc. must be evaluated independently)
• Fine telangiectasia / fine hair: 10-20 ms
• Spider veins / medium hair: 20-30 ms
Reticular leg veins / coarse hair: 40 60 ms• Reticular leg veins / coarse hair: 40-60 ms
• Epidermis: ~5-10msp• Longer than this allows heat to exit the epidermis, reducing risk of burns
• Much shorter prevents the epidermis from heating. Pulses must be less than ~0 4 ms to provide safety
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Pulses must be less than ~0.4 ms to provide safety.
• For bulk heating of dermis with Titan, common pulse durations are 3-5 seconds.
FluenceFluenceFluenceFluence
Fluence = J / cm2
Describes the average energy density of the entire pulse
Fluence is typically the final parameter adjusted, based on clinical response
Fluence is ONLY significant once pulse duration, Fluence is ONLY significant once pulse duration, wavelength and spot size are all set correctly
Multiple systems with equal fluence, but different pulse durations / spot sizes will result in significantly different durations / spot sizes will result in significantly different clinical outcomes
– Can range from safe and efficacious treatments to high rate of complications even though fluence is the same
– Joules is time and power dependent, but the body and selectivity require specific pulse durations for targeting and efficacy
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Fluence, Pulse Duration & Spot Size Fluence, Pulse Duration & Spot Size CombinationsCombinationsFluence, Pulse Duration & Spot Size Fluence, Pulse Duration & Spot Size CombinationsCombinations
Peak Power (Beam Intensity)
1500020 J/cm2 with 5 mm spot – The graph below shows some commonly used Cutera settings and
peak powerpeak power.
– The combination of parameters is what is critical to determine clinical efficacy
– To provide 60 J/cm2 in 10ms (a setting used for hair removal), a10000
To provide 60 J/cm in 10ms (a setting used for hair removal), asystem must have a minimum power shown by the blue line
– With less power, a system can still achieve the required fluence, butonly at a pulse duration that is ineffective for some treatments.
C t ’ l id hi h k bilit id
5000
– Cutera’s lasers provide high peak power capability over a wide range of pulse durations for maximum versatility in parameter selection.
1000
60 J/cm2
with 10 mm spot 60 J/cm2 with
10 mm spot 60 J/cm2 with
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Pulse Duration (in ms)0.3 ms 10 ms
p
20 ms 30 ms 40 ms10 mm spot 60 J/cm2 with 10 mm spot
CoolingCoolingCoolingCooling
The epidermis has melanin– Melanin absorbs most wavelengths creating a competing chromophore– Without cooling, the epidermis will heat while the target heats
Primary types of coolingPrimary types of cooling– Contact Copper, Contact Sapphire, Cryogen Spray, Bulk air cooling
Pre-Cooling– Reduces initial temperature allowing safe temperature rise during Tx
• Copper Sapphire Cryogen Bulk Air• Copper, Sapphire, Cryogen, Bulk Air– Ideally pre-cooling controls the skin temp to achieve the same temperature prior
to every pulse (challenging with bulk air)
Post-Cooling– Extracts heat from tissue to prevent bloom and reduce time at elevated t acts eat o t ssue to p e e t b oo a d educe t e at e e ated
temperature• Copper, Sapphire, Bulk Air
Parallel Cooling– Cools during pulse delivery
• Sapphire– Most significant if pulse duration is long relative to thermal conduction time in
tissue (> ~100ms)• Thermal conduction time in tissue (essentially water with heat extraction from vessels)
increases with the square of distance4ms cools 30um
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– 4ms cools ~30um– 400ms cools ~300um
Lasers in UseLasers in UseLasers in UseLasers in UseLasers in UseLasers in UseLasers in UseLasers in Use
Hair RemovalHair RemovalHair RemovalHair Removal
Target: – Melanin in the hair
Wavelength:Wavelength:– Melanin absorption, low hemoglobin absorption and low water absorption– Low enough melanin absorption to penetrate through the epidermis
(>750nm)
Depth of Treatment– Must penetrate deeply to reach the hair bulb
Problems:– Melanin is the target for Selective Photothermolysis– The epidermis has melanin– Heat must be retained in the hair follicle to treat
Solution to Problem:– Must provide epidermal cooling– Pulse durations >5 ms to protect the epidermis
Pulse durations <100 ms to confine heat to the hair follicle
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– Pulse durations <100 ms to confine heat to the hair follicle– Smaller hairs require shorter pulse durations
Wavelength: Wavelength: Challenge of LightChallenge of Light--Based Hair RemovalBased Hair RemovalWavelength: Wavelength: Challenge of LightChallenge of Light--Based Hair RemovalBased Hair Removal
Melanin is in the epidermis & hair
Laser Light
The more melanin, the more heat
Epidermal safety is
Melanin
Epidermal safety is determined by the amount of melanin & laser parameters
– Skin type & tan– Wavelength – Fluence
Cooling
Targets
– Cooling
Growth Stage of the Hair– Anagen
C t
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– Catagen– Telogen
Anatomy of a Human Hair
Vascular LesionsVascular LesionsVascular LesionsVascular LesionsVascular LesionsVascular LesionsVascular LesionsVascular Lesions
Vascular (Leg and Facial Veins)
Spider Veins (0.5 – 1.5 mm)-blue purple or red-blue, purple or red
Fi S id V iFine Spider Veins (< 0.5 mm) -red
Deep Reticular Veins (1 – 4 mm)-blue
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Vascular TreatmentsVascular TreatmentsVascular TreatmentsVascular Treatments
Target: Hemoglobin
Wavelength– Anything from 500-600– Not between 600-900– Anything from 900-1064
Pulse Duration– Maintain thermal confinement to target vessels (5-60 ms)– Shorter pulse durations for small diameter, longer for large diameter
Problem– Melanin is more highly absorbed than hemoglobin– Larger vessels tend to be deeper– Multiple sized vessels
Solution– Wavelength Selection for high hemoglobin to melanin contrast
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g g g– Cooling to protect the epidermis– Multiple spot sizes to match vessel size and depth
Review of Absorption by Review of Absorption by WavelengthWavelengthReview of Absorption by Review of Absorption by WavelengthWavelength
AbsorptionOptimal vascular results
100
Melanin
Optimal vascular results require sufficient hemoglobin but minimal melanin absorption
10
H l bi
1
Hemoglobin
Important for vascular
Wavelength (nm)
532 1064585 694 810755FD
Nd:YAGRuby Alex Diode Nd:YAG
treatments
42
Nd:YAG Pulsed Dye
Ratio of Hemoglobin to Melanin Ratio of Hemoglobin to Melanin AbsorptionAbsorptionRatio of Hemoglobin to Melanin Ratio of Hemoglobin to Melanin AbsorptionAbsorption
Hemoglobin/Melanin Absorption
Vascular treatment:
• Hemoglobin absorption (blood vessels) is good
• Melanin absorption (epidermis) is bad
• 500 ― 600 nm and 940-1064 nm lasers are best for vascular treatments
Wavelength (nm)
532 1064585 694 810755FD
Nd:YAG Pulsed Ruby Alex Diode Nd:YAG
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Pulsed Dye
Pigmented Pigmented Pigmented Pigmented LesionsLesionsLesionsLesions
Pigmented Lesion TreatmentsPigmented Lesion TreatmentsPigmented Lesion TreatmentsPigmented Lesion Treatments
Target: Melanin
WavelengthWavelength– 500-700 nm (High melanin absorption)
Pulse Duration– Shorter pulses are more aggressive– Longer pulses allow for more gradual heating – safer for darker
skin types and low contrast pigmented lesions
Problem– Cooling reduces the efficacy when treating pigment because the
treatment intentionally heats the epidermisy p
Solution– On-Demand Skin Cooling
Pulse Duration Selection
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– Pulse Duration Selection
Laser GenesisLaser GenesisLaser GenesisLaser GenesisLaser GenesisLaser GenesisLaser GenesisLaser Genesis
Laser GenesisLaser GenesisLaser GenesisLaser Genesis
Target: Hemoglobin in microvasculature (papillary dermis) and bulk heating
Wavelength– 1064 nm Nd:YAG
Pulse Duration– Very short microsecond pulses
Problem– Melanin is more highly absorbed than hemoglobing g
Solution– Microsecond pulses thermally confine heat to targets smaller in size than
the epidermisTh id i i b l l d i h d d – The epidermis is subsequently a large target and is not heated to damage levels making the laser modality safe for all skin types and tanned skin
– High frequency pulsing cumulatively heats the papillary dermis and upper reticular dermis
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Targets for Laser Genesis Targets for Laser Genesis ProcedureProcedureTargets for Laser Genesis Targets for Laser Genesis ProcedureProcedure
Hemoglobin absorption used to heat (not damage) fine upper vascular plexus
Water absorption used to conduct heat into upper dermisdermis
Results in reduction of diffuse redness and
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diffuse redness and stimulation of new collagen production
TitanTitanTitanTitanTitanTitanTitanTitanTreating Skin LaxityTreating Skin Laxity
Skin LaxitySkin LaxitySkin LaxitySkin Laxity
Target: Water
Wavelength1100 1800 nm– 1100-1800 nm
– Wavelengths below 1100 nm absorb in melanin and hemoglobin increasing risk to the epidermis
• Increases variability across patients (limiting efficacy)• Limits skin types safely treated by the device
Pulse Duration– Long pulse durations to provide safe heating for collagen contraction
Problem– Bulk heating does not have thermal confinement yet the treatment needs to
spare the epidermis– There is no “specific” chromophore for the laser to target– Short pulse durations do not localize heating to the depths desired for efficiacy
and can create burnsand can create burns
Solution– Contact cooling over the entire epidermis being treated– Target water absorption and control the amount of absorption to control depth
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– Provide long pulses to heat and maintain volumetric heating
Treating Skin Laxity with TitanTreating Skin Laxity with TitanTreating Skin Laxity with TitanTreating Skin Laxity with Titan
Sustained heating of the dermis
Treatment Objectives– Collagen contraction
L t ti l ti f – Long-term: stimulation of collagen remodeling
– Epidermal protection
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Titan and Water Absorption Titan and Water Absorption Titan and Water Absorption Titan and Water Absorption
Absorption Spectra
Designed to absorb in water yet penetrate deeply for optimal results
1000
Titan Spectrum
100
1/cm
) Water Absorption
10
Abs
orpt
ion
(1
11000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000
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0.1
Wavelength
Collagen Contraction Collagen Contraction Collagen Contraction Collagen Contraction
Heat disrupts the bonds linking the collagen
Collagen coil “relaxes” resulting in a shorter Collagen coil “relaxes” resulting in a shorter, thicker strand
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NeocollagenesisNeocollagenesisNeocollagenesisNeocollagenesis
New Collagen Growth – Long-termThermally induced wound response– Thermally induced wound response
– Happens gradually (3 – 6 months)– Improves skin texture
Collagen Matrix
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PearlPearlPearlPearlPearlPearlPearlPearlResurfacing LaserResurfacing Laser
complementarycomplementary——not not cannibalisticcannibalistic----productsproductscomplementarycomplementary——not not cannibalisticcannibalistic----productsproducts
• What are we trying to treat?
• How do we treat this best (from a physician and patient ti )?
Full Treatment vs. Fractional Treatment Decision Chartf f
perspective)?
Location Depth
# of Tx
Full Cover
Down
Time Full
# of Tx
Frac.
Down
Time Frac.
Full Coverage or Fractional?
Cutera Solution
<100 Lentigines Epiderm
is
<100 micron
s1-2 3-4
days 4-6 2-3 days
Full – best results in the
fewest treatments
with less days PearlTexture /
Fine lines Epidermis and <100 3-4 3-4 with less days
of total downtime.
Fine lines and wrinkles
is and Papillary Dermis
microns
1-2 3-4 days 4-6 3-4
days
Moderate to l
300 – Fractional Ablative– l
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Deep Wrinkles and Scars
Reticular Dermis
800 micron
s
1 30 days 1-2 5-7
days
AblativeDowntime and
healing are best
Pearl Fractional
Absorption (Water)Absorption (Water)Absorption (Water)Absorption (Water)
Water Absorption by WavelengthWater Absorption by Wavelength
10000
100000
10
100
1000
n (1
/cm
)
0.1
1
10
500 2500 4500 6500 8500 10500
Abs
orpt
ion
0.0001
0.001
0.01
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Wavelength (nm)
Pearl’s Mechanism of ActionPearl’s Mechanism of ActionPearl’s Mechanism of ActionPearl’s Mechanism of Action
Top Down: • Full Epidermal Treatment p
through Ablation and Coagulation
Ablation: up to 1/3 of the
natural dressing
• Ablation: up to 1/3 of the epidermis ablated during treatment
• Coagulation: Up to 2/3 of the
Ablation removes tissue
residual heatgepidermis coagulated during treatment• Provides a natural dressing
that peels off in 3 5 days
residual heat
that peels off in 3-5 days
Bottom Up: Collagen Stimulation• Collagen Remodeling: Residual
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heat in dermis stimulates new collagen