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Laser hair removal and Vascular Treatment with Excell HR Laser

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Key Parameters for Successful Laser Hair Removal
Excell HR Technical Properties
High Power 755nm Alexandrite
Long Pulse 1064nm ND Yag
Clinical Applications and results
My Laser Journey
My Personal Experiences with Lasers
A short history of my experience with Excell HR laser and Its advantages

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Laser hair removal and Vascular Treatment with Excell HR Laser

  1. 1. Excell HR Laser - Hair Removal and Vascular Treatments. My Personal Experiences www.ekremcivas.com www.civashairtransplant.com civasestetik@gmail.com
  2. 2. Titles Part I a. Key Parameters for Successful Laser Hair Removal b. Excel HR Technical Properties c. High Power 755nm Alexandrite d. Long Pulse 1064nm ND Yag e. Clinical Applications and results Part II – My Laser Journey – My Personal Experiences with Lasers – A short history of my experience with Excell HR laser and Its advantages
  3. 3. excel HR™ 21st Century Hair Removal PART Ia Key Parameters for Successful Laser Hair Removal
  4. 4. What Makes a Successful LHR System? Wavelength Pulse Duration CoolingFluence Spot Size
  5. 5. Wavelength (nm): 585 694 755 810 1064 2790 2940 10600 Laser Type: PDL Ruby Alex Diode Nd:YAG YSGG Erbium CO2  Wavelength determines absorption target  Absorption spectra help determine ideal wavelengths to heat desired targets  Wavelength affects light scattering (spread)  Shorter wavelengths experience more scattering  Scatter and absorption limit depth of heating PenetrationDepth Key Parameters for Successful LHR 1. Wavelength
  6. 6. Nd:YAG • 1064 nm • Skin Types I-VI • Safest wavelength for darker skin and tanned patients • Effective on dark, coarse hair Pulsed Light (IPLs) • 590 to 1200 nm • Skin Types I-V; best for light skin and dark hair • Shallower penetration – deeper, thicker hairs not treated as effectively • Less precise – can lead to heating of skin pigment Alexandrite • 755 nm • Skin Types I-V; ‘gold standard’ for I-IV • More effective for finer, lighter hair • Most globally requested, trusted and utilized wavelength Diode Laser • 800, 810 nm • Skin Types I-III; less for IV, V • Peak Power/Brightness is a fraction of Nd:YAG/Alex lasers – can be less effective on finer, lighter hair • Blind to treatment area Hair Removal Light Source Comparison
  7. 7. Wavelength - Depth Visible Infrared Dalgaboyu (nm): 532 585 694 755 810 1,064 Laser Type: FD 1064 PDL Ruby Alex Diode Nd:YAG
  8. 8. Wavelength - Chromophore 532 1064585 694 810755 1 10 100 Melanin Hemoglobin Pulsed Dye Ruby Alex Diode Nd:YAG Wavelength (nm)FD Nd:YAG
  9. 9. Key Parameters for Successful LHR 2. Spot Size • Treat target and reduce risk to deeper structures by selecting appropriate spot size (particularly for 1064 nm) • Smaller spot size = less penetration, more scatter – Targets more superficial structures (superficial, fine hair follicles) • Larger spot size = deeper penetration, less scatter – Targets deeper structures (hair)
  10. 10. Key Parameters for Successful LHR 3. Pulse Duration (PD) • Measured in milliseconds (ms), based on target size and skin type • Pulse duration controls efficacy – Speed of heat escape is proportional to target size – Shorter pulses are effective because energy is delivered faster than it can escape – Longer pulses protect the epidermis because heat can escape preventing heat rise (Nd:YAG) • Pulse must be shorter than the thermal relaxation time of the hair – Coarse hair = 25-45 ms – Fine hair = 3-10 ms
  11. 11. Key Parameters for Successful LHR 4. Fluence • Measured in Joules/cm2 (J/cm2), amount of energy applied in a given area • Total energy delivered is determined by both fluence and spot size • Adjustments should be made based on clinical endpoints and epidermal response Decrease Large Spot Sizes Darker Skin Types Increase Small Spot Sizes Lighter Skin Types Fluence
  12. 12. Key Parameters for Successful LHR 5. Cooling • Laser targets melanin in target hair follicles – cooling protects the epidermis • Cooling reduces the temperature rise in the epidermis and protects it from damage, permitting higher fluences to be delivered • Cooling acts as a local anesthetic for improved comfort • Types of cooling – Contact Cooling – Cryogen (refrigerant) Cooling – Refrigerated Air Cooling • Contact cooling is superior as Cryogen cooling does not provide the same level of variable protection and safety
  13. 13. Key Parameters for Successful LHR 5. Cooling COOLING Fluence Cooling Pre-Cooling Pre-Cooling + Post-Cooling Pre-Cooling + Parallel + Post-Cooling Improved Comfort & Safety
  14. 14. excel HR™ 21st Century Hair Removal PART Ib excel HR technical properties
  15. 15. • Versatile, High Performance – High-Power 755 nm Alexandrite + Versatile 1064 nm Nd:YAG – Effectively treats ALL skin types – Easily set 3-18 mm spot sizes optimized for hair and vascular • Rapid, powerful energy delivery – Coverage rate 5.1 cm2/sec (755 nm) – truPulse™ consistent long pulse energy delivery (1064 nm) • Comfortable treatments with Sapphire contact cooling – The only high power Alex product on the market with contact cooling – Effective, safe, comfortable – Superb visibility of treatment site 15 excel HR
  16. 16. What can I treat with a premium 755 nm / 1064 Nd:YAG nm laser? Hair Removal Vascular Lesions Benign Pigmented Lesions
  17. 17. excel HR Indications for Use • Hair reduction on all skin types (Fitzpatrick I – VI) all hair type, including tanned skin • Vascular lesions treatment • Skin Rejuvenation • Benign pigmented lesions treatment • Onychomycosis • Planter verruca treatment • Seborrheic keratosis
  18. 18. Compact & Modern Design • Small footprint • Quick start up • Runs quiet and cool • Plugs into 220v No Disposables or Consumables • No consumables, no CFC’s, no per shot, per patient costs Intuitive User Interface • Easy to navigate parameters Real Time Calibration • System continually monitors laser output to ensure each laser pulse is exactly the same. • No waiting for calibration High-power Alexandrite and Long- pulse Nd:YAG Laser • 50J Alex/80J Nd:YAG Max Energy • Proprietary truPulse™ technology – the only true long pulse Nd:YAG • Up to 2 Hz Alex/10 Hz Nd:YAG Superior Sapphire Contact Cooling • Pre, parallel and post-cooling excel HR Advanced Design, Modern Ergonomics 18 Modern Ergonomics • Robust, extra-long 3 meter fiber for optimal reach and easy patient access • Motorized spot size adjust – no switching of fiber-optic assemblies
  19. 19. Excellent Visibility • Large diameter sapphire window • Visibility throughout treatment Adjustable Spot Size • Motorized, on-the-fly adjustments • No switching of fiber-optic assemblies • 3-18 mm (Nd:YAG); 5-18 mm (Alex) • Real time calibration • Without wasting time Sapphire Contact Cooling • Clinically superior for laser hair removal • Pre-, parallel-, and post-cooling • Adjustable temperature sapphire window 4°C to 20 °C excel HR Intelligent Energy Delivery 19
  20. 20. •30% Smaller Footprint •HALF the Volume 35” 45” excel HR Space Saving Footprint
  21. 21. Sapphire Contact Cooling Patient Preference • Patient preference study* – 5 subjects, Single LHR treatment – ½ Tx with excel HR, ½ Tx with GentleMax Pro – Energy delivery levels closely matched – Patients rated pain score, overall satisfaction level 0 5 10 15 20 25 0 1 2 3 4 5 6 7 8 9 10 Back #1 Thigh #1 Chest #1 Chest #2 Legs #1 EnergyDelivered(J) TxDiscomfortScore Subject excel HR competitor (cryo) Energy (J) excel HR Energy (J) competitor (cryo) 100% of subjects preferred the excel HR treatment overall! All subjects found excel HR to be the more comfortable Tx! excel HR was 20% more comfortable on average! *Data on file
  22. 22. Sapphire Contact Cooling The Importance of Cooling • Melanin is the target in hair follicles, but is also a target in the epidermis – Cooling reduces the temperature rise in the epidermis and protects it from damage, permitting higher fluences to be delivered to the hair follicles • Cooling acts as a local anesthetic for improved comfort • Cryogen (refrigerant) cooling does not provide this level of variable protection and safety
  23. 23. Sapphire Contact Cooling The Physicians Choice for Comfort & Safety • “Sapphire contact cooling is superior for laser hair removal – index matching and compression enable target structures to be heated more efficiently while pre-, parallel-, and post-cooling spares the epidermis.” Source: Lasers Surg Med 2000; 26(2): 130-144 Evaluation of Cooling Methods for Laser Dermatology H.H. Zenzie, MS, G.B. Altshuler, PhD, M.Z. Smirnov, PhD, and R.R. Anderson, MD • With a sapphire window temperature variable from 4oC to 20oC, physician have controllable cooling to maximize safety, comfort and results
  24. 24. Sapphire Contact Cooling Improved Efficacy with Refractive Index Matching • When the refractive index is “matched”, there is little or no bending (refraction) when the light enters the transmission medium • Refractive index values of sapphire and epidermal tissue are optimally matched – as a result, the coupling of laser energy into tissue is more efficient than through air Sapphire refractive index is optimally matched to skin and results in more efficient coupling of laser energy to follicular target structures Refractive index mismatch between air and skin results in less efficient coupling of laser energy to target structures excel HR Other Technology
  25. 25. Sapphire Contact Cooling Index Matching & Optical Damping with Sapphire Lens • Minimizing the light bending (refraction) ensures that more of the light reaches the target tissue • Matching the light path with the refractive index allows the light to back scatter and escape without causing heat build up at the skin’s surface – this is referred to as optical damping • Sapphire contact cooling creates near ideal conditions for optical damping – a thin liquid layer can be used to provide optical coupling and enhance the optical damping effect Index matching between sapphire and skin allows back scattered light to escape, further protecting the epidermis from heat build-up Refractive index mismatch causes internally reflected laser light to accumulate under the skin and contribute to epidermal heating
  26. 26. Sapphire Contact Cooling Index Matching & Optical Coupling Sapphire, n = 1.7 Air , n = 1.0 Antireflective coating w/ 99.5% transmission Gel, n = 1.4 Skin, n = 1.4 Sapphire, gel and skin refractive indexes are closely matched and step down in index for direct optical coupling of laser photons into skin WINDOW
  27. 27. excel HR Enhanced Efficacy With Compression • Skin compression collapses blood vessels, stretches the skin and often decreases its thickness – thus shortening the distance to follicular target structures for more efficient heating
  28. 28. Sapphire Contact Cooling Patient Safety Benefits • Contact cooling guarantees that laser treated areas are cooled and protected – Effective as long as the sapphire is in contact with the skin. • Cryogen-spray cooling can result in burns if laser and cryogen are misaligned – Only cools until the cryogen evaporates – Incorrect positioning can result in burns, hyperpigmentation “Now it’s over 2 months after and I have scars everywhere where I was treated!” LASER TREATED AREA LASER TREATED BUT NOT COOLED AREA CRYOGEN SPRAY AREA
  29. 29. Sapphire Contact Cooling Other Operational Benefits • Environmental – No contribution to global warming like cryogen spray • Tetrafluoroethane (R-134a) has a high global warming potential • Candela DCD inventors @ Beckman Institute urging alternative1,2 • Operating Environment – Doesn’t expose operator and patient to harmful CFCs3 like cryogen spray • Operating Efficiency – Doesn’t require 15 minute “warming time” like cryogen – No pre-treatment alignment of “spray pattern” required • System operating costs – No impact to operating costs – disposable cryogen canisters impact operating costs significantly ($5-45K/year) 1. Jia W, Svaasand LO, Nguyen TB, Nelson JS Dynamic skin cooling with an environmentally compatible alternative cryogen during laser surgery. Lasers Surg Med. 2007 Dec;39(10):776-81; 2. US 2008/0071332 A1; 3. Material Safety Data Sheet, Clickmed Corporation, Gloucester, MA.
  30. 30. excel HR™ 21st Century Hair Removal PART Ic High Power 755 nm Alexandrite
  31. 31. excel HR High Power 755 nm Alexandrite Hair Removal Vascular Lesions Benign Pigmented Lesions
  32. 32. 755 nm Alexandrite High Power 755 nm Alexandrite Fitzpatrick Skin Types I – IV
  33. 33. High Power 755 nm Alexandrite Overview • Most trusted and utilized wavelength for laser hair removal globally • Only laser with sufficient melanin absorption and peak power to effectively remove finer, lighter hair • Has proven long-term results for permanent hair reduction in skin prototypes 1-IV1,2 and is considered the ‘gold standard’ for treatment of these skin types • The Alex wavelength is preferentially absorbed by melanin and an optimized pulse width efficiently targets small to medium follicular structures with less thermal diffusion 1. Grunewald S et al. Lasers Surg Med 2014; 46: 13-19. 2. Davoudi SM et al. Arch Dermatol 2008; 144(10):1323-7.
  34. 34. • Max Delivered Energy: 50 J • Fluence: 4 - 100 J/cm2 • Spot Size: 5 – 18 mm Automatic Adjustable • Pulse Duration: 3 ms • Repetition Rate: 0 to 2 Hz • High power – 16.7 Kilowatts Peak Power – no system faster or more powerful • Epidermal Cooling: Cold Sapphire, Adjustable 4-20°C High Power 755 nm Alexandrite Technical Specifications
  35. 35. excel HR™ 21st Century Hair Removal PART Id Long Pulse 1064 nm ND YAG with Exclusive truPulse Technology
  36. 36. excel HR Long Pulse 1064nm Nd:YAG Hair Removal Vascular Lesions Superficial Pigmented Lesions
  37. 37. 1064 nm Nd:YAG Long Pulse1064 nm Nd:YAG Fitzpatrick Skin Types I – VI
  38. 38. Long Pulse1064 nm Nd:YAG Overview • Cutera recognized as world leader in 1064 nm technology • Neodymium yttrium aluminum garnet (Nd:YAG) • Use of long pulse Nd:YAG for laser hair removal first published in 2001 – Lévy JL, Trelles MA, de Ramecourt A. J Cosmet Laser Ther. 2001 Dec; 3(4):175-9. – Goldberg DJ, Silapunt S., Dermatol Surg. 2001 May; 27(5):434-6. • Only truPulse™ 1064 nm laser on the market • Greater depth of penetration than other lasers (>5 mm when used with epidermal cooling) • Lower melanin absorption (ideal for darker skin types) • Long-pulsed Nd:YAG is considered the safest wavelength for hair removal in skin types IV-VI, as well as tanned skin1,2 – it safely and effectively targets larger deeper follicular structures in darker skin types 1. Wanner M. Dermatol Ther 2005; 18(3):209-216. 2. Battle EF Jr. J Drugs Dermatol 2011; 10(11): 1235-9
  39. 39. Long Pulse1064 nm Nd:YAG Technical Specifications • Max Delivered Energy: 80 J • Fluence: 3 – 300 J/cm2 • Spot Size: 3 – 18 mm Automatic Adjustable • Pulse Duration: 0.1 – 300 ms • Repetition Rate: 0 to 10 Hz • High power – 14 Kilowatts Peak Power – fastest, most powerful system • Epidermal Cooling: Cold Sapphire, Adjustable 4-20°C
  40. 40. Long Pulse1064 nm Nd:YAG Penetration Depth
  41. 41. excel HR Long Pulse 1064 nm Nd:YAG • truPulse™ – the only Nd:YAG laser with a true long pulse temporal beam profile that measurably delivers consistent levels of long pulse energy, pulse after pulse (not a composite pulse) 10 msec truPulse™ Competitor “10 msec”
  42. 42. excel HR™ 21st Century Hair Removal PART Ie excel HR Clinical Applications and Results
  43. 43. excel HR Contraindications and Potential Complications Contraindications include: – Patients who are pregnant – Patients who are undergoing treatment for skin cancer
  44. 44. excel HR Precautions • Do not treat patients who have taken Accutane in the past 6 months • Anticoagulants may increase the risk of purpura or bruising • Gold therapy may cause blue-gray discoloration • Vitiligo may cause de-pigmentation • Pre-treatment with an antiviral may be indicated for patients with herpes • Use caution when treating patients with a history of keloids or hypertrophic scarring • Patients with hormone disorders (e.g., Polycystic Ovarian Syndrome) may not see effective hair reduction • Do not treat over open wounds
  45. 45. excel HR Warnings • Do not treat over dysplastic nevi or questionable pigmented lesions • Do not treat over or close to: – Tattoos or permanent make-up – Metal or electronic implants
  46. 46. excel HR Patient Selection • Patients should have brown or black hair – Laser light is not absorbed by white, gray, red or light-blond hair • excel HR is indicated for use on all skin types – The 755 nm wavelength is recommended to treat skin types I-V – The 1064 nm wavelength is recommended to treat skin types I- VI including tanned skin
  47. 47. excel HR Pre-Treatment Guidelines • Clean the skin by removing all make-up and/or topical anesthetic • Ensure that the treatment area is clean shaven • Instruct patients to not wax, pluck or tweeze hair between treatments • Topical anesthetic is optional and must be removed before treatment – CAUTION: Toxicity may result from overuse. Consult the product labeling for any anesthetic used • Ensure that ALL people in the treatment room are wearing safety eyewear
  48. 48. excel HR Treatment Precautions • Be extra cautious when treating delicate or highly sensitive areas (knuckles, genitalia, ears, upper lip, etc.) – Provide extra cooling with handpiece and/or frozen gel pack. Thinner skin is more easily damaged – Insert damp cotton ball inside ear canal when treating the ear – Pull skin away from testes to treat – When treating near the mouth, a moist gauze can be placed between the lips and teeth to protect teeth from discomfort • Use extreme caution when treating near the eye – Always treat outside the orbital rim of the eye aiming the beam away from the orbit. – Always use patient eye protection – Point the treatment window away from the eye and apply to the skin outside of the orbital rim
  49. 49. excel HR Patient Comfort • Cool Compress – May be applied to increase patient comfort and increase epidermal protection • Topical anesthetic can be applied – For highly sensitive areas – For patients with low pain tolerance – Must be removed before treating – CAUTION: Toxicity may result with overuse – Consult the manufacturer’s labeling
  50. 50. excel HR Post Treatment Guidelines For best results, ensure patient adheres to post-care instructions: – Avoid sun exposure and use a broad spectrum (UVA/UVB) sunscreen – Redness and peri-follicular edema (looks like a rash/bug bites) are common and resolve with time – Bruising and swelling are less common but may occur and will resolve with time – If a blister develops, treat as a wound – Hair may take up to 2 weeks to fall out – Avoid heat – hot tubs, saunas, etc. for 1-2 days – Avoid skin irritants (examples below) for a few days post-treatment Products containing tretinoin, retinol, benzoyl peroxide, glycolic/salicylic acids, astringents, etc. – Do not wax or pluck between treatments
  51. 51. excel HR Treatment Intervals • Treatment Interval recommendations are a general guideline only and are a compilation of intervals used by successful operators • Facial hair: 6-8 week intervals between treatments • Body hair: 8-10 week intervals between treatments • Back or Leg hair: 10-12 week intervals between treatments • To maximize hair response, it is often best to space the treatments further apart
  52. 52. Clinical Results Preliminary Clinical Treatment (755 nm) – Patient X (Chest) Pre- Tx 6 Weeks Post 1 Tx Photos courtesy of Cutera Research Center
  53. 53. Clinical Results Preliminary Clinical Treatment (755 nm) – Patient Y (Full Back) Photos courtesy of Cutera Research Center Skin Type V Pre-Tx 6 Weeks Post 1 Tx 3 Months Post 1 Tx
  54. 54. Clinical Results Preliminary Clinical Treatment (755 nm) – Partial Back Photos courtesy of Cutera Research Center Pre-Tx 6 Weeks Post 1 Tx 3 Months Post 1 Tx
  55. 55. Clinical Results Preliminary Clinical Treatment (755 nm) – Patient Z (Under Arm) Pre-Tx 6 Weeks Post 1 Tx Photos courtesy of Cutera Research Center 3 Months Post 1 Tx
  56. 56. Clinical Results 1064 nm Nd:YAG Laser Hair Removal Pre- Tx Post- Tx Photos courtesy of Eliot F. Battle, Jr., MD Skin Type V
  57. 57. Clinical Results 1064 nm Nd:YAG Laser Hair Removal • Pseudofolliculitis Barbae Pre-Tx Post- Tx Photos courtesy of Cutera Research Center
  58. 58. Clinical Results 1064 nm Nd:YAG Laser Hair Removal Pre-Tx 8 Wks Post 3 Txs Photos courtesy of Greg Waslen, MD
  59. 59. Clinical Results 1064 nm Nd:YAG Laser Hair Removal Skin Type IV (Indian) Pre-Tx Post 4 Txs Photos courtesy of Kevin Smith, MD
  60. 60. Clinical Results 1064 nm Nd:YAG Laser Hair Removal Pre-Tx Post-Tx Photos courtesy of Samuel Lederman, MD
  61. 61. excel HR Summary • excel HR is the modern day solution for hair removal, redefining safe, effective, and comfortable laser hair removal treatments • Combination of 755 nm + 1064 nm can treat ALL skin types • Fastest, most powerful hair removal system on the market • Integrated Sapphire contact cooling • Only true long pulse Nd:YAG • Rapid ROI with low cost of ownership & no consumable costs • Efficient operation with motorized spot size adjust & real time calibration • Handpiece design provides superb visibility of treatment site • Versatile – best Nd:YAG on the market for treating veins 61
  62. 62. www.ekremcivas.com www.civashairtransplant.com civasestetik@gmail.com
  63. 63. Part II a. My Laser Journey b. My Personal Experiences with Lasers c. My short history of working with Excel HR laser and its advantages
  64. 64. Education and Practice 1993 – Graduated from medicine school 1999 – Completed my residency in Dermatology 1999 – Introduced to hair surgery and began my practice in hair transplantation.
  65. 65. Before-After Hair Transplant
  66. 66. The ‘All About Hair Clinic’ Idea • My patients wanted to do both; – Hair transplant – Hair removal of unwanted hair at the same time. • I needed to have Laser • The ‘All About Hair Clinic’ idea developed
  67. 67. The ‘All About Hair Clinic’ Idea + + =
  68. 68. My Laser Journey 2003 - Decided to buy laser – I spent a whole year researching on which laser to buy – I did not want to do just laser hair removal. 2004 – Bought Cutera ND Yag : – Was able to do vascular treatment, laser hair removal and skin rejuvenation. – Improved myself in vascular treatments – Started making money out of it – Laser hair removal was running seamlessly without any problems.
  69. 69. My First Laser Cutera Vantage, 2004
  70. 70. I started with treatment of easy lesions One session, results immediately after
  71. 71. Vascular treatment around the nose area Results after 1 session
  72. 72. My Laser Journey Second Laser; ND Yag Cutera Excel 2008 – One laser could not cater for both laser hair removal and vascular treatment I bought my second laser; ND Yag Cutera Excel
  73. 73. I was becoming more experienced Results after 1 session
  74. 74. Port wine stain Results after 1 session
  75. 75. Hemangioma Results after 1 session
  76. 76. More Vascular Treatments
  77. 77. More Vascular Treatments
  78. 78. Publication ND Yag laser treatment for vascular lesions 2010 – I co-authored the book “ND Yag Laser Treatment for Various Vascular Lesions” that was published in the United States.
  79. 79. Laser Genesis At the same time, I was profiting from other benefits of ND Yag laser
  80. 80. 2 Months Post 6 TxsBefore Photos Courtesy of David Vasily, M.D. Laser Genesis Diffuse Redness Treatment
  81. 81. Laser Genesis Pore Treatment
  82. 82. Laser Genesis Scar and superficial wrinkles treatment
  83. 83. My Laser Journey Cynosure Alexandrite 2011 – The demand for laser hair removal was increasing; – To be better placed in the market, I needed a laser specifically for hair removal – I bought Cynosure Alexandrite laser. – The patients were more pleased with it than I expected – I had made the right decision.
  84. 84. More applications of ND Yag laser Meanwhile, I was continuously expanding my applications of NdYAG laser
  85. 85. Laser Genesis Surgery Scar Treatment
  86. 86. Laser Genesis Acne Scar Treatment 6 Tedavi sonrasıÖncesi Photos Courtesy of Tomei & Ashraf Badawi, M.D.
  87. 87. Onychomycosis and Verruca In the last 3 years I’ve been treating onychomycosis and palma plantar verruca.
  88. 88. Before 6 months after Before and After Clinical Documentation Infected Area=23.6% Infected Area = 9.4%
  89. 89. Before After 1 month Plantar verruca
  90. 90. My Laser Journey Cutera Excel HR 2014 - Cutera Excel HR was introduced – I did not need another laser. – However, due its good technical parameters and low consumable costs, I saw its advantage and bought it.
  91. 91. How could I use both Cynosure and Excel HR? Could Cynosure patients adopt to Excel HR? • Could we convince Cynosure patients to continue their sessions with Excel HR? – To take advantage of the low consumable cost • I requested them to try Excel HR • If they were not pleased with the results and comfort, they would go back to Cynosure. • Patients were more pleased with Excel HR. • Once again, I had made a good choice.
  92. 92. Summary My great experiences with Excel HR: – Alexandrite – NdYag
  93. 93. My great experiences with excel HR Alexandrite • With the continuous (pre, parallel, post) cooling ; – There is less pain, less risk of side effects hence safer and certainly effective laser hair removal. • No breaks needed during treatment because of less pain – Treatment takes a shorter time.
  94. 94. My great experiences with excel HR Alexandrite With quick start time, real time calibration and quick switching time, there is no wasting of time.
  95. 95. My great experiences with excel HR Alexandrite The matching of the laser path and refractive index of the skin, gel and contact window reduce scattering of laser light. – Thus, the light only reaches the targeted location.
  96. 96. Sapphire Contact Cooling Index Matching & Optical Coupling Sapphire, n = 1.7 Air , n = 1.0 Antireflective coating w/ 99.5% transmission Gel, n = 1.4 Skin, n = 1.4 Sapphire, gel and skin refractive indexes are closely matched and step down in index for direct optical coupling of laser photons into skin WINDOW
  97. 97. My great experiences with excel HR Alexandrite I have never observed the Paradoxical hypertrichosis effect with this laser. This is because, laser light is not scattered to the edges due to the contact window.
  98. 98. My great experiences with excel HR Alexandrite More effective with fine hairs
  99. 99. My great experiences with excel HR ND Yag Due to truPulse technology, – Stable energy can be supplied throughout the pulse duration, in the remaining spot area.
  100. 100. My great experiences with excel HR ND Yag Flexibility in pulse duration. – Ability to set up the pulse duration in milliseconds (e.g. 0.3ms) to warm up the area under the skin during rejuvenation – For thick hairs or veins, you can set up the required energy with high pulse duration (e.g. 40 ms)
  101. 101. My great experiences with excel HR ND Yag With contact cooling and parallel cooling; • Vascular treatments and laser hair removal procedures are less painful. • Before, only pre and post cooling was available. With large spot size up to 18mm; • Laser hair removal can be done faster
  102. 102. Percentage of North American laser procedures 102 34% 19% 12% 10% 7% 6% 5% 4% 3% Hair Removal Skin Rejuvenation Skin Resurfacing Vascular Lesion Benign Pigmented Lesion Skin Tightening Tattoo Removal Acne Onychomycosis SOURCE: US MARKETS FOR LASER, LIGHT, AND ENERGY DEVICES 2013
  103. 103. We are able to accomplish over 73% of the laser procedures with excel HR… Hair Removal %34 Skin Rejuvenation %19 Skin Resurfacing %12 Vascular lesion %10 Benign pigmented lesion %7 Skin Tightening %6 Tatoo Removal %5 Acne %4 Onychomycosis %3 Verruca %? Total %73+?
  104. 104. Thank You for your undivided attention. Questions?

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