Dr. Patrick Treacy lectures on IPL (Dublin)

Intense Pulsed
Light (IPL™)
‘Benefits & Drawbacks’
Dr. Patrick Treacy
MD Ailesbury Clinics Ltd.
Professional Beauty Dublin Oct 2012

MEDICAL DISCLOSURE:
 Dr. Patrick J. Treacy is a Cosmetic Doctor presently on the Specialist Register in
the UK & Ireland. Specialist Dermatologist.
 Previously worked in United States., United Kingdom, Australia, New Zealand,
South Africa and Gibraltar.
 No financial interest or stock in Lumenis nor do I receive any additional
remuneration for giving this IPL lecture.

Agenda
 IPL Skin Treatments Using Photorejuvenation

 The Science Behind IPL
 What IPL Can Do
 Skin Treatments Using Photorejuvenation
 Type I Type II Type III (pending FDA clearance)
 Technologies Available on IPL Platforms
 Unwanted Veins Tattoo Removal
 Treatment of Wrinkles and Skin Laxity
 Treatment Considerations
 Complications of IPL
 What’s New in IPL technology

Before and After
Female with facial veins
Before and after 3 IPL treatments
Courtesy of Jerry Darms, MD, Lake Oswego, Oregon
Before After

Before and After
Female with facial veins
Courtesy of Jerry Darms, MD, Lake Oswego, Oregon
Before After
Telangiectasia

Before and After
Female with ruddy complexion
Courtesy of Robert Weiss, MD, Hunt Valley, Maryland
Before After

Before and After
Female with ruddy complexion
Before After
Rosacea

Before and After
Female with sun damage
Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado
Before AfterLentiges

Before and After
Before AfterSun Damage

Before and After
Before After
Sun Damage

Before and After
Female with poikiloderma
Courtesy of Mary Grey, MD, Auckland, New Zealand
Before After

Before and After
Female with poikiloderma
Courtesy of Mary Grey, MD, Auckland, New Zealand
Before After
Poikiloderma

Before and After
Female with age spots (sun-induced freckles)
Before and after 1 IPL treatment
Courtesy of Franklin Johnson, MD, Mineola, New York
Before After
Age Spots

Before and After
Male with vascular changes
Courtesy of Gayle Rothenberg, MD, Houston, Texas
Before After
Vascular Changes

Before and After
AfterBefore
Histology

What is IPL?
 IPL = Intense Pulsed Light
 Visible and near infra-red light, 500-1200 nm
 Efficacious
 Flexible
 Safe
Elora, IPL Quantum and Lumenis One

How IPL Works:
Selective Photothermolysis
 Selective
 Specially selected wavelengths of light penetrate the skin,
reaching the target (hemoglobin, melanin) with minimal
epidermal/dermal absorption
 Photothermo-
 The light is converted to heat in the target
 -Lysis
 Heat coagulates the proteins in the target and is
conducted to the cells around, causing mechanical
damage
 Clearance by immune system cells

How IPL Works:
Selective Photothermolysis
1. Specially selected wavelengths of light penetrate the skin
2. Target (haemoglobin, melanin) absorbs the light with minimal
epidermal/dermal absorption
3. Light is converted to heat, destroying the vessel or lesion
4. Damaged tissue is removed by the body

Quick Rule 1: Different objects preferentially absorb
different wavelengths of light. (selective absorption)

Quick Rule 2 The right wavelength can selectively destroy
the object without affecting the surrounding tissue.
(selective photothermolysis)

Laser Types
x-rays
cosmic rays
Microwaves
TV and
radio
waves
Excimer
KTP Nd:YAG
Er:YAG
190-390
488-514
532
577-630
755
694
1064
2940
10600
UV
VISIBLE
INFRARED
400 nm 700 nm
Holmium
2100

Properties of Laser Light
 Collimated: Minimal divergence of light bundle
 Monochromatic: Only one wavelength
 Coherent: Defined phase relation
White light
(Divergent)
White light
(Complete visible spectrum)
Laser Light Laser Light Laser Light
White light
(Incoherent)

IPL vs. Laser
 Single wavelength targets
single peak of melanin and
hemoglobin’s absorption
spectra to destroy target
 Wavelength cannot be
adjusted for individualized
treatment
 Multiple wavelengths target
multiple peaks of melanin
and hemoglobin’s
absorption spectra to
destroy target
 Wavelengths can be
optimized to individuals’
skin types and
conditions, using filters
 Minimal ocular hazard
 No down-time, non-
ablative procedure with
minimal side-effects
Laser IPL

 During the pulses, light
energy is delivered
 During the delays, the
tissue cools
 More energy can be be safely delivered to
the target
IPL’s Efficacy:
Multiple Synchronized Pulsing
Pulse 1 Pulse 2 Pulse 3
Delay 1 Delay 2

Technologies Available on IPL
Platforms

Two heads are better than one Nd:YAG Module
2 Spot Sizes (2 x 4 mm and 6
mm) to ensure precision
treatment with computer-
enabled recognition
Continuous contact cooling
with SapphireCool
Light Guides to measurably
increase patient comfort
and enhance Light Guide
durability

What IPL Can Do
 IPL is the gold-standard for photorejuvenation
 Treats redness and rosacea symptoms
 Treats brown pigmentation and age spots
 Leaves the skin soft and smooth
 Treats the full face, neck, chest, and hands
 Requires no downtime

What IPL Can Do
Type I Skin Treatments Using Photorejuvenation:
 Erythema/Flushing
 Rosacea symptoms
 Telangiectasia
 Hyperpigmentation
 Melasma
 Photoaging

 Why treat pigmentary conditions?
 75% of the Irish population between the
ages of 35 and 65 have some type of
treatable pigmented lesion.
What IPL Can Do
Pigmentary Conditions

 Treatment options for pigmentary
conditions:
 IPL
 Lasers
 Liquid nitrogen
 Chemical peels
 (Micro-) Dermabrasion
 Surgery
 Topicals, including bleaching
 Prescription drugs
 No treatment
What IPL Can Do

What IPL Can Do

What IPL Can Do
Vascular Conditions
 Treatment options for vascular conditions:
 IPL
 Lasers
 Sclerotherapy
 Compression stockings
 Combination
 No treatment

What IPL Can Do
Vascular Conditions
 Why treat Vascular Conditions?
 1 million Irish people suffer from
benign vascular condition such as:
 Spider veins and other telangiectasia
 Haemangiomas
 Port wine stains and other vascular
malformations - 3 in 1000 births
 Rosacea - estimates of 150,000 Irish
people, many who go untreated

What IPL Can Do
Vascular Conditions

What IPL Can Do
Type II Skin Treatments Using Photorejuvenation
 Dermal and epidermal structural changes
 Elastotic changes
 Wrinkles

What IPL Can Do
Type II : Clinical Research

Before 6 Months After
5-ALA therapy followed by IPL treatment
What IPL Can Do
Type III : Photodynamic
Photos courtesy of Mitchel Goldman, MD
Pending FDA Clearance

 Procedure
 Acetone scrub
 5-ALA therapy with
30 minute incubation
 Lumenis IPL at 30
J/cm2
Before After
What IPL Can Do
Type III : Photodynamic
Photos courtesy of Dore Gilbert, MD
Pending FDA Clearance

Before
Female with hair on the chin
Before and 6 months after 3 IPL treatments
After
What IPL Can Do
Unwanted Hair

Before
Female with spider veins
Before and 2 months after 4 IPL treatments
Courtesy of Marc Troxler, MD, Arlesheim, Switzerland
After
What IPL Can Do
Unwanted Veins

 Why treat leg veins and deep vascular lesions?
 Varicose veins are present in approximately 50% of women
and 20% of men before the age of 60.
 50% of people with varicose veins are bothered by
symptoms. Almost all are bothered by appearance.
What IPL Can Do
Unwanted Veins

Treatment Considerations
 Parameter
selection
 Easy presets
for novices
 Customizable
parameters
for advanced
users

Treatment Considerations
 Contraindications
 Malignancy
 Prolonged sun exposure or tanning within four
weeks pre- or post-treatment
 Photosensitizing drugs
 Relative contraindications
 Diabetes
 History of keloid scarring
 Pregnancy

IPL Photorejuvenation
Complications / Adverse Effects
• Dissatisfaction
• Ecchymosis (purpura)
• “Tiger Stripes”
• “Leopard Spots”
• Burns
• No scars to date
• Hyperpigmentation
• Hypopigmentation
• Epidermal Crusting
Adverse reactions can spoil everything -
for the patient, for the dr, for all the drs
Photos: R Weiss MD
pre
1 day post
3 weeks post

Causes for Burns
Fluence too high
Filter wavelength too short
Pulse duration too short
Pulse delay too short
Insufficient quantity of gel
NO TRAINING!

OPT – Optimal Pulse Technology
“Square Off” the pulse
Typical IPL pulses have
energy peaks, followed by
decline
Lumenis One and M22 have
the ability to control the
pulse shape, each of them
individually
OPT: squares off and
equalizes the pulses,
delivering consistent,
homogeneous energy over
the duration of the pulse
Even more important with a
train of pulses

OPT – Optimal Pulse Technology
Safety
Eliminating the energy peak
at the beginning of the
pulse
Efficacy Current Pulse Shape
Addition of energy to the
ineffective decline at the
end of the pulse
New Pulse Shape
Reproducibility
Homogeneous “squared off”
energy distribution

Just what you need, when you need it
The new Multi-Application platform
Grows with your business
Allows add-ons
Expands to treatment needs
Adapts to future applications as they emerge

A single head with many ideas
• One Treatment Head
• Change Filters instead of hand
piece
• Saves time, storage space and
purchase of multiple,
expensive treatment heads
• 6x Expert Filters:
(515, 560, 590, 615, 640, 695
nm)
• 2x SapphireCool Light Guides
(15 x 35mm; 8 x 15mm)

Cut off Filters
Treatment of following skin conditions with just one Head:

Clinical Indications
What can we treat?

Lentigines
 Solar
“Age," "sun" or "liver" spots
Commonly appear as medium to dark brown
Hands, face, forearms and chest
Senile
Most fair-skinned people in middle age
Flat, round or oval-shaped, and have a slightly
irregular border.

Solar Keratosis
 Warning sign you are prone
to sun damage and skin
cancer
 Red, flattish, scaling dry
skin that may sting if
scratched
 Appear on areas of skin
most often exposed to the
sun, like hands and face
 Most common in people
over forty years.
Keratosis

Café-au-lait
 Most often present at birth
 Determined by color of
coffee and milk
 50 % chance of
reoccurrence
 Treat with IPL or Q-
Switch

Haemosiderin
 Brownish pigment
containing iron
 May make the skin
appear brown or orange
after a bruise or other
injury heals.
 Post injury that causes
red blood cells to leak
i.e. sclerotherapy

Becker nevus
 Skin disorder predominantly
affecting males
 Nevus first appears as an
irregular pigmentation
 On the torso or upper arm, and
gradually enlarges irregularly,
becoming thickened and often hairy

Ota Nevus
 Blue to dark brown
pigmentation
 Dermal - Usually at birth
 The nevus of Ota is usually
located in the region of the eye
and maxillary division of the
trigeminal nerve
 Treat with IPL or Q-Switch

Ito Nevus
 The nevus of
Ito is usually
located on the
shoulder, side
of neck, and
supraclavicular
areas

Hyperpigmentation
 Excess skin pigmentation
 Can be the symptom of a severe
disease
 In certain conditions melanocytes
can become abnormal and cause
an excessive amount of darkening
in the color of the skin
 Treatment combination IPL and
Hydroquinone (bleaching cream)

PWS – Port Wine Stain
 Child
• Present at birth
• Pink to dark or bluish red, abnormal blood
vessels
• Do not change color when gently pressed and
do not disappear over time
 Adult
• May become darker and may bleed

After 4 TreatmentsBefore
Female, Skin Type II, Port Wine Stain – ARM and SHOULDER
Universal IPL treatment head and Nd:YAG
IPL: Triple pulse, 3/20/3/20/3, 590 nm filter, 20-29 J/cm2
Nd:YAG: Single pulse, 14 ms, 110 J/cm2 Basmat Zamir, MD

Port Wine Stain
After 4 TreatmentsBefore
Female, Skin Type II, Port Wine Stain – ARM and SHOULDER
Universal IPL treatment head and Nd:YAG
IPL: Triple pulse, 3/20/3/20/3, 590 nm filter, 20-29 J/cm2
Nd:YAG: Single pulse, 14 ms, 110 J/cm2 Basmat Zamir, MD

 Facial
• Dilated superficial
blood vessels
• Red, pink or
purple, they will
absorb more of the
laser light than the
surrounding normal
skin
• IPL effective, may
reoccur

Telangiectasias
 Facial
• Dilated superficial
blood vessels
• Red, pink or
purple, they will
absorb more of the
laser light than the
surrounding normal
skin
• IPL effective, may
reoccur

 Truncal
• Thin skin secondary
to long-term steroid
use or aging, collagen
vascular disease, and
hormonal variation
(particularly estrogen)

Hemangioma
 Nodular
 Raised, flesh-colored nodule,
which often has a bluish hue or an
overlying telangiectatic patch
 Regular
 Bright red, flat area resembling a
port-wine stain
 Upper layers of skin

Rosacea
Progressive Stages of Rosacea
 Stage One
• Flushing skin
 Stage Two
• Persistent redness and inflammation
• Unexplained bumps and pimples
• Not painful

Rosacea
 Stage Three
• Visible blood vessels
• Painful to the touch
• Thickening on the nose or cheeks
• Blood pooling under the skin :
bruising
 Stage Four: Full-Blown
• Eye irritation
• Burning or stinging, crusty, scaly,
with persistent pain
Combination of topical, antibiotic
medication , and IPL

 Uniform brown color is usually
seen over the cheeks, forehead,
nose, or upper lip.
 Associated with the female
hormones estrogen and
progesterone
 Treatment with IPL can be
difficult
 Treatment combination with
hydroquinone
 Avoid sun exposure

Melasma
 Uniform brown color is usually
seen over the cheeks, forehead,
nose, or upper lip. It is most
often symmetrical (matching
on both sides of the face)
 Associated with the female
hormones estrogen and
progesterone
 Treatment with IPL can be
difficult
 Combination with
hydroquinone

Poikiloderma
 Reddish-brown colour
 Erythema and mottled
pigmentation seen on
the sides of the neck
 Most commonly seen in
women
 Photosensitizing
chemicals in perfumes
or cosmetics

Age Spots/ Telangiectasias
 (M) Mild
 Over exposure to the
sun
 (S) Severe
 Dense pigmentation
and enlarge
capillaries
 (N-F) Non-Facial
 Hands, arms, chest
exposed to sun
 Use lower energy

Dr. Patrick Treacy lectures on IPL (Dublin)

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Dr. Patrick Treacy lectures on IPL (Dublin)