SPECTRA™
Dual Mode Nd:YAG Laser
AGENDA
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Laser safety
Basic laser physics
Laser-tissue interaction
Introduction to the SPECTRATM SYSTEM
Clinical Protocols
– Patient assessment and pre-treatment
– Treatment
– Post-treatment
– Expected sequelae and adverse events
• Contact information for Lutronic departments
• Questions and discussion
LASER SAFETY
REGULATORY AGENCIES
• NATIONAL
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ANSI
OSHA: Occupational and Safety Health Administration (US)
CDRH FDA: Food and Drug Administration – Center for Devices
and Radiological Health (U.S.)
• STATE LAWS AND REGULATIONS
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Scope of practice: who may operate lasers
Educational requirements
• COUNTY OR CITY LAWS AND REGULATIONS
• INTERNATIONAL
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MDD: Medical Devices Directive (EUR)
EU-OSHA: European Agency for Safety and Health at Work (EUR)
IEC: International Electrotechnical Commission
ANSI
• The American National Standards Institute: a private non- profit
organization that facilitates development of standards for products,
services, processes, systems in the US.
• ANSI accredits standards that are developed by representatives of
other standards organizations, government agencies, consumer
groups, companies, and others.
• Government agencies such as OSHA use the ANSI guidelines to set
their individual requirements and standards.
• Non-governmental agencies such as The Joint Commission,
Association of Perioperative Registered Nurses, American Society for
Lasers in Medicine and Surgery and more have referenced this
standard as their guideline.
• ANSI Z136.3-2011 is the most recently published standard for safe
use of lasers in health care, and will be represented in this
presentation.
ANSI LASER CLASSIFICATIONS
Z136.3-2011
ANSI Laser
Classification
Description
Class 1
Any system containing a laser that cannot emit laser radiation at levels that are known to cause eye or skin injury
during normal operation.
Class 1M
Considered incapable of producing hazardous exposure unless viewed with collectionoptics.
Class 2
Visible lasers considered incapable of emitting laser radiation at levels that are known to cause skin or eye injury
within the time period of the human eye aversion response (0.25s).
Class 2 A
For FDA/CDRH: visible lasers that are not intended for viewing and cannot produce any known eye or skin injury
during operation based on a maximum exposure time of 1000 s.
Class 2 M
Emits in the visible portions of the spectrum, and is potentially hazardous if viewed with collectingoptics.
Class 3 A
FDA/CDRH visible lasers less than 5 times the Class 2 limit.
Class 3 R
A laser that is potentially hazardous under some direct and specular reflection viewing conditions if the eye is
appropriately focused and stable.
Class 3 B
Medium powered lasers that present a potential eye hazard for intra-beam (direct) viewing or for viewing specular
(mirror-like) reflections. Class 3B lasers do not present a diffuse (scatter) reflection hazard or significant skin hazard
except for higher powered Class 3B lasers operating in certain wavelengths.
Class 4
High-powered lasers (visible or invisible) that present acute hazard to the eye and skin for both direct exposure and
for diffuse reflections. Class 4 lasers also present a potential hazard for fire (ignition) and by-product emissions from
target or process materials.
LASER CLASSIFICATION & STANDARDS
SPECTRATM classification:
• Class IV laser by Center for Devices and Radiological Health
(CDRH)
• Class 4 laser by European Standard (EN 60825-1)
Follow ANSI, OSHA, European standard:
• Contact Laser Institute of America (LIA)
T: (800) 34LASER for current ANSI and OSHA standards
- http://www.laserinstitue.org
- i.e., ANSI Z136.3, ANSI Z136.1 and EN 207
• ANSI: American National Standards Institute
ANSI CONTROL CATEGORIES
• Administrative Controls (facility and Laser
Safety Officer ‘LSO’)
• Documentation, training programs, etc.
• Procedural Controls (facility and LSO)
• Policies, safety glasses, signs, etc.
• Engineering Controls (the manufacturer)
• Safety Interlocks, standby, emission indicators
• Emergency stop switch, Key switch
• Covered footswitch (where appropriate)
LASER SAFETY OFFICER (LSO)
• Every facility must appoint an LSO
• LSO verifies Documentation
• Facility LSO is responsible for the Laser Log, including
(but not limited to):
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System and Equipment Audits
Laser Maintenance Records
Safety Audits
Education – Initial and On-going
Competency – Skills Check Lists
NHZ : NOMINAL HAZARD ZONE
• The NHZ is the actual area (boundary) where injury could
occur by the laser beam.
• The NHZ is determined by the LSO or facility based on
manufacturer specifications.
• The NHZ is determined primarily by the wavelength of the
system, but can also be influenced by factors such as :
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Incident power
Spot Size and Divergence Angles
Exposure Time
MPE (maximum permissible exposure)
• Most small practices determine the entire treatment room
to be the NHZ.
VERIFY PROPER EYE PROTECTION
• Ensure all persons in treatment room are wearing
protective eyewear appropriate for the laser used.
• Best Practice: If a patient’s face is to be treated, they
should wear opaque or metal eye goggles or shields.
• A laser beam can cause severe corneal or retinal
injury, depending on the wavelength.
• Best Practice: A pair of goggles should be placed
outside the NHZ so entering personel can put on
goggles before entering the NHZ
SAFETY PRECAUTIONS FOR THE EYES
• Do not treat within the bony orbit of the eye.
• Ocular Hazard Zone:
• Laser energy emitted by the SPECTRA™,
when focused by the ocular lens onto the
retina, will have a very high irradiance
(e.g., even the 5 mW 532 nm aiming beam
could produce over 250 W/cm² at the macula,
the most sensitive part of the retina)
Protective Eyewear Required
• Operator Glasses for 532 + 1,064 nm
• OD ≥6.5 for 190 - 534 nm
• OD ≥6.0 for 910 – 1,070 nm
• OD ≥5.0 for 850 – 1,070 nm
• Operator Glasses for 585 + 650 nm
• OD ≥5.0 for 190 - 400 nm , 645 - 670 nm
• OD ≥6.0 for 585 - 665 nm
• Patient Goggles or Shields
• Opaque material e.g., metal
SAFETY GUIDELINES
• ‘Laser in Use’ warning sign on door
• Pair of operator goggles outside of door
• Enclosed room with opaque fire resistant window coverings
• Allow any flammable liquids used for cleaning the skin to fully
evaporate before treatment
• Have a fire extinguisher available
• Water must be available (e.g., faucet or in bowl)
• Avoid the use of instruments with reflective surfaces
• Be aware of other reflective surfaces (mirrors, trolleys, etc.)
BASIC LASER PHYSICS
BASIC LASER PHYSICS
The electromagnetic spectrum is comprised of visible colors,
infrared, radio, X-rays and gamma rays, which are all forms of
light. Wavelengths vary in size as depicted below.
Source http://www.alk aon.net/tag/electromagnetic-spectrum
BASIC LASER PHYSICS
• LASER: Light Amplification by Stimulated Emission of Radiation
• Lasers are devices that emit light using a process of optical
amplification.
• Laser light is very different from other light:
White (sunlight, light bulbs, IPL, etc.)
Laser Beam
Non-collimated
Collimated
Polychromatic
Monochromatic
Non-coherent
Coherent
• There are many types of lasers and many mediums such as
gases, dyes, crystalline rods, and diodes, which are used to
create various wavelengths.
BASIC LASER PHYSICS
Lasers used in cosmetic dermatology range from the
high 400 nm range to 10,600 nm.
LASER
TISSUE INTERACTION
LASER/LIGHT TISSUE INTERACTION
There are five mechanisms of action with lasers or
light treatment depending on the system type
(laser or non-laser), the wavelength and the
incident power density:
1. PhotoTHERMAL
2. PhotoCHEMICAL
3. PhotoMECHANICAL (acoustic)
4. PhotoDISRUPTIVE
5. PhotoBIOACTIVATIVE
LASER TISSUE INTERACTION
When light is applied to tissue there are four
reactions:
1. Reflection (from the surface of the target)
2. Scatter (forward, lateral and back-scattering)
3. Transmission (deep into the target tissue)
4. Absorption - the ultimate desired key reaction
in the appropriate targeted chromophore
LASER TISSUE ABSORPTION SPECTRUM
Source: Department of Medical & Scientific Affairs, Lutronic Corporation
Source: Department of Medical & Scientific Affairs, Lutronic Corporation
SELECTIVE PHOTOTHERMOLYSIS
• Different laser wavelengths are preferentially absorbed
by their corresponding chromophores (target).
• The main goal of selective photothermolysis is to heat
the targeted pigments swiftly with a laser and destroy
them without damaging surrounding tissue.
• Targeted pigments are selectively damaged through the
absorption of light and the subsequent instant
photothermal energy transfer, with minimal conducted
heat to the surrounding normal tissue.
PARAMETER CONSIDERATIONS
• To achieve selective photothermolysis, we need three
factors.
1. Appropriate wavelength - selective absorption
2. Short pulse width - targeting and heat confinement
3. Very high peak power (irradiance) - desired effect
• Ideally, the pulse width should be equal to or shorter
than the Thermal Relaxation Time (TRT) of the target
(e.g. melanin or tattoo ink) to confine thermal damage
selectively to the target.
Q-SWITCHED LASERS: SPECTRA
• Q-switching is a process in which the quality of the
beam is amplified, making it possible to produce
ultra-short pulse durations in the nanosecond
domain or shorter, delivering a high peak power.
• The pulse duration with Q-switched lasers is so short
that it creates photo-acoustic and -osmotic
shockwaves which fragment the pigment particles.
• The tiny fragments of pigment are then engulfed by
macrophage cells and carried away by the lymphatic
system.
SELECTIVE PHOTOTHERMOLYSIS
Q-Switched Nd:YAG Laser
(SPECTRATM et al.)
Laser
Beam
Chromophores
(e.g.melanin or ink particles)
Explosion
Source: Department of Medical & Scientific Affairs, Lutronic Corporation
Fragmented
chromophores
Macrophage cell
Absorption by macrophages
and excretion by the
lymphatic system
INTRODUCTION TO THE
SPECTRATM SYSTEM
COMPONENTS OF SPECTRA
TM
Articulated Arm
Handpiece
Control Panel
Handle
Key switch
Caster
Calibration Port
Emergency Stop Button
System Main Body
SPECTRA SYSTEM OVERVIEW – SPEC.
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Laser Medium: Nd:YAG
Wavelengths: 1064 nm / 532 nm (Option: 585 nm, 650 nm)
Operation Modes: Q-switched (5 ns )& Spectra Mode (300 μs)
Beam Profile: Top Hat Mode
Pulse Energy: Max 1.2 J
Pulse Widths: 5 - 10 ns (Q-switched Mode) / 300 μs
(Spectra Mode)
3-8 Zoom Collimated Handpiece (Max 8 mm Spot Size)
Pulse Rate: Max. 10 Hz
Energy Calibration: External, Auto-Calibration & Self-Restoration
Auto-Detected Handpiece Spot Size
SPECTRA HANDPIECES
TM
3-8 mm Zoom
Collimated
(Standard)
Source: Research and Development Center, Lutronic Corporation
585 nm Dye
(Optional)
650 nm Dye
(Optional)
AUTO-DETECTED HANDPIECE
AUTO-RECOGNITION
• Changing the Handpiece
spot size automatically
changes the GUI spot size.
• Ensures the GUI fluence
matches the output
delivered, preventing
adverse events due to
unexpected excessive
fluence.
ZOOM HANDPIECE
Pigmented Lesions
• Spot size is different depending on the distance between the tip of handpiece and skin
surface.
• If the tip of handpiece is pulled slightly from the skin surface, the spot size gets smaller,
thus the irradiance (power density) increases accordingly with a correspondingly more
powerful laser/tissue interaction. (Power Density = Output power [W]/Spot size [cm2])
• It is recommended to use this handpiece always in contact with the skin surface.
Size of the area
affected by laser
beam = Spot size
✔
✕
ZOOM COLLIMATED HANDPIECE
SoftPeel, SpectraPeel, Laser Toning, Pigmented
Lesions
• Standard Handpiece, most commonly used
• Spot size can be adjusted (e.g., 3-8 mm at 1,064 nm)
• Laser beam is collimated (not focused); as a result the spot size remains
constant. The operator can work without having the tip of the handpiece in
contact with the skin surface.
• It is still recommended to keep the tip as close as possible to the skin.
DYE HANDPIECES
585 nm for Sky Blue Tattoos
650 nm for Green Tattoos
The Spectra System automatically recognizes the handpiece,
and the user simply adjusts the fluence.
CONNECTING THE HANDPIECE
• Take off the protective cap covering the end
of the articulated arm. Hold the end of the
articulated arm steady.
• Carefully insert the handpiece into the end
of the arm. Gently turn the rotating collar at
the end of the articulated arm in a counterclockwise direction (as shown by the arrow
in the illustration) until the handpiece is
firmly connected.
• Be sure that the handpiece is securely
fastened.
CONNECTING THE HANDPIECE
• Hold the handpiece cable
connector and articulated
arm cable connector.
• Line up the arrows on the
two connectors and connect
them to each other as
shown in the illustration.
CLEANING THE HANDPIECE
1. Remove the tip from the handpiece: hold the handpiece body with one
hand and GENTLY pull the handpiece tip with the other hand.
2. Gently clean the handpiece and exterior system components with hospital
grade anti-viral, anti-bacterial, anti-fungal solution, EXCEPT the lens at the
end of the handpiece body.
3. To eliminate all foreign matter from the lens, use a cotton swab saturated
in 90% alcohol to clean it thoroughly.
CLEANING THE HANDPIECE
4.
In addition, be sure to remove any debris on the inner side of the
handpiece tip using the same method.
5.
After thoroughly cleaning the handpiece, shine a light onto the window
of the handpiece to examine it and check for cleanliness.
6.
Reassemble the handpiece in reverse order from disassembly.
7.
If the handpiece is not to be used immediately, wipe it with a dry cotton
cloth and place it in the handpiece case.
CALIBRATION (OPTIONAL)
1. Before starting calibration, check the beam mode.
2. Connect the articulated arm as shown in the figure.
3. After entering the setup mode, press the “Calibration”
button at the bottom of the screen.
CALIBRATION (OPTIONAL)
3. As shown in the illustration, the device checks that the end
of the articulated arm is connected to the calibration port.
4. Once the “Start” button is displayed as shown in the right
hand panel, press it to start the calibration process.
CALIBRATION (OPTIONAL)
5. Calibration then commences, and the process completes
automatically as shown in the illustrations.
ERROR STATUS MESSAGES
Message
Code
Possible Cause for
Errors
Actions to Take
CODE 01
Emergency Error
Turn off the device and unlock the emergency stop switch. Restart the device.
CODE 02
Main Shutter Error
Turn off the device, wait 2 minutes before restarting the device.
CODE 03
Water Flow Error
Refill with cooling water according to the instructions. (Refer to the Operator’s
Manual)
CODE 04
Door Open
Turn off the device, wait 2 minutes before restarting the device.
CODE 24
Energy Setup Error
It is possible to use the device temporarily, but the device is unstable. Before using the
device again, you must contact your local Lutronic distributor for inspection
CODE 30
Power Module Error
Turn off the device, wait 2 minutes before restarting the device.
CODE 32
AC Contactor Error
Turn off the device, wait 2 minutes before restarting the device.
CODE 33
Water Level Error
Refill with cooling water according to the instructions.
(Refer to the Operator’s Manual)
CODE 34
Interlock Switch Off
Turn off the device, wait 2 minutes before restarting the device.
CODE 36
Simmer Error
Turn off the device, wait 2 minutes before restarting the device.
CODE 37
Water Temp. Error
Turn off the device and contact your local Lutronic distributor for inspection
Note : If the problem persists despite following the recommended action, contact your
local Lutronic distributor
GRAPHIC USER INTERFACE
Fluence
Energy density per unit area (J/cm²)
Spot Count
The total number of laser shots
fired. The Reset button sets the
shot count back to zero
Aiming Beam
Visually shows the target of the
treatment laser; possible to adjust
light intensity.
Pulse Rate
The number of pulses which are
emitted per second
Memory
Saves parameters into the system
Memory, recalls and displays the
parameters on the control panel
Spot size
Shows the spot size of the laser
beam, automatically detected
depending on the handpiece
fitted and spot size selected on
the handpiece
Wavelength
Selects wavelength and mode
Toning
Saves the basic parameters for
laser toning
Standby / Ready
Standby – Parameters can be set, but laser energy cannot be
emitted, even if the footswitch is depressed
Ready – laser energy can be emitted
Source: Research and Development Center, Lutronic Corporation
USING THE MEMORY FUNCTION
To save frequently used parameters to memory:
1. Enter Memory mode by pressing the Memory button located at the
bottom of the screen as shown in the figure.
2. Activate the parameter setting section by pressing the Modify
button located at the bottom of the screen.
USING THE MEMORY FUNCTION
3. After setting parameters in the parameter setting section, press one of
the memories at left of the screen to save the setting. At this time, a
popup window is displayed to make sure users want to save the selected
memory. Then press the OK button.
USING THE MEMORY FUNCTION
4. Press the Rename button located at the bottom of the screen to set the
memory name. The keyboard pop-up appears as below.
5. Using the keyboard, type a memory name into the blank space and press
the Accept button.
USING THE MEMORY FUNCTION
6. As shown in the figure, saving a memory is complete. It is possible to
return to the original name while inputting the new name by pressing
the Restore button.
USING THE MEMORY FUNCTION
To load the saved parameters FROM memory:
1. Enter Memory mode by pressing the Memory button. Press a
memory to recall it. The selected memory is highlighted in yellow.
2. Recall the memory to the operation mode by pressing the Accept
button at the top of the screen. The selected memory can be
cancelled by pressing the Restorebutton.
SPECTRA INDICATIONS
• Tattoo (inc. colored)
• Melasma
• PIH
• Skin Rejuvenation
• Active Acne*
•Post Acne Erythema
• Nevus of Ota
• Lentigo
• Freckles
• Seborrheic Keratosis
• Large Pores**
• Others
*Note: No FDA clearance for active acne / inflammatory acne
**Note: No FDA clearance for large pores
Tattoo Removal
THE PHYSICS OF LASER TATTOO REMOVAL
• Each pulse of energy penetrates the skin and is absorbed by the tattoo ink.
• As the tattoo ink particles absorb the energy, they heat up and then shatter into
tiny fragments.
• Then, over the weeks following treatment, the body’s immune system flushes the
tattoo ink particles away from the location, lightening the appearance of the tattoo.
• Each laser treatment breaks down more and more of the tattoo ink until none
remains.
SelectivePhotothermolysis
From 3 Greek rootwords
• "photo" = light
• "thermo" = heat
• "lysis" = destruction
Precise targeting of a structure or tissue using a
specific wavelength of light with the intention of
absorbing lightinto that target area alone.
The energy directed into the target area produces
sufficient heat to damage the target while allowing
the surrounding area to remain relatively untouched.
MECHANISM OF ACTION FOR TATTOO
REMOVAL
• Q-switching is a special type of laser pulse creation. Q-switched lasers produce
intensely powerful, brief pulses of energy – for Spectra lasting just 5 nanoseconds
(10-9).
• Tattoo ink particles are extremely small (typically nanometers in diameter), and so
they need to be heated for a very brief period of time to warm up and explode.
• The longer the pulse the more time for heat to conduct to surrounding tissue. By
using very short nanosecond pulses heat is confined to pigment particles leaving
the surrounding tissue intact.
Macrophage
Q-Switched Nd:YAG Laser
Pigment or ink particles
Source : Lutronic illustration
Explosion
Absorption and
drainage by human
immune system
SPEED OF TREATMENT
3-8 MM ZOOM COLLIMATED
HANDPIECE
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Large 8 mm spot size enables rapid treatments of tattoo inks
o 3-8 mm adjustable on-the-fly spot size change
o Set the spot size to the tattoo size
Easier on operator
o Collimated output eliminates need to maintain specific distance from tissue
o Auto-recognition handpiece provides consistent fluences
TARGETING TATTOO INK
• Tattoos come in every color and different colors absorb and reflect different
wavelengths. An apparent color, however, can be a mixture of different pigments.
• To breakup the tattoo ink particles the wavelength used must be well-absorbed.
• When treating multicolored tattoos, access to a variety of laser wavelengths is
important.
• The most common wavelengths used for laser tattoo removal are 1064 nm and 532
nm – they can treat 95%+ of tattoos.
• The optional 585 nm and 650 nm dye handpieces are useful for treating
sky blue or green inks.
LETTING THE BODY DO ITS WORK
• Tattoo removal is not an instant fix – it’s usually a several month
commitment. Most tattoos require between 5 and 10 treatments fspaced
at least 6 weeks apart.
• The tattoo ink is injected at different depths within the dermis. The
shallowest layers of ink absorb the energy and shatter. Once the body
flushes away the top layers of ink the deeper layers be treated.
• In effect, every successive tattoo removal treatment affects deeper and
deeper layers of ink until none remain.
• It takes time for the body to flush away the shattered tattoo ink from
within the skin. Phagocytic cells gradually moving the ink particles to the
lymph nodes, where the pigments remain. Because the body can only
flush away the ink at a certain speed, it’s beneficial to wait as long as
possible between treatments to see maximum fading from each session.
Also, the waiting period allows any scabs or blisters to heal, minimizing the
possibility of over-treating the area and causing unwanted side effects.
SPECTRA – BEFORE AND AFTER
PICTURES
Tattoo
Removal
SPECTRA – TATTOO REMOVAL
Before
4 Mo. After 3 Tx
4 Mo. After 9 Tx
Courtesy of Medermis Clinic, USA
SPECTRA – TATTOO REMOVAL
Before
After 8 Tx
Courtesy of Medermis Clinic, USA
SPECTRA – TATTOO REMOVAL
After
Before
Courtesy of Medermis Clinic, USA
SPECTRA – TATTOO REMOVAL
Before
After 12 Tx
Courtesy of Medermis Clinic, USA
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 10 Tx
Courtesy of Matthew Werner, M.D. (Rancho Mirage, CA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 10 Tx
Courtesy of Matthew Werner, M.D. (Rancho Mirage, CA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 7 Tx
Courtesy of Matthew Werner, M.D. (Rancho Mirage, CA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 7 Tx
Courtesy of Kevin Duplechain, M.D. (Lafayette,LA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 2 Tx
Courtesy of Kevin Duplechain, M.D. (Lafayette,LA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 2 Tx
Courtesy of Kevin Duplechain, M.D. (Lafayette,LA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 5 Tx
Courtesy of Kevin Duplechain, M.D. (Lafayette,LA)
SPECTRA – TATTOO REMOVAL
BEFORE
AFTER 2 Tx
Courtesy of Kevin Duplechain, M.D. (Lafayette,LA)
SPECTRA – TATTOO REMOVAL
BEFORE
Post 2 year 4 months
Courtesy of Kevin Duplechain, M.D. (Lafayette,LA)
Clinical
Protocols:
Tattoo Removal
PATIENT ASSESSMENT AND PRE-TREATMENT
• Obtain complete patient history
• Manage patient’s expectations
• Discuss number of treatments
• Discuss contraindications
• Discuss complications & possible side effects
• Record clinical indications
CONTRAINDICATIONS
• Allergic response to topical anesthetics, antibiotics, or other medications
• Healing disorders such as those caused by diabetes mellitus, connective tissue
disease, radiation therapy, HIV ,hepatitis, or chemotherapy
• Seizure disorder caused by bright light
• Unrealistic expectations regarding the outcome of the treatment
• An inability or unwillingness to follow treatment guidelines
• Cancerous or premalignant lesions
• Active suntan or sunbed exposure: Patients should have avoided UV exposure
for at least four weeks prior to treatment
• Use of artificial tan or tanning products
• History of keloid scarring
• Psoriasis or eczema
• Active herpes / herpes simplex
• Skin infections on or around in the area to be treated
PRE-TREATMENT
• If possible, use sunblock and/or bleaching cream to lighten
the color of the skin for some weeks prior to treatment. This
allows for better laser penetration.
• Cleanse the face with alcohol or acetone to remove oil and
excess sebum from the skin surface and pores.
• Remove residue with cotton pads soaked in warm water.
• Pat the face dry with a towel or cotton cloth.
• If EMLA or equivalent anesthetics are to be used, follow the
directions provided by the manufacturer.
TREATMENT: PARAMETERS
Wavelength (nm)
•
The wavelengths can be selected by pressing the “wavelength” button.
•
There are wavelength modes available, 1064, 532 and Spectra.
•
With the addition of optional solid dye handpieces, 585 nm and 650 nm
wavelengths are also available for other tattoo pigments.
Mode on GUI
Wavelength
1064
1,064 nm
532
532 nm
Description
Laser radiation at 1064 nm in Q-switched mode. The pulse width is 5-10 ns and the
peak power and energy density are higher than that of Spectra Mode for the same
duration
Green laser radiation at 532 nm in Q-switched mode. The peak power and energy
density are high
Laser radiation at 1064 nm with a pulse width of 300 µs. The peak power and energy
density are thus much lower than that of Q-switched mode for the same duration
Spectra
1,064 nm
585
585 nm
585 nm laser radiation is derived from the Q-switched 532 nm source laser which
pumps the 585 nm solid dye handpiece
650
650 nm
650 nm laser radiation is derived from the Q-switched 532 nm source laser which
pumps the 650 nm solid dye handpiece
TREATMENT: PARAMETERS
• Fluence (J/cm2)
• Fluence represents the incident energy (J) per 1 cm2
.
• It is adjustable using the up and down push buttons on the right side.
• The range of values varies automatically according to the “Spot Size”
and “Wavelength” set on the control panel.
•
Spot Size (mm)
• Spot size represents the spot size of the laser beam at the end of the
handpiece.
• The value of the fluence displayed on the GUI depends on the width
and energy of the pulse and the beam spot size.
TREATMENT: PARAMETERS
• Pulse Repetition (Hz)
• Pulse Repetition represents the number of pulses delivered per second.
• It can be adjusted by pressing the up and down buttons.
• It can be set at 1, 2, 4, 5 as well as 10 Hz and single shot (S1).
• Shot Count
• Shot Count represents the total number of laser shots delivered.
• The number can be reset to zero by pressing the ‘Reset’ button on the left side
of the screen.
• Aiming Beam
• The brightness of the aiming beam can be adjusted.
TREATMENT: PARAMETERS
• PERFORM TEST SPOTS
• Performing test shots is very important both for safety and to determine the
settings for optimum outcomes.
• Adjust the fluence for each session according to the patient’s skin reactions or
pain.
• Check the skin reaction 10 - 15 minutes after the test shot. Allow longer for
darker skin types.
• Tattoo test spots:
• After 1 or 2 test shots on the edge of a tattoo, check for frosting and if the
tattoo color has changed.
• Caution: Lip tattoo pigments may include iron oxide which can turn black after
laser treatment. Permanent make-up can be problematic to treat, so be sure
to obtain appropriate consent in case of adverse reactions. Test shots are
recommended to observe the skin reaction.
TREATMENT: TECHNIQUES
TATTOOS
• Tattoos are ink particles located in the dermis or subdermal
tissues that have been encapsulated as foreign bodies. In
their stable state, they are too big to be removed by
macrophages, the skin’s natural scavenger cells, and so
remain as colored artificial lesions.
• Using ultrashort pulse width, high peak power light at
various wavelengths, lasers can fracture and explode the
ink particles into microscopic pieces that the macrophages
can remove, harnessing the natural energy of light and the
natural responses of the body to dispose of the fragmented
ink particles.
TREATMENT: TECHNIQUES
TATTOO REMOVAL
•
The treatment sessions for tattoo removal may vary depending on the
types and depth of tattoo pigment particles.
•
In rare cases, red-colored tattoos may darken after tattoo removal
treatment because red tattoos sometimes contain iron oxide. Therefore,
test shots should be carried out prior to the treatment.
•
As the treatment sessions continue, gradually increase the fluence since
there will be less and deeper pigment chromophores than in previous
sessions.
•
Do not overdo the treatment in a single session. Routine treatment
requires at least 2 sessions minimum.
TREATMENT: BEST PRACTICES
TREATMENT: TATTOO REMOVAL PARAMETERS
1064 – BLACK, DARK BLUE, BROWN, ALL COLORS INITIALLY
TREATMENT: TATTOO REMOVAL PARAMETERS
532 - RED, PURPLE, ORANGE
TREATMENT: TATTOO REMOVAL PARAMETERS
TREATMENT: TATTOO REMOVAL PARAMETERS
TREATMENT: CLINICAL END POINTS
TATTOO REMOVAL
The endpoint is determined:
• Tattoos: tattoo turns white (frosting of the epidermis) and there is an
appearance that suggests pinpoint bleeding might occur.
Before Treatment
Immediately after
Treatment
Before Treatment
Immediately after
Treatment
POST TREATMENT
TATTOO REMOVAL
• If desired, apply antibacterial ointment every morning & night until crust
peels off.
• Apply dressing on the day of treatment. Dressing provides protection
against invasion of microorganisms until crust forms.
• Avoid contact with water on the day of treatment: shower or washing can
be done the following day.
• Complete all patient records noting the full treatment details including
laser type, wavelength, pulse width, fluence, spot size and where
appropriate the number of shots. Patient records should be signed and
dated. Schedule follow ups as necessary.
• Advise patients to avoid picking at or damaging any crust that may occur
and to let the scab fall off naturally to avoid scarring.
• If tattoos are treated below the knee or below the elbow, advise elevation
for 24- 48 hours.
EXPECTED SEQUALAE & ADVERSE EVENTS
• EXPECTED SEQUELAE
•
Tattoo Removal
• Immediate frosting of the epidermis over the tattoo
• Slight edema and erythema
• Mild pinpoint bleeding
• Blisters can form
EXPECTED SEQUALAE & ADVERSE EVENTS
EXPECTED SEQUELAE
• Persistent tattoos or pigmentation: Although positive results
can be achieved in most cases, some tattoo particles located
deep in the dermis may not be totally removed, even with
repeated treatments. Some cosmetic tattoo inks contain
metallic ink particles that do not respond well to laser
treatment while other tattoo inks may change in color. These
tattoos cannot normally be treated with a laser, or many
repeated treatments may be needed to remove them.
EXPECTED SEQUELAE & ADVERSE EVENTS
• Transient Hypopigmentation
The increased melanin absorption seen with shorter wavelength lasers
can increase the risk for hypopigmentation. In most patients the treated
area loses pigmentation and becomes lighter in color. This is temporary
and may last up to 4 weeks.
• Allergic Reaction
Local allergic responses to many tattoo pigments have been reported, and
allergic reactions to tattoo pigments after Q-switched laser treatment are
also possible. Q-switched lasers mobilize the tattoo ink fracturing the
particles into the intercellular space possibly generating a systemic allergic
response. If an allergic reaction to ink is noted, future Q-switched laser
treatment is not advised.
EXPECTED SEQUELAE & ADVERSE EVENTS
• Hyperpigmentation
This is a very rare reaction with Nd:YAG lasers. However, if it does occur, it
may last 3 - 6 months. Hyperpigmentation is related to the patient’s skin
type, and darker skin is more likely to become hyperpigmented no matter
which wavelength is used. The melanocytes of dark-skinned patients tend
to respond to stimuli such as lasers. Hence, the pre- and postoperative use
of lightening agents such as hydroquinone is important. Treatment with
hydroquinones and broad spectrum sunblocks will usually resolve the
hyperpigmentation.
• Textural Changes
Transient textural changes should be noted and monitored but usually
resolve within 1 - 2 months and are rarely permanent. If a patient is prone
to pigmentary or textural changes, longer treatment intervals are
recommended.
EXPECTED SEQUELAE & ADVERSE EVENTS
ADVERSE EVENTS
• Burns and blisters
• Infection at the treatment site
• As with the use of any laser system, scarring is a
possibility, but rare.
In the occurrence of adverse events please
CONTACT LUTRONIC @ 888-588-7644
FDA 510(k) & CE Clearances
CONTACT INFORMATION
• Caution is advised when treating patients with any of the
listed contraindications.
• In the event of adverse events, contact Lutronic
immediately.
• You may reach any of our departments by calling the main
office at:
888-588-7644
Questions?
Dyschromia Reduction
and Laser Toning
REMOVAL OF UNWANTED PIGMENT
• Basic mechanisms
– Theory of selective photothermolysis
– Damage melanosome or melanocyte?
• What and where is the pigment?
PHYSICS PRINCIPLES
• SELECTIVE ABSORPTION
– Melanin the target chromophore has a
broad spectrum of absorption
• TISSUE SCATTER
-
Larger spot size has deeper effect
• WAVELENGTHPENETRATION
– Shorter wavelengths have higher
absorption and greater scatter so they
don’t penetrate as deep as longer
wavelengths
REMOVAL OF BENIGN PIGMENTED
LESIONS
• The nanopulse Nd: YAG laser is the gold standard in treating moderate and
deep pigment disorders and more recently melasma.
– <750 ns pulses disrupt melanosomes through a photoacoustic disruption longer pulse durations (eg, 400 microseconds) do not
– This is consistent with the theory of selective photothermolysis, which states
that the pulse duration of an emitted laser wavelength must be less than the
thermal relaxation time of the targeted object.
– A typical 1-µm melanosome has a thermal relaxation time of 0.5-1 μs.
• Long-pulse, broad-band approaches such as IPL can be effective
– Create sufficient bulk heating to cause sloughing of epidermis which removes
the pigment containing keratinocytes
– For PIH and melasma bulk heating approaches are not recommended because
bulk heating and inflammation can further stimulate melanocytes
SPECTRA LOW FLUENCE Q-SWITCHED
YAG 1064 ηm* MELASMA TREATMENT
1st pass
1.6 – 1.8 J/cm2
With carbon lotion
2nd
1.0 J/cm2 to mild
erythema
pass to mild erythema
1.0 J/cm2
without carbon lotion
1-2 week
interval
A 1st pass with carbon
lotion is optional
1.6 – 1.8 J/cm2
Repeat for 7 – 12 treatments
*Q-Switch 1064nm 5 ns fixed pulse width setting
WHAT IS IMPORTANT WHEN
TREATING MELASMA
240
Other 1064 nm Q-S
Lasers
Lower Peak Power
Max. Peak Energy : 240 Mega Watt
SPECTRA
High Power
Short PW
QSw 1064 nm
100
50
Longer PW
Less melanin breakdown
Thermal damage can stimulate melanocytes
High recurrence of melasma
* Lutronic Illustration
Melanin breakdown
No Thermal damage to stimulate melanocytes
No recurrence after treatment
ULTRASTRUCTURAL FINDINGS:
3D RECONSTRUCTION
(All images courtesy JY Mun)
Dendritic
processes
Two melanocytes are seen in 3D, reconstructed from
the data from 500 x 50 nm slices and computer
rendered: color is for illustrative purposes only.
Image is of skin from a melasma patient before skin
toning
Journal of Electron Microscopy, 2011; 60: 11–18
A melanocyte from the same patient after laser
toning. The cell is still alive, but appears to have
undergone a ‘dendrectomy’
SPECTRA – BEFORE AND AFTER
Pigmentation, Melasma,
PIH and Vascular
SPECTRA – SKIN REJUVENATION &
PIGMENT
Before
After 13 Tx
Courtesy of Melanie D. Palm, M.D. (Solana Beach, CA)
SPECTRA - PIGMENT
BEFORE
Courtesy of I.H. Kim, M.D. (Korea)
AFTER 8 Tx
SPECTRA - PIGMENT
BEFORE
Courtesy of I.H. Kim, M.D. (Korea)
AFTER 8 Tx
SPECTRA - PIGMENT
BEFORE
Courtesy of I.H. Kim, M.D. (Korea)
AFTER 8 Tx
SPECTRA – MELASMA & PIGMENT
Courtesy of Kevin Duplechain, M.D. (Bethlehem, PA)
SPECTRA – MELASMA & PIGMENT
Before
Courtesy of Melanie D. Palm, M.D. (Solana Beach, CA)
After 8 Tx
SPECTRA – MELASMA AND PIGMENT
Before
After 10 Tx
Courtesy of John Shieh, M.D. (South Pasadena, CA)
SPECTRA - MELASMA
Before
After 12 Tx
Courtesy of Melanie D. Palm, M.D. (Solana Beach, CA)
SPECTRA - MELASMA
Before
After 6 Tx
Courtesy of Melanie D. Palm, M.D. (Solana Beach, CA)
SPECTRA - MELASMA
Before
After 13 Tx
Courtesy of Melanie D. Palm, M.D. (Solana Beach, CA)
SPECTRA - MELASMA
Before
After 12 Tx
Courtesy of John Shieh, M.D. (South Pasadena, CA)
SPECTRA – MELASMA, SPLIT FACE
Treated
Untreated
BEFORE
Courtesy of I.H. Kim, M.D. (Korea)
Treated
Untreated
AFTER 7 Tx
SPECTRA - MELASMA
BEFORE
Courtesy of B. S. Chandrashekar, M.D. (India)
AFTER 10 Tx
SPECTRA - PIH
BEFORE
AFTER 12 Tx
Courtesy of W. S. Kim, M.D. (Korea)
SPECTRA - LENTIGO
BEFORE
AFTER
Courtesy of Matthew Werner, MD, USA
SPECTRA – EPIDERMAL NEVUS
BEFORE
AFTER 8 Tx
Courtesy of B. S. Chandrashekar, M.D. (India)
Clinical Protocols:
Dyschromia Reduction
and Laser Toning
PATIENT ASSESSMENT AND PRE-TREATMENT
• Obtain complete patient history
• Manage patient’s expectations
• Discuss number of treatments
• Discuss contraindications
• Discuss complications & possible side effects
• Record clinical indications
CONTRAINDICATIONS
• Allergic response to topical anesthetics, antibiotics, or other medications
• Healing disorders such as those caused by diabetes mellitus, connective tissue
disease, radiation therapy, HIV ,hepatitis, or chemotherapy
• Seizure disorder caused by bright light
• Unrealistic expectations regarding the outcome of the treatment
• An inability or unwillingness to follow treatment guidelines
• Cancerous or premalignant lesions
• Active suntan or sunbed exposure: Patients should have avoided UV exposure
for at least four weeks prior to treatment
• Use of artificial tan or tanning products
• History of keloid scarring
• Psoriasis or eczema
• Active herpes / herpes simplex
• Skin infections on or around in the area to be treated
PRE-TREATMENT
• If possible, use sunblock and/or bleaching cream to lighten
the color of the skin for some weeks prior to treatment. This
allows for better laser penetration.
• Cleanse the face with alcohol or acetone to remove oil and
excess sebum from the skin surface and pores.
• Remove residue with cotton pads soaked in warm water.
• Pat the face dry with a towel or cotton cloth.
• If EMLA or equivalent anesthetics are to be used, follow the
directions provided by the manufacturer.
TREATMENT: PARAMETERS
Wavelength (nm)
•
The wavelengths can be selected by pressing the “wavelength” button.
•
There are wavelength modes available, 1064, 532 and Spectra.
•
With the addition of optional solid dye handpieces, 585 nm and 650 nm
wavelengths are also available for other tattoo pigments.
Mode on GUI
Wavelength
1064
1,064 nm
532
532 nm
Description
Laser radiation at 1064 nm in Q-switched mode. The pulse width is 5-10 ns and the
peak power and energy density are higher than that of Spectra Mode for the same
duration
Green laser radiation at 532 nm in Q-switched mode. The peak power and energy
density are high
Laser radiation at 1064 nm with a pulse width of 300 µs. The peak power and energy
density are thus much lower than that of Q-switched mode for the same duration
Spectra
1,064 nm
585
585 nm
585 nm laser radiation is derived from the Q-switched 532 nm source laser which
pumps the 585 nm solid dye handpiece
650
650 nm
650 nm laser radiation is derived from the Q-switched 532 nm source laser which
pumps the 650 nm solid dye handpiece
TREATMENT: PARAMETERS
• Fluence (J/cm2)
• Fluence represents the incident energy (J) per 1 cm2
.
• It is adjustable using the up and down push buttons on the right side.
• The range of values varies automatically according to the “Spot Size”
and “Wavelength” set on the control panel.
•
Spot Size (mm)
• Spot size represents the spot size of the laser beam at the end of the
handpiece.
• The value of the fluence displayed on the GUI depends on the width
and energy of the pulse and the beam spot size.
TREATMENT: PARAMETERS
• Pulse Repetition (Hz)
• Pulse Repetition represents the number of pulses delivered per second.
• It can be adjusted by pressing the up and down buttons.
• It can be set at 1, 2, 4, 5 as well as 10 Hz and single shot (S1).
• Shot Count
• Shot Count represents the total number of laser shots delivered.
• The number can be reset to zero by pressing the ‘Reset’ button on the left side
of the screen.
• Aiming Beam
• The brightness of the aiming beam can be adjusted.
TREATMENT: DERMATOLOGIC PARAMETERS
TREATMENT: BEST PRACTICES
TREATMENT: TECHNIQUES
LASER TONING
•
•
•
•
Treat with under 50% spot overlap and 2-3 passes until mild erythema
appears. Over 80-90% overlapping might cause side effects such as PIH.
During treatment around the eye and over the cheek bone, decrease the
number of passes and watch the skin reaction. These areas are sensitive
with very thin skin and redness can easily occur.
Keep the end of the handpiece within 3 cm from the skin during the
treatment.
Using a bright light, make a final check for untreated areas.
Mild erythema
Before treatment
Immediately after treatment
TREATMENT: TECHNIQUES
LASER TONING is a treatment method using the Q-switched 1064 nm
wavelength without spectra lotion. Laser Toning not only treats melasma but
also yields additional benefits in terms of improved skin tone and texture,
with minimal risk of adverse effects and virtually no downtime.
Low-fluence
Q-switched
1064 nm Nd:YAG
Source: Medical & Scientific Affairs, Lutronic Corporation
POST TREATMENT
LASER TONING
•
Thoroughly clean the skin surface using a neutral cleansing lotion and cotton
pads dipped in cool water. This will help reduce erythema.
•
Complete patient records, recording full treatment details including: laser type,
wavelength, pulse width, fluence, spot size and, where appropriate, the number
of shots. Patient records should be signed and dated. Schedule follow-ups as
necessary.
•
Advise patients that sunscreen with a Sun Protection Factor (SPF) of at least 30
should be applied one hour before going outdoors for at least two weeks after
treatment.
•
Advise patients not to use any harsh products such as glycolic acid, retinol or
alcohol based toner for at least 48 hrs after treatment.
TREATMENT: CLINICAL END POINTS
PIGMENTED LESIONS & TATTOO REMOVAL
The endpoint is determined:
• Pigmented Lesions: pigment darkens, frosting of the epidermis occurs, or
the skin appears slightly erythematous
POST TREATMENT
PIGMENTATION
• If desired, apply antibacterial ointment every morning & night until crust
peels off.
• Apply dressing on the day of treatment. Dressing provides protection
against invasion of microorganisms until crust forms.
• Avoid contact with water on the day of treatment: shower or washing can
be done the following day.
• Complete all patient records noting the full treatment details including
laser type, wavelength, pulse width, fluence, spot size and where
appropriate the number of shots. Patient records should be signed and
dated. Schedule follow ups as necessary.
• Advise patients to avoid picking at or damaging any crust that may occur
and to let the scab fall off naturally to avoid scarring.
EXPECTED SEQUALAE & ADVERSE EVENTS
• EXPECTED SEQUELAE
• Laser Toning
• Mild erythema
• Pigmented Lesion Treatment, Soft Peel, 532 Peel
• Slight darkening of pigment
• Slight edema
• Frosting of epidermis over the lesion
EXPECTED SEQUALAE & ADVERSE EVENTS
EXPECTED SEQUELAE
• Persistent tattoos or pigmentation: Although positive results
can be achieved in most cases, some tattoo particles located
deep in the dermis may not be totally removed, even with
repeated treatments. Some cosmetic tattoo inks contain
metallic ink particles that do not respond well to laser
treatment while other tattoo inks may change in color. These
tattoos cannot normally be treated with a laser, or many
repeated treatments may be needed to remove them.
• Some pigmented lesions, such as melasma, may also return
after treatment. Repeated treatments may or may not result
in further improvement.
EXPECTED SEQUELAE & ADVERSE EVENTS
• Transient Hypopigmentation
The increased melanin absorption seen with shorter wavelength lasers
can increase the risk for hypopigmentation. In most patients the treated
area loses pigmentation and becomes lighter in color. This is temporary
and may last up to 4 weeks.
• Allergic Reaction
Local allergic responses to many tattoo pigments have been reported, and
allergic reactions to tattoo pigments after Q-switched laser treatment are
also possible. Q-switched lasers mobilize the tattoo ink fracturing the
particles into the intercellular space possibly generating a systemic allergic
response. If an allergic reaction to ink is noted, future Q-switched laser
treatment is not advised.
EXPECTED SEQUELAE & ADVERSE EVENTS
ADVERSE EVENTS
• Burns and blisters
• Infection at the treatment site
• As with the use of any laser system, scarring is a
possibility, but rare.
In the occurrence of adverse events please
CONTACT LUTRONIC @ 888-588-7644
FDA 510(k) & CE Clearances
Hollywood Laser Peel
aka Spectra Peel
NOT TO BE CONFUSED WITH
SPECTRA 532 LASER PEEL!
DUAL PULSE MODES
COMBINATION THERAPY ENABLED
Q-Switched Mode
5-10 nsec – short pulse
5nsec
Shorter pulse width → High peak power
• Break down & removechromophore
• Tattoo Removal
• Melasma
• Laser Peel
Explosion of Particle
300μsec
SPECTRA Mode
300 µsec – quasi-long pulse
Longer pulse width → Thermal effect
• Skin Rejuvenation
Thermal Diffusion from Particle
Source : LutronicIllustration
COMBINATION THERAPY: SPECTRA
PEEL
Carbon Lotion seeps
into pores
Carbon Lotion is
gently heated
* Lutronic has a Method Patent to target pigmented lotions
Carbon Particles
explodes
PATENTED SPECTRA PEEL TREATMENT
IMMEDIATE AND LONG TERM EFFECTS
Changes within 1st and 2nd Tx
•
•
•
•
•
Dyschromia is Improved
Clearer, Younger Looking Skin
Exfolliates the Stratum Corneum
Stimulates Collagen Regeneration
Reduces Sebum Production
Changes after the 3rd Treatment
•
•
•
•
•
•
Gentle Heating
Removing the Carbon
Softens Skin Tone
Improves Skin Texture
Continues to Regenerate Collagen
Reduces Inflamed Acne and Improves Acne Scar s
Reduces Pore Size
Improves Fine Lines and Wrinkles
Source: Dr. Melanie Palm, MD, MBA
SPECTRA – BEFORE AND AFTER
Skin Rejuvenation &
Other
CLINICAL PHOTOS
Large Pores*
Before
Courtesy of T. Fujimoto, MD, Japan
*Note: No FDA clearance for large pores
1 Month After tx
CLINICAL PHOTO – ACNE & POSTACNE REDNESS
For Internal Use Only
Before
Courtesy of J.H. Kim, Dermatologist, South Korea
After
CLINICAL PHOTO – ACNE & POSTACNE REDNESS
For Internal Use Only
Before
Courtesy of J.H. Kim, Dermatologist, South Korea
After
SPECTRA – ACNE SCARS &
SKIN REJUVENATION
BEFORE
AFTER 4 Tx
Courtesy of Lori Robertson MSN, FNP (Rancho Cucamonga , CA )
SPECTRA – ACNE SCARS &
SKIN REJUVENATION
BEFORE
AFTER 10 Tx
Courtesy of Lori Robertson MSN, FNP (Rancho Cucamonga , CA )
SPECTRA - ROSACEA
BEFORE
Courtesy of Lori Robertson MSN, FNP (Rancho Cucamonga, CA )
AFTER
KEY POINTS
SPECTRA: Key Points
• Superior tattoo removal
• Spectra Mode : for active acne* and better skin
rejuvenation
• Melasma: Only laser with FDA Clearance
• Unique Patented Procedure: Spectra PeelTM
• Beam quality stability at 1064 & 532 nm,
especially at lower fluence at 532 nm: minimize
or less PIH!!
• Many Peer reviewed papers and KOL
endorsement
* No FDA clearance for active acne / inflammatory acne
Questions?