Accolade
QS Alexandrite 755 nm
Benign Pigmented Lesions and Tattoo Removal
Market Size and Incidence
• Epidermal Lesions- Superficial
• 30% of population has solar lentigines
• 10% of population has café-aulait
• 60% have freckles
• Dermal Lesions
• Nevus of Ota and Ito (Acquired Dermal Melanocytosis)
– 0.014%-0.034% of Asian population
– 0.4-0.8% of people of Japanese and Korean descent
• Cosmetic, Medical, Body Art Tattoo
• Permanent makeup tattoos
• Reconstructive medical tattoos after mastectomy and surgery
• Cosmetic tattoos to cover up scars and other skin imperfections
2
• Body Art Tattoos
Treatment Market Size
• Benign Pigmented Lesion Removal
• Global treatment size $2.50 Billion to $6.48 Billion
• 2008 expected US market size $38 M at CAGR 12%*
• Tattoo Removal
• 2008 expected US market size $120 M at CAGR 17%*
• International market estimated $45 M
*Source: Millennium Research Group
3
Nano vs microsecond
Pulse Width
•
Effectively destroys melanosomes and tattoo
pigments
Ultra-short pulse widths required to shatter
melanosome/ pigments by photoacoustic
effect
•
Nanosecond
Pulse Width
P
o
w
e
r
Equal amounts
of energy
Microsecond
Pulse Width
Courtesy of:
4
Dr. Wang Hongwei
Time
Peking Union Medical College Hospital
Benign Pigmented Lesions
• Discoloration caused by high concentration of melanocytes in a
particular area
• Treatments include cover up with makeup, or painful removal by
dermabrasion or cryosurgery
• Mostly for pediatric treatments or as an adjunct procedure in skin
rejuvenation for adults
• Lasers remove pigmented lesions through photoaccoustic effects
• Melanin absorbs laser energy more intensely than the surrounding
tissue which leads to fracturing of the pigment and melanocyte cell
death
• Fractured melanin/melanocyte is removed by the immune system
5
Nevus of Ota
• First described in 1861
• Bluish hyperpigmentation along the first or
second branches of trigeminal nerve
• Most patients have no family history
• Age of onset- perinatal period or puberty
• Significant predominance among women
• Male to female ratio 1:4.8
• Female hormones suggested as potent
stimuli
• Other stimuli include infection, trauma, or
ultraviolet light exposure
6
Source: Chan and Kono et al Nevus of Ota: Clinical Aspects & Management, SKINmed, 2003
Nevus of Ito, Mongolian spots &
Other conditions
Nevus of Ito
• Variant of Nevus of Ota.
• Skin pigmentation occurs is more diffuse and
less mottled in the acromioclavicular region
Mongolian spot
• Sacrococcygeal region
• Usually regresses and disappears during
childhood.
• The spot is found in almost all newborn Chinese,
Japanese and Mongolian children, as well as
some white and black children.
Becker Nevus and Henry Nevus
7
Treatment of Pigmented
Lesions
8
Treatment of Pigmented
Lesions
9
Incidence – Tattoos
• Sixth fastest-growing retail business in the United States in recent
years
• 80% of tattoo customers are upper middle-class white suburban
females
• 15-20% of US teens and young adults have tattoos (40M Americans)
• 23% of college students have tattoos
• 50% of everyone receiving a tattoo, wants it removed (ASDS)
“In the 90’s I did five laser treatments a month… now I do that in one
day” Elizabeth McBurney, MD
10
Source: The Pulse, Hofstra University and
ASDS- American Society of Dermatologic
Surgery
Treatment of Tattoos
11
Treatment of Tattoos
12
The Accolade
• Q-Switched Alexandrite Laser
• The Speed of Alex
• The Spot Size of Ruby
• Removes Pigmented Lesions
• Removes Black, Blue, Brown
and Green Tattoos
13
Correct Wavelength
for Specific Treatment
Alexandrite 755 nm
14
Effective Wavelengths
Accolade
• 755nm
1320nm Nd:YAG
• Absorbed by
most pigments
• Greater depth of
penetration for
treating deeper
structures
• 50-70 ns pulse
width
• Disrupts
melansomes and
tattoo pigments
15
Accolade Specs
16
Wavelength
755 nm
Spot Size
2.0 mm
(Max Fluence 18 J/cm2)
3.0 mm
(Max Fluence 10 J/cm2)
4.0 mm
(Max Fluence 5 J/cm2)
5.0 mm
(Max Fluence 2.8 J/cm2)
Pulse Width
Short Pulse: Min 50 nsec
Long Pulse: 150 μsec
Pulse Rate
1, 2, 5, 10 Hz
Beam Delivery
Optical Fiber
Accolade Improved Design
• Faster than other competing systems
• 2x spot size of other Alex
• More than 10x the speed of Ruby
• Faster Treatments and Faster
Clearance
• Larger Spot and Higher Repetition rate
give the fastest treatment possible
• Larger Spot means deeper penetration for
faster clearance
17
Accolade Treatments
Characteristics
• Accolade treatments are gentler
• Less painful especially for the face
• Greater specificity towards target chromophore
• Reduces damage to peripheral tissue
• Minimum pinpoint bleeding
• Decreases incidence of scarring
18
Accolade
Features and Benefits
Features
Wavelength:
755 nm
Short pulse:
minimum 50 ns
Long pulse:
150 μs
Spot/ Fluence:
2 mm; min10 to max18 J/cm
2
3 mm; min5 to max10 J/cm
2
4 mm; min3 to max5 J/cm
2
5 mm; min1.6 to max2.8 J/cm
1, 2, 5, 10 Hz
Rep Rates:
19
2
Benefits
 Target absorption by tattoo pigments
 Treats Black, Blue, Green colors
 Target absorption by melanin
 Reduces damage to surrounding tissues
Intense high peak energy targeting:
 Tattoo pigments
 Melanosomes (cell structures with melanin)
 No cooling needed (optional)
 Superficial vascular lesions
 Persistent epidermal lesions
Short Pulse; treats deeper skin levels
Short Pulse; most commonly used; deeper
Short Pulse; treats large areas faster
Short Pulse; treats larger areas faster
 Better treatment control
 Faster treatment with higher rep rates
 Lower rep rates prevent treatment overlap
Weakness of Other Lasers
Other Suppliers
Supplier C
QS Alexandrite
Supplier H
QS ND:YAG
Features

QS Alexandrite 755 nm with
QS 1064nm & 532nm

Laser Pump Laser

Low QS 1064/532 Fluence

Max 5 Hz Rep Rate
Weakness

Highly unstable

Internal machine is the QS Alexandrite laser

1064/532 driven by handpiececs

Inadequate energy for any treatment with 1064/532

Slower treatment





Other Nd YAG
20


QS ND:YAG
1064 nm & 532 nm
Two hand pieces- 585 nm &
650 nm (dye polymer)
Claims to do a lot of functions
with one box
Low price
Small size



More side effects from pinpoint bleeding due to nonspecific absorption by hemoglobin & water
Low energy hand pieces not effective
Expensive hand pieces
More painful treatments than the Alexandrite laser


Unstable pulse width
High variability & quality
Comparison of Different Lasers
System Type
Wavelength
Pulse Width
Max Fluence per Spot
Size
Max Rep Rate
Aiming Beam
Electrical Requirments
Size (HxWxD)
Price
21
Affinity
Nd:YAG QS
1064nm
532nm
6 nsec
8 mm
6mm
4 mm
3mm
2mm
*
*
3 J/cm2
1.5 J/cm2
7.0
3.0
12.0
6.0
28.0
14.0
1, 2, 5, 10 Hz
Red LED
200/220 VAC/15A
32"x10" X 27"
(81cmx26cmx69cm)
$95,500
Accolade
QS Alexandrite
755nm
min 50 ns
150 µsec
*
5mm
4mm
3mm
2mm
*
2.8 J/cm2
5 J/cm2
10 J/cm2
18 J/cm2
10 Hz
Red Diode Laser
220 Vac/20A, 50/60Hz, single
41"x15"x25"
(104cmx38cm64cm)
$95,500
MedLiteTM C6
Nd:YAG & Dye Impregnated Polymers
1064
532
585
5–20 ns
8 mm
6mm
4 mm
3 mm
2 mm
2 J/cm2
3.0
6.0
12.0
*
AlexTriVantage
QS Alex & QS nd: YAG
650 755nm
532
1064
50 nsec
140 µsec*
*
*
*
1.4 J/cm2
*
*
3.0
*
*
3.5 J/cm2 2.1 J/cm2
4.0
5.0
8.0
4.5
1, 2, 5 &10
Red aiming beam
220 V, Single Phase, 8 Amps or 110 V, 15 Amps
28.5" X 12" X 31.8"
(81cmX30.5cmX72.5cm)
$85,000
5mm
4mm
3mm
2mm
4 J/cm2 1 J/cm2
6 J/cm2
11 J/cm2 3 J/cm2
25 J/cm2 6 J/cm2
1, 2, 3, 5 Hz
Ring Style
2 J/cm2
6 J/cm2
13 J/cm2
43"x16"x30"
(109cmx40cmX76cm)
Clinical Results: Nevus of Ota
BEFORE
22
AFTER
Nevus of Ota Before & After
BEFORE
AFTER
4 treatments
Courtesy of:
Dr. Wang Hongwei
23
Peking Union Medical College Hospital
Nevus of Ota Before & After
BEFORE
AFTER
Courtesy of:
Dr. Wang Hongwei
24
7 treatments
Peking Union Medical College Hospital
Pigmented Lesion Before & After
BEFORE
AFTER
3 treatments
Courtesy of:
Dr. Wang Hongwei
25
Peking Union Medical College Hospital
Freckles Before & After
BEFORE
AFTER
1 treatment
Courtesy of:
Dr. Wang Hongwei
26
Peking Union Medical College Hospital
Tattoo Treatment Before & After
Eyebrow Tattoo
BEFORE
AFTER
After 2 treatments (5.8-8.6 J/cm2)
Courtesy of:
Dr. Lu Zhong Huashan Hospital
27
Caution: Spot test first. Tattoo pigments with iron may
turn jet black with laser; continue treatment for black
Tattoo Treatment Before & After
BEFORE
AFTER
After 3 treatments (5.8-8.6 J/cm2)
Courtesy of:
Dr. Lu Zhong Huashan Hospital
28