Chapter 5: ER YAG 2940 Nm Fractional Laser Flashcards
What is fractional laser?
Skin resurfacing
Textural damage
Lines and wrinkles
Skin dullness
Open pores
Skin types 1-V
Explain further about skin resurfacing
Elimination of Rhytids, improving skin texture
Improvement in appearance of sun & age spots
Partial to full epidermal peeling
Minimized downtime, minimal side effects & minimal risk of complications
What does laser radiation do to the tissue being treated?
generates internal heat of tissues
In accordance to the absorption of tissue content chromophore with regards to the specific wavelength
What wavelength is water absorption of light most optimal?
2940nm
What % of skin tissue content is water
60-80%
What effect does the 2940 nm laser- tissue interaction result in?
The ablation of superficial skin layers with minimal collateral thermal damage
What is cold ablation?
Is when the duration of the energy delivery to the target is too short, ablation occurs before significant heat diffusion can take place
This results in lowered heat distribution to the surrounding tissues
Thermal ablation
Our devices and protocols offer longer pulse durations (widths) which allow greater heat diffusion and increases the thermal effect on surrounding tissues
What is fractional mode?
An array of micro beams that produce a spatial pattern of dots rather than one single large dot
The ER:YAG Laser affects small islet of tissue, while tissues in between these islets remain intact m
Deeper tissue ablation and quick re-epithelialization can be achieved which leads to shorter healing times
What is fractional intended to be used for?
Superficial skin resurfacing
What is fractional effective in treating?
superficial textural damages, light pigmentations
In some cases (mild scars) acne scars
How is downtime & post secondary treatment reduced?
Fractional mode reduces downtime since the intact areas of the skin (between the spots) accelerate the healing process of the ablated areas
 The ER:YAG fractional mode handpiece is supplied with two matrix tips..
- 7X7 matrix
2. 9X9 matrix
7x7 matrix
Penetrates deeper
Greater energy per dot
lower dot density
 (49) > greater heating achieved
9x9 matrix
Less energy per dot, yet higher density
(81)
Recommended for preservation as it is less thermal
Energy per pulse
1.4 J/ pulse
Pulse width (duration)
Ranges between 1 - 1.2 - 1.5 - 2 msec
Spot size
11x11
Rate
1-2-3 Hz
Energy per dot
7x7 matrix = up to 28 mJ/ dot
9x9 matrix = up to 17 mJ/ dot
What is the procedure duration?
30 minutes
How does the skin appear after tx?
Red and swollen
What if the patient previously suffered from herpes simplex in the treatment intended area
It is recommended to use prophylactic oral or antiviral agents following the treatment as well as 24 hours prior treatment
..until full epithelialization occurs according to the physicians discretion
What is useful as a preparation for laser skin resurfacing treatment to reduce the potential risk of hyperpigmentation?
Pre-treatment with glycollic acid or topical hydroquinone 
What if a client has a tattoo near the tx area?
Avoid the tattoo and 1 cm surrounding it
If a client is receiving treatment surrounding the eyes what do you do? 
Make sure the patient stainless steel protective eyewear is properly and Stabley positioned
What needs to be applied before the procedure?
Topical anaesthesia
Can you completely remove a damaged lesion in the first treatment?
Sometimes it’s not possible
it is better to gradually treat the desire tissue and consecutive treatments
How many passes with fractional?
Number of passes should be between 2-4
However a higher number of passes make cause close overlapping and void fractional properties 
Greater caution is required when treating patients with skin types
Greater than four
>IV
Pre-treatment consultation must include a detailed discussion of
Planned treatments
Potential risks, benefits and costs
Realistic expectations
Lesion type must be accurately identified
Patient forms such as consent form, medical history form etc. must be filled out and signed
Treatment protocol
Clean & disinfect area
Ask if they’ve had sun exposure or tanned in the last 2 -3 weeks
Take before pictures
Apply topical anesthesia 1 hour prior to tx & remove prior to treatment
Prepare cold packs to apply before, during, and after treatment. With an external cool air device.
Set treatment parameters
Protective eyewear & gloves
Ensure you have the correct hand piece tip
Handpiece should always be perpendicular with skin, gentle contact with 20% overlap
Keep skin taut in wrinkled/ saggy areas
Patient Is expected to report a gradual healing sensation at the treatment site
Once procedure is done, what disposable cloth in cold water and gently lay the cloth on the treated area without touching the skin
Post tx
Recommended parameters
Area: forehead/ peri orbital Pulse width: 1 msec Tip: 7x7 for tx 9x9 for preservation Number of passes skin type 1-3: 1-2 Number of passes skin types 4 to 5: 1
Area: upper chest & neck Pulse width: 1-1.2 msec Tip: 7x7 for tx 9x9 for preservation Number of passes skin type 1-3: 2-4 Number of passes skin types 4 to 5: up to 2
Area: face Pulse width: 1-1.5-2 Tip: 7x7 for tx 9x9 for preservation Number of passes skin type 1-3: 2-4 Number of passes skin types 4 to 5: up to 2
- greater ms and more passes for thicker skin and deeper lines
- shorter ms and 7x7 tip are recommended for 1st treatment
Immediate Post treatment
Apply cold packs or wet disposable cloth for 10 minutes
Apply soothing cream
Do not rub
Post treatment following days
Apply antibiotic cream to prevent infection
Frequent washing with soap free cleanser
Ointment until scabs are gone
Avoid sun
Wear protective headwear, clothing and sun protection of at least spf 30
After re-epithelialization
A daily regimen which includes sun block, soothing cream, or gels and moisturizer
When should you photograph clients during this treatment
1 week, 2 weeks, 1 month, 3 months, 6 months following treatment
Post treatment effects
Immediate:
Mild burning sensation
Mild redness & swelling for a few days
Mild bleeding for a few minutes
Following days:
Discomfort, irritation, itch, mild burning
After 1-3 weeks:,
Healing continues, peeling, superficial crusting
Temporary hyper/hypo pigmentation
Skin fragility & sensitivity to sun & cosmetic products
Final results
Skin texture improvement
Spot blanching
Glowing skin
Fractional program facts
Treatment: skin resurfacing
Number of treatments: 1-6
Interval: 4-6
Total course: up to 6 months
1st tx to initial visible results: 1 week post tx
First tx to final results: up to 9 months
Follow up 12 months after last treatment
