Chapter 5: Er:YAG 2940nm Fractional Laser

Question 1

What does skin resurfacing target (indications)?

Answer 1

• textural damage
• lines and wrinkles
• skin dullness
• open pores

*skin types I-V

Question 2

Benefits of skin resurfacing and what to expect:

Answer 2

• elimination of Rhytids, improving skin texture
• improvement in the appearance of sun & age spots
• partial to full epidermal peelings (depending on the numbers of stacked pulses, tip size, skin hydration level, etc)
• minimized downtime, minimal side effects and minimal risk of complications

Question 3

How does laser radiation create heat in skin resurfacing treatment area?

Answer 3

-Laser radiation is able to ablate or generate internal heat of treated tissues, in accordance to the absorption of tissue content chromophores with regards to the specific wavelength

Since…
-water absorption of light peaks at 2940nm wavelength
-60-80% of skin tissue content is water
—>The 2940nm laser/tissue interaction will result in the ablation of superficial skin layers with minimum collateral thermal damage

Question 4

How does Ablation & Pulse Duration work?

Answer 4

-In theory, when the duration of the energy deliver to the target is too short, ablation occurs before significant heat diffusion can take place
—>This results in lowered heat distribution to surrounding tissues (Cold Ablation)

-However, our device and supported protocols offer longer pulse durations (width) which allow greater heat diffusion and increases the thermal effect on surrounding tissues (Thermal Ablation)

Question 5

Ablation and Thermal Induction Diagram:

Question 6

What is Fractional Mode of skin resurfacing?

Answer 6

• An array of micro beams, that produce a spatial pattern off dots rather than one single large dot
• in Fractional mode, the Er:YAG laser only effects small islets of tissue, while tissues between these islets remain intact
• In this mode, deeper tissue can be achieved, as well as quick re-epithelialization, leading to shorter healing times

Question 7

What is the Er:YAG fractional resurfacing laser intended to be used for?

Answer 7

-for more superficial skin resurfacing
—it is very effective in treating superficial textural damages; light pigmentations, and in some cases, when scares are mild, it can be useful and effective in treating acne scars
-the fractional mode reduces downtime and post-treatment secondary effects since the intact areas of the skin (between the spots) accelerate the healing process of the ablated areas

Question 8

The Er:YAG Fractional Mode hand piece is supplied with 2 matrix tips:

Answer 8

Question 9

Energy per pulse and per dot diagram:

Answer 9

Question 10

Describe the Fractional LASER 2940 application screen:

Answer 10

• User friendly control panel
• to choose the treatment depth , simply select ms and the appropriate pre-set program
• the Joule is automatically set for the appropriate intensity

Question 11

Pre-treatment recommendations and considerations:

Answer 11

1. The procedure duration is usually 30 minutes, after which the skin surface will appear red and swollen
2. If the patient had previously suffered from Herpes Simplex Infection in the treatment-intended area, it is recommended to use Prophylactic oral anti-viral agents following the treatment, until full re-epithelialization occurs, according to the physicians discretion
3. pre-consumption of these agents 24 hours in advance is recommended as well
4. Pre-treatment with glycolic acid or topical hydroquinone is useful as a preparation for laser skin resurfacing treatment; it can reduce potential risk hyper-pigmentation
5. Treating around a tattoo? Make sure you do not treat the tattoo and the 1cm surrounding it. Allow a distance of at least 1cm as a margin (perimeter)

Question 12

Recommendations Pre-treatment:

Answer 12

1. Appropriate eye-protection is used with accordance to the laser wavelength. When treating an area close to the eye surrounding, make sure the patients stainless steel protective eye wear is properly and stably positioned
2. Topical anesthesia should be applied before the procedure. The cream must be gently yet thoroughly removed just prior to treatment
3. Sometimes, it is not possible to completely remove a damaged lesion in the first treatment. It is better to gradually treat the desired tissue in consecutive treatments
4. Number of passes should be between 2-4; however, a higher number of passes may cause overlapping and avoid fractional properties
5. Greater caution is required when treating patients of skin types > IV

Question 13

Consultation for Fractional Laser Skin Resurfacing:

Answer 13

Pre-treatment consultation must include a detailed discussion of:

1. Planned treatments
2. Potential risks, benefits, and costs
3. Realistic expectations
4. Lesion type must be accurately identified
5. Patient forms (Consent Form, Medical History Form) must be filled and signed

Question 14

Remember! Do not treat patients with contraindicated medical conditions without permission from a physician:

Answer 14

1. Absolute contraindications
2. Relative contraindications
3. Please refer to chapter 3
4. Refer to your User Manual

Question 15

When seeking approval it is important to….

Answer 15

If unsure, the physicians permission should be in writing and include:

1. The patients specific health or medical condition
2. Details of the intended treatment
3. Permission to perform the treatment, taking into account the patients medical condition

*The permission should be documented in the patients records.

Question 16

Treatment Protocol:

Answer 16

Question 17

Recommended parameters diagram:

Answer 17

Question 18

Immediate after care for fractional laser:

Answer 18

1. apply cold packs or wet disposable cloths for 10 minutes
2. Apply a generous layer of soothing cream
3. Do no rub the skin

Question 19

After care in the following days of fractional laser treatment:

Answer 19

1. recommended to apply antibiotic cream to prevent infection, subject to physician discretion
2. Frequent washing with soap fire cleanser, & application of ointment until all scans are gone
3. If the patient must go outdoors after 2 days, suitable protective headwear/ clothing and sun protection cream of at least SPF 30 should be applied

Question 20

Care for after re-epithelialization for fractional laser:

Answer 20

1. A daily regimen e which includes application of appropriate sun block, soothing creams or gels, and moisturizers should be followed
2. All patients should be photographed at time points of 1 week, 2 weeks, 1month, 3 months, and 6 months following treatment

Question 21

Immediate post treatment effects and sensations for fractional laser:

Answer 21

1. Mild burning sensation
2. Mild diffuse redness and swelling for a few days
3. Mild bleeding may occur for a few minutes following the treatment, after relatively aggressive treatments are performed

Question 22

Effects and sensations in the following days post fractional laser treatment:

Answer 22

1.discomfort, irritation, itch, mild burning sensation

Question 23

Effects and sensations in the following 1-3 weeks post fractional laser treatment:

Answer 23

1. Healing continues, peeling, superficial crusting
2. Temporary hyper/hypo pigmentations
3. Skin fragility and sensitivity to sun and any cosmetic product

Question 24

Final results following fractional laser skin resurfacing treatment:

Answer 24

1. Skin texture improvement
2. Spot blanching
3. Glowing skin

Question 25

Consecutive Treatments Diagram:

Answer 25