Laser Hair Removal Flashcards
Consulting physician responsibilities
Quarterly audits
Write Rx
Adverse situations
LSO
Keep staff trained on safety protocols
Keep machines safe and maintenanced
Can shut down operation if not safe
LASER
Light Amplification by the Stimulated Emission of Radiation
Electromagnetic spectrum
Arranged by frequency of waves from shortest(fastest, high intensity) to longest(slowest, lower intensity)
Measure of a wavelength?
Nanometer (nm) or micron (1/1000 nm)
4 common LHR lasers?
694 Ruby
755 Alexandrite
810 Diode
1064 Nd:YAG
What part of the spectrum is thermal?
Infrared IR
3 Chromosphores
Water, hemoglobin, melanin
LHR Chromosphore
Melanin in the hair follicle, treat without targeting the blood or water surrounding
What wavelength targets the water Chromosphore?
Er:YAG and CO2, ablative treatments
Stimulated Emission
Excited electron absorbs photon, when returning to resting, it emits 2 photons, they all bounce around multiplying
Laser components
2 mirrors, one is partially reflective, light source and laser medium in between
Coherent light waves
Travel in unison
Laser light properties
Monochromatic, collimated, coherent
Visible light properties
Polychromatic, divergent, scattered
What determines Optical Energy?
Flouence, spot size and pulse duration
Unit of energy?
Joule
Unit of power?
Watt
4 laser properties
Absorption, reflection, transmission, scatter
Absorption in LHR
Follicle absorbs energy and converts to heat to destroy the follicle
Destroy the target while protecting the surrounding tissue is called…
Selective Photothermolysis, non ablative
Thermal Relaxation Time
Time it takes for 50% loss of heat
Pulse duration for TRT
Larger target heats and cools slower, needs longer width, smaller target (fine hair) heats and cools faster, needs shorter width
Ablative
Destroying the epidermis, targeting water
IPL properties
Full spectrum, non coherent, BBL
IPL components
Mirror above light source, filtered to allow the chosen wavelength through
Cooling options
Cold us gel Chill tip Zimmer Ice packs Cryogenic spray
Why epidermal cooling?
To protect skin from burning and patient comfort
Radio frequency RF
Electric wavelength between two poles to enhance heating of treated target, attracted to the heat from laser
RF depth
Half the distance of the nodes
Light emissions
Continuous or pulsed
Laser emissions
Homogenous or fractionated
Pseudofolliculitis barbae
Ingrown hairs
Layers of the skin
Epidermis
Dermis
Hypodermis or subq
What layer of the epidermis are the melanocytes in?
Basal layer
Types of hair
Vellus - fine, unpigmented
Terminal - course, pigmented
Where is melanin in the follicle produced?
Bulb and upper bulge, deepest in anagen phase
Types of melanin
Eumelanin - brown, black (our target)
Pheomelanin - red, gold
Growth phases of hair
Anagen - active
Catagen - transitional
Telogen - dormant
Body parts with long growth cycles
Back, chest, legs
What is safest wavelength for dark skin?
1064, deeper wavelength allows epidermal melanin to stay safe
Wet or dry lasers
Use gel or not
Tanned patients need which laser?
Nd:YAG, goes deeper to miss the epidermal pigment
How can you protect epidermis?
Cooling
Decrease flouence
Longer pulse width
Benefit of a larger spot size?
Speed
Delivers higher effective flouence bc scattered photons stay in the target area
Hormonal effects on hair
Male androgen increase size and pigment
Female estrogen decrease size and pigment
Pretreatment no nos
Sun 2 wks Antibiotics 10 days RetinA 3 days Self tanner 1 wk Waxing tweezing 4 wks Accutane 6 mos Botox 7 days Fillers 2 wks Open skin (herpes, sores, acne, cuts, etc)
Danger with facial treatment and Nd:YAG?
Need to cover teeth
Post care
Stay out of sun for 2 wks Use SPF Cool packs and aloe if needed No swimming, sweating, tubbing, sauna No friction No exfoliation for 2 days
Side effects and complications
Erythema Edema Blistering Hypo pigment Hyper pigment Histamine reaction HSV
Bell curve for results
5-10% poor
80% good
5-10% great
Treatment interval and why?
6 weeks apart, hair grows in cycles, at any given time only a fraction of hair is in the active state we are targeting
Limitation of treating men’s backs?
Low % of anagen hairs and long telegenic phase… Lots of treatments over a long period of time
Hormonal conditions?
Hirsutism Hypertrichosis Cushing's syndrome Androgenital syndrome PCOS
How to approach hormonal hurdles?
Will need more treatments, set expectation up front, start with 6 and evaluate results
Levels of burn
First degree - epidermal only, no blistering
Second degree - dermis injured, blistering
Third degree - subq injured
He do you know patient is burned?
Lingering heat
Grey or ashy appearance after shot
Blistering next day
What to do for burn?
Have patient come in to take a look or immediate cooling
Polysporin or silvadene depending on severity
Consulting physician if necessary (2 degree)
Photograph
Follow up
Burns in dark skin?
Do not appear immediately
Phases of wound healing?
Inflammatory
Proliferative/rebuilding
Remodeling
What part of the spectrum is LHR laser in?
Near infrared, does not cause blink reflex as it is invisible
What class lasers do we use?
Class IV
Eye protection
Goggles labeled for the particular wavelength you are working with, ablative lasers do not really harm the eye but we still wear goggles
Is suction needed for LHR?
No, the odor is from burnt hair, but doesn’t actually produce a smoke plume like ablative treatments
Check before treating
Sun
Meds
Shaven, no wax
No topicals
What is considered successful treatment series?
85% reduction
1 goal while in room
Safety & Efficacy
