Chapter 5: ER YAG 2940 Nm Fractional Laser

Question 1

What is fractional laser?

Answer 1

Skin resurfacing
Textural damage

Lines and wrinkles

Skin dullness

Open pores

Skin types 1-V

Question 2

Explain further about skin resurfacing

Answer 2

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

Question 3

What does laser radiation do to the tissue being treated?

Answer 3

generates internal heat of tissues

In accordance to the absorption of tissue content chromophore with regards to the specific wavelength

Question 4

What wavelength is water absorption of light most optimal?

Answer 4

2940nm

Question 5

What % of skin tissue content is water

Answer 5

60-80%

Question 6

What effect does the 2940 nm laser- tissue interaction result in?

Answer 6

The ablation of superficial skin layers with minimal collateral thermal damage

Question 7

What is cold ablation?

Answer 7

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

Question 8

Thermal ablation

Answer 8

Our devices and protocols offer longer pulse durations (widths) which allow greater heat diffusion and increases the thermal effect on surrounding tissues

Question 9

What is fractional mode?

Answer 9

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

Question 10

What is fractional intended to be used for?

Answer 10

Superficial skin resurfacing

Question 11

What is fractional effective in treating?

Answer 11

superficial textural damages, light pigmentations

In some cases (mild scars) acne scars

Question 12

How is downtime & post secondary treatment reduced?

Answer 12

Fractional mode reduces downtime since the intact areas of the skin (between the spots) accelerate the healing process of the ablated areas

Question 13

 The ER:YAG fractional mode handpiece is supplied with two matrix tips..

Answer 13

1. 7X7 matrix

2. 9X9 matrix

Question 14

7x7 matrix

Answer 14

Penetrates deeper
Greater energy per dot
lower dot density

 (49) > greater heating achieved

Question 15

9x9 matrix

Answer 15

Less energy per dot, yet higher density
(81)

Recommended for preservation as it is less thermal

Question 16

Energy per pulse

Answer 16

1.4 J/ pulse

Question 17

Pulse width (duration)

Answer 17

Ranges between 1 - 1.2 - 1.5 - 2 msec

Question 18

Spot size

Answer 18

11x11

Question 19

Rate

Answer 19

1-2-3 Hz

Question 20

Energy per dot

Answer 20

7x7 matrix = up to 28 mJ/ dot

9x9 matrix = up to 17 mJ/ dot

Question 21

What is the procedure duration?

Answer 21

30 minutes

Question 22

How does the skin appear after tx?

Answer 22

Red and swollen

Question 23

What if the patient previously suffered from herpes simplex in the treatment intended area

Answer 23

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

Question 24

What is useful as a preparation for laser skin resurfacing treatment to reduce the potential risk of hyperpigmentation?

Answer 24

Pre-treatment with glycollic acid or topical hydroquinone 

Question 25

What if a client has a tattoo near the tx area?

Answer 25

Avoid the tattoo and 1 cm surrounding it

Question 26

If a client is receiving treatment surrounding the eyes what do you do? 

Answer 26

Make sure the patient stainless steel protective eyewear is properly and Stabley positioned

Question 27

What needs to be applied before the procedure?

Answer 27

Topical anaesthesia

Question 28

Can you completely remove a damaged lesion in the first treatment?

Answer 28

Sometimes it’s not possible | it is better to gradually treat the desire tissue and consecutive treatments

Question 29

How many passes with fractional?

Answer 29

Number of passes should be between 2-4 | However a higher number of passes make cause close overlapping and void fractional properties 

Question 30

Greater caution is required when treating patients with skin types

Answer 30

Greater than four | >IV

Question 31

Pre-treatment consultation must include a detailed discussion of

Answer 31

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

Question 32

Treatment protocol

Answer 32

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

Question 33

Recommended parameters

Answer 33

``` 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

Question 34

Immediate Post treatment

Answer 34

Apply cold packs or wet disposable cloth for 10 minutes Apply soothing cream Do not rub

Question 35

Post treatment following days

Answer 35

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

Question 36

After re-epithelialization

Answer 36

A daily regimen which includes sun block, soothing cream, or gels and moisturizer

Question 37

When should you photograph clients during this treatment

Answer 37

1 week, 2 weeks, 1 month, 3 months, 6 months following treatment

Question 38

Post treatment effects

Answer 38

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

Question 39

Final results

Answer 39

Skin texture improvement Spot blanching Glowing skin

Question 40

Fractional program facts

Answer 40

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