Ellman Sandstone Cheveux™

1. Ellman Sandstone Cheveux™ Permanent Hair Reduction 810 Diode Laser

2. From Razor to Laser • Methods of hair removal • Shaving • Waxing / plucking • Depilatories and creams (bleaches) • Electrolysis / electrothermolysis • Laser/light-based hair removal

3. Benefits of Laser Hair Removal • Treats a large area quickly • Low risk of side-effects • Temporary hair reduction for all hair types • Long-term growth delay • Permanent hair reduction

4. Absorption Spectrum of Major Chromophores in Skin Cheveux™ Diode Laser

5. How Laser Hair Removal Works • Laser energy is selectively absorbed by the melanin in the hair follicle and converted to heat, injuring the follicle. • Most hair is permanently removed. Hair that does regrow is finer and lighter than before.

6. Appropriate Pulse Durations • Pulse duration: key in destroying the follicle without excessive damage to the epidermis • With a pulse duration and energy chosen properly for a particular skin type, the follicle can be destroyed with minimal heat damage to the epidermis (selective photothermolysis). • The larger the target, the longer the thermal relaxation time (defined as the time required for an object to cool to 50% of the temperature achieved immediately following laser exposure). • Finer hair has shorter TRT. • Coarser hair has longer TRT. • Longer pulses allow heat to safely spread from the epidermis, especially important with darker skin types (e.g. 100ms, 400ms).

7. Who is a Candidate? • The Cheveux™ is safe and effective on all skin types and tanned skin • Works best on darker hair • Red or light brown hair may take more treatments to be effective • Blonde, gray and white hair do not contain melanin so treatments are not recommended • Can treat any area of the body • For safety avoid treating within ocular socket/orbit or on mucous membrane

8. Number of Treatments • Three phases of normal hair growth: • Anagen (active) • Catagen (regression) • Telogen (resting) • Follicle most susceptible during anagen phase • 1/3 to 2/3 of hair is in Anagen phase at any time • Hair has most melanin in the bulb during Anagen phase and absorbs the most energy to disable stem cells • Multiple treatments required 4 to 6 weeks apart • 3-6 treatments for lighter skin patients • 4-8 treatments for darker skin patients • During initial treatment, only 1/3-2/3 hair will be effected • Permanent reduction typically 50-90% following multiple treatments

9. Pre-Treatment • Pt. cannot wax, pluck or undergo electrolysis for 6 weeks beforehand • Can shave or trim • Avoid active tanning in area to be treated for 4 weeks prior to treatment • No self-tanning products 2 weeks prior to treatment • Obtain photographs

10. Pre-Treatment • Patient selection • Gray or blond hair not good candidates • Avoid treating if history of pronounced keloids • Avoid treating over tattoos or permanent make-up • History of herpes simplex virus (HSV) - pretreat with antiviral medication • Stop Accutane for at least 6 months • Caution if patient on photosensitizing medications • Caution if history of hyper- or hypopigmentation

11. Eye Safety • Can cause severe retinal injury • No treatment within bony orbit of eye (outer canthus). Treatment of eyebrows not recommended. • Ocular Hazard Zone: • 164 feet / 50 m • Use occlusive goggles when treating the face

12. Safety • Enclosed room, windows covered • Laser safety sign posted outside door • Laser in standby when not actively used • Key removed when not in use • Laser beam directed only at target or calibration port

13. Safety • Footswitch clean and out of way when not in use • Do not treat over paper or cloth • Do not store flammables in the room • Available fire extinguisher • Follow ANSI standards for Class IV laser • Contact Laser Institute of America (LIA) (800) 34LASER for current ANSI and OSHA standards

14. Laser Hair Removal Technique • Treatment is simple and straightforward • Set patient expectations • Obtain health history • Informed consent signed • Area clean and shaved prior to treatment • If desired, topical anesthetic cream applied 30-60 minutes before treatment • Caution if lidocaine allergy • Settings chosen based on skin type and hair density • Look for the presence of a tan • Test spotting recommended

15. Fitzpatrick Skin Type Classification Scale

16. Suggested Treatment Parameters

17. Suggested Treatment Parameters

18. Suggested Treatment Parameters

19. Suggested Treatment Parameters

20. Operator Technique • Secure wrist strap! • Apply water-based gel on area to be treated (this may be kept refrigerated) • Apply gel in no bigger than 12 inch square area as it tends to dry out • Spot size is 9mmX9mm – laser spreads under skin • Overlap 10% • Larger spot sizes – deeper penetration in skin • Apply slight compression • Keep chilled tip flat on the skin surface at a 90oangle • -Surface skin is cooled by chilled tip (4° C) to minimize heating of skin • Inspect and clean tip frequently during treatment! • Caution if treating over moles or suspicious lesions

21. Expected Sequelae and Tips • Observe skin for unwanted effects such as excessive erythema, blistering • Perifollicular edema is to be expected – resolves in 2 hours • Perform a test spot behind ear to ensure safety to skin – wait 24 hours • Do not overlap over 10% or treat area twice • Make sure tip is always in contact with skin when treating • Place wet gauze under lip when treating • Do not try to sculpt eyebrows • Never treat inside orbital rim • Use goggleswhen treating glabellar area to protect eyes • Place cotton ball in ears when treating tregus • Place white sponge behind ear when treating pinna • Stop treatment If greying or separation

22. Positive Clinical Endpoints • Perifollicular erythema and edema • Bumps around follicle several minutes after treatment • Less pronounced on darker skin types Courtesy C. Dierickx M.D.

23. Post-Treatment Sunburn sensation is normal Takes 2 weeks for hair to shed If desired, cold compress, aloe or hydrocortisone cream applied after treatment Gently clean area twice daily Stop glycolics, retinoids etc Sunscreen for 6 weeks over the area Describe singed hair and shedding process Patient returns in 4-8 weeks for next treatment After completion of initial treatment touch-up treatments at 6 month intervals may be required to disable resistant hairs in treatment area

24. Potential Risks • Perifollicular edema/erythema • Favorable post-treatment response • Usually resolves w/in 24 hours • Local blisters - too high fluence, dark skin • Hyper/Hypopigmentation • Transient, should clear within 6-12 months, • Fluence and skin type dependent • Scarring – Extremely rare

25. Ideas For Getting Started Promote • Good idea to treat staff so they can speak knowledgeably about procedure • Mention availability to patients • Brochures • Posters in waiting room, office bathrooms, exam rooms • On-hold message introducing laser • Phone staff should be able to answer basic questions