Michael J. Tomcik, M.D.

1. Michael J. Tomcik, M.D.

2. MiXto sx® Microfractional CO2 Laser at the Advanced Laser and Skin Care Center Michael J. Tomcik, MD William Ting, MD

3. WHY CO2 Gold standard for smoothing, tightening and resurfacing. Ablative > Non-Ablative CO2 > Erbium > Near Infrared Heats the dermis greater than all other wavelengths.

5. CO2 CO2 CO2 1540 1540 1540 Necrosis Coagulation

6. Why MiXto sx® Microfractional CO2 Innovative Computerized Pattern Generator Microspot - 300u Covers 20% of the surface on each pass Algorythm avoids heat build-up

7. MiXto sx® after 24 hours

8. Why MiXto sx® Microfractional CO2 Innovative Computerized Pattern Generator Microspot - 300u Covers 20% of the surface on each pass Algorythm avoids heat build-up

9. Video

10. Why MiXto sx® Microfractional CO2 Price Two Year Warranty Results

11. Two Controls Depth of heating (sx) Tissue ablation (power)

12. Choosing your settings Baseline*- 8 sx, 8 power Face*- may do multiple passes Acne/Chicken Pox - 6 sx, 11 power Tightening - 5 sx, 10 power Neck, Décolletage, Hands and Arms* - generally one pass 6 sx, 10 power *These are only recommended as guidelines, each patient needs to be evaluated individually.

13. Benefits of MiXto sx® Versatile (Face, Neck, Décolletage, Hands and Arms) Easy and fast Face (20 – 40 minutes) Neck (15 - 30 minutes) Chest (20 – 30 minutes) Each Hand (10-15 minutes) Topical anesthetic BLT (20%, 6%, 4%) TLC Pharmacy, Hermosa Beach - 310-798-5400 All skin types

14. Benefits of MiXto sx® (cont.) Minimal Discomfort Moderate Sunburn sensation – 30 minutes – 3 hours Erythema and Edema – 1 – 3 days Tightening and Itching – 7 days Minimal Risks for: Hypo/Hyper Pigmentation Scarring Minimal downtime Face – 3-6 days Neck and Hands – 7-10 Days Chest – 10 – 21 Days

15. Progression Photo’s

16. Before

17. Post Op - Day 2

18. Post Op - Day 3

19. Post Op - Day 9

20. Progression #1 DAY 2 DAY 3 DAY 9 BEFORE

21. Before

22. Post Op - Day 3

23. Post Op - Day 6

24. Post Op - Day 12

25. Progression #2 BEFORE DAY 3 DAY 6 DAY12

26. Before

27. Post Op – 10 Minutes

28. Post Op - 24 Hours

29. Post Op - 3 Days

30. Post Op - 8 Days

31. Progression #3 10 Minutes 24 Hours Before 3 Days 8 Days

32. Progression #4 Type III – 52 Yrs – Face 2 Passes (Sx 6/Pwr 10) Neck 1 Pass (Sx 6/Pwr 10) 30 Days – Post Op 6 Days – Post Op

33. Before/After Photo’s

34. Before/After Photo’s Type II – 2 passes Sx 6/Pwr 10

35. Before/After Photo’s Type II – 36 Yrs. – 2 passes Sx 6/Pwr 10

36. Before/After Photo’s Type IV – 44 Yrs – 3 Passes Sx 6/Pwr 10

37. Before/After Photo’s Type I – 56 Yrs. – 2 Passes Sx 6/Pwr 10

38. Before/After Photo’s Type IV – 58 Yrs. – 3-4 Passes Sx 6/Pwr 10

39. Patient Selection • Realistic Expectations 2. Medical History • Herpes Simplex • Keloids • Pregnant/Breast Feeding • Accutane within 12 months • Committed to Sunscreen – 45 or higher

40. Pre-Operative No Asprin or Anti-Inflamatory Drugs – 3 days prior/post Famvir – 500 mg – T.I.D. – 10 days Keflex – 500 mg – T.I.D. – 7 days TriLuma Cream – 4 weeks prior to treatment every second to third day for skin types II, III, IV.

41. Post-Op • Immediate • Hydrating Gel (Cicalfate - Avene, Aloe Vera Gel, etc.) • Sunscreen - SPF 45 or higher • Fan • 7 Days • Hydrate – Luke Warm Shower – 5 X a day • Lubricate • Elta M.D. • Aquaphor • Sunscreen - SPF 45 or higher • General • No financial decisions for 24 hours • Avoid Sun Exposure • Sunscreen, Broad Brim Hat, Scarf • Avoid Strenuous Exercise 3 – 7 days • Call office for any pain greater than a mild sunburn

42. Physician Recommendations Proceed cautiously Use Eye Protection Be less aggressive on neck, chest, hands, arms Gradually increase power Gradually decrease SX Remember – Ablative lasers CAN scar