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Titan

Titan . New from Cutera. Non-ablative Skin Rejuvenation. Catch-all term for many conditions Superficial pigmented lesions Superficial redness and vascularity Pore size and texture Wrinkles Skin Laxity

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Titan

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  1. Titan New from Cutera

  2. Non-ablative Skin Rejuvenation • Catch-all term for many conditions • Superficial pigmented lesions • Superficial redness and vascularity • Pore size and texture • Wrinkles • Skin Laxity • Many different approached exist to address different aspects, leading to some confusion in marketplace

  3. Treating Skin Laxity • Target the dermis at a depth of 2 to 4 mm • Goal of treatment includes: • Immediate collagen contraction • Long-term collagen stimulation

  4. Prior Non-ablative Approaches • Intense Pulsed Light • Broadband light from 560 to 1200 nm targeting hemoglobin and melanin • Optimal for targeting superficial pigment and vascularity • Infrared Lasers (1320 nm and 1450 nm) • Target water to provide localized heating • Superficial penetration due to strong absorption by water • Radio-frequency devices • Bulk heating caused by resistance in the skin • Preferential heating of the fat due to higher resistance of fat compared to the dermis

  5. Titan Procedure – Our Goal • Develop a unique light source to… • Create a thermal response in the dermis that … • 1) Induces tightening of lax skin and • 2) Induces collagen stimulation.

  6. Titan Procedure – Our Approach • Deliver many wavelengths of infrared light to … • Heat water in Tissue • Create the desired temperature profile across the dermis… • While protecting and preserving the epidermis

  7. Advantages of Light • Optical power measurement and tissue response to light is straightforward and well understood • Even, uniform heating of tissue using water as the target chromophore • Much lower per-treatment costs • No single-use disposables are used • Consumable cost is due to replacement of the light source

  8. Titan Procedure: Pre-Cooling

  9. Titan Procedure: Treatment

  10. Titan Procedure: Post-Cooling

  11. Thermal Comparison to RF Device • Thermal camera images demonstrating temperature profile in tissue model for RF and Cutera devices • Thermal profiles show significant heating in the dermis from 2 to 4 mm depths • Epidermis is safely maintained below 40 °C RF Device Titan 1 cm reference in each photo

  12. Titan procedure

  13. Titan Users Group • United States • Brian Biesman, MD • Barry Dibarnardo, MD • Roy Grekin, MD • Suzanne Kilmer, MD • Leonardo Rasi, MD • Vic Ross, MD • Javier Ruiz-Esparza, MD • Bruce Russell, MD • Adrian Yi, MD • Canada • Don Groot, MD • Kevin Smith, MD • Japan • Taky Kubota, MD, Ph.D.

  14. Results • Early results on the abdomen are the most significant • Clinical study underway • Treatment on the face is more challenging • Best results seen on the jowls • Older patients with lax skin appear to be the best candidates for treatment • There will be some non-responders

  15. Treatment of cheeks & submental area. 3 passes at 42-44 J/cm2. Pre-op 1 month after 2nd Treatment Photos Courtesy Bruce Russell, MD

  16. Treatment Technique – Another Approach • One approach in use is to use a more moderate fluence, such as 30 J/cm2, which is normally well tolerated by the patient and apply a large number of pulses in the treated area. • Example 1: Eyebrow Lift. For this patient, the area of the forehead that, when contracted, would provide lifting of the eyebrows was treated with multiple passes (122 pulses) at 30 J/cm2. Photos Courtesy Javier Ruiz-Esparza, MD Areas Treated

  17. Pre-Treatment 2 Months after 1 Treatment with 122 pulses at 30 J/cm2 at locations shown on previous slide. Treatment Technique – Another Approach Photos Courtesy Javier Ruiz-Esparza, MD

  18. Pre-Treatment Immediate Post Tx 2 Months after 1 Treatment with 122 pulses at 30 J/cm2 at locations shown on previous slide. Treatment Technique – Another Approach Photos Courtesy Javier Ruiz-Esparza, MD

  19. Treatment Technique – Another Approach • Example 2: Lower Face. For this patient, the submental and cheek areas were treated with 140 pulses at a fluence of 30 J/cm2. Immediate response shown: Pre-op Immediate Post Photos Courtesy Javier Ruiz-Esparza, MD

  20. Blinded Evaluation Study • Informal study performed by Don Groot, MD • 9 patients were treated for lax skin using high fluences (44 to 50 j/cm2), 4 passes per session, 1 to 2 sessions • Evaluations took place 1 to 2.5 months post treatment: • Before and after photos were placed in random order • 16 evaluators reviewed the photos • Instructed to select the photo which demonstrated a reduction in skin laxity

  21. Informal Blinded Evaluation • Correct photo was chosen 90% of the time (average score was 8.1 out of 9) • Of the 16 evaluators, 8 selected the post treatment photos correctly every time • The lowest score was 6 correct out of 9

  22. Clearances • U.S. Clearances • Pending clearance for the treatment of wrinkles • Cleared for topical heating for the purpose of elevating tissue temperature for the temporary increase in local circulation where applied • International Clearances • Cleared for the treatment of wrinkles in Europe • Cleared for general dermatological use in Canada

  23. Summary • Titan is a promising new technology using light to provide deep dermal heating • Treatment appears promising for many parts of the body including abdomen, underarms and jowls

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