Presentación sobre el láser médico de diodo para depilación "Vectus", a cargo de la Dra. Josefina Royo de la Torre, subdirectora de Instituto Médico Láser, en el VI Simposio de Palomar Medical Inc.- Presentation "Vectus Diode Laser": details of the new system for permanent hair removal.

1. 13-16 Septiembre 2012

2. Medical Laser Hair Removal
Vectus
New System for Permanent Hair Removal
Dra. Josefina Royo de la Torre
Dr. Javier Moreno-Moraga
Instituto Médico Láser, Madrid, SPAIN

3. Capturing and profiling adult hair follicle stem cells
Rebecca J Morris, Yaping Liu, Lee Marles, Zaixin Yang, Carol Trempus,
Shulan Li, Jamie S Lin, Janet A Sawicki and George Cotsarelis.
The hair follicle bulge possesses putative epithelial
stem cells.
Characterization of these cells has been hampered by the inability to target bulge cells genetically. Here,
we use a Keratin1-15 (Krt1-15, also known as K15) promoter t o target mouse bulge cells with an
inducible Cre recombinase construct or with the gene encoding enhanced green fluorescent protein
(EGFP), which allow for lineage analysis and for isolation of the cells. We show that bulge cells in adult
mice generate all epithelial cell types within the intact follicle and hair during normal hair follicle cycling.
After isolation, adult Krt1-15-EGFP-positive cells reconstituted all components of t he cutaneous
epithelium and had a higher proliferative potential than Krt1-15-EGFP-negative cells. G enetic p rofiling of
hair follicle stem cells revealed several known and unknown receptors and signaling pathways important
for maintaining the stem cell phenotype.
Ultimately, these findings provide potential targets for the treatment of hair
loss and other disorders of skin and hair.
Nature Biotechnology 22, 411 - 417 (2004) Published online: 14 March 2004 | doi:10.1038/nbt950

4. Capturing and profiling adult hair follicle stem cells
All keratinocyte lineages within hair follicles are derived from bulge cells during normal hair follicle cycling in vivo .

5. Elongated Hair Removal:
Delayed follicular growth:
Matrix damage
Permanent Hair Removal:
Bulge stem cells and papilla damaged. (In the
interphase outer root sheath and conective
tissue).
G.B.Altshuler et al. Laser in Surg & Med. 29:416-432 (2001)

6. Action on the bulge
Thermal diffusion

7. Action on the bulge
Thermal diffusion
Follicle stem-cells don't bear a significant amount of melanin(Altshuler)

8. Selective Photothermolysis Theory
•Selective light absorption of the target vs.
surrounding tissue.
•Pulsewidth is significantly shorter than target
thermal relaxation time.
•Light energy is higher than target damage
threshold.

9. Selective Photothermolysis
Thermal Relaxation Time (TRT) and Laser Pulsewidth
•Pulsewidth ≤ TRT
•TRT (sec): (0.4÷2.5) d 2 (mm)
•TRT
•0.01 mm vessels: 0.01 msec
•0.1 mm vessels: 1 msec
•Hair follicle: 10-200msec
•Hair shaft: 3msec

10. Extended Theory
of Selective Photothermolysis

11. Extended Theory
of Selective Photothermolysis
Example of non-uniformity target
Blood vessels
Chromophore: Blood
Target: Wall
Hair follicle
Chromophore: Melanin hair shaft
Target: Stem cells in outer root sheath

12. Extended Theory
of Selective Photothermolysis
Classical vs Extended Photothermolysis
Classical Theory
The target is damaged by direct heating of absorbed light
Extended Theory
The target is damaged by heat diffusion from light
absorbing chromphore

13. Extended Theory
of Selective Photothermolysis
Classical vs Extended Photothermolysis
Classical Theory
The chromophore contained target must be damaged
Extended Theory
The chromophore have to be prevented from absorption
loss (complete damage)

14. Extended Theory
of Selective Photothermolysis
The absorption and diffusion coefficients are altered by phase transitions
(melting hair and melanin).
Not exceed the temperature of the heater absorption.
With Vaporization/Ablation and
Softening/Melting,
the heater stops accumulating
heat.
There are:
Boiling and bubbling acting as
phase transitions that may alter
the heat diffusion to the target

15. Extended Theory
of Selective Photothermolysis
When target and pigment are separate, to produce Thermal Damage it is needed:
1.-Deposit enough energy into the absorbent area:
1.1.-Absorption coefficient heater.
1.2.-Emission energy density.
2.-Good heat diffusion between the absorbent zone and outer target structures
2.1.- Diffusion coefficient between heater and surrounding area
(avoid phase transitions).
2.2.- Distance between pigment and target.

16. Extended Theory
of Selective Photothermolysis
Classical vs Extended Photothermolysis
CONCEPTION OF THERMAL DAMAGE TIME (TDT)
Time required for the front of damage to
propagate from the chromophore to the target

17. Extended Theory
of Selective Photothermolysis
Classical vs Extended Photothermolysis
Classical Extended
Pulsewidth is Pulsewidth is close
signifcantly shorter to target thermal
than target thermal damage time TDT
relaxation time TRT
Higher fluences are posible because the longer pulse

18. Extended Theory
of Selective Photothermolysis
The Extended Theory calculates the pulse width ideal for a "target"
away from the "heater" considering the time of heat diffusion from the
"heater" to the outermost part of the "target”. (Altshuler)
TDT = time irreversible thermal damage to the outermost portion of
the "target"
For a follicle of 200 micras, TDT = 170 msec

19. Palomar is a leading designer of laser patents
Palomar works closely with
W ellm an I nstitute,
Massachusetts General Hospital

20. The Vectus Laser is an intelligent choice that uses
optimized technology for
permanent fast laser hair removal.

21. The Vectus Laser is a intelligent choice for
permanent fast laser hair removal.

22. Features
1.-High peak power
Spots: 1.2 x 1.2: 1.44 cm ² 2.3 x 3.8= 8.7 cm²
Large spot size option for fast coverage
Small spot size option for precise treatments

23. Features
2.-Large Hand Piece
1.44 cm ² 8.7 cm²

24. Features
3.-Uniform spacial beam profile without “hot spots”
Vectus Laser
Small Sapphire Optic

25. Features
3.-Uniform spatial beams profile without “hot spots”
Vectus Laser
Large Sapphire Optic

26. Features
4.-Uniform time beams profile
Pulse shape optimum for stem cell coagulation

27. Features
5.-Photon Recycling for maximum treatment results
With photon recycling,
we can increase the fluence available to heat the target by 1.5 to 2 x

28. Features
5.-Photon Recycling for maximum treatment
results

29. Features
6.-Skin cooling more intense 0ºC vs 5ºC

30. Features
7.- Melanin index reader
Advanced technology melanin
reader measures relative
melanin index
Adds an element of treatment
confidence

31. May enable more ancillary staff to conduct treatments
It may not be sufficient to define the phototype
The active melanin index can be increased in relative form

33. Features
8.-Easy parameterization
Enhanced GUI allows for customized
treatments by selecting pacient’s:
•Hair density
•Fitzpatrick Skin Type or Skintel Value
•Hair diameter
•Hair color

34. Benefits
1.Better permanent hair removal
2.Reduced number of treatments
3.Large safety gap
4.Shorter treatment time
5.Lower pain

35. Due to
1. Peak power 2 times higher
2. Fluency is 1.1-2 times higher with safety
3. Pulse shape optimum for stem cells coagulation
4. Super uniform beam without hot spots
5. Larger spot size
6. 15-40% more follicles heating from magic mirror
7. Better cooling to 0ºC versus 5ºC
8. Melanin index (MI) measurement and automatic selection of
fluency.

36. Vectus histology shows complete follicular
coagulation = effective cell death

37. Vectus histology shows complete follicular
coagulation = effective cell death

39. Before 6 Mo Post Tx 4

40. Before 6 Mo Post Tx 3

41. Before After 2 Treatments
Photos courtesy of Sean Doherty, MD
Boston Plastic Surgery Associates, Concord, MA
Co-Medical Director, Palomar Medical Technologies, Inc., Burlington, MA

42. Before After 1 Treatment
Photos courtesy of Sean Doherty, MD
Boston Plastic Surgery Associates, Concord, MA
Co-Medical Director, Palomar Medical Technologies, Inc., Burlington, MA

46. Late perifollicular
edema
The perifollicular
edema takes longer
to appear than other
devices but more
intensely

47. Late perifollicular
edema
The perifollicular
edema takes longer
to appear than other
devices but more
intensely

48. Before & After immediately,
No hair carbonization
The hair fall could take longer

49. Before & After immediately,
No hair carbonization
No smells
No cliks

50. By Vectus, the hair shaft keeps intact
Alexandrite, Vectus
Immediately after hair removal treatment Immediately after hair removal treatment
Melting of hair shaft and melanin Hair shaft and melanin don’t
show changes

51. Before and after
inmmediately
(Confocal)
The hair shaft keeps complete

52. Woman leg : 1 session
Before and after 4 months
Clearance in hair density over 50% with one only session
Very safe
Very fast
IMPROVING THE CLASSICAL EXPECTED RESULTS IN LASER HAIR REMOVAL