Dr. Patrick Treacy lectures on IPL (Dublin)

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Dr. Patrick Treacy lectures on behalf of Lumenis on IPL . Intense pulsed light, commonly abbreviated as IPL, is a technology used by beauty studios and medical practitioners to perform various skin treatments including hair removal and photorejuvenation. The technology utilises a broad spectrum lightsource, with a general spectral range of 515 to 1200 nm. Various cutoff filters are commonly used to filter out lower frequencies and narrow this spectrum to target specific structures and chromophores. Because of the broad spectrum of the IPL light source they are unique, as opposed to lasers, in the ability to filter the light spectrum to target various chromophores in the skin

Dr. Patrick Treacy lectures on IPL (Dublin)

  1. 1. Intense Pulsed Light (IPL™) ‘Benefits & Drawbacks’ Dr. Patrick Treacy MD Ailesbury Clinics Ltd. Professional Beauty Dublin Oct 2012
  2. 2. MEDICAL DISCLOSURE:  Dr. Patrick J. Treacy is a Cosmetic Doctor presently on the Specialist Register in the UK & Ireland. Specialist Dermatologist.  Previously worked in United States., United Kingdom, Australia, New Zealand, South Africa and Gibraltar.  No financial interest or stock in Lumenis nor do I receive any additional remuneration for giving this IPL lecture.
  3. 3. Agenda  IPL Skin Treatments Using Photorejuvenation   The Science Behind IPL  What IPL Can Do  Skin Treatments Using Photorejuvenation  Type I Type II Type III (pending FDA clearance)  Technologies Available on IPL Platforms  Unwanted Veins Tattoo Removal  Treatment of Wrinkles and Skin Laxity  Treatment Considerations  Complications of IPL  What’s New in IPL technology
  4. 4. Before and After Female with facial veins Before and after 3 IPL treatments Courtesy of Jerry Darms, MD, Lake Oswego, Oregon Before After
  5. 5. Before and After Female with facial veins Before and after 3 IPL treatments Courtesy of Jerry Darms, MD, Lake Oswego, Oregon Before After Telangiectasia
  6. 6. Before and After Female with ruddy complexion Before and after 3 IPL treatments Courtesy of Robert Weiss, MD, Hunt Valley, Maryland Before After
  7. 7. Before and After Female with ruddy complexion Before and after 3 IPL treatments Courtesy of Robert Weiss, MD, Hunt Valley, Maryland Before After Rosacea
  8. 8. Before and After Female with sun damage Before and after 3 IPL treatments Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado Before AfterLentiges
  9. 9. Before and After Female with sun damage Before and after 3 IPL treatments Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado Before AfterSun Damage
  10. 10. Before and After Female with sun damage Before and after 3 IPL treatments Courtesy of Nathan Trookman, MD, Colorado Springs, Colorado Before After Sun Damage
  11. 11. Before and After Female with poikiloderma Before and after 3 IPL treatments Courtesy of Mary Grey, MD, Auckland, New Zealand Before After
  12. 12. Before and After Female with poikiloderma Before and after 3 IPL treatments Courtesy of Mary Grey, MD, Auckland, New Zealand Before After Poikiloderma
  13. 13. Before and After Female with age spots (sun-induced freckles) Before and after 1 IPL treatment Courtesy of Franklin Johnson, MD, Mineola, New York Before After Age Spots
  14. 14. Before and After Male with vascular changes Before and after 3 IPL treatments Courtesy of Gayle Rothenberg, MD, Houston, Texas Before After Vascular Changes
  15. 15. Before and After AfterBefore Histology
  16. 16. The Science Behind IPL
  17. 17. What is IPL?  IPL = Intense Pulsed Light  Visible and near infra-red light, 500-1200 nm  Efficacious  Flexible  Safe Elora, IPL Quantum and Lumenis One
  18. 18. How IPL Works: Selective Photothermolysis  Selective  Specially selected wavelengths of light penetrate the skin, reaching the target (hemoglobin, melanin) with minimal epidermal/dermal absorption  Photothermo-  The light is converted to heat in the target  -Lysis  Heat coagulates the proteins in the target and is conducted to the cells around, causing mechanical damage  Clearance by immune system cells
  19. 19. How IPL Works: Selective Photothermolysis 1. Specially selected wavelengths of light penetrate the skin 2. Target (haemoglobin, melanin) absorbs the light with minimal epidermal/dermal absorption 3. Light is converted to heat, destroying the vessel or lesion 4. Damaged tissue is removed by the body
  20. 20. Quick Rule 1: Different objects preferentially absorb different wavelengths of light. (selective absorption)
  21. 21. Quick Rule 2 The right wavelength can selectively destroy the object without affecting the surrounding tissue. (selective photothermolysis)
  22. 22. Spectral Selectivity
  23. 23. Laser Types x-rays cosmic rays Microwaves TV and radio waves Excimer KTP Nd:YAG Er:YAG 190-390 488-514 532 577-630 755 694 1064 2940 10600 UV VISIBLE INFRARED 400 nm 700 nm Holmium 2100
  24. 24. Selective Photothermolysis
  25. 25. Properties of Laser Light  Collimated: Minimal divergence of light bundle  Monochromatic: Only one wavelength  Coherent: Defined phase relation White light (Divergent) White light (Complete visible spectrum) Laser Light Laser Light Laser Light White light (Incoherent)
  26. 26. IPL vs. Laser  Single wavelength targets single peak of melanin and hemoglobin’s absorption spectra to destroy target  Wavelength cannot be adjusted for individualized treatment  Multiple wavelengths target multiple peaks of melanin and hemoglobin’s absorption spectra to destroy target  Wavelengths can be optimized to individuals’ skin types and conditions, using filters  Minimal ocular hazard  No down-time, non- ablative procedure with minimal side-effects Laser IPL
  27. 27.  During the pulses, light energy is delivered  During the delays, the tissue cools  More energy can be be safely delivered to the target IPL’s Efficacy: Multiple Synchronized Pulsing Pulse 1 Pulse 2 Pulse 3 Delay 1 Delay 2
  28. 28. Technologies Available on IPL Platforms
  29. 29. Two heads are better than one Nd:YAG Module 2 Spot Sizes (2 x 4 mm and 6 mm) to ensure precision treatment with computer- enabled recognition Continuous contact cooling with SapphireCool Light Guides to measurably increase patient comfort and enhance Light Guide durability
  30. 30. What IPL Can Do  IPL is the gold-standard for photorejuvenation  Treats redness and rosacea symptoms  Treats brown pigmentation and age spots  Leaves the skin soft and smooth  Treats the full face, neck, chest, and hands  Requires no downtime
  31. 31. What IPL Can Do Type I Skin Treatments Using Photorejuvenation:  Erythema/Flushing  Rosacea symptoms  Telangiectasia  Hyperpigmentation  Melasma  Photoaging
  32. 32.  Why treat pigmentary conditions?  75% of the Irish population between the ages of 35 and 65 have some type of treatable pigmented lesion. What IPL Can Do Pigmentary Conditions
  33. 33.  Treatment options for pigmentary conditions:  IPL  Lasers  Liquid nitrogen  Chemical peels  (Micro-) Dermabrasion  Surgery  Topicals, including bleaching  Prescription drugs  No treatment What IPL Can Do Pigmentary Conditions
  34. 34. What IPL Can Do Pigmentary Conditions
  35. 35. What IPL Can Do Vascular Conditions  Treatment options for vascular conditions:  IPL  Lasers  Sclerotherapy  Compression stockings  Combination  No treatment
  36. 36. What IPL Can Do Vascular Conditions  Why treat Vascular Conditions?  1 million Irish people suffer from benign vascular condition such as:  Spider veins and other telangiectasia  Haemangiomas  Port wine stains and other vascular malformations - 3 in 1000 births  Rosacea - estimates of 150,000 Irish people, many who go untreated
  37. 37. What IPL Can Do Vascular Conditions
  38. 38. What IPL Can Do Type II Skin Treatments Using Photorejuvenation  Dermal and epidermal structural changes  Elastotic changes  Wrinkles
  39. 39. What IPL Can Do Type II : Clinical Research
  40. 40. Before 6 Months After 5-ALA therapy followed by IPL treatment What IPL Can Do Type III : Photodynamic Photos courtesy of Mitchel Goldman, MD Pending FDA Clearance
  41. 41. Before 6 Months After 5-ALA therapy followed by IPL treatment What IPL Can Do Type III : Photodynamic Photos courtesy of Mitchel Goldman, MD Pending FDA Clearance
  42. 42.  Procedure  Acetone scrub  5-ALA therapy with 30 minute incubation  Lumenis IPL at 30 J/cm2 Before After What IPL Can Do Type III : Photodynamic Photos courtesy of Dore Gilbert, MD Pending FDA Clearance
  43. 43. What IPL Can Do Unwanted Hair
  44. 44. Before Female with hair on the chin Before and 6 months after 3 IPL treatments Courtesy of Robert Weiss, MD, Hunt Valley, Maryland After What IPL Can Do Unwanted Hair
  45. 45. Before Female with spider veins Before and 2 months after 4 IPL treatments Courtesy of Marc Troxler, MD, Arlesheim, Switzerland After What IPL Can Do Unwanted Veins
  46. 46.  Why treat leg veins and deep vascular lesions?  Varicose veins are present in approximately 50% of women and 20% of men before the age of 60.  50% of people with varicose veins are bothered by symptoms. Almost all are bothered by appearance. What IPL Can Do Unwanted Veins
  47. 47. Treatment Considerations  Parameter selection  Easy presets for novices  Customizable parameters for advanced users
  48. 48. Treatment Considerations  Contraindications  Malignancy  Prolonged sun exposure or tanning within four weeks pre- or post-treatment  Photosensitizing drugs  Relative contraindications  Diabetes  History of keloid scarring  Pregnancy
  49. 49. IPL Photorejuvenation Complications / Adverse Effects • Dissatisfaction • Ecchymosis (purpura) • “Tiger Stripes” • “Leopard Spots” • Burns • No scars to date • Hyperpigmentation • Hypopigmentation • Epidermal Crusting Adverse reactions can spoil everything - for the patient, for the dr, for all the drs Photos: R Weiss MD pre 1 day post 3 weeks post
  50. 50. Problems
  51. 51. Problems
  52. 52. Problems
  53. 53. Problems
  54. 54. Causes for Burns Fluence too high Filter wavelength too short Pulse duration too short Pulse delay too short Insufficient quantity of gel NO TRAINING!
  55. 55. Photorejuvenation
  56. 56. Photorejuvenation
  57. 57. What’s new in IPL?
  58. 58. OPT – Optimal Pulse Technology “Square Off” the pulse Typical IPL pulses have energy peaks, followed by decline Lumenis One and M22 have the ability to control the pulse shape, each of them individually OPT: squares off and equalizes the pulses, delivering consistent, homogeneous energy over the duration of the pulse Even more important with a train of pulses
  59. 59. OPT – Optimal Pulse Technology Safety Eliminating the energy peak at the beginning of the pulse Efficacy Current Pulse Shape Addition of energy to the ineffective decline at the end of the pulse New Pulse Shape Reproducibility Homogeneous “squared off” energy distribution
  60. 60. Accessories M22 Cart
  61. 61. Just what you need, when you need it The new Multi-Application platform Grows with your business Allows add-ons Expands to treatment needs Adapts to future applications as they emerge
  62. 62. Technology & Applications
  63. 63. A single head with many ideas • One Treatment Head • Change Filters instead of hand piece • Saves time, storage space and purchase of multiple, expensive treatment heads • 6x Expert Filters: (515, 560, 590, 615, 640, 695 nm) • 2x SapphireCool Light Guides (15 x 35mm; 8 x 15mm)
  64. 64. Cut off Filters Treatment of following skin conditions with just one Head:
  65. 65. Cut off Filters
  66. 66. Pigmented Lesions
  67. 67. Clinical Indications What can we treat?
  68. 68. Pigmented Lesions
  69. 69. Lentigines  Solar “Age," "sun" or "liver" spots Commonly appear as medium to dark brown Hands, face, forearms and chest Senile Most fair-skinned people in middle age Flat, round or oval-shaped, and have a slightly irregular border.
  70. 70. Solar Keratosis  Warning sign you are prone to sun damage and skin cancer  Red, flattish, scaling dry skin that may sting if scratched  Appear on areas of skin most often exposed to the sun, like hands and face  Most common in people over forty years. Keratosis
  71. 71. Café-au-lait  Most often present at birth  Determined by color of coffee and milk  50 % chance of reoccurrence  Treat with IPL or Q- Switch
  72. 72. Haemosiderin  Brownish pigment containing iron  May make the skin appear brown or orange after a bruise or other injury heals.  Post injury that causes red blood cells to leak i.e. sclerotherapy
  73. 73. Becker nevus  Skin disorder predominantly affecting males  Nevus first appears as an irregular pigmentation  On the torso or upper arm, and gradually enlarges irregularly, becoming thickened and often hairy
  74. 74. Ota Nevus  Blue to dark brown pigmentation  Dermal - Usually at birth  The nevus of Ota is usually located in the region of the eye and maxillary division of the trigeminal nerve  Treat with IPL or Q-Switch
  75. 75. Ito Nevus  The nevus of Ito is usually located on the shoulder, side of neck, and supraclavicular areas
  76. 76. Hyperpigmentation  Excess skin pigmentation  Can be the symptom of a severe disease  In certain conditions melanocytes can become abnormal and cause an excessive amount of darkening in the color of the skin  Treatment combination IPL and Hydroquinone (bleaching cream)
  77. 77. VASCULAR LESIONS
  78. 78. PWS – Port Wine Stain  Child • Present at birth • Pink to dark or bluish red, abnormal blood vessels • Do not change color when gently pressed and do not disappear over time  Adult • May become darker and may bleed
  79. 79. After 4 TreatmentsBefore Female, Skin Type II, Port Wine Stain – ARM and SHOULDER Universal IPL treatment head and Nd:YAG IPL: Triple pulse, 3/20/3/20/3, 590 nm filter, 20-29 J/cm2 Nd:YAG: Single pulse, 14 ms, 110 J/cm2 Basmat Zamir, MD
  80. 80. Port Wine Stain After 4 TreatmentsBefore Female, Skin Type II, Port Wine Stain – ARM and SHOULDER Universal IPL treatment head and Nd:YAG IPL: Triple pulse, 3/20/3/20/3, 590 nm filter, 20-29 J/cm2 Nd:YAG: Single pulse, 14 ms, 110 J/cm2 Basmat Zamir, MD
  81. 81.  Facial • Dilated superficial blood vessels • Red, pink or purple, they will absorb more of the laser light than the surrounding normal skin • IPL effective, may reoccur
  82. 82. Telangiectasias  Facial • Dilated superficial blood vessels • Red, pink or purple, they will absorb more of the laser light than the surrounding normal skin • IPL effective, may reoccur
  83. 83.  Truncal • Thin skin secondary to long-term steroid use or aging, collagen vascular disease, and hormonal variation (particularly estrogen)
  84. 84. Hemangioma  Nodular  Raised, flesh-colored nodule, which often has a bluish hue or an overlying telangiectatic patch  Regular  Bright red, flat area resembling a port-wine stain  Upper layers of skin
  85. 85. IPL SKIN TREATMENTS
  86. 86. Rosacea Progressive Stages of Rosacea  Stage One • Flushing skin  Stage Two • Persistent redness and inflammation • Unexplained bumps and pimples • Not painful
  87. 87. Rosacea  Stage Three • Visible blood vessels • Painful to the touch • Thickening on the nose or cheeks • Blood pooling under the skin : bruising  Stage Four: Full-Blown • Eye irritation • Burning or stinging, crusty, scaly, with persistent pain Combination of topical, antibiotic medication , and IPL
  88. 88.  Uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip.  Associated with the female hormones estrogen and progesterone  Treatment with IPL can be difficult  Treatment combination with hydroquinone  Avoid sun exposure
  89. 89. Melasma  Uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face)  Associated with the female hormones estrogen and progesterone  Treatment with IPL can be difficult  Combination with hydroquinone  Avoid sun exposure
  90. 90. Poikiloderma  Reddish-brown colour  Erythema and mottled pigmentation seen on the sides of the neck  Most commonly seen in women  Photosensitizing chemicals in perfumes or cosmetics  Avoid sun exposure
  91. 91. Age Spots/ Telangiectasias  (M) Mild  Over exposure to the sun  (S) Severe  Dense pigmentation and enlarge capillaries  (N-F) Non-Facial  Hands, arms, chest exposed to sun  Use lower energy

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