줄리아성형외과피부과, 장비, noblex

1. Design

2. What’s Long Alexandrite?
Hair removal
Fine Hair
Medium Hair
Thick Hair
Long
pulse
Pigmented lesions
Freckle
Lentigo
Alexandrite
Whitening
Fractional
mode
Large Pore
Black head
Large
Output

3. What’s advantage?
Dual cylinder HP
High power
Fast treatment
Zoom HP
Gas Cooling(RCS)
Square Pulse
New Generation
Whitening WITH
Fractional HP

4. Type Diode IPL Nd:YAG Alexandrite
Fine ★★ ☆ ★★☆ ★★★★
Medium ★★ ★★ ★★★ ★★★
Thick ★★ ★★★ ★★★★ ★★☆
Hair removal
Type Diode IPL Nd:YAG Alexandrite
Skin(Ⅰ, Ⅱ) ★★ ☆ ★★ ★★★★
Skin(Ⅲ, Ⅳ) ★★ ★★★ ★★★★ ★★★★
Skin(Ⅴ) ★★ ★ ★★★★ ★★

5. Dual cylinder HP
Safe Treatment
More effective
Dual cylinder system
Dual cylinder system composes a special cylinder, and it makes a beam almost like TMO00.
So, it results in uniformed irradiations of energy output.

6. Zoom Handpiece
Only one zoom handpiece to adjust spot size without requiring changing handpiece.

7. Correlation with spot size and laser
penetration depth
A larger spot size enables greater
penetration depth which
improves absorption of energy to
the targeted hair follicle.
Noblex offers up to
20mm spot size
Save Treatment
hours
More effect
Big spot size

8. Fractional hand piece
Good Melanin Absorption by 755nm, Powerful Energy using the fractional handpiece
New Generation Whitening without side effects by selective absorption
NO downtime
Strong whitening
effect
Less side effect

9. Fractional hand piece
Total DOT : 120 EA
DOT size : 400 μm
SPOT size : 15 Ø

10. 755nm VS 1064nm : more absorption rate about melanin
Absorptiveness Wavelength
More effect
Less PIH

11. Safe Treatment
Skin Protection
Less pain
More effective
Gas Cooling(RCS)
RCS method rapidly cools down the epidermis and have 2 step before & after shot

12. Gas Cooling(RCS)

13. Noblex A company
Spot
size
Energy (J/cm²) Spot
size
Energy (J/cm²)
2 600 1.5 600
3 460 3 460
5 150 6 150
7 100 8 100
10 60 10 60
15 40 15 40
20 9 3 Hz 18 9 2 Hz
Permissible Watt
(Power supply)
39600 W Permissible Watt
(Power supply)
26333 W
High power & Fast treatment

14. Square Pulse
Current 400~700V
Pulse duration 50ms
Noblex possesses a square pulse type based on 18,000 uF high capacity and stable control
system which produces high treatment results with fewer side effects.
A square pulse is the ideal pulse type as it releases continuous energy during pulse duration
then returns the energy to 0 afterwards.
If the energy is not constant, treatment results become less effective and it is more likely for
side effects to appear afterwards.
Stable Power
Less side effect

16. 595 nm spot size of 7 mm 3 ms with the
LPPDL, between 13 and 15 J/cm2
755 nm spot size of 8 mm and
a pulse duration 3 ms with the LPPAL.
35 and 50 J/cm2
Comparison study of a long-pulse pulsed dye laser and a long-pulse
pulsed alexandrite laser in the treatment of port wine stains
LI LI1, TARO KONO1, WILLIAM FREDERICK GROFF2, HENRY H. CHAN3,
YOSHIHIKO KITAZAWA1 & MOTOHIRO NOZAKI1
Journal of Cosmetic and Laser Therapy. 2008; 10: 12–15

17. Treatment of Becker’s Nevi With a Long-Pulse Alexandrite Laser
JAE EUN CHOI, MD, JI WOONG KIM, MD, SOO HONG SEO, MD, PHD, SANG WOOK SON, MD, PHD,
HYO HYUN AHN, MD, PHD, AND YOUNG CHUL KYE, MD, PHD
Eleven Korean patients with Fitzpatrick skin type III to V were
included in this study.
A long-pulsed alexandrite laser with a wavelength of 755nm and a
pulse duration of 3 ms was used.
Patients were treated with a fluence of 20 to 25 J/cm2 and a spot
size of 15 to 18 mm, 2-3 months intervals.
Treatment sessions are 2-6 time
Cryogen spray cooling was not used- epidermal pigment destroy- I
think about that – post cooling +
Dermatol Surg 2009;35:1105–1108

18. Results
Excellent response 2
good response 5
fair response 4
all patients, hair density
decreased
Some hypopigmentation
Erythema , scars

19. Use of a Variable Long-Pulse Alexandrite Laser in the Treatment of Facial
Telangiectasia
E. VICTOR ROSS, MD, KEN. J. MEEHAN, PA-C, YACOV DOMANKEVITZ, PHD,y JOHN P. TRAFELI, MD,
JOELLE ANNANDONO, PA-C, AND MARK JACOBY, MD
The 40-ms pulse width achieved the optimal balance of pain tolerance, epidermal
tolerance, and vessel reduction. Mean fluence was 88 J/cm2, with a 6-mm spot.
Overall, a 48% reduction in vessels was noted after one treatment. Side effects were
minimal.
CONCLUSIONS In fair-skinned patients with large telangiectasia, the alexandrite laser
is a good option for vessel reduction.
Dermatol Surg 2010;36:470–474

20. A Side-by-Side Comparative Study of 1064 nm Nd:YAG, 810 nm Diode and
755 nm Alexandrite Lasers for Treatment of 0.3–3 mm Leg Veins
Sorin Eremia, MD* Cindy Li, DO,†and Sanusi H. Umar, MD‡*Division of dermatology, UCLA, Los Angeles,
California, † Brockton Cosmetic Surgery Center, Riverside, California, and ‡ Division of Dermatology, Martin
Luther King/Drew Medical Center, Los Angeles, California
Table 4.
Clearing Results (22 patients, 66 sites)
0% 0–25% 25–50% 50–75% 75–100%
Nd:YAG 1 1 0 2 32
Diode 4 3 4 1 5
Alexandrite 2 2 1 3 4
Dermatol Surg 2002;28:224–230

21. Treatment of trichostasis spinulosa with 0.5-millisecond
pulsed 755-nm alexandrite laser
Ashraf Badawi & Mouhamad Kashmar
Lasers Med Sci (2011) 26:825–829
Treatment of trichostasis spinulosa with a 755-nm long-pulsed
alexandrite laser
S Toosi,* AH Ehsani, P Noormohammadpoor, N Esmaili, M Mirshams-Shahshahani, F Moineddin
JEADV 2010, 24, 470–473
pulse duration 3 ms, fluence 14–20 J/cm2, and spot size
10 mm. 3~4 treatments
pulse duration 0.5 ms, fluence 15–17 J/cm2, and spot size 5 mm.
A single treatment with a short-pulsed 755-nm alexandrite
laser appears to be a rapid, minimally painful, and effective
treatment for TS in patients of skin types II to V.

23. Treatment of Acanthosis Nigricans of the Axillae Using
a Long-Pulsed (5-msec) Alexandrite Laser
ALAN ROSENBACH, MD,n AND RAMIN RAM, BSw
METHODS.
A single axillae was treated using the
long-pulsed alexandrite laser. (5 msec)
Ten sessions were required
fluences of 16 to 23 J/cm2
10- or 12.5-mm spot sizes.
RESULTS.
greater than 95% clearance was achieved
after seven sessions.
There was no recurrence after 2 years
Dermatol Surg 2004;30:1158–1160

24. Use of a Long-Pulse Alexandrite Laser in the Treatment of
Superficial Pigmented Lesions
JOHN PAUL TRAFELI, MD, JULIA M. KWAN, MD, KENNETH J. MEEHAN, PA-C,
YACOV DOMANKEVITZ, PHD,y SANDRA GILBERT, BS, KENNETH MALOMO, BS, AND EDWARD VICTOR ROSS, MD
STUDY DESIGN/METHODS Eighteen patients underwent a single treatment session
using a variable pulse-width alexandrite laser.
Test sites a 10-mm spot size and up to four pulse widths (3, 20, 40, 60 ms) with
and without epidermal cooling.
Full treatments were performed 3 weeks later using optimum test parameters. The
patients were evaluated at 3 and 6 weeks.
3ms, no cool, low fluence
Dermatol Surg 2007;33:1477–1482

25. Superficial pigmented lesion
치료 시 중요한 점

26. 레이저 치료 시 조직과 반응하는 Action Mechanism

27. 1. Photochemical

28. Light
Thermal changes in
the surroundings
Heat diffusion
Chromophore
Transformation
of light into heat
Absorption
of light
Heated
2. Photothermal
(1) a wavelength that is strongly absorbed by
the targeted organelle and penetrates into
the targets,
(2) a pulse duration short enough to confine the
thermal energy within the target,
(3) a pulse intensity suffcient to heat the
organelle above some threshold temperature.

29. Laser
(Continuous irradiation)
Epidermis
Laser
(Pulsed irradiation)
Alteration by heat diffusion
Chromophore

30. 3. Photoacoustic effect (shock wave)
ns pulse, high energy
Vesicles
Bullae
Petechia
Purpura
Crushed tissue, ink,
melanosome

31. Table 1 Melanin-specific lasers (Q-switched lasers)
Type Ruby Alexandrite Nd:YAG
Wavelength (nm) 694 755 1,064
Penetration depth Deep Deepest Deep
Absorption by melanin Good Good Bad
Pulse-width (nanosec) 20–40 50 or 100 5–10
TRT of melanosome <TRT =TRT <TRT
Photoacoustic effect Moderate Mild Sever
TRT thermal relaxation time

32. Long-pulsed lasers
– damage to the surrounding tissue of the dermal melanocytes or
melanophages,
– cannot be used for the treatment of dermal melanocytosis.
– However, they are used for the treatment of melanocytic nevi,
because they can reduce the number of short-pulsed laser treatments,
– show a good response to epidermal pigmentation because
of their thermal effects on melanosome-containing keratinocytes,
– activation of epidermal melanocytes ; PIH
Q-switched lasers
– good response to dermal melanosis : dermal melanocytes or
melanophages
– epidermal pigmentation : melanosome-containing keratinocytes
also destroy activated epidermal melanocytes
Basics of laser application to dermatology
Shinichi Watanabe
Arch Dermatol Res (2008) 300 (Suppl 1):S21–S30

34. Mechanism of postinflammatory hyperpigmentation
·RM AM
K
K
Cytokines
activated
melanocytes
Fully-melanized
melanosomes (stage IV)
Resting
melanocytes

35. Fractional hand piece

36. Use of a Noblex Laser(long-pulse alexandrite laser) in the
treatment of melasma and superficial pigmented lesions.
1. 100 Korean patients (skin types III–V) with melasma,
letigines, freckle, and other epidermal pigmented
lesions
2. The melasma area and severity index (MASI) score; ?
3. 기간 1월20일~3월20일 2개월 ; ?
4. 평균 치료횟수 1 회 -3 회
5. 치료간격 2 주 ~ 4 주
6. 15mm spot size fractional hand piece
pulse duration : 1 ms (0.5ms, 3 ms )
fluences : 30 J ~ 65 J

37. Patient satisfaction
1. Aggravation : 2
2. no improvement : 10
3. a little improvement : 43
4. good improvement : 26
5. excellent improvement : 19
문제점
 짧은 기간, 정확한 parameter ?
 Pulse duration 의 차이 : 0.5 ms, 1 ms, 3 ms
 Fluence 에 아주 많이 민감
 Target 의 색 농도에 따라 결과 차이가 크다
 background skin color
 dermal melanosis ; melasosome, melanophage, melanocytes – 꼭 확인
**reduce the number of short-pulsed laser treatments**
Results

38. TABLE 1. Melasma Area and Severity Index (MASI) Scoring System
A: Percentage of the total area involved
0 = none
1= 0–10
2 = 10–29
3 = 30–49
4 = 50–69
5 = 70–89
6 = 90–100
D: Darkness of the melasma compared to normal skin
H: Homogeneity of the hyperpigmentation
0 = normal skin color without evidence of involvement
1 = barely visible hyperpigmentation/specks of involvement
2 = mild hyperpigmentation/small patchy areas of involvement
1.5cm diameter
3 = moderate hyperpigmentation/patches of involvement 42 cm
diameter
4 = severe hyperpigmentation/uniform skin involvement without
any clear area
MASI score = Forehead 0.3(D1H)A1Rt. Malar 0.3(D1H)A1Lt. Malar 0.3(D1H)A1Chin
0.1(D1H)A.

39. 임상사진 촬영 장비 : A-one

42. red bluegreen
Color splitting image

61. Dermal lesion P.I.H

62. Dermal lesion P.I.H

63. Overlap side effect

64. Image adjustment
VS
Image handling

65. Image handling

66. Image adjustment