This myth might be the cause. 

"8. MYTH: Let winter-ravaged skin hibernate — cut back on pro treatments.

TRUTH:  Actually, winter is one of the best times to start in-office laser treatments like laser hair removal, as pre-laser skin shouldn't be at all tanned, and post-laser skin won't tolerate sun exposure."

To expand on this particular myth, many of Cutera's aesthetic laser and light treatments such as Titan, Laser Genesis, CoolGlide Laser Hair Removal and CoolGlide Excel Laser Vein Therapy are color-blind; they can be performed on all six skin types and can be performed year-round, irregardless of tanned or tanning skin. 

Let your patients know they don't have to wait for Spring or Summer to start laser or light-based cosmetic treatments.  In fact, they will appreciate that they can get a head-start now!

Laser based technology basic principles:


Lasers, General Principles and Physics

Laser radiation, like all light, consists of electromagnetic radiation.

Lasers and the Eye

Laser Safety Filter Guide

Advanced Skin Care with Laser based technology may require methods of pain managament and control.

 

Examples of Pain Control for Ablative Procedures

 

 

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

 

A topical anesthetic is recommended for most ablative procedures. Prior to treatment, a topical anesthetic such as 7% lidocaine and 7% tetracaine is generally used. CAUTION: Toxicity may result with the overuse of topical anesthesia. Consult the manufacturer’s labeling.

 

Example: Some practices are using a BLT which is a compounded anesthetic.

It is usually 10-20% Benzocaine, 6% Lidocaine and 4% Tetracaine.

It is best to leave the anesthetic on for at least 45 min to an hour.

 

Additional forms of pain management are often used to assist in patient comfort, examples include but are not limited to the following:

 

A Zimmer skin cooling system or small fan blowing

 

Anxiolytics for relaxation and further pain control

 

Nerve blocks

 

Acetaminophen

 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

 

Opioids

 

For more detailed information for assessment and management of acute pain:

 

Institute for Clinical Systems Improvement; Sixth Edition March 2008;

Health Care Guideline: Assessment and Management of Acute Pain

 

http://www.icsi.org/guidelines_and_more/gl_os_prot/musculo-skeletal/pain_acute/pain__acute__assessment_and_management_of__2.html

Laser based technology and IPL technology may be used for a vascular treatment and skin rejuvenation. Clients often present with both pigmented lesions and facial veins caused by actinic damage.

Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes measuring between 0.5mm and 1mm millimeters in diameter^.
They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin.

Causes of Telangiectasia

Rosacea, acne rosacea, and actinic telangiectasia

Causes of Varicose Veins and Spider Veins

Varicose Veins and Spider Veins

Laser based technology requires that the treatment provider accurately assess client skin type. Successful skin rejuvenation may require treatment of pigmented lesions, skin tightening and Laser vein treatment. In order to minimize and manage unexpected outcomes and possible complications the treatment provider must choose correct parameters on the aesthetic laser system based on a comprehensive skin type evaluation. The Roberts Skin Type Classification System is a 4-part serial system that comprehensively identifies a patient's skin type characteristics, and provides data to predict the skin's likely response to insult, injury, and inflammation (i/i/i) for individuals of global skin types. The clinician evaluates 4 elements (phototype, hyperpigmentation, photoaging, and scarring) and assigns a numeric "feature" to each, according to established and original scales. This classification system can uniquely help determine the course of treatment, clarify postprocedure expectations, and optimize outcomes. This individualized approach to identifying features and elements in various skin types will positively impact on physician communication, patient awareness and compliance, and preventive measures.

Patient eye protection is imperative to prevent permanent eye damage from Laser based technology. It can difficult to perform a laser vein treatment, Laser Genesis or a Limelight facial if the patient safety goggles are not adjustable.

Download the PDF file for patient laser goggle

For further information, contact:

Laser based technology is regulated by the FDA based on ANSI standards.  Cutera is committed to safe use of  Lasers in Dermatology.  Links have been provided to help educate our clients on the Rules and Regulations associated with the use of aesthetic systems.  Some information may be directed toward Laser Surgery and may appear to not be related to advanced skin care, however, the principles of safety are the same.

USE OF LASERS/DELEGATION OF MEDICAL FUNCTIONS REGULATION BY STATE

Laws and Regulations

Current Legislation Pending by State

Directory of State Medical Boards


Laser Regulatory Agencies and Professional Organizations

Food and Drug Administration

American National Standards Institute (ANSI Z136.3)

Joint Commission on Accreditation of Health Organizations (JCAHO)

JCAHO

OSHA (Occupational Safety & Health Administration)

Association of Operating Room Nurses

American Society for Laser Medicine and Surgery (ASLMS)

Clients seek advice for advanced skin care for Acne, Melasma and skin rejuvenation. It is important to identify the root cause of the condition in order to recommend an appropriate and effective treatment.

Three main factors contribute to the formation of acne: androgenic hormones, plugging of the hair follicle, and bacteria.   7 Acne Myths

Melasma is hyperpigmentation in sun exposed areas. The skin care treatment plan for melasma may include topical medications, chemical peels and Laser based technology.

Laser Genesis has been found to be helpful as a part of skin care treatment plan for treating Melasma. However, it should be noted that anything you use to treat Melasma may make it worse. A treatment protocol that is very effective for one client will not work on a different client and may even make their symptoms worse.
R. Lierly, RN

There are possible complications that are associated with the use of any aesthetic laser system. A comprehensive health history including past medical history, allegies, medications, hobbies and lifestyle choices (smoking, alcohol, sun exposure) help the treatment provider identify and prevent possible complications that may occur. Accurate initial assessment, reassessment and evaluation of the intervention along with client education are key to reducing the incidence of complications associated with Laser based technology.

Laser Hair Removal can present an uncommon side effect of
paradoxical hair growth along with the more common side effects found with permenant hair reduction.

Skin Rejuvenation and Laser resurfacing complications can be classified as mild, moderate or severe. It is important that the treatment provider be able to correctly identify and treat these possible complications. Do not ever perform a treatment that may produce a side effect that you are unable to recognize and treat. Accurate assessment and client education are key minimizing many of the potential complications.

Vascular lesions can be associated with other disease processes and require the correct diagnosis of the lesion before deciding on which laser based technology would be most appropriate for the vascular treatment.

Treating pigmented lesions or using an IPL device can prove to be challengeing to many treatment providers. Performing a test spot in the area of treatment and then evaluating epidermal response 48 hours later can be very valuable in preventing unwanted damage to the epidermis ("foot printing"). However, the test spot may take 1-2 months to demonstrate the signs of post inflammatory hyperpigmentation.

R. Lierly, RN

Advanced skin care and Laser based technology has become increasingly popular and growing field of study for many health care professionals. Clients are requesting a number of diverse procedures when they seek our assistance. It is not uncommon to have a client who requests "Skin Rejuvenation". The skin care treatment plan may consist of skin tightening, Laser Genesis and a Limelight facial for a vascular treatment or pigmented lesions. It is quite possible that this same client may later request a chemical peel, Botox or fillers and even Laser hair removal. The diversity of the procedures requires the treatment provider to have a wide range of knowledge in order to adequately meet the client's needs. Some resources I have found to be easy to read and a very valuable resource are listed below. Of course, there are many specialized books that are available and can be found at the links listed below.

Cosmetic Laser Books

Laser and Lights Volume 2

Cosmetic Laser Surgery

R. Lierly, RN

Most laser based technology used in Dermatology creates a laser induced thermal injury by the absorption of electromagnetic energy by chromophores in the skin (melanin, hemaglobin and water). Thermal damage to structures of the skin is a combination of time and temperature, the temperature to which the cell is heated as well at the time period for which the temperature is sustained. The goal of controlling a thermal injury requires careful selection of wavelength, fluence, pulse duration and spot size. Skin color in addition to Cooling the epidermis before, during and after a laser pulse must be taken into consideration to prevent unwanted thermal injury to adjacent tissues. The failure to properly assess the client, select appropriate parameters and ineffective or improper cooling may all contribute to an unwanted adverse effect of a burn injury.

Laser hair removal, Laser vein treatment and the treatment of pigmented lesions can all result in a unwanted burn injury. The first objective in burn wound care is to dissipate the heat. Clinical evidence indicates a beneficial effect from immediate active cooling of a burn injury to dissipate the heat.
Cool tap water or saline compresses is an effective method of cooling. Colder substances such as ice can be detrimental by extending the zone of injury by constricting the blood vessels. The period of time that is required for active cooling is brief. Cooling stabilizes skin mast cells, decreasing histamine release, thereby, decreasing edema of the wound. Cooling is an effective way of controlling the pain of a partial-thickness burn. Cooling for pain control may be achieved by using moist cool compresses, not ice packs.

Treatment providers should not perform any procedure that produces a side effect that they are unable to recognize and treat. Treatment of a side effect must comply with the standard of care ordinarily used by other healthcare professionals practicing their profession in the same or similar locality and under the same or similar circumstances. The failure of a healthcare professional to observe the standard of care is negligence.
It does not matter if the burn injury was caused by an Aesthetic Laser system of some other heat source, the standard of care remains the same.
I have included several links for burn injury first aid to reference as the standard of care.
Mayo Clinic
Health Sciences Center, University of Utah
Burn Injury Lawyers
Massachusetts General Hospital

Total Burn Care

--- Renee Lierly, RN

Many factors contribute to the development of telangiectatic facial veins and leg veins. Age, heredity, pathological conditions, occupations that require long periods of standing and pregnancy can all contribute to development venous disease. A successfull vascular treatment is dependent upon comprehensive history including presenting complaint, active symptoms, history of vascular disease, and general health and occupation history. Varicose vein treatment may require a combination of Laser based technology and sclerotherapy to adequately address the client's needs. Any successful vascular treatment is dependent on the treatment provider being able to successfully locate facial veins, legs veins and any reticular feeder veins that are often associated with the superficial telangiectasias.

There are several tools that can aid the visualization of the superficial venous system:

Syris V600 headlamp uses cross polarization technology allows the user
to see approximately 1mm below the skin's surface. 

The new Venoscope^® II transilluminator utilizes an array of high intensity LED lights to transilluminate the patient’s subcutaneous tissue thereby highlighting the veins which absorb the light rather that reflecting it.

The VeinViewer by Luminetx® uses a combination of near-infrared light and patented technologies to image vascular structures, thus allowing physicians, nurses and other healthcare professionals to clearly see accessible vasculature

directly on the surface of the skin.

Skin of Color can present with unique conditions that must be taken into consideration when developing a skin care treatment plan.
Skin of Color is highly susceptible to Post-Inflammatory Hyperpigmentation and requires special care whether performing a chemical peel or using Laser based technology to treat pigmented lesions, performing Laser hair removal, Skin Rejuvenation or a Vascular Treatment.
The Fitzpatrick Skin Type Test is very important to help determine skin type. The FitzpatrickSkin Type Test takes into consideration an individual's genetic predisposition that may not be reflected in the color of the skin but can highly influence the individual's ability to form hyperpigmentation in response to trauma or the use of an Aesthetic Laser System.

--Renee Lierly, RN

Laser based technology is both safe and effective for permanent hair reduction, skin rejuvenation, skin tightening, laser vein treatment and treatment of pigmented lesions. The use of an aesthetic laser system for advanced skin care requires the operator to be familiar standards of care and laser safety in order to be in compliance with Laser regulatory agencies such as JCAHO, OSHA, ASNI standards and state regulations.

The Laser Training Institute offers Aesthetic Laser Training and National Laser Certification. The laser course offers a foundation in aesthetic office procedures and safety.

Renee Lierly, RN

Laser Based Technology is used by Biomedical Engineers, Laser Manufacturers, Physicians, Nurses, Aesthetic and Cosmetic Laser Users. It is important to be up to date on the latest FDA regulations, State Licensing Requirements & Laser Certification whether you perform Laser Hair Removal, Vascular Treatments, Skin Tightening or do Skin Rejuvenation. However, Laser Based Technology is found in many areas outside of Aesthetic Systems. Whatever your needs are for Laser Safety or CME/CEU credits Laser Training Institute is a great resource.
Laser Training Institute
Professional Medical Education Association, Inc.
Provider Approved by the California Board of Registered Nursing
Category II CME’s for physicians

Allied Health Association offers medical malpractice insurance for physicians working in the spa environment. This insurance was developed in response to an expanding need for liability insurance for the growing medspa industry. This insurance covers advanced skin care procedures and Laser based technology. The skin care treatments covered are skin rejuvenation procedures such as resurfacing, vascular treatment, chemical peel, Botox, fillers and much more.

Source: Modern Medicine Publish date: Jul 1, 2008

Renee Lierly, RN

Are you considering a new aesthetic laser technology but are not sure if your current patients are interested in having treatments?

Ask them.

You can put out surveys in your reception area and/or send an email to your patients.  On your survey, ask if they would be interested in the new procedure and offer a small discount to anyone who responds.

If you are about to implement the new technology, then let your patients know it's coming.  Set up countertop signs in your reception and treatment rooms.  Send an email or a postcard annoucing your new aesthetic laser system and what it can do for your patients.  Offer discounts or packages to encourage "early adopters", let them be your evangelists and drive referrals to your practice.

Get the word out! 

A skin care treatment plan to manage the symptoms of Rosacea may include topical and oral medication, Laser based technology, avoiding agravating factors, skin care products and may even include camoflage makeup. Many treatment providers combine Cutera's Infrared Technology of Laser Genesis and the visible to infrared technology of a LimeLight facial (LimeLight 520nm-1100nm) to address the vascular treatment needs of flushing, diffuse redness and telangiectasia.
It is important to educate the client that a treatment plan for Rosacea only helps to control the active signs and symptoms. Rosacea is a chronic condition.

Treating Your Skin with "Intense Pulsed Light"

By Kevin C. Smith MD FACP FRCPC

About the author:
Dr. Kevin Smith is a dermatologist in Niagara Falls, Ontario with a particular interest in protecting the skin and in correcting skin problems resulting from aging, rosacea and sun damage. He is an expert in the use of Botox®, fillers, lasers and intense pulsed light to maintain and enhance the appearance of the skin, and have lectured on those subjects across North America, and in Europe, Asia and Mexico. Read more at www.smithlaser.com

--Renee Lierly, RN

---

Skin care treatment plans start with washing the face. Skin rejuvenation and improvement in the overall texture and quality of the skin can be achieved by combining Laser based technology and cosmeceuticals together in an advanced skin care program. It is important to wash the face with something clean in order to prevent introducing bacteria into the skin. One simple way to achieve this is by the use of disposable daily cleansing pads, such as Aveeno Positively Radiant Daily Cleansing Pads  These dual-textured cleansing pads are smooth on one side to lift away dirt, oil and makeup and textured on the other side to gently exfoliate and smooth away dry patches. Gentle enough for everyday use and even for sensitive skin. Additional Product Benefits Include: soap-free, oil-free, hypoallergenic, noncomedogenic.

Travel tip: Count out the number of pads needed for your trip, add a small amount of your favorite facial wash, place in zip lock bag. They do not count as a liquid or a gel. You can always wash your face with a clean, soft pad or use the textured side for a mild exfoliation.
 
How to wash your face 

Renee Lierly, RN