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!
This
article by Rhonda L. Rundle appeared in today's Wall Street Journal.
Interesting excerpts: "Vanity appears to be trumping frugality in a looks-conscious society. Despite the dismal economic climate, most women -- and men -- who undergo appearance-enhancing treatments such as Botox injections are spending hundreds or even thousands of dollars a year to maintain the regimen, aesthetic physicians say. Meanwhile, some older patients who are putting off or forgoing expensive facelifts are instead opting for less-costly injections and laser treatments."
and "Increasingly, many aesthetic patients view their treatments as professional self-preservation rather than as a personal indulgence. Appearances make a difference, says Kathleen Hudson, a 57-year-old marketing consultant in Falls Church, Va. "If you're in the business world and you want to be competitive with the younger people, you need to stay on top of your game," she says."
Lastly, "Wendy Lewis, a plastic-surgery consultant who sees clients in New York, London, and West Palm Beach, says she also advises physicians to adopt some of the same sales-promotion strategies as retailers. This holiday season, for the first time in over 11 years in business, she is offering her consumer clients a complimentary additional consultation if they purchase one between now and Valentine's Day. If high-end stores "can send out gift certificates the week before Christmas, Ritz Carlton has deals all over, and B.R. Guest restaurants offer 20%-off gift cards, it seems only reasonable that our clients deserve a bonus, too," she tells physicians."
Wendy Lewis will be hosting an educational webinar for Cutera - details to follow shortly.
Aesthetic physicians - consider offering and marketing special packages to emphasize the importance of looking good; i.e. competitive to potential clients as a means of helping them keep or obtain new employment.
Skincare Regimens to Optimize Laser SuccessAdvanced Skin Care and skin rejuvenation starts with careful assessment of the client and tailoring the treatment plan to address the client's concerns.
Dr. Gold emphasizes that routines be customized to each patient’s needs. “You need to look at the patient as an individual. And you need to look at what’s bothering them and what they are there for, and then come up with a treatment regimen that is useful for them before, during and after your procedures,” Dr. Gold says.
Tailoring your treatment regimens to each patient before and after laser resurfacing can be as important as the technology you choose in striving to help patients recapture the more youthful appearance they seek.
After laser treatment, skincare routines promote rapid healing, and enhance and reduce the risk of complications such as infection, pigmentary changes and scarring.
A successful Laser vein treatment is dependent on proper evaluation of the leg veins.
The visual appearance of the lower extreme ties is a useful, but not always reliable, guide to the peripheral venous condition. Multiple factors contribute to varicose veins. Intrinsic pathological conditions combine with extrinsic environmental factors to produce a wide spectrum of disease.
Heredity seems to be particularly important in determining susceptibility to primary valvular failure.
Occupations that require prolonged standing can lead to chronic venous distention and secondary valvular incompetence at any level. Women seem to be more susceptible to this problem, most likely because vein walls and valves periodically become more distensible under the influence of cyclic increases in progesterone.
Pregnancy is an important risk factor that causes varicosities through several mechanisms. Most important are circulating hormonal factors that increase the distensibility of vein walls and soften valve leaflets. Another factor is the increase in venous capacity the develops to accommodate a greatly expanded circulation blood volume. Age is an independent risk factor for varicosities because with advancing age the elastic lamina of the vein becomes atrophic and the smooth muscle layer begins to degenerate, leaving a weakened vein that is more susceptible to dilatation. Most patients with venous insufficiency have subjective symptoms of pain, soreness, burning, aching, throbbing, cramping, muscle fatigue, and restless legs.
"Vein Diagnosis&Treatment: A Comprehensive Approach"
Robert A. Weiss; Feied, Craig F.; Margaret A. Weiss
Greater Saphenous VeinVenous AnatomyVaricose Veins
Laser Hair Removal&Permanent Hair Reduction
Each hair has 3 distinct components: the bulb, which lies near the insertion of the erector pili, the isthmus, and the infundibulum.
Pluripotential cells in the bulb and bulge areas cause growth of the hair follicle. Melanocytes are present in these areas. For most people, the bulb is approximately 4 mm beneath the surface of the skin (deeper in some individuals). Therefore, a considerable laser-penetration depth is required to remove the bulb.
Hair grows in cycles. Anagen is the active growth phase, catagen is the transition phase, and telogen is the resting phase. The duration of the anagen phase governs the length of hair at different body sites. Lasers are truly effective in only the anagen phase, when hair-matrix cells divide rapidly and migrate outward from the shaft and when the melanin load is at its highest. During the catagen phase, mitosis ceases, the hair matrix regresses, the papilla retracts to a place near the bulge, and capillary nourishment diminishes. In the telogen phase, the follicle detaches from the papillae and contracts to a third of its original depth, eventually falling out. The telogen phase varies in duration from one body area to the next. For example, the telogen phase may last as long as a year for hair on the leg.
The ratio of anagen follicles to telogen follicles varies with body location. Because not all of the hairs are in the anagen phase at any 1 time, laser treatment must be repeated to capture the new hairs coming into the anagen phase.
The timing of treatments is important because hair should be treated during the anagen phase. This phase is short (6-12 wk) for hair on the head, and treatments are spaced a month apart. On the trunk, the telogen phase lasts 12-24 wk, and 2-month spacing is best.
Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
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:
Tom Barrows
Innovative Optics, Inc
763-425-7789 ph
763-425-6689 fax
1-800-990-1455
Bio2 Cosmeceuticals treatment products are designed to enhance healing time by reducing the patient's recovery time and redness (erythema) from chemical peels and ablative laser treatments.
The amount of
melanin in the skin can influence the skin care treatment plan.
Accurate skin typing is very important to the success of the Laser treatment and helps to identify the client's risk of adverse events related to pigment (hyper or hypo pigmentation) . Skin color is influenced by genetics and exposure to ultraviolet radiation.
Fitzpatrick Skin Type ChartCertain melanin makes skin more vulnerable to sunburnCauses of Hyperpigmentation
Topical agents used in the management of hyperpigmentation
Postinflammatory HyperpigmentationPerform a physical exam and ask questionsTreating Acne in Skin of ColorAesthetic Procedures in Skin of Color
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. |
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
I received a sample pack of TheraPearl ice packs recently. They are interesting in appearance - blue beads that move about within a clear pouch. How many of us have used a bag of frozen peas as an ice pack? I certainly have and TheraPearls are much more elegant.
Consider the value of ordering these with your practice's web site or logo. You need an ice pack for a procedure such as BOTOX, fillers or laser vein treatment. You send your patient home with a TheraPearl ice pack that sports your brand or web site, and the patient is reminded of you and that procedure every time they open their freezer. As the packs are re-usable, the value or message lasts as long as the pack.
It's an interesting idea; modifying a disposable into a marketing tool.
I visited the web site of an aesthetic practice recently and I noticed that they asked the visitor to sign up for their newsletter and receive a $50 gift certificate.
What a great idea - they collect the visitor's email (which has to be a valid email in order to receive the gift certificate). They email a gift-certificate for a set dollar amount good for any non-physician treatment (i.e. can be delegated, not for retail products) such as BOTOX Cosmetic, laser hair removal, laser vein treatments or a skin rejuvenation procedure. The certificate is good for up to one year from the date of the email (entire page must be presented).
This is an enticing offer - they may choose a procedure which costs $100-$200 and this certificate gives them a 25-50% discount. I would find this offer very compelling to visit and check out this aesthetic practice.
For those customers who offer
Pearl, Cutera offers an opportunity to provide a $100 discount on a customer's first Pearl treatment, seen on our Treatment Provider. Just update your practice's information in your
VIP account and to offer this discount. Visitors will see a
coupon icon next to your practice's listing which they can click on and print out. The coupon has your practice's contact information included.
Skin, Inc. reports on studies that show growth in the overall number of aesthetic laser procedures performed.
One highlight of the article is "Diagonal Reports forecasts that the cosmetic laser procedure market could grow by much more than 100% over the next three years."
and "Top cosmetic laser procedures are:
- Hair removal
- Skin rejuvenation
- Skin tightening
- Blemish removal
- Damage repair—sun, acne, tattoos and so on
- Cellulite"
That is great news for any aesthetic practice which uses lasers for hair removal, skin rejuvenation, photo-damage and skin tightening.
Pulse duration is one of the most significant laser parameters to understand. Proper pulse duration is key to a safe, consistent and effective laser hair removal or vascular treatment. For this reason, it is typically the first parameter set by practitioners. Vein treatments include facial veins, leg veins and an occasional varicose vein treatment--although varicose veins are part of a larger medical condition not treated by a non-invasive aesthetic laser system.
Pulse duration determines the volume of tissue treated by the laser. Long pulse durations treat large volumes, short pulse durations treat small volumes. As an analogy, imagine a hot iron. A person can tap the surface of a hot iron that is several hundred degrees and not feel pain or get a blister. The reason is only the most superficial cells heated up during the time their finger contacted the iron. The heat did not have time to spread deeper into the finger. Conversely, it's extremely difficult to hold a hot cup of coffee even though it's far less hot than the iron. The difference is contact time. The cup is in contact for a long time so heat has time to conduct into the finger. Another analogy that compares to laser treatments is a pot full of hot soup. The soup stays hot in the pot for a long time, but if it's poured into 10 separate bowls, the bowls of soup cool down rapidly. This is because small objects give away heat to their surroundings more rapidly than large objects.
These same concepts are used when performing a laser vein treatment or laser hair removal treatment with an aesthetic laser system. The goal of every treatment is to heat the target you want to treat, but do as little collateral damage to surrounding tissue as possible. Large vessels (like leg veins) are like a pot of soup. They heat up slowly, and also don't give away their heat to their surroundings as well as small veins. This means long pulse durations will heat the vein, but still not heat surrounding tissue. In contrast, small veins, like facial veins, are very small and give away heat to their surrounding tissue quickly. This means energy must be applied in a short time--faster than they can give away their heat. If the pulse duration is too long, some of the energy (heat) ideally meant to treat the vein is lost into surrounding tissue heating the surrounding tissue, but not the vein. So, if the pulse duration is too long, more fluence (power) is required to achieve a clinical endpoint, but some power was wasted in surrounding tissue increasing the risk of complications. If the pulse duration is too long, it becomes impossible to treat the target regardless of the amount of fluence.
Using the correct pulse duration results in the most consistent outcomes with the lowest risk of complication. This allows the lowest amount of fluence to have the greatest impact on the target with the greatest degree of protection to the epidermis. In a nutshell, every treatment wants to use a pulse duration shorter than the time it takes for the target (hair or vein) to give away heat (thermal relaxation time) and longer than the time required for the epidermis to give away heat. Pulse durations longer than 5-10 ms provide epidermal safety by the same principal that prevents a long pulse duration from efficiently treating a small vein. The longer the pulse duration, the safer it is to the epidermis, but if it's too long, it will cease to be effective on the target.
So, in summary, how does someone select the correct pulse duration? Small targets require short pulse durations, large targets respond to long pulse durations. Longer pulse durations maximize epidermal safety. The following are approximate times to help select the correct pulse duration. If the duration is within about 5-10 ms of the ideal pulse duration, the treatment will achieve maximum efficacy and safety with minimum fluence. Remember, cooling is also a critical factor effecting epidermal protection and is also required for safe treatments.
Hair Treatment:
- Fine = 5-20 ms
- Medium = 15-30 ms
- Coarse = 25-50 ms
- Very coarse = 40-80 ms
Vein Treatment (size of vein is measured diameter):
- Typical pulse durations range from 10ms to 100ms for small high pressure telangiectasias to large low flow leg veins.
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