Creighton Laser Consultants. Creighton Family Medicine-Twin Creek Carlos Prendes MD Nancy Rounds CMA Joseph Stangl PAC

Transcription

1 Creighton Laser Consultants Creighton Family Medicine-Twin Creek Carlos Prendes MD Nancy Rounds CMA Joseph Stangl PAC

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3 Overview The different layers of the skin The skin s role in the human body Hair follicles and the skin Science of Laser treatments Hair removal Pigmented skin lesion treatments Vascular treatments 3

4 General Skin Facts Largest organ Three layers: Epidermis Dermis Subcutaneous tissue Thick and thin 4

5 General Skin Facts Protection Defense Sensation Heat regulation Storage Excretion Absorption 5

6 Located in epidermis Produce melanin, a brown pigment that helps screen against the harmful effects of UV light Melanocytes 6

7 Fitzpatrick Skin Types Skin Type I II III IV V VI Skin Color Very fair, "transparent" Fair Fair to light olive Olive to brown Dark Brown Black How the skin reacts to sun Always burns, never tans Always burns, tans with difficulty Burns mildly, tans slowly Rarely burns, tans with ease Very rarely burns, tans very easily Never burns, tans very easily 7

8 Human Hair Growth Cycle 8

9 Hirsutism Hypertrichosis Hyperandrogenism Idiopathic Hirsutism Causes of Excessive Hair Late onset congenital adrenal hyperplasia Ovarian tumors Adrenal causes Pregnancy: luteoma of pregnancy Drugs 9

10 Permanent Hair Reduction FDA has a different definition than the public may have. According to the FDA, the definition of permanent hair reduction is long-term, stable reduction in the number of hairs growing after a treatment regimen. 10

11 Light Amplification by Stimulated Emission of Radiation LASER 11

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13 How does a laser affect the hair? The laser light passes through the melanin in the skin Laser light is absorbed by the melanin in the follicle Energy is converted into heat Heat destroys the hair follicle 13

14 Depth of penetration by wavelength 14

15 Contraindications Light Sensitivity to the Treatment Wavelength Accutane (Claravis, Sotret & Amnesteem generics) Medications Contraindication to Sunlight* Seizure Disorders Triggered by Light Recent Sun Exposed Skin Sun Tan Suspicious Lesions Vitiligo *not too much of a concern since laser light and sunlight are different wavelengths 15

16 Tattoos in the area to be treated The longer a person has had a tattoo the farther you need to stay away with the laser The ink can spread out as far as 3mm and become a target for the laser Contraindications (continued) 16

17 Pre Treatment Shave the day of or the night before the treatment Discontinue waxing / electrolysis, depilatories etc. once treatments start SPF 30 sunscreen for 4-6 weeks prior to treatment if sun exposure can t be avoided Avoid sun exposure, tanning booths or creams Caffeine can make skin more sensitive 17

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25 Laser Hair Removal Treatment Schedule Face: 4-6 weeks Bikini and underarms: 6-8 weeks Chest, Abs, Back, Arms and Legs: 8-10 weeks 3 treatments in a package Most people will need between 5-10 treatments Be realistic 25

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27 15 Year Old Girl 27

28 Gender: Female Skin Tone: Fair Description: 44-year-old woman treated with the Candela GentleLase Laser (an alexandrite laser) for hair removal of the chin area. Patient was shaving twice daily before treatments. After photos taken after three treatments one year after last treatment (2 months apart). Patient required 5 treatments. Photos courtesy of: Stuart Bentkover, M.D. Bentkover Facial Plastic Surgery & Laser Center 20 Worcester Center Blvd., Ste. 675 Worcester, Massachusetts (MA) PH (508)

29 Age: 22 Gender: Female Description: Laser Hair Removal with the Candela GentleLase laser (an alexandrite laser) After photos were taken one year after surgery. Photos courtesy of: Stuart Bentkover, M.D. Bentkover Facial Plastic Surgery & Laser Center 20 Worcester Center Blvd., Ste. 675 Worcester, Massachusetts (MA) PH (508)

30 Pre-Treatment Post-Treatment two months after third ND-Yag treatment Gray hairs still present 30

31 Before After 31

32 GentleLase 10mm spot 20Jcm 2 32

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34 Before After 34

35 Before After 35

36 Before After 36

37 Before After 37

38 Before After 38

39 Before After Pre Tx Post Tx 17 mths. 39

40 Before After Some wavelengths like a 810nm and 1064nm will have trouble getting this fine hair. 40

41 Before After Pre Tx Post 3Tx 6 mths. 41

42 Other things the laser will treat 42

43 Cherry Angiomas Cherry angiomas are bright red, small (usually 1-4 mm), papules commonly seen on the trunk of adults. Larger, older lesions can be more of a purple or blue color. These lesions are medically insignificant. 43

44 Nevus A nevus is a benign overgrowth of pigment skin cells called melanocytes on the skin surface present at birth or appearing early in life. They fall into two categories, congenital and acquired. Acquired Congenital Acquired 44

45 Melasma Blemish Melasma (also known as the mask of pregnancy when present in pregnant women) is a tan or dark facial skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy medications. The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. 45

46 Varicose and Spider Veins Some of the lasers used for hair will be effective on blue leg veins. Typically in the.6 to 3mm size range. More effective on spider veins Varicose veins are deeper and won t respond to laser hair removal wavelengths. 46

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48 Things our laser won t t treat etc. etc. Please consider a consultation with the Dermatology Clinic at Creighton University Medical Center for the following conditions. 48

49 Stork Bites/Salmon Patches Stork bite hemangioma. These lesions are very common-approximately 30% of the population has them. Stork bites are common vascular lesions of the newborn. They consist of one or more pale red patches, most often seen in the midline on the forehead, eyelids, tip of the nose, upper lip, and at the hairline on the back of the neck. They fade with pressure, but when the pressure is removed, the reddish appearance returns. Stork bites clear on their own over a period of months and are gone by 18 months-except for those on the back of the neck. These may persist for years, but are generally covered by hair. 49

50 Port Wine Stains Pre-op 3 months PD tx A port wine stain, is a birthmark consisting of malformed, dilated blood vessels in the skin. It is not a type of hemangioma. Anyone can be born with a port wine stain. They occur in 1 in 200 to 400 babies. They are not contagious They are permanent Can t be prevented Pre-op 5 txs PD laser 50

51 Contact Dermatitis Contact dermatitis is a skin reaction that occurs after exposure to a substance that either irritates the skin or triggers an allergic response. If the skin condition is caused by contact with an irritating or harsh substance, that is primary irritant contact dermatitis. If the skin condition is an allergic reaction to a substance, that is allergic contact dermatitis. The symptoms and treatment of both types of contact dermatitis are similar. Contact Dermatitis Neomycin 51

52 Active herpes lesions Orofacial infection These infections may appear on the lips, nose or in surrounding areas. The sores may appear to be either weeping or dry, and may resemble a pimple, insect bite, or large chickenpox lesion. Lesions typically heal after a few days to a week (or more), but this varies among individuals. 52

53 Plaque Psoriasis Skin lesions are red at the base and covered by silvery scales. It can be itchy and painful. Psoriasis is autoimmune in origin, and is not contagious. 53

54 Shingles/ Herpes Zoster Reactivation of varicella zoster virus, leading to a crop of painful blisters. It occurs very rarely in children and adults, but its incidence is high in the elderly (over 60), as well as in any age group of immunocompromised patients. 54

55 Skin Tags Small benign tumors that form primarily in areas where the skin forms creases, such as the neck, armpits, and groin. They also occur on the face, usually on the eyelids. They range in size from two to five millimeters, although larger ones have been seen. 55

56 Vitiligo Patchy loss of skin pigmentation due to an auto-immune attack by the body's own immune system on skin melanocytes. It frequently begins in late adulthood, with patches of unpigmented skin appearing on extremities. The patches may grow or remain constant in size. Occasional small areas may repigment as they are recolonized by melanocytes. Laser hair removal may aggravate this condition. 56

57 Questions? Free consultations available