The skin. The skin is the external layer of the body Variable thickness (frictional forces) Several functions as :

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2 The skin The skin is the external layer of the body Variable thickness (frictional forces) Several functions as : Protection (mecanical, physical and chemical) Metabolism (production of vitamin D) Thermoregulation (by the capillaries and the sweat glands) Sensations ( nerves) Built up in 3 layers Epidermis Dermis Hypodermis

3 Epidermis Keratinocytes: exfoliation or skin peeling in days Melanocytes: synthetise melanin = UV protection Dermis Blood vessels Nerves Glands (sweat, sebaceous) Fibroblasts in dermal matrix : synthetise fibers Collagene:bonding agent Elastin: skin elasticity

4 EPIDERMIS PR DERMIS HYPODERMIS Skin anatomy HR

5 Pigmentation Depends on heredity and sun light exposure Skin type Hair Eyes Skin Frekles Sunburn Sun tan 1 Red/Blond Blue or green Milky +++ Always 0 2 Blonds/Medium Light to medium Light ++ Always Light tan 3 Chestnut brownmedium to dark Medium + Frequent Normally tan 4 Medium to dark Dark Medium dark 0 Rare Brown 5 Dark Dark Dark 0 Rare Dark brown 6 Dark Dark Very dark 0 0 Dark

6 Skin aging Natural process Starts around the age of 25 Skin modifications Skin texture Colour Relief Moisturising

7 Skin aging 1. Genetic or chronological aging Linked to age and/or hormonal modifications Genetically programmed Thinning of skin layers Slowing down of cellular activity Reduction of capacity to store water Dry skin, thin layers, reduction of elasticity and tone 2. Environmental aging External factors (sun, tobacco, pollution) Skin texture modifications Modification activity of melanocytes Weakening of superficial vessels Fibers depletion (or abnormal fibers) Age spots Telangectasia Wrinkles

8 Rejuvenation Creams Massages Dermabrasion Chemical peeling Laser resurfacing

9 Efficiency Laser resurfacing Photorejuvenation Dermabrasion Massage Creams Chemical peelings Side effects

10 Consumer s request Atraumatic Pain-free No side effect Quick treatment Quick results Affordable

11 PhotoRejuvenation Definition Is the use of a filtered light beam with low fluence in order to reduce atraumatically the effects of skin aging Synonymous Skin rejuvenation, Photofacial, Non ablative resurfacing 2 types of photorejuvenation According to the type of lesions to be treated

12 Photorejuvenation Type of Photorejuvenation Indications Type I Type II Muddy complexion Superficial hyperpigmentation (sun Lentigo, melasma, ephelides) Benign vascular lesions (telangiectasia and overall redness) Loss of elasticity and tone Dilated pores Lines & wrinkles

13 Photorejuvenation What can be treated Pigmentation (sun damage) Hyperpigmentation, Lentigines, Freckles, melasma Benign vascular lesions Telangectesia, rosacea, diffuse redness Skin relief Dilated pores, loss of elasticity, lines and wrinkles

14 The Light Light Rayons Gamma Rayons X UV Infra rouges Micro ondes Ondes radio Grandes ondes Light = Electromagnetic radiation between 400 and 800 nm Transports a great deal of energy = the photon When absorbed the energy is transformed into heat Heat stimulate or destroy the target Only some chromophores can absorb the energy

15 Absorption Absorption curves Haemoglobin Melanin Water Wavelengths nm

16 Interaction Skin/Light Reflection Scattering Absorption

17 Photothermolysis Parameters to be controlled Wavelenghts Pulse duration Fluence

18 Absorption Wavelenghts 418 Haemoglobin Melanin Water Wavelengths nm

19 Photothermolysis Pulse duration Depends on the size and the shape of the target Cooling time of the target = Relaxation Time (RT) Main target small size = short RT ,5

20 Fluences High fluences not needed Pigmentation

21 How it works Light Pigmented lesions

22 How it works Light Vascular lesions

23 Modality 1 How it works Modality 2 Modality 3 Fibroblasts Fibroblasts Fibroblasts Wrinkles

24 Patients selection Aesthetical demand Understand the patient request Selection of skin types (no types 4, 5 and 6) No suntan 3 weeks before and after Inform patient (informed consent) Patients satisfaction is highly dependant on this selection

25 Contra-indications Doubtful skin blemishes History of tumour Pregnant women Diabetics Pace maker Haemophiliacs Anticoagulant treatments Epilepsy Photosensitising treatment Skin pathology

26 Parameters Determine the predominance of the lesions Pigmentary predominance Vascular predominance Lines and wrinkles Always treat Pigmented lesions before vascular or wrinkles

27 Parameters Pigmented lesions Always start with the lowest fluence (highest pigmentation) Make a spot test and adapt the fluence if necessary Treat full face uniformly Do not pass over the same place twice

28 Pigmented lesions Too high fluence may lead to transient hyperpigmentation

29 Pigmented lesions When treating localized area protect the peripheral zones In this case 2 to 3 shots may be necessary until change in colour

30 Pigmented lesions Dirty face on the following days After 10 to 15 days, exfoliation Pigmentation disapears or is lighter Skin is more tonic ans smoother Make an appointment in 3 weeks time Do another session if necessary Warning Beauty spots or suspect blemishes must not be treated

31 Vascular lesions 2 pulse durations according to the size of vessels Always start with the lowest fluence (highest pigmentation) Make a spot test and adapt the fluence if necessary

32 Vascular lesions Assess vessel size accurately Too thick or too fine vessels cannot be treated Treat only the area Do not pass over the same place twice After session there is a slight rash (redness) (maybe few hours) Some results are immediatly visible Make an appointment in 3 weeks time Average of 1 to 5 sessions at 3-4 weeks interval

33 Lines and wrinkles Cannot treat deep wrinkles Pass one or twice on the wrinkles One session every 10 days

34 Hints Pigmented and vascular treatment will also be active on wrinkle reduction but more agressive treatment The fourth line is a soft treatment (longer to be active) Vascular can be combined with wrinkle if not on the same area Do not do vascular and pigment treatment during the same session

35 Summary VASCULAR PREDOMINANCE Thick vessels Fine vessels Select pigmentation in the dark red line (3rd line) and treat the required zones. See client again in 3 to 4 weeks. Select pigmentation in the light red line (2nd line) and treat the required zones. See client again in 3 to 4 weeks. PIGMENTARY PREDOMINANCE Localized Whole face Select pigmentation in the brown line (1st line). Protect the peripheral zones, carry out 1 to 3 flashes (the zone changes colour). See client again in 3 to 4 weeks. Select pigmentation in the brown line (1st line). Treat the whole face. See client again in 3 to 4 weeks. LINES & WRINKLES Localized Select pigmentation in the "Waves" line (4th line). Treat the zones in question. Repeat session every 10 days.

36 Results

37 Results

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39 Results

40 Carry out a treatment Remove make up Shave if necessary Masking of pigmented area (mole, tatoo) Applying of optical gel Setting the parameters Put on the protective glasses Press the light guide against the skin Press the trigger button and check the cutnaeous reaction without glasses Adjust the parameters if necessary and proceed to the session Wipe the quartz of the applicator with a soft cloth to remove any surplus gel

41 Precautions Remove regularly your glasses to check the cutaneous reaction Regularly wipe the light guide Check the client s reactions and his/her sensitivity

42 After treatment It may temporary appear: Erythema Oedema Hyper or hypo-pigmentation Dirty face Unwanted hair removal No exposure to the sun for 3 weeks or use a sun screen (SPF>20)