Innovative Low Fluence-High Repetition Rate Technology for Hair Removal

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1 Innovative Low Fluence-High Repetition Rate Technology for Hair Removal Dr. Joseph Lepselter Alma Lasers Ltd. Caesarea, Israel Houten, Holland April 14, 2012

3 Terms LHR = laser hair removal SHR = super hair removal

4 Introduction

5 Global Aesthetic Laser Market Body Contouring, 7% Skin Resurfacing (Ablative), 9% Hair Removal, 29% Skin Tightening, 11% Tattoo Removal, 3% Acne Reduction, 3% Pigmented Lesion, 6% Vascular Lesion, 6% Skin Rejuvenation, 26% Source: Frost & Sullivan 2006; Millennium Research Group, 2006, Med Insight,

6 Growth of Laser Hair Removal

7 LHR Publications* [ ~600*] >

8 LHR Technology 1064nm? 810nm 755nm 694nm nm

9 LHR Efficacy & Safety High 755nm 810nm Effectiveness 694nm 1064nm Low Safety High

10 LHR Technology 1064nm? 755nm 810nm 694nm 755nm 810nm 1064nm 694nm nm

11 LHR Technology? SHR

12 LHR Technology LHR SHR

13 LHR Adverse Side Effects Pain Erythema Edema Dyspigmentation Foliculitis/pseudofoliculitis Crusting/blistering Burn

14 LHR Limitations Factor Pain Solution Local anesthesia, cooling, low energy, vacuum Burns dark skin Long pulse, long wavelength, strong cooling, low energy Thin hair Low efficacy No solution; many treatments High energy, short wavelength

15 Skin Interaction

16 LHR

17 Selective Photothermolysis The laser optical energy* is absorbed by the melanin in the hair follicle. The hair s bulb, bulge and papilla areas are heated. The surrounding tissue remains unaffected. *Wavelength, pulse duration and fluence

18 35J/cm 2

19 Problems with any high fluence laser Burns, especially with dark skin tones

20 Standard Technique At 2 Hz = 2cm/sec

21 Standard Technique At 2 Hz = 2cm/sec

22 HR Pulse PP 30 msec Energy (W) 35J/cm 2Hz Time (msec)

23 LHR Single Pulse/High Fluence

25 SHR

26 Fluence 10J/cm 2

27 Repetition Rate 10Hz

28 Average Power 100 Watts

29 IN-Motion Technique

30 SHR End-Points LEG -Erythema -Perifollicular erythema

31 SHR Pulse 10J/cm 2

32 SHR Multi Pulse/Low Fluence

34 Old vs. New LHR High peak power Low average power Low coverage rate Slow procedure Painful Anesthetic required Adverse side effects SHR Low peak power High average power IN MOTION; fast No anesthetic Virtually no pain No adverse side effects

35 What Is SHR? A photo-thermal event by which preset parameters - wavelength, pulse duration, very high average power, low fluence, and very fast repetition rate laser beam cause step-wise, accumulative, heat build-up to both the dermis and hair follicle. Reduced pain sensation. Reduced risk of adverse side effects. Improved results with thin, light colored hair.

36 New In Motion Technique! What Is Technique? In-motion technique creates a high average output power, while utilizing low fluence and high repetition rate for the ultimate virtually painless procedure.

37 Technique Advantages Replacing the old stationary method in Lasers and IPLs Providing safer treatments by raising a large area s temp. gradually and allowing even distribution of energy and faster treatments Allowing using lower energy levels and achieving the same high efficacy as the old stationary method Less risk for complications and more control during the procedure Less burning/stinging sensation for the patient- virtually pain free treatments!

38 SHR Biometrics

39 Total Energy (kj) [J/cm 2 ] x [Hz] x time [sec] = kj 10 [J/cm 2 ] x 10 [Hz] x 80 [sec] = 8,000J 8kJ 100J/sec *1kJ = 1000J

42 10 cm 15 cm 150cm 2

43 10 cm 15 cm 8-10kJ

44 10 cm SHR 1x1 cm 2 Average ~53 J/cm J : 150 cm 2 = cm

45 x 80 sec = 1120sec = minutes

46 12 Screen SHR Female Treatment Areas

48 4 Abdomen Arm Calve Thigh 3 6

50 SHR Settings Fitzpatrick Skin Type Fluence (J/cm 2 ) I-III 9-10 IV 7-8 V-VI 5-6

51 SHR Settings/Asian Skin Fitzpatrick Skin Type Fluence (J/cm 2 ) I-III 8-9 IV 6-7 V-VI 5-6

52 SHR Thin Hair Settings Fitzpatrick Skin Type Fluence (J/cm 2 ) I-III IV V-VI - -

53 Hair Density Consideration

54 Hair Density and Temperature Low Thermogenic Effect High Thermogenic Effect C C Non-dense dense

55 Hair Density and Temperature Low Thermogenic Effect High Thermogenic Effect C C Non-dense 10kJ dense 8kJ

56 Small Areas Stack Mode

57 SHR (Non-Stack)

58 SHR (Stack)

59 Stack Mode The Stack mode is indicated when small areas up to 25 cm 2 such as upper lip, chin, bikini line, back of the hand.

60 Stack Mode The Stack mode is being used in small areas (up to 25 cm 2) such as perioral area (upper lip, chin), sideburns, submental, back of the hand. The Stack mode can be used up to 10J/cm 2.

61 15cm 2 4cm 2 4cm2 15cm 2

64 Stack 7 25 Fluence (J/cm 2 ) Area (cm 2 ) 5 5

65 Stack vs Skin Types - VI

66 Stack vs Skin Types 7J/cm 2 6J/cm 2 5J/cm 2 - VI

67 Stack Stationary 7J/cm 2 II IV 6J/cm 2 - VI

68 Small Areas

69 Stack Mode Settings Skin Type (Fitzpatrick I-VI) Fluence (J/cm 2 ) Accumulative Energy (kj) I-III IV V VI * Repetition Rate is 10Hz ** Grid size: up to 25 cm 2

70 Stack Algorithm 7J/cm 2 7J/cm 2 6J/cm 2 6J/cm 2 5J/cm 2 5J/cm 2 - VI

71 15cm 2 4cm 2 4cm2 15cm 2

72 Stack Non-stack 5cm 5cm 5cm 10cm

73 Treatment Intervals Area Average Subsequent Txs Face Body Every 4-6 weeks Every 6-8 weeks When re-growth appears (about 2 months) When re-growth appears (about 3 months)

74 HR Mode

76 Clinical Publications

77 Clinical Publications 1. Braun M. Permanent laser hair removal with low fluence high repetition rate versus high fluence low repetition rate 810 nm diode laser a split leg comparison study. J Drugs Dermatol Nov; 8(11 Suppl): s Braun M. Low Fluence Multiple Pass vs. High Fluence Single Pass Diode Laser Hair Removal - Two Years Post Treatment. ASLMS 30th Annual Conference, April 2010 Poster No Nunes R, et al. Diode laser for permanent hair reduction using SHR volumetric heating technique: 2,448 subjects ASLMS 30 th Annual Conference, April 2010 Poster No Trelles MA, Urdiales F, Al-Zarouni M. Hair structures are effectively altered during 810nm diode laser hair epilation at low fluences. J Dermatolog Treat Mar; 21(2): Royo J, et al. Six-month follow-up multicentre prospective study of 368 patients, phototypes III to V, on epilation efficacy using an 810 nm diode laser at low fluence (pending publication).

78 SHR Histology Trelles MA, Urdiales F, Al-Zarouni M. Hair structures are effectively altered during 810nm diode laser hair epilation at low fluences J Dermatolog Treat Mar; 21(2):

79 Figure 1: Skin x 125 HE/EO. Cytopathic and vacuole changes at the keratinocyte level are clearly seen.

80 Figure 2: Skin x 400 HE/EO. Perifollicular oedema and peribulb thermal damage, represented by darker staining, and polymorphic nuclear cell inflammatory infiltration are noticed respecting the integrity of the neighbouring tissue.

81 Figure 3. Skin x 250 HE/EO. Images of haemorrhaging are seen in between the collagen fibres at the stroma hair level.

82 Figure 4: Skin x 400 HE/EO. Perifollicular oedema is clearly noticed as a consequence of thermal effects.

83 Figure 5: Skin x 400 HE/EO. Presence of hair disruption with detachment from its shaft. Peri-isthmic fibrosis is observed together with inflammatory infiltration.

88 Clinical Evidence

89 Before After 4 Tx

90 Before After Before After 5 Tx

91 Before After 5 Tx

92 Before After Before 4 weeks After 3 Treatments

93 Before 6 weeks After 2 Treatments

94 Photos Courtesy: Kyle Holmes, M.D. Davis Laser Center, CA. USA 6 month after 7 Tx.

95 Photos Courtesy: Kyle Holmes, M.D. Davis Laser Center, CA. USA 6 month after 5 Tx.

96 Photos Courtesy: Kyle Holmes, M.D. Davis Laser Center, CA. USA 6 month after 6 Tx.

97 Photos Courtesy: Kyle Holmes, M.D. Davis Laser Center, CA. USA 6 month after 5 Tx.

98 Photos Courtesy: Kyle Holmes, M.D. Davis Laser Center, CA. USA 6 month after 3 Tx.

99 SHR Safety* High *diode *diode Effectiveness Low OLD PAIN, erythema, blistering, scabbing, hypopigmentation, hyperpigmentation, NEW SHR Minimal discomfort No after treatment adverse side effects High Safety

100 SHR vs HR High Effectiveness HR SHR Low High Safety

101 SHR - Summary 1. Minimal pain 2. Similar efficacy to gold standard technologies 3. Treat all skin types; very safe 4. Year long procedure 5. No disposable 6. Ease of use In Motion procedure

102 Caesarea Old-Port BC 22

103

SHR Pain Free Hair Free

SHR Pain Free Hair Free Brochure Treatment Laser Hair Removal AFT Hair Removal SHR by Alma Lasers Pain Free Hair Free Alma Laser s SHR technology is the world s most popular and widely used method of laser