M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Hands-On Laser Workshop M. Christine Lee, MD, MPH The Skin and Laser Treatment Institute Walnut Creek, CA www.skinandlasertreatment.com • [email protected]JULY 30, 2016 2016 Summer Meeting Boston, MA July 28-31, 2016 Hynes Convention Center DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY M. Christine Lee, M.D. Hands-On Laser Workshop Investigator– Lumenis, Cutera, Syneron, Iridex, Solta, Ulthera, Cynosure, Fotona, BTL M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA 2016 Summer Meeting Boston, MA July 28-31, 2016 Hynes Convention Center M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Ablative and Fractional Resurfacing M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Carbon dioxide (CO2) laser appeared in 1964 and became the most widely used laser in derm. CO2 emits invisible infrared beam at 10,600 nm wavelength, targeting both intracellular and extracellular water. When light energy is absorbed by water-containing tissue, skin vaporization occurs with production of coagulative necrosis in the remaining dermis. Removes the deepest layer of epidermis (100 μm for CO2 compared to 30 μm for Erbium) which results in the best results. Disadvantage is that it also results in longest downtime, greater discomfort and inconvenience, greater risk of side-effects and complications compared to less invasive options. Limited to use on face whereas fractional and Erbium can be used all over the body. Down time and clinical effect varies based on energy applied, number of passes delivered, degree of pulse or scan overlap, complete/incomplete removal of partially desiccated tissue between each laser pass Results are also affected by pre-op and post-op care Laser Resurfacing M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Fractional photothermolysis was developed in 2004 by Manstein and colleagues. A pixilated pattern of full-thickness columns of coagulation is created in this process. These columns of coagulation are termed micro thermal zone (MTZ). Shorter recovery time and rapid healing are attributable to the healthy tissue that surrounds the MTZs. Advantage of fractional resurfacing is less downtime, faster recovery, less pain, and less side-effects and complications compared to traditional ablative resurfacing. Disadvantage is need for multiple treatments to achieve optimal results. Gold standard for wrinkles is CO2 laser resurfacing. But new gold standard for acne scarring is probably fractional resurfacing. Tradeoff for wrinkles: Longer downtime = more invasive = better results Laser Resurfacing M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Erbium:YAG ablative resurfacing (2940 nm wavelength) is more superficial in its level of ablation compared to CO2. These short pulsed lasers with stronger water absorption were less injurious to deeper tissues; they ablate the superficial tissue but leave little residual thermal damage. However, these lasers were good for smoothing the surface but did not have the same tightening effect as CO2 lasers. The next level of advancement entailed increasing the pulse width of the Erbium lasers to include some deposition of heat (increased thermal coagulation) which would allow tightening. Erbium lasers vary greatly in their efficacy due to whether they possess the ability to do just pure ablation (shorter pulse) vs. ablation plus thermal coagulation (longer pulse). Erbium lasers which have longer pulse width such as Fotona and Sciton are capable of achieving more “CO2-like” results. Laser Resurfacing M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Downtime with Erbium can vary greatly from 2 to 7 days depending on the fluence used, number of passes, overlap (as opposed to 10-14 days with CO2 laser). Because of faster recovery, greater tolerability, and minimal side effects, Erbium and fractional resurfacing have become the most popular and sought after resurfacing procedures and have largely replaced CO2 ablative resurfacing. Very few cosmetic derm or plastic surgery practices perform CO2 laser despite the excellent results due to the “high hassle” factor. Almost all aesthetic practices perform many Erbium and fractional laser resurfacing procedures and they are considered essential workhorses for any aesthetic laser practice. Laser Resurfacing M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Invasive Laser Ablation Deep Acne Scars Severe Rhytids & Actinic Damage Sebaceous Hyperplasia Benign Adnexal Neoplasms (Syringomas) Xanthelasmas/Xanthomas Rhinophyma Tattoos CO2, Er:YAG, Fractional Resurfacing M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Wrinkle Reduction Lasers Device Type Wrinkle Reduction Downtime Grade After 1 Treatment After 6 Treatments Wound Redness CO2 Laser A+ 70% N/A 7-10 Days 1-3 Months ActiveFX A- 40% 80% 60% After 3 Treatments 3 Days 5-7 Days re:Pair B+ 30% 60% 3 Days 5-7 Days Erbium B+ With Multiple Treatments 30% 60% 1-2 Days 4-7 Days Plasma B- With Multiple Treatments 25% 50% 1-2 Days 4-7 Days Fractional Resurfacing C+ With Multiple Treatments 20% 40% Minimal to None 4-7 Days (but more severe than Erbium) CoolTouch D+ With Multiple Treatments <10% <20% Minimal to None 1-3 Days
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2016 AAD Hands-on Laser Workshop Handouts Final SP Dynamis M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA Modalities non-ablative full beam
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M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Hands-On Laser Workshop
M. Christine Lee, MD, MPHThe Skin and Laser Treatment Institute
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
2016 Summer MeetingBoston, MAJuly 28-31, 2016Hynes Convention Center
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Ablative and Fractional Resurfacing
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Carbon dioxide (CO2) laser appeared in 1964 and became the most widely used laser in derm. CO2 emits invisible infrared beam at 10,600 nm wavelength, targeting both intracellular and extracellular water. When light energy is absorbed by water-containing tissue, skin vaporization occurs with production of coagulative necrosis in the remaining dermis.Removes the deepest layer of epidermis (100 µm for CO2 compared to 30 µm for Erbium) which results in the best results. Disadvantage is that it also results in longest downtime, greater discomfort and inconvenience, greater risk of side-effects and complications compared to less invasive options. Limited to use on face whereas fractional and Erbium can be used all over the body.Down time and clinical effect varies based on energy applied, number of passes delivered, degree of pulse or scan overlap, complete/incomplete removal of partially desiccated tissue between each laser passResults are also affected by pre-op and post-op care
Laser Resurfacing
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Fractional photothermolysis was developed in 2004 by Manstein and colleagues. A pixilated pattern of full-thickness columns of coagulation is created in this process. These columns of coagulation are termed micro thermal zone (MTZ). Shorter recovery time and rapid healing are attributable to the healthy tissue that surrounds the MTZs.
Advantage of fractional resurfacing is less downtime, faster recovery, less pain, and less side-effects and complications compared to traditional ablative resurfacing. Disadvantage is need for multiple treatments to achieve optimal results.
Gold standard for wrinkles is CO2 laser resurfacing. But new gold standard for acne scarring is probably fractional resurfacing.
Tradeoff for wrinkles: Longer downtime = more invasive = better results
Laser Resurfacing
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Erbium:YAG ablative resurfacing (2940 nm wavelength) is more superficial in its level of ablation compared to CO2. These short pulsed lasers with stronger water absorption were less injurious to deeper tissues; they ablate the superficial tissue but leave little residual thermal damage. However, these lasers were good for smoothing the surface but did not have the same tightening effect as CO2 lasers. The next level of advancement entailed increasing the pulse width of the Erbium lasers to include some deposition of heat (increased thermal coagulation) which would allow tightening.
Erbium lasers vary greatly in their efficacy due to whether they possess the ability to do just pure ablation (shorter pulse) vs. ablation plus thermal coagulation (longer pulse). Erbium lasers which have longer pulse width such as Fotona and Sciton are capable of achieving more “CO2-like” results.
Laser Resurfacing
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Downtime with Erbium can vary greatly from 2 to 7 days depending on the fluence used, number of passes, overlap (as opposed to 10-14 days with CO2 laser).
Because of faster recovery, greater tolerability, and minimal side effects, Erbium and fractional resurfacing have become the most popular and sought after resurfacing procedures and have largely replaced CO2 ablative resurfacing.
Very few cosmetic derm or plastic surgery practices perform CO2 laser despite the excellent results due to the “high hassle” factor. Almost all aesthetic practices perform many Erbium and fractional laser resurfacing procedures and they are considered essential workhorses for any aesthetic laser practice.
Laser Resurfacing
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Introducing SP Dynamis
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
A non-disposable combination Erb:YAG Nd:YAG laser system that can deliver both ablative and non-ablative therapies via variable spot sizes and scanning patterns that utilize Piano and Frac3 modes, six unique adjustable pulse durations and a tissue effect indicator
Key Technical Specifications
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
2 - 10 mm 2 - 10 mm 2 - 12 mm bare fibers 600um and 945 nm
Spot size- scanning 3 and 6 mm 3 and 6 mm 4 mm scan up to 40 x 40 mm
/
Special features
Wireless Footswitch - comfort in sysetm usage
VSP - Variable Square Pulse
EFC - Energy Feedback Control, unique automatic selfcalibration per each pulse
FRAC3®
mode - unique, 3D non-ablative fractional treatments with Accelera pulses
Smooth mode - non ablative thermal ErYAG modality
Erbium:YAG
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Erbium YAG Laser
Can be applied as: ABLATIVE (remove tissue and pigmentation) NON ABLATIVE (heat deposit – tightening)
Can operate in : FULL SPOT = Total area coverageFRACTIONAL= Microspot minimizing aggression
Can be applied with: HANDPIECE SCANNER
What is Erbium YAG Smooth Mode ?
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
• Special TRAIN of long pulses that create a unique Extra Long Pulse that can generate deep heat deposition with no necrosis, bleeding or pain
100 µm
Heating depth of + 1500 µmSmooth mode in stretch marks
Nasogenian Grooves & Nasolabial Folds
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA15 Minute Procedure – Requires No Anesthesia
Intraoral Application: Fractional – Non ablative – Smooth mode Erbium:YAG
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Fotona Laser 4D
★ Intraoral (fractional nonablative Erbium Smooth mode with super long-pulsed 250 msec)
★ Frac3 (fractional Nd:YAG with high peak power)★ Piano mode (extra super long-pulsed 6 sec
Smooth mode for this step if want to keep it noninvasive)
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Neodymium YAG with Adjustable Pulse Duration
Microseconds Miliseconds Seconds
Watts
LONG
PULSE
FRAC3
PIANO MODE
Kilowatts
QCW
Peak Power
Pulse duration
!FRAC 3 : fractional, deep, high peak power pulses = Skin tightening, pigment removal, hair removal
!QCW: Quasi Continuous Wave - small packets of pulses at high repetition = Laserlipolysis, tissue cutting and coagulation
!Long Pulse : Heat deposition for coagulation and bactericidal effect = Acne, onychomycosis, vascular tx, warts
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Neodymium:YAG
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
• Hair removal
• Vascular lesions
• Active acne
• Warts
• Onychomycosis
• KeloidsM. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Indications for UsePort Wine Stains Mod Acne Vulgaris Warts Telangiectasia
Treatment of WrinklesSpider VeinsLeg VeinsVenus LakeRosacea
Hemangiomae Vascular LesionsProcedures
★ Leg Veins★ Telangiectasias★ Spider veins★ Venous lakes★ Port Wine Stains★ Facial veins★ Hemangiomas★ Rosacea
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Key Benefits ★ Immediate visible results★ Good patient tolerance★ Low incidence of secondary
effects★ Highly effective treatment
Nd:YAG
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Tattoo Removal
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Tattoo Removal• Based on theory of selective photothermolysis. Energy is absorbed by the ink particles in a
very short time, typically nanoseconds or picoseconds. Sufficient energy must be delivered and absorbed by the tattoo ink to break up the pigment. The shock wave created by this energy causes the pigment to fragment or shatter.
• Different lasers are used for different tattoo colors. Consequently, multi-color tattoo removal almost always requires the use of two or more laser wavelengths.
• Types of lasers used:
• Q-switched frequency doubled Nd:YAG: 532 nm - creates a green light which is highly absorbed by red and orange. This wavelength is highly absorbed by melanin which makes it effective for brown spot removal.
• Q-switched Ruby: 694 nm - creates a red light which is highly absorbed by green and dark tattoo pigment. This is the best wavelength for blue ink.
• Q-switched Alexandrite: 755 nm - creates a red light which is highly absorbed by green and dark tattoo pigment. Works well on green tattoo but because of its weaker peak power (it is the weakest of all the Q-switched devices) it works only moderately well on black and blue ink.
• Q-switched Nd:YAG: 1064 nm - creates a near-infrared light absorbed by all dark tattoo pigments and is the safest wavelength to use on tissue due to the low melanin and low hemoglobin absorption.
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Tattoo Removal
• Dye modules are available for some lasers to convert 532 nm to 650 nm or 585 nm light which allows one laser system to safely and effectively treat multi-color tattoo inks. (the QX-Max by Fotona which we are using in today’s laser workshop is one of those lasers.)
• Multiple treatments usually spaced at least 7 weeks apart are required to remove tattoos.
• Certain colors are more difficult to remove than others. Green and blue are more resistant.
• Picosecond lasers using 755 nm, 532 nm, and 1064 nm wavelengths have been developed and are reported to be more effective in treating resistant colors like green.
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
BODY CONTOURING
Thermage for Body (Solta)
Titan (Cutera)
truSculpt (Cutera)
Exilis Elite (BTL Industries)
Cellutone (BTL)
Z Wave (Zimmer)
iLipo (Chromogenex)
Venus Freeze (Venus Concept)
Vaser Shape (Sound Surgical)
VelaShape (Syneron)
SmoothShapes (previously Eleme, now Cynosure)
Refit (Viora)
Bella Contour (Real Aesthetics)
Legend (Lumenis)
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Exilis EliteBTL Aesthetics
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Key Advantages
• Focused, Continuous • Monopolar RF • Controlled Cooling • Real-Time Temperature • Monitoring • EFC (Energy Flow Control) • Impedance Intelligence • Body and Face
Applicators • No Costly Consumables
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Focused Monopolar RF• Uniform Volumetric Heating
• Consistent collagen and fat response • Deep
• Reach depths up to 2.5 cm • Flexible
• Customize treatments by targetingspecific depths of tissue
• Safe • No hot spots • Closed loop system widely used in aesthetics
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Real Time Temp. Monitoring
Adjust energy to ensure patient comfort without sacrificing efficacy.
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Controlled Cooling
• Ability to treat various layers of tissue- dermis to full subcutaneous fatM. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Body & Face Applicators
Built in Temp Monitor• Abdomen • Love Handles • Back Fat • Arms • Thighs/Knees • Four Treatments
90 Watt Applicator• Full Face • Neck/ Decollete • Periorbital • Elbows • Hands • Two Treatments
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Mechanism of Action
• RF energy- volumetric heating of tissue by exciting molecules rapidly (3 million times per second)
• Tissue resistance (impedance) to movement creates heat
• RF energy is color blind – treats all skin types
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Collagen RemodelingMonopolar RF Mechanism of Action
• Initial Clinical Response • Immediate collagen contraction • Water molecules separated from collagen molecules cause collagen to
“denature” and therefore contract • Clinical Result – wound healing response
• Collagen deposition and remodeling • Dermal contraction results in tightening • Fibrous septae contraction results in contouring
Source: “Histological and Ultrastructural Evaluation of the Effects of a Radiofrequency- Based Non-ablative Dermal Remodeling Device” Archives of Dermatology February 2004, B.Zelickson, M.D. et al
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
ClinicallyProven
Safe&Efficacious
CustomizableTreatment
TreatallBodyArea
VirtuallyPainless
MinimalConsumables
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Current Market Pricing & Costs• $400-$600 per area for 4 body Tx’s• $800-$1200 per area for 2 face Tx’s• Average time of treatment is 30-50 min.
• Minimal consumables• Disposable ground electrode at $4 per treatment• Baby oil or ultrasound gel for conduction• The device is paid in full after only 35 patients
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Summary
• Face and Body Applicators can be used all over the face, neck and body
• Patient comfort with controlled cooling
• No costly consumables
• Easy to delegate
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Fat Melting
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
• Multiple + & - electrodes emitted simultaneously create the world’s first and
only non-contact, Selective RF™ energy field.
• First and only true multipolar design.
Multipolar, Selective RF
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
• Vanquish delivers RF energy, selectively absorbed by Fat which heats it to the point of permanent reduction
• Skin and Muscle are not affected
• Think of a traditional light bulb – the copper wires on either side conduct energy
• The filament in between is not conductive but receives the energy which gets hot and gives light
Mechanism of Action
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Lightbulb Conductive and Resistive Properties
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Muscle and skinare extremely polarized
Fat is not effectively polarized
Vector of Electrical Intensity
• Fat tissue is not easily polarized due to its low water content & low relative permittivity
• This creates a high internal electric field measured by the Vector of Electrical Intensity
• Vector of electrical Intensity Efat is approx 10 x higher than Emuscle, skin
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Depth of Penetration
• Focal point is Approx. 10mm below the surface
• Uniformly heats Approx. 5mm - 15mm to 43 - 45ºC
10mm5mm
15mm
43-45ºC
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
• Core Applicator • Articulating Arm • Generator and
Operator Interface • Small Footprint • Easy to Move • Easy to Operate
Device Component Summary
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Vanquish Device
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Homogenous Thermal Profile
With the largest spot size in it’s category
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Skin surface temperature 40° post treatment. At 1cm deep temperature is 44° for 26 minutes.
BTL Vanquish: Homogenous Heating of Skin and Fat Tissues
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Apoptosis/pseudoinflammationof the fat cells
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Histology
After 1st treatment
After 4th treatment
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Gross Pathologic Examination
Volume of the fat layer – treated area
Volume of the fat layer untreated area
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
The Results: Volumetric Reduction
measured in fat layer
Approximately a 60% Reduction
Before Thickness of subcutaneous
fat tissue 7.6 mm
After 4 weeks Thickness of subcutaneous
fat tissue 2.9 mm
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
DemographicsSex, n (%) 22 (91.7)
Female 2 (8.3)
Male
Age, y
Mean (SD) 47.9 (11.2)
Median (range) 47 (30-69)
BMI
Mean (SD) baseline 23.9 (2.1)
Mean (SD) 3 months f/u 23.6 (2.3)
Race, n (%)
White 19 (79.1)
African American 1 (4.2)
Other 4 (16.7)
BTL Vanquish ME: Evaluation and Safety of Selective RF
Results
Average Circumference Reduction
4.22cm at 3 month F/U
3 Independent Evaluator’s Assesment
88% Accuracy
Safe & Efficacious Yes
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Vanquish Leg Applicator Protocol• Treatment Parameters
• 4 Treatments
• 30 minutes (each leg)
• Start power: 80W titrate PRN
• Patient positioning
• Sitting or semi-reclined position
• Edge of bed closest to device
• Bolster inner or outer thigh, if necessary
• Drape the pubic bone with a towel
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Vanquish Leg Applicator
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
BODY CONTOURING
Thermage for Body (Solta)
Titan (Cutera)
truSculpt (Cutera)
Exilis Elite (BTL Industries)
Cellutone (BTL)
Z Wave (Zimmer)
iLipo (Chromogenex)
Venus Freeze (Venus Concept)
Vaser Shape (Sound Surgical)
VelaShape (Syneron)
SmoothShapes (previously Eleme, now Cynosure)
Refit (Viora)
Bella Contour (Real Aesthetics)
Accent V-Shape (Alma)
Legend (Lumenis)
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Comparison Between Liposonix, Ultrashape, Zeltiq, Trusculpt
Treatment of Love Handles:Liposonix: 20 minutes x 1 treatment to lose 2.5 cm to 4 cm (results seen at 3 months after 1 Rx)
Ultrashape: 20-30 minutes x 2-3 sessions to lose 2.5 to 4 cm (results seen at 2 weeks after 2-3 Rx’s)Zeltiq: 2-4 hours x 2-3 sessions to lose < 2 cm (results seen at 3-4 months after 2-3 Rx’s)
TruSculpt: 1 hour x 2 sessions to lose < 1 cm (results seen at 2 months after 2 Rx’s)
M. Christine Lee, M.D. • The Skin and Laser Treatment Institute • Walnut Creek, CA
Comparative Analysis Tissue Response To Different Modalities
1UltraShape research – data on file, 2Liposonix published data, 3Zeltiq published data