Palomar #2 Scars and Striae

Paul WienerSenior Vice President

Advances in the Treatment of Scars and Striae*

Non-Ablative Fractional Technology

*pending FDA Submission

© Palomar Medical Technologies 2008. All rights reserved.

© Palomar Medical Technologies 2008. All rights reserved.| www.palomarmedical.com

Lux1540™ Fractional

Non-Ablative Laser


Fractional Photothermolysis (FP)

Pigmented lesion

Vascular lesion


Lux1540™ Fractional Non-Ablative Laser

• Wavelength: 1540 nm• Spot Size: 10 and 15 mm• Max. Energy: 70 mJ/mb• Pulse Width: 10-15 ms


Current FDA Approvals for Lux 1540

• Soft tissue coagulation

• Skin resurfacing

• Acne scars

• Surgical scars

• Melasma


Micro Lens Array


Specifications: Lux1540 Laser

Parameters

Spot size, mm 15 10

Pitch, mm 0.6 1

Energy per microbeam, mJ 10 or 15 5 - 70

Pulsewidth, ms 10 or 15 10 or 15

Microbeams density, cm-2 320 100

•


Fractional Resurfacing Using Microbeams of Thermal Damage

• Lattices of optical micro beams generate lattices

of micro denaturated columns in the skin

• Minimizes wound volume in comparison to bulk

treatment (ablative resurfacing)

• Increases safety margin

• Maximizes wound surface to recruit wound healing mediators

• Faster healing process

• Treat scars, roughness,+ dyschromia


Treatment Conditions

• Moderate Correction– Melasma– Photodamage– Superficial Roughness

• Deep Correction

– Acne Scars

– Surgical Scars

– Striae* * Pending FDA Submission


Placement of Handpiece

• Size of Sapphire

• Active area

• Not treated area


Tile Cascade

50%

10mm/100mB

overlap:

line = 5mm

row = 2mm

15mm/320mB

overlap:

line = 7.5mm

row = 3mm

20%


Treatment Technique

1. Pass

2. Pass

3. Pass

4. Pass

5. Pass


Benefits of Tile Cascade

• Uniform coverage• Optimal density• Total energy is delivered to an area before

significant edema occur– This ensures good, consistent depth of columns

from the first pass to the last

• Good patient comfort– Can post cool treated area with CoolRoller


The Rotating Technique

• Keep the handpiece at the same place and rotate each pass from about 45o

• Aids with discomfort .

• Thanks to Dr. Maurice Adatto, Geneva Switzerland, for his work on this technique


First Pulse


Second Pulse


Third Pulse


Scars

• 4.5 to 16% of the general population affected by scars.

• Impact of scars:– Aesthetic disfigurement and resulting impacts on

patient psyche.– Functional issues: poor elasticity of scar tissue

can limit movement in areas of the body that were extensively damaged

– Pruritis, pain dysthesia


Etiology of Scars

• Scars are caused by abnormal cytokine (TGF-Beta) mediated wound repair mechanism. Scar tissue lacks the tensile strength, elasticity, and pliability of normal skin

• Types of Scars:– Hypertrophic scars are raised erythematous or

hypopigmented. – Atrophic scars are dermal depressions caused by

inflammatory destruction of dermal collagen (bites, varicella, acne, etc.) or mechanical loss of dermis and resultant thinned epidermis (surgical, traumatic, splayed scars).


Treatment of Scars

• Current treatments for post-surgical and post-traumatic scars have issues of efficacy or significant side effects.

• Current treatments:

– PDL for hypertrophic scars and keloids gives inconsistent results. • Common side effects: Purpura for 7-10 days

– Recontouring of atrophic scars with CO2 and Er:YAG laser resurfacing (1-2 tx).

• Common side effects: Extended patient downtime, PIH, infection, possible hypertrophic scarring and hypopigmentation.


Fractional Non-Ablative Treatment of Scars

• Fractional photothermolysis creates columns of thermal damage surrounded by healthy tissue

• Potential for efficacy with minimal patient down time and side effects

• Potential mechanisms to improve scars:

– Dermal collagen and elastin remodeling

– Photothermolysis of scar microvasculature in dermis

– Normalization of pigmentation via migration of normal melanocytes at boundaries of thermally coagulated columns.


Scar Histology after Treatment with Lux1540™

Atrophic Scar (baseline) Atrophic Scar Tissue 2 weeks post tx with 1540

Coagulation Zone

Note improvement in collagen organization; more rete ridges

Vasily & Tannous, MD


Scar Histology after Treatment with Lux1540™

Atrophic Scar Tissue (baseline) Atrophic Scar Tissue 2 weeks post tx with 1540

Note increased elastin; more organized elastin fibers

Silver StainVasily & Tannous, MD


Deep Correction: Acne Scars

Improve thumbprint and ice pick scarring.• Treatment strategy: 10 mm, 15 ms, 50-70 mJ/mb, 3-5

passes.• Stretch skin, use compression = good contact.• If surface has irregular contour, use LuxLotion.• Blanching during Tx is common, resolves in

30 minutes.• May see short-term improvement, but full benefit

takes about 4-6 months.


Post 3 Treatments

Pre-Treatment

Maurice Adatto, MDGeneva, Switzerland


Lux1540 Fractional

2 months Post 4 Treatments2 months Post 4 TreatmentsPre TreatmentPre Treatment

Stan Kovac., MD


Acne scar Lux1540

Photos courtesy of Robert and Margaret Weiss, MD


Pre Tx 1 month post Tx #7 with 1540

Lux1540 Fractional ™

David B. Vasily, MD


Deep Correction: Surgical & Traumatic Scars

• Similar approach to acne scars• Treatment strategy:10 mm, 15 ms, 50-60 mJ/mb,

3-5 passes• Improvement seen with single Tx at 3-4 weeks –

continued improvement over time, additional Tx


DV#26 Pre-Treatment

2

Post 3 Treatments3-5 weeks apart

Post Skin Graft ScarAesthetica Cosmetic & Laser Center

David B. Vasily, M.D.


Pre Tx6 Weeks Post 2 Treatments

Post Surgical ScarAesthetica Cosmetic & Laser Center

David B. Vasily, M.D.

Pre-Treatment


Pre-Treatment 3 Months Post 3 Treatments

Aesthetica Cosmetic & Laser CenterDavid B. Vasily, M.D.

Scar Treatment of PostTattoo Removal Scar with Lux1540™


Pre-Treatment

6 Weeks Post3 Treatments

Treatment of Surgical Scar with Lux1540™



36223

1 Month Post TreatmentPre-Treatment



6873

1 Month Post 3 TreatmentsPre-Treatment



Mirror EnhanceDavid B. Vasily, MD


Pre-treatment

3 wks. Post TX#4 with 1540

Treatment of 40-year old Bullous Dermatosis Scars with Lux1540™

David Vasily, MD


Post 3 1540 TxPre-1540 Treatment

Remodeling of Scar Tissue with Lux1540

David Vasily, MD


Striae

• Associated with stretching of the skin

• Glucocorticoid hormones prevent fibroblasts from forming collagen & elastin fibrils necessary to keep rapidly growing skin taunt

• Creates a lack of supportive material as the skin is stretched leading to epidermal and dermal tears


Striae

• Striae may also occur as a result of abnormal collagen formation, or a result of medications or chemicals that interfere with collagen formation.

• May also be associated with longtime use of cortisone compounds, diabetes, Cushing disease, Ehlers-Danlos syndrome, post-pregnancy, and rapid weight gain or increased muscle girth.– 75-90% of women develop some degree of stretch marks

during pregnancy. The sustained hormone levels usually results in appearance during month 6-7


Deep Correction: Striae

• Studies ongoing

• Good results reported

• Settings: 10 mm, 15 ms, 40-70 mJ/mb, 3-5 passes– Lower energy, higher density – Higher energy, lower density

• Increased risk of PIH and prolonged erythema


Striae Lux1540


Photos courtesy of Francesca de Angelis, MD

Striae Lux1540



Striae Lux1540



Striae Lux1540


Photos courtesy of Dr. Kolesnikova Milan,Italy

Striae Lux1540


Baseline Post-Treatment


Striae Lux1540




Striae Lux1540


Lux 1540

Striae




Treated sideDr. deAngelis


Striae Lux 1540 + Lux DeepIR

Photos courtesy of and Maurice A. Adatto, MD


Striae Lux 1540 + Lux DeepIR


6 Months Post-Treatment

Pre-Treatment



Conclusions

• Fractional Photothermolysis using the Lux1540™ can be an effective treatment for surgical and post-traumatic scars.

• Lux1540 can significantly improve a variety of both hypertrophic and atrophic scars, despite the cause or age of scar, with minimal to no side effects

• Lux1540™ can be used to treat hypopigmented and hyperpigmented scars

• Lux1540™ is proving to be the most consistent light based modality of treatment for striae

• Lux1540™ treatments offer excellent convenience of use and patient comfort.


StarLux Handpieces & Applications

Permanent Hair Reduction

PhotofacialsPigmented LesionsVascular Lesions

Acne PreventionPigmented Lesions

Leg VeinsVascular Lesions

Fractional Non-Ablative Skin Resurfacing and Soft Tissue Coagulation

Permanent Hair ReductionPigmented Lesions

Fractional Skin Tightening through Soft Tissue Coagulation

Fractional Ablative Skin Resurfacing


Thank You

Palomar #2 Scars and Striae

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