Creighton Laser Consultants

Creighton Laser Consultants
Creighton Family Medicine-Twin Creek
Carlos Prendes MD Nancy Rounds CMA
Joseph Stangl PAC
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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
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General Skin Facts
Largest organ
Three layers:
Epidermis
Dermis
Subcutaneous
tissue
Thick and thin
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General Skin Facts
Protection
Defense
Sensation
Heat regulation
Storage
Excretion
Absorption
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Melanocytes
Located in epidermis
Produce melanin, a
brown pigment that
helps screen against
the harmful effects of
UV light
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Fitzpatrick Skin Types
Skin Type
Skin Color
How the skin reacts to sun
I
Very fair, "transparent"
Always burns, never tans
II
Fair
Always burns, tans with difficulty
III
Fair to light olive
Burns mildly, tans slowly
IV
Olive to brown
Rarely burns, tans with ease
V
Dark Brown
Very rarely burns, tans very easily
VI
Black
Never burns, tans very easily
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Human Hair Growth Cycle
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Causes of Excessive Hair
Hirsutism
Hypertrichosis
Hyperandrogenism
Idiopathic Hirsutism
Late onset congenital
adrenal hyperplasia
Ovarian tumors
Adrenal causes
Pregnancy: luteoma of
pregnancy
Drugs
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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.
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LASER
Light
Amplification by
Stimulated
Emission of
Radiation
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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
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Depth of penetration by wavelength
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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
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Contraindications (continued)
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
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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
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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
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15 Year Old Girl
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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) 01608
PH (508) 363363-6500
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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) 01608
PH (508) 363363-6500
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Pre-Treatment
Post-Treatment two months after
third ND-Yag treatment
Gray hairs still present
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Before
After
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GentleLase 10mm spot 20Jcm2
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Before
After
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Before
After
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Before
After
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Before
After
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Before
After
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Before
Pre Tx
After
Post Tx 17 mths.
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Before
After
Some wavelengths like a 810nm and 1064nm will have trouble getting this fine hair.
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Before
Pre Tx
After
Post 3Tx 6 mths.
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Other things the laser will treat
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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.
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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
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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.
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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.
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Things our laser won’t treat…etc.
Please consider a consultation with the Dermatology
Clinic at Creighton University Medical Center for the
following conditions.
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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.
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Port Wine Stains
Pre-op
3 months PD tx
Pre-op
5 txs PD laser
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
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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
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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.
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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.
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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.
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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.
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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.
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Questions?
Free consultations available