Untitled - DermaMed Solutions
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1. Gap between treatments 4 weeks Number of sessions typically 8 10 Abdomen Unwanted body hair often appears on the lower abdomen usually concentrated along a line from the navel to the pubis e Do not treat over any jewelry to avoid focusing energy inadvertently e Treat in rows from the navel to the top of the bikini line pubis Gap between treatments 4 weeks Number of sessions typically 8 10 32 Backs Male and female backs should be marked with gridlines using a white pencil Only work in zones to avoid gel warming too much in areas waiting to be treated Take care when treating over bony areas spine and scapula Gap between treatments 4 weeks Number of sessions typically from 10 sessions 33 Arms e Mark out the sub divided area to be treated using a white pencil e ltis preferable to treat around sections of the arm rather than along the length of the arm If required you can treat around the elbow or wrist Gap between treatments 4 weeks Number of sessions typically from 8 sessions 34 Half legs It is usually easier to treat around the leg than along the length of the leg e Section off the leg in rectangular gridlines using a white pencil e Onthe shin and ankle reduce the fluence because of sensitivity caused by proximity to bony areas Treatment here can be painful especially the ankle e Remember the patient will have to move several times to allow the operator2. Use of oral isotretinoin or tretinoin in the previous 3 6 months for the treatment of acne or other dermatological conditions Pregnancy until periods return and breastfeeding is stopped because hormonal imbalance may reduce treatment effectiveness Use of drugs for diabetes due to possible photosensitivity and poor wound healing Use of anti coagulant drugs Presence of a pacemaker unless the pacemaker manufacturer confirms in writing that it is safe to treat the patient Use of any topical medication perfumes deodorants sun block essential oils or other skin lotions which could cause photosensitivity Presence of surgical metal pins or plates under the tissue to be treated Age under 18 years if the establishment is not registered to treat children or if parental permission is withheld 11 A doctor s letter should also be obtained before treating patients who are reportedly using quinidine any anti psychotic medication or large combinations of cardiac diuretic drugs topical steroid creams in the area to be treated general anesthesia in the last 3 months local anesthetic treated areas in the past month and any cases in which you are uncertain about any reported medical condition or medication Treat with caution and obtain a doctor s letter if you are uncertain about anyone who has e Fake tan e Allergies e Hormone abnormalities such as polycystic ovarian syndrome e Cold sores in the treatment area e Previous depilation
3. The spectral distribution of a typical xenon lamp IPL overlaid with absorption curves for blood red melanin black and water blue Spot size The spot size of the light source s delivery device can also affect the depth of penetration of the energy In a highly scattering medium such as skin light diffusion at the edges of the beam causes spreading of the energy as it penetrates into the tissue As a consequence a larger spot size delivers more energy at a given depth Unlike traditional IPL devices the Quadra Q4 uses twin flash lamps to produce a large rectangular spot size on skin of 8 9 cm which ensures that the light energy penetrates deeper into the skin With the Quadra Q4 there is no need to overlap spots and the large spot size ensures faster and more comfortable treatment Photon energy deposited per unit volume White Light White Light Wide Beam Narrow Beam Enpdenmis Darmi Depth of penetration by spot size Large spot sizes increase depth of penetration Pulse duration The total amount of energy applied to a tissue in a single pulse is determined by the energy level or fluence and the duration of the pulse The pulse duration is not only important in determining energy applied it is also important in the selective destruction of target tissues Generally the pulse of IPL light used will be longer for thicker hair and shorter for finer hair By choosing long pulses of light for hair removal t
4. areas at several increasing energy density levels until a suitable starting energy level is determined e The starting energy is that which will produce a heat response in the skin which feels hot or like a prickle to the patient but is tolerable In addition some redness may develop in the treatment area within a few minutes Should a strong histamine like allergic reaction occur with swelling immediately around the hair follicles with general raw redness around the area the energy level is too high e Normally the skin will feel warm temporarily after treatment and any redness will disappear within minutes or a few hours Typical Treatment Parameters for Hair Removal For lighter skin Clinical data have shown that for lighter skin types Fitzpatrick Skin Types 1 3 single pulses of 25 40 msec with energy ranges of 12 16 J cm have proven to be effective The choice of treatment program also depends on the hair thickness Hair Removal Treatment Parameters for Light Skin eed eee ee Type 16 For dark skin Darker skin can react to light treatment by hyper or hypo pigmenting so it is best treated with a longer pulse width to spread out the energy and make the treatment safer and more comfortable This means either using a higher number program in the single shot section or using multi pulsing As the skin color darkens the energy range should stay in the same region however triple pulses should be used to allow
5. inter pulse epidermal cooling Hair Removal Treatment Parameters for Dark Skin 17 TEST TREATMENTS Testing is required to establish the best starting IPL energy level and to reduce the risk of unwanted side effects from over treatment Test areas should be evaluated on or near the treatment site using the lowest recommended fluence for the skin type increasing the fluence if necessary until the patient feels a ping heat or mild discomfort according to the individual s pain tolerance Testing should be ceased immediately if any side effects occur When performing the first test area on a new patient you have only 1 3 chances to establish the energy level For larger areas such as facial areas d collet forearms etc it is easy to establish a test area However for small areas such as specific pigmented blemishes spider nevi etc only one shot can be made In that case it should be the best estimated shot On Lighter Skin Types 1 3 use this sequence e One shot at the lowest energy level predicted by skin type e One shot 1 J cm above the lowest predicted energy level e One shot 2 J cm higher than the lowest predicted energy level to evaluate tissue response On Darker Skin Type 4 use this sequence e One shot 0 5 J cm below the lowest energy level predicted by skin type e One shot at the lowest energy level predicted by skin type e One shot 0 5 J cm above than the lowest predicted energy level
6. that available in the Professional version how they re chosen is the primary difference HAIR REMOVAL SKIN TYPE ach aha PROGRAM J cm sme 25 moreover A ae ee Single 300 1201070J em7 A singe 25 ooro 8 sige 38 2060 A t re Ta oe ee wate 20 25 oeeo e Treatment Parameters Are Guidelines Only The parameters listed in this table and throughout this treatment guide are intended as guidelines only The use of test patches is strongly advised as patient to patient variation may affect the treatment outcome and the possible incidence of side effects How to Choose Treatment Parameters General Guidelines To choose the initial treatment parameters e Exclude all unsuitable subjects eg those with pre existing medical conditions such as cancer those taking contraindicated drugs those with suntans etc e Determine the subject s underlying Fitzpatrick Skin Type AND the skin type of the area to be treated A subject s general Fitzpatrick Skin Type is assessed on a body area not normally exposed to the sun The area to be treated may appear different from the underlying skin type due to sun damage age or specific local skin tone that must be taken into account 15 e Use the list of treatment program options in the User Manual for the system being used or in the appropriate treatment guide ie Hair Removal or Photoaging to identify Starting programs e Undertake test
7. that for the treatment session they should Avoid wearing tight clothing Do NOT use sun blocking creams within 24 hrs of scheduled treatments 13 CHOOSING TREATMENT PARAMETERS IPL systems work by heating target tissues sufficiently to damage or destroy them In hair removal the overall objective is to find the optimal therapeutic window where the energy absorbed is sufficient to damage the follicle without causing significant damage to surrounding epidermal tissue Treatment Parameters Quadra Q4 systems have two primary parameters operators can adjust to determine the therapeutic window e Fluence is a measurement of energy density in other words it is the amount of energy delivered in Joules per square centimeter Higher fluence means more energy delivered to the tissue e Pulse duration as discussed previously is the length of time over which the pulse of energy is delivered Pulse duration is usually measured in milliseconds msec At a given fluence long pulse durations deliver energy more slowly short pulse durations deliver energy more quickly The appropriate fluence and pulse duration depend on the patient s skin type Fitzpatrick Scale and the condition being treated In general darker skin should be treated with longer pulse durations 14 Treatment Programs The treatment programs available for hair removal are shown in the figure The range of available pulse lengths and energy levels is similar to
8. to evaluate tissue response The choice to go higher with the second and third test shots will be based upon a number of factors including e Did the patient experience the sensation of a ping or heat e ls the area in question tanned e What has been the patient s response to treatment on other body areas for patients who have been treated previously 18 Post testing Instructions After testing patients should be given clear instructions on post Quadra Q4 skin care in particular sun avoidance and avoidance of injury to the skin Recording Details of the test treatment performed should be recorded in the patient s record including Treatment area Quadra Q4 type Program Pulse width Fluence Number of shots The entry should be signed timed and dated The Quadra Q4 treatment register log book must be completed recording treatment in the same way Follow up Patients with skin types 1 3 should return in 3 7 days for final evaluation and treatment Patients with skin types 4 5 should wait for 14 days to be sure no late emerging side effects Occur 19 PERFORMING HAIR REMOVAL WITH THE QUADRA Q4 Treatment Room Set up Check List Make sure any required IPL hazard warning notices are in place at entrances Close window blinds and cover any mirror surfaces to reduce reflection hazard Check fire extinguisher location suitable for electrical fires Make sure all Local Rules Treatment Protocols a
9. treatments e Reported HIV infection or hepatitis Transsexuals may be treated although results can vary and Quadra Q4 treatment should follow 6 months after completion of hormone therapy Conditions that affect hormone levels such as thyroid conditions oral steroids hormonal therapy and polycystic ovaries can be treated but results may vary and patients should be made aware of reduced or delayed realistic outcomes Pre treatment Counseling Patients should be instructed in pre treatment skin care and should be provided with take home instructions recommending that they e Don t expose their skin to UV light sun exposure or the use of fanning beds or self tan for at least 4 weeks before and or between IPL treatments e Don t depilate with waxing plucking or threading shaving or depilatory creams are acceptable before and or between IPL treatments e Don t use bleaching creams or perfumed products e g aromatherapy oils for 24 48 hrs before treatment sessions e Avoid swimming in strong chlorinated water immediately before an IPL treatment session e Avoid exfoliating microdermabrasion or peels for 1 week before treatment sessions e Keep the area to be treated clean and dry 12 Hydrate the body by drinking plenty of water Protect the skin from sun exposure with suitable clothing and use of sunscreen of SPF 30 before first treatment and between subsequent treatment sessions Patients should be advised
10. AFTER 2 hairs showing Treatment effect by stage of hair growth In this cross section only two hairs are in anagen before treatment Treatment destroys the two hair follicles but does not affect the remaining hairs that are in either catagen or telogen sessions depending on the new growth cycle and the body area Long term or Permanent Hair Reduction Remember even repeated treatment will not result in a permanent removal of all hair in the area treated More precisely light based hair removal will result in long term stable reduction in the number of hairs re growing after the treatment regimen The process is thought to work as follows Hair growth is delayed as the hair growth cycle is accelerated into the telogen phase which on some parts of the body may be several months Hair follicles damaged by exposure to intense flash of light are miniaturized and re grow as lighter colored finer hairs or vellus hair no color Hair follicles are completely coagulated resulting in permanent damage fo the cells responsible for their re growth PRE TREATMENT ASSESSMENT DOCUMENTATION AND COUNSELING Patients considering any IPL indication should go through a pre treatment assessment and documentation process The process includes Providing detailed information about the procedure and its risks Taking a medical history to elicit any special circumstances photo sensitizing medication or pote
11. Quadra QA HAJR REMOVAL GUIDI TABLE OF CONTENTS Indications Warnings and Disclaimers neennnnnnn nst ran a trattata 2 MOT Oan ares tree ett EA ster tier EE ATE erate EE A aes ere et nest 3 Long term Hair Reduction Using Intense Pulsed Light IPL ss ss eee eceeeereee 4 Pre treatment Assessment Documentation and Counseling 9 CHOOSING Treatment Parameters i a a 14 Performing Hair Removal with the Quadra Q4 oie ennnennnnnn ern nn 20 PFOGICGETIDS Oy BOGV ARCO ia ice sneeest 25 Handling Treatment related Problems ccccccccccesccssccessccesscessecessecesseessesessesesesses 4 Post treatment Care and Counseling ss eeneennnnnnnnnnnnnnnnnnenan nn t nr n tn r rna tratta 43 Relerences Bipliodraph ii ii ee ead B ei ie ee 44 Indications Warnings and Disclaimers Page USA FDA 510K CLEARANCE KO71883 Quadra Q4 intense pulsed light is indicated for use in Dermatological and Plastic Surgery applications and specifically for long term stable or permanent hair reduction In addition Quadra Q4 is indicated for the treatment of benign cutaneous vascular lesions and the treatment of benign pigmented lesions Quadra Q4 is indicated for the treatment of mild to moderate inflammatory Acne Vulgaris WARNING The information provided in this document is intended for general guidance in the use of the Quadra Q4 IPL device for long term hair reduction It is not intended as an expert protocol or medica
12. access to all aspects of the legs Gap between treatments 6 weeks Number of sessions typically from 8 sessions 35 Knees e Treat the knee with the leg out straight not bent e Adapt the light guide to the shape of the knee e If the knee is bony treat at lower fluence similar to the setting for shin and ankle Gap between treatments 6 weeks Number of sessions typically from 8 sessions Upper legs e Mark out the legs in sections with gridlines using a white pencil e Treating large areas like the upper leg or thigh can be stressful and tiring for the patient e Cool the areas in sections and change the cooling gel periodically approximately every 30 flashes to avoid excessive heat build up Gap between treatments 6 weeks Number of sessions typically from 8 sessions 36 Toes and fingers Every patient is a different shape adjust the position of the light guide to suite the shape of the patient s treatment area It is possible to treat two adjacent digits with a single flash Gap between treatments 4 weeks Number of sessions typically from 8 sessions 37 Underarms The underarms are probably the easiest area to start with and to learn Quadra Q4 use However some parts of the underarm can be very sensitive especially in the centre where hair growth is thickest so start at the farthest hairs out on the arm towards the elbow and move steadily towards the breast telling the patient it will ge
13. cles lack sufficient melanin to absorb the energy It s important that patients have realistic expectations about the permanence of hair removal Although light based treatments will permanently reduce the total number of body hairs and although the hairs that re grow will often be finer and lighter in color treatment will not result in a permanent removal of all hair in the area treated More precisely light based hair removal will result in long term stable reduction in the number of hairs re growing after a treatment regimen which may include several sessions LONG TERM HAIR REDUCTION USING INTENSE PULSED LIGHT IPL How It Works The skin has three primary targets that absorb light melanin blood and water These targets are called chromophores Light energy absorbed by chromophores is converted to heat energy Hair removal using Quadra Q4 light therapy consists of creating sufficient heat in the hair follicle to damage the cells that cause hair re growth During treatment light that isn t reflected off the surface scatters in the skin where it is absorbed by melanin in the hair follicle The light energy is converted to heat energy and by conduction the heat is transferred to adjacent cells Sufficient heating kills the cells and prevents the follicle from growing new hair Light based hair removal Light that isn t reflected from the surface a is scattered in the skin b and is absorbed by melanin in the hair follic
14. determine Gap between treatments 4 weeks Number of sessions typically 8 10 30 Bust and d collet Unwanted hair growth in female patients can occur in the center of the chest between the breasts and this can be treated easily taking care with energy settings as the chest bone sternum is close to the body surface in this area and may be sensitive Moreover the d collet is often tanned and sun damaged and does not heal easily if over treated therefore treat with caution starting with lower fluence levels More commonly unwanted hair appears around the periphery of the areola which may be treated as follows e Cover up the red areola nipple area using shields Fibrella cut outs white adhesive labels or damp cotton gauze e Do not treat over the darker areola skin as more energy will be absorbed here e With the nipple safely protected the whole area may be treated in rows over the protective shielding to ensure that all the hairs at the margin of the areola are treated Gap between treatments 4 weeks Number of sessions typically 8 10 31 Male chest Unwanted chest hair growth in male patients can be treated easily taking care with energy settings as the chest bone sternum is close to the body surface in this area and may be sensitive e Mark gridlines to delineate sub divided areas of treatable size using a white pencil e Reduce the fluence over bone or dense hair use cooling packs
15. en treatments 4 weeks Number of sessions typically 8 10 2 Male beards Most typically men request beard re shaping to reduce hair growth on the lower third of the neck where shirt collars rub and leads to soreness following shaving and in growing hairs and inflamed infected hair follicles pseudo tolliculitis barbae PFB Care should be taken on the lower third of the neck because this area is delicate and does not heal as well as facial areas if over treated Also first treatments of the beard in this area should be cautious as there may be a lot of hair which means a lot of melanin and consequently a lot of heat discomfort generated in the IPL treatment It is one of the areas where the use of reusable cooling gel packs kept in the freezer can be helpful both for about a minute or two before treatment to reduce level of discomfort and afterwards to draw out heat from the area and reduce inflammation Post treatment application of derma renewal gel or other calming lotion is desirable Results of treatment can be excellent in this area and much appreciated by the patient Spot clearing of hair on the upper cheeks can also be undertaken but full clearance of the beard is not advisable except in gender reassignment cases he to she since complete removal of the beard changes facial masculinity characteristics and makes the face look more feminine Complete loss of male facial hair can also result in certain premature ageing charac
16. ergy first The area should be cleaned with water only any creams may leave a residue which could affect the efficiency of the treatment Mark the extent of the skin area to be treated with a white eye liner pencil In the area to be treated white out small lesions moles etc and cover any sensitive areas tattoos lips etc with cut out adhesive white labels to protect them from absorbing light energy 7 age Q betes ka tt A Cover sensitive areas 21 Give the patient and any assistant or observer present in the room suitable protective safety glasses Disposable adhesive ocular shields should be placed over the eyes of the patient if treating facial areas near to the eyes where safety glasses would allow light penetration under the rim Ocular shields are available for purchase through DermaMed Solutions Item 31 9300 IPL Eye Shields 75 00 for a 50 pack Set up the Quadra Q4 program and predicted energy setting based on skin type hair density etc Cool the area with ice recommended or if you will be using a cold pack change frequently to ensure temperature is effective enough to cool the skin Cold packs change frequently during treatment The operator must wear suitable safety glasses during Quadra Q4 treatment and blink during the flash to limit light entering the operator s eyes and thereby improve visibility of the treatment area after the flash If Using Gel If you c
17. he operator will avoid collateral damage to epidermal melanin as the tiny particles of melanin in the skin have time to lose absorbed heat during a long pulse compared with say a much larger hair follicle structure which will hold its heat longer The Hair Growth Cycle and Repeated Treatments Hair grows in a cycle of three phases The anagen phase is the growth phase of the hair The catagen phase is a brief portion of the hair growth cycle in which the growth stops The telogen phase is the dormant phase of the hair Hair can only be treated successfully during the anagen phase because it is the only phase in which the follicle contains sufficient melanin for effective heating Anagen Catagen Telogen Hair growth cycles Hair can only be treated successfully during the anagen phase Each follicle in human skin maintains an independent growth rhythm from the other follicles At any given time the majority of hair follicles are at some point in anagen The remaining follicles are either in catagen or telogen Because hair can be removed effectively by light based methods only during anagen several treatments at different times are required to destroy all of the hair follicles in an area for long term or permanent hair reduction An average of 6 10 sessions is needed for permanent hair reduction depending on the hair color thickness density etc and 4 10 weeks is the recommended gap between BEFORE 2 hairs showing
18. hoose to use Clear ultrasonic gel either dispense sufficient ultrasound gel into a small container or deposit blobs of clear ultrasound gel directly onto the skin from the dispenser bottle and using a clean wooden spatula spread a layer of gel over the skin approximately 2 3 mm thick The gel must be kept cold but not frozen in a fridge Li Do not overwork the gel on the skin as it will heat up Do not reuse the gel infection risk 22 Using the Quadra Q4 Applicator Place the light guide crystal flat to the skin touching the surface of the skin Press the light guide into the area being treated Use firm pressure when treating hair with the contact crystal to bring the hair shaft closer to the light source and improve absorption in the hair The light guide should be flat against the skin Place the treatment spots directly next to one another with minimal overlap Make sure there are no gaps between the treatment spots Beware If The light guide overlaps a previous treated area over treatment risk The light guide treats skin without hair no effect over tattoos or fanned skin over treatment risk The light guide leans to one side insufficient energy delivered to the target Part of the light guide is not in contact with the skin insufficient energy delivered to the target After Using the Quadra Q4 Applicator Ensure that the skin area is completely treated no ob
19. isk of further emission of Quadra Q4 energy Remove the mains plug Appropriate details should be recorded in the patient notes including the extent of the partially completed treatment and details of any untoward side effects The Quadra Q4 factory service engineer should be informed immediately of the circumstances of the equipment failure and an Incident Report completed 42 Posr IPL TREATMENT INSTRUCTIONS Patients should be instructed in post treatment skin care and should be provided with written take home instructions recommending they Don t expose skin to UV light sun exposure or the use of tanning beds or self tan for at least 2 weeks Don t shave for 48 72 hrs after facial treatment Don t use bleaching creams or perfumed products for 24 48 hrs Don t pick or scratch the treated area Avoid rough handling of the area treated Leave any skin responses alone they are temporary and will subside Avoid very hot baths showers steam baths sauna for 1 week Avoid swimming in strong chlorinated water for 1 week Avoid exfoliating or peels for 1 week Avoid rough sports for 24 48 hrs Avoid wearing tight clothing Keep the area clean and dry Hydrate the body by drinking plenty of water Use sunscreen min SPF 30 and consider using protective cotton gloves for driving a hat to protect facial areas Immediately post treatment effective skin cooling of the epidermis can be helpful The use of ice or cooli
20. ive skin therapy Stop treatment Cool the skin and moisturize Review after 24 hr and restart treatments at lower fluence Normally resolves in 24 hrs If a burn associated reaction is expected a one time application of a local steroid ointment may be indicated medical prescription Cool the area regularly using cloth wrapped ice packs or cooling gel Advise the patient to use pure aloe vera and skin protection as for a mild sunburn until the sensation disappears If the reaction persists have the patient consult a doctor Cool area thoroughly for pain relief If already blistered or burn recommend burn sprays and creams from the pharmacy Have the patient consult a doctor Follow the adverse incident procedure Cool area throughout for pain relief Have the patient consult a doctor Follow the adverse incident procedure Advise the patient to moisturize and protect the skin from sun exposure and further injury Instruct the patient to leave the skin alone and not to rub it Have the patient consult a doctor if the condition persists Advise the patient to avoid skin exposure and use a sun block for six months Have the patient consult a doctor Follow the adverse incident procedure Advise the patient to keep the area cool and to apply pure aloe vera gel Have the patient consult a doctor if the itching persists e Reassess the patient s history and increase fluence depending on skin reaction 4 Only retreat areas
21. l advice The treatment parameters suggested here are those reported by experienced users in published literature or reported directly to DermaMed Solutions LLC However the user alone bears full responsibility for choosing treatment parameters operation of the device and appropriate patient care TRAINING Training is a key factor in consistently achieving successful treatment outcomes At a minimum all operators should receive basic training in light science light based hair removal and the safe use of laser IPL devices No two devices are identical in the way they deliver light energy so it is vital to obtain training Contact DermaMed Solutions LLC for training opportunities INTRODUCTION Lasers and intense pulsed light IPL devices have been used in aesthetic applications now for more than ten years In that time both the technology and treatment practices have improved Today people with almost all skin types can take advantage of light based treatments for long term hair reduction Lasers and IPL devices target melanin in hair follicles Light absorbed by melanin is converted into heat that in destroys the cells responsible for hair regrowth Very dark skin types may not be appropriate for light based treatment because high levels of melanin in the epidermis absorb light energy and increase the risk of epidermal damage Red head blonde and grey white hair types respond poorly to light based treatments because their folli
22. le c Sufficient heating destroys surrounding cells and prevents growth of new hair Protecting the Epidermis Because the epidermis also contains melanin which gives skin it natural color care must be taken to select appropriate energy levels that effectively remove hair without damaging the surrounding epidermis Similarly suntan and fake tan absorb light energy like naturally dark skin and light based hair removal treatments should be delayed until all active tan and fake tan has subsided Characteristics of Light that Affect Absorption As you might expect the amount of radiant energy that will be absorbed by a tissue also depends on characteristics of the light source specifically energy level applied the wavelengths of the light the spot size of the delivery device and the duration of each pulse of light Wavelength The wavelength of the light energy is a key parameter that affects the interaction between a light and the tissue IPL devices produce mostly visible broad band wavelengths of light Potentially harmful short wave UV light lt 400 nm is filtered out by the lamp itself and hardly any long wave infrared light is produced by a xenon lamp The remaining wavelengths between 530 nm and 1000 nm are well absorbed by melanin 1 80E 04 7 of a 1 u L60E 04 1 AD64 04 1 20E 04 LOOE 04 sity arbitary 00E 04 Wen amp 00E 04 4 00E 04 2 00E 04 4 TODE 0 IPL wavelengths and absorption
23. mbrane of the anal area directly e Inmales treating the penis should be avoided j Gap between treatments 4 weeks Number of sessions tvpicallv from 8 sessions 39 Intimate body areas treatment procedures If you are requested to do treatments on patients wishing to have intimate areas treated male or female these are the following procedures you should consider If you not wish to do this treatment don t Another member of staff may be present for additional personal security Always respect the privacy and dignity of the patient More cooling gel than normal should be applied to delicate areas Cooling should be extended for delicate areas 40 HANDLING TREATMENT RELATED PROBLEMS After treatment the skin may be red and feel warm These normal transient changes should disappear within minutes or a few hours 24 hours at the most More severe treatment related side effects may also occur with overtreatment They may appear immediately or shortly post treatment 0 24 hrs in rare cases late emerging side effects typically 24 72 hrs may occur bcs Bakka a Treatment related Side Effects i Post Treatment Excessive persistent heat and redness Damage to natural skin texture crust blister burn Edema fragile skin purpura Late Emerging Change in pigmentation hyper and hypo pigmentation Excessive hypo pigmentation or scarring Prolonged itching in the treatment area Ineffect
24. nd patient documentation is available for reference Check availability of all required supplies couch roll razors gloves tissues refrigerated clear ultrasound gel wooden spatulas skin cooling gel packs white marker pencils wipes post treatment skin calming lotion such as dmSkincare s derma renewal gel etc Close the entrance door to prevent unauthorized entry and to protect the privacy and dignity of the patient by suitable means e g use towels during intimate area treatment eye safety etc Check ventilation extractor fan air conditioning etc Contact your Laser Protection Advisor for further assistance on safety issues 20 Patient Preparation Check List Ensure all patient questionnaires general medical history and consent forms are completed and signed by the patient and the operator Consent Forms should ideally be signed each time before an IPL treatment Ask patient to remove all jewelry make up deodorant etc in the treatment area The treatment area or test area should be shaved before treatment The patient should attend with unwanted hair present at least stubble a few mm long so that the operator can check hair thickness and color at the treatment site accurately Prepare treatment area 2 Apply cold gel 3 Apply light Hair removal treatment sequence Remove any loose hairs from shaving using gauze or adhesive tape as hair left on the skin surface will absorb Quadra Q4 IPL en
25. ng gel packs aloe vera gel etc can improve patient comfort and reduce post operative erythema 43 REFERENCES BIBLIOGRAPHY Ancona D Stuve R and Trelles MA A multi centre trial of the epilation efficacy of a new large spot size constant spectrum emission IPL device Journal of Cosmetic and Laser Therapy 2007 9 139 147 Ash C Town G and Bjerring P Relevance of the structure of time resolved spectral output to light tissue interaction using intense pulsed light IPL Lasers in Surgery and Medicine 2008 Vol 40 2 83 92 Ash C Town GA Martin GR Preliminary trial to investigate temperature of the iPulse glass transmission block during treatment of Fitzpatrick I IV V and VI skin types Lasers Med Sci 2006 22 1 4 9 Clement M Daniel G amp Trelles MA Optimising the design of a broad band light source for the treatment of skin Journal of Cosmetic and Laser Therapy 2005 7 177 189 Omi T and Clement M 7he Use of a Constant Spectrum Uniform Temporal Profile Intense Pulsed Light Source for Long Term Hair Removal Journal of Cosmetic and Laser Therapy 2006 8 138 145 Town GA Ash C Eadie E Moseley H Measuring key parameters of intense pulsed light IPL devices J Cosmetic Laser Therapy 2007 9 3 148 160 Vedamurthy M and Town G Use of Intense Pulsed Light IPL in Skin Types IV and V An Indian Experience Australasian Journal of Cosmetic Surgery 2008 Vol 4 1 64 73 44
26. ntial contraindications Determining the patient s skin type Answering any questions the patient may have Helping set realistic patient expectations about the outcome of the treatment Obtaining informed consent and reviewing with the patient Performing a test treatment for suitable patients to establish predicted treatment parameters Carefully recording all relevant information gathered Setting a follow up appointment to evaluate the test and begin treatment Sending the patient home with instructions for pre treatment skin care Skin Analysis Fitzpatrick Skin Typing Skin type is one of the most important factors in identifying whether patients are appropriate candidates for light based hair removal and in determining initial treatment parameters Skin is most often classified based on the Fitzpatrick Skin Classification Scale The scale classifies skin based on complexion pigmentation and tendency to burn According to Fitzpatrick skin can be classified according to six types as shown in the table and figure Fitzpatrick Skin Classification Scale Caucasian Always burns Very light complexion never fans Light eyes Freckles Usually blond or reddish hair color Caucasian Usually burns Light complexion tans with difficulty Light eyes Occasional to frequent freckles Blond reddish light brown hair color Darker Caucasian light Asian Sometimes mild Medium complexion burn gradually Light to dark eyes ia Hair color
27. ormonal and can take many sessions to control Use a piece of white Fibrella cloth white card or white adhesive label to shield areas if required Gap between treatments 4 weeks Number of sessions typically 8 10 29 Upper lip When treating hair on the upper lip moustache area remember that the central area below the nostrils nasal alia is particularly sensitive Mostly the upper lip area can be treated with 2 3 shots depending on spot size but an extra shot may be needed at each corner of the mouth just above and lateral to the lip commissure where additional hair growth is often found e Remember to remove alll lip gloss lip salve or make up e Apply white pencil to mask any semi permanent lip liner on the lip margin e Shield the lips with damp cotton wool or white adhesive label before treating e Use gel sparingly as it can easily obstruct the nostrils which is unpleasant for the patient Gap between treatments 4 weeks Number of sessions from 10 sessions 26 Chin area Hair growth under the chin sub mental area can be dense and coarse and care should be taken with fluence settings Reduce fluence over the bone Perform test areas under the chin if possible Change positioning depending on the shape of the chin Press light guide firmly to bring the light energy closer to deep follicles Avoid over treating the lower third of the neck which does not heal easily Gap betwe
28. t more sensitive towards the middle of the treatment A single row of 4 5 shots is usually sufficient on most patients Gap between treatments 4 weeks Number of sessions typically 6 8 sessions 38 Bikini line There are three different types Bikini Extended and G String The simplest is the Bikini which follows the line of the underwear beware oniv treat with white lingerie which is usually described as the upper groin area The Extended bikini line refers either to the inner groin area or front of thighs G String describes an area including the natal cleft area around but not including the anus Only experienced therapists should attempt these treatments with IPL e Patients should be provided with disposable white cotton g strings On no account treat over dark colored underwear as it will absorb IPL energy e Start from the least sensitive and lightest area of the groin at an appropriate fluence for the skin color see Treatment Parameters It is recommended to treat both upper groin areas before moving on to the next area as the machine settings will usually be similar e When treating the Extended bikini line it will normally be necessary to adjust the parameters to accommodate the darker pigment in this area Again treat both areas at the same time Finally for the G String particular care should be taken to further reduce fluence where necessary and avoid treating the mucous me
29. teristics emerging as occurs in women such as upper lip whistle lines White hair in older males usually needs some additional electrolysis treatment to remove these resistant hairs completely Gap between treatments 4 weeks Number of sessions typically 8 10 full beard removal will 15 sessions 28 Hairline The hairline has a high percentage of anagen hairs and therefore may be treated every 4 weeks or less Remember to cover the rest of the hair with a white headband or towel to protect follicles along the hairline e Use a mirror with your patient before treatment so you can discuss areas precisely e Remember to reduce the fluence over the bone e Try not to overlap pulses Gap between treatments 4 weeks Number of sessions typically from 8 sessions 29 Middlebrow The hair between the eyebrows should be treated with caution Particular care should be taken at the edge of eyebrows where angled growth of hair follicles may lead to unwanted reduction Where space is insufficient for the size of the crystal block it may be necessary to shield the rest of the eyebrows with white self adhesive labels e Place opaque eye shields or cotton wool pads over the eyes e Apply sufficient cooling gel e Use a single shot only e Avoid treating eyebrows for shaping reasons as the hairline may appear permanently notched or broken following treatment as precise hair follicle position in the eyebrows is difficult to
30. that have experienced treatment related side effects when the areas have healed fully and only after testing is repeated Adverse Incident Procedure If anything goes wrong during treatment such as serious skin reaction excessive pain patient taken ill etc treatment should be stopped immediately Appropriate information should be recorded in the patient notes including the extent of the partially completed treatment and details of any untoward side effects Serious skin damage should be referred immediately to the Emergency Department of the nearest hospital or via the patient s doctor to an appropriate medical specialist if necessary In all cases of eye damage or suspected eye over exposure to the Quadra Q4 flash an immediate eye test by an ophthalmic specialist should be arranged through a doctor or the Emergency Department of the nearest hospital Adverse Event Reporting Adverse event reporting requirements vary by state Serious adverse events are those involving death life threatening injury hospitalization disability or congenital abnormality as well as those that require intervention to prevent permanent impairment or damage In general serious adverse events must be reported to regulatory authorities in a timely manner Procedure in the Event of Equipment Failure In the event of equipment failure treatment should be abandoned immediately and the emergency stop button pressed and or the key removed to prevent any r
31. usually brown to dark Mediterranean Asian Hispanic Rarely burns tans Darker complexion with ease Dark eyes Dark brown to black hair color Middle Eastern Latin American light Very rarely burns skinned black Indian tans very easily Dark complexion Dark eyes Dark brown to black hair color Dark skinned black Never burns tans Black complexion very easily Black eyes Black hair color Visual representation of the Fitzpatrick Skin Classification Scale Contraindications Patients with any of the following contraindications should not be treated with IPL unless a letter from the patient s primary care physician is available confirming that the patient can be treated safely Tanned skin active tan through sun exposure or tanning bed use in the previous 30 days because of increased risk of hyper pigmentation Waxing plucking sugaring or threading depilation treatment of the area in the previous 4 6 weeks because the follicle has been removed Hypopigmentation e g vitiligo Any inflammatory skin condition e g eczema active Herpes Simplex etc at the treatment site because it may aggravate the condition Presence or cancer or current cancer drug therapy History of keloid scarring because any IPL burn may produce a keloid scar Epilepsy because repeated consecutive flashes may induce a fit Use of St John s Wort herbal remedy in the past 3 months for depression due to photosensitivity
32. vious gaps Put the Quadra Q4 into STANDBY Remove safety eyewear If using gel once the area has been treated remove the ultrasound gel using a spatula and then tissues 23 Check the area for redness and record in patient notes Apply ice or a cooling gel pack to any sensitive areas if required Apply a calming lotion such as dmSkincare s derma renewal gel or D20 solution Always use a sunscreen of SPF 30 or higher We recommend dmSkincare s daily eclipse SPF 30 physical sunscreen Complete the patient treatment notes and record any unusual occurrence Provide post treatment advice and take home information sheet found at the end of the manual Book your patient s next treatment Switch off the Quadra Q4 clean the crystal treatment guide with a moist tissue or an isopropyl wipe and prepare the room for the next patient 24 PRACTICAL TIPS BY BODY AREA All areas of the body can be treated except inside the orbit of the eye eg underneath the eyebrows or on mucous membranes eg inside nostrils ears etc Facial Area Make a line of treatment spots down the face along the jaw line and add rows above as necessary where hair removal is needed until all required cheek areas are covered Pay particular attention to the following points Avoid accidentally treating the scalp hair Do not promise long term hair reduction on vellus or accelerated long vellus hair Remember the hair growth you see may be h
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