Transcript Slide 1

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Trivantage
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–Tattoo
Second
level & Benign Pigmented Lesions
Removal
• Third level
– Fourth level
» Fifth level
Patient Selection
• The 532nm and 755nm wavelengths should only
be used on skin types I-IV as they have greater
absorption by the skins natural melanin
• The 1064nm wavelength can be used on darker
skin types IV-VI and test spots are highly
recommended.
• All patients should avoid sun exposure, tanning
beds, and sunless tanning products for 1 month
prior to treatment
How Does the Laser Work?
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Photo-acoustic vs. Photo-thermal
Targets colors of tattoo pigment or melanocyte
Blue/Black/Red/Green/Brown respond well
Orange/Yellow/Powder Blue/Pink Do Not
Breaks down pigment into smaller pieces
Phagocytosis clears the area
Selective Photothermolysis & The Photo-Acoustic Effect
- 755nm, 532nm, 1064nm emission is highly absorbed by
melanin and dark tattoo particles
• These wavelengths penetrate from 1 to 4 millimeters into the
skin
• Nanosecond pulse duration is shorter than the thermal
relaxation times of the smallest targets
• Tattoos & Pigmented Lesions are affected not only by Selective
Photothermolysis, but also subsequent photo-acoustic
shockwaves that cavitate the smallest ink particles/melanocytes,
promoting phagocytosis
Pigment Absorption
The Shorter the Pulse the Greater the Fracture of the Tattoo Pigment
Wavelengths
• 755 nm should be used for GREEN & BLUE
• 532 nm should be used for RED & BROWN
• 1064 nm should be used for BLUE & BLACK
Alex TriVantage
New 1064 & 532 Hand Pieces
• Laser Pumped Laser
• The laser produces a
755nm wavelength that will
pass through a Nd:YAG
medium creating a 1064nm
wavelength
• For the 532nm wavelength
it passes through two
mediums
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– Second level
Types
• Third level
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of Tattoos
Tattoo Categorization
Tattoo Type
Pigment Type
Ink Concentration
Pigment Depth
Professional
Organometallic Dyes
Dense
Deep
Amateur
India Ink (Carbon)
Sparse
Variable
Cosmetic
Iron or Titanium Oxide
Sparse
Superficial
Traumatic
Carbon, Metals, Dirt
Variable
Variable
Medical
India Ink (Carbon)
Sparse
Superficial
Tattoo Clearance
Tattoo Type
Number of Treatments
Professional
6 to 12
Amateur
2 to 6
Cosmetic
1 to 4
Traumatic
2 to 6
Medical
2 to 6
Professional Tattoos
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Done by tattoo parlors
Ink is deposited deeper in dermal layer
Quality of ink is greater
Requires far more treatments than other
tattoo categories
Amateur Tattoos
• Performed crudely by friends
• May appear grey or blue/black in color
• Variances in amount of ink and depth of
penetration
• Not particularly clear with clean definition
Cosmetic Tattoos
• Typically applied by an
authorized/certified cosmetologist
• Lip liner, eyeliner and eyebrow tattoos
are very popular
• Pigment is deposited very
superficially
Traumatic Tattoos
• Result of mechanical penetration of a foreign
body such as glass, metal or dirt
• Can potentially be embedded so deeply that
removal is tough
Medical Tattoos
• Tattoos placed for purposes of marking
radiation ports or for catheter placement
• Appear lighter in color (blue/black or grey)
• Unfortunate reminder to patient
• Physician release recommended prior to
treatments
Clinical Endpoints
• When using the 755nm wavelength
– Start with a low recommended fluence, perform a test
spot and look for the appropriate skin response
– Slight frosting of the skin
• If little or no tissue response is noticed, increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
Clinical Endpoints
• When using the 532nm wavelength
– Start with a low recommended fluence, perform a test
spot and look for the appropriate tissue response
– Slight frosting of the skin
• If little or no tissue response is noticed, increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
• Purpura, or bruising is possible due to absorption by
competing blood vessels
Clinical Endpoints
• When using the 1064nm wavelength
– Start with a low recommended fluence, perform a test
spot and look for the appropriate tissue response
– Slight raising of the skin appearing opaque
• If little or no tissue response is noticed, increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
– Always perform test spots on darker fitzpatrick skin
types (IV-VI)
Treatment Intervals
• Time between tattoo removal treatments is
recommended between 8-12 weeks
• Performing re-treatment too soon may interfere with
macrophage activity
• It should be noted that increased fluence may
improve efficacy, however; it also increases the
potential for adverse skin reactions (scarring).
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– Second
level Pigmented
Benign
• Third level
– Fourth level
» Fifth level
Lesions
Benign Pigmented Lesions
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Solar Lentigines
Dyschromia
Freckles/Ephelides
Cafe-au-lait/Pigmented Birthmarks
Nevus of Ota
Clinical Endpoints
• Endpoints are the same as with tattoos
– Slight frosting of the lesion
– Try to avoid pinpoint bleeding
• If little or no tissue response is noticed, increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
• Usually takes fewer treatments (2-3 on average)
than tattoos as they are more superficial
Treatment Intervals
• Time between pigmented lesion treatments is
recommended between 4-6 weeks for most lesions
• Nevus of ota should be re-treated at 8-12 weeks
• Lesions treated with the micro-second pulse
duration should also be re-treated at 8-12 weeks
Pigmented Lesions
• The Alex Trivantage at
755nm has the option of
treating pigmented lesions
with a 100 µs pulse
duration
• Fluences will be higher
than those used with the
50ns
• Judge tissue response
accordingly
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– Second
level
Treatment
• Third level
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Instructions
Pre-treatment Instructions
• Topical Anesthetic may be used
– LMX-4, Emla, or a B.L.T. (benzacaine, lidocaine,
tetrocaine) compound are frequently used
• Area MUST be cleaned prior to treatment
Post-treatment Instructions
• Clean area
• Apply dressing to treated area
– Apply ointment to keep area moist (Aquaphor,
bacitracin or even Vaseline are commonly
used)
– Cover area and ointment with a non-stick
dressing (telfa)
• Advise patient to keep clean and to not pick,
scratch or aggressively wash the treated
area
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Operation, Safety &
– Second level
• Third levelMaintenance
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General Specifications
• Repetition rates:
– 1, 2, 3, 4, 5 Hz
– Hz = pulses per second
• Spot sizes are:
– 755 nm – 2mm(Gold), 3mm(Black), 4mm(Red)
– 1064 nm – 2mm(Gold), 3mm(Black), 5mm(Red)
– 532 nm – 2mm(Gold), 3mm(Black), 5mm(Red)
Wavelength & Spot Sizes
Wavelengths & Spot Sizes
Protective Eyewear
• Since the Alex Trivantage
has 3 different
wavelengths, the
appropriate eyewear must
be worn at all times
• This includes proper
Optical Density AND
wavelength
• The Alex Trivantage has a
screen reminding users of
these requirements
Eye Safety
** WARNING **
• The Alex Trivantage 532nm and 1064nm hand pieces contain
lasers and require special handling considerations for optimum
performance and safety.
• Unlike the 755nm hand pieces, these hand pieces deliver a
non-diverging beam. If you pulse the laser with the hand piece
aimed at the wall, floor, or other object several meters away, it
will create a burn mark
• Always take precaution to ensure that all persons in the room,
while the laser is in use, utilize the appropriate eyewear.
Appropriate Eyewear
• 532nm @ 6.0 Optical Density
• 755nm @ 6.8 Optical Denisty
• 1064nm @ 5.7 Optical Density
Other Safety Concerns
• The Alex Trivantage 532 nm and 1064 nm hand
pieces contain Factory Aligned Lasers and require
special handling considerations for optimum
performance and safety.
• The Hand Pieces can break
• SOMEONE COULD GET HURT
Other Safety Concerns
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DO NOT DROP THE HAND PIECES!
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The internal components are fragile! They are factory
aligned under strict environmental conditions – cannot
be repaired in the field!
Handpiece Storage
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ALWAYS store the hand pieces in the top
compartment of the laser.
The lid should be kept OPEN after the laser has
warmed up and close the lid when the laser is
off.
Temperature control issues.
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New hand pieces need to be warm before use
Not too warm as with the cover closed and
running).
Foot Pedal Safety
• Prior to performing treatments
• Ensure that all personnel in the treatment room are safe
by locking the front wheels and visually checking that
the footswitch air hose is free and clear.
• If the laser or anything else rolls on the hose while firing
the laser, it will continuously pulse non-stop
unexpectedly.
• The Emergency Stop Button will be your only way to stop
the laser from pulsing.
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– Second level
User
• Third level
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» Fifth level
Interface
User Interface
• 755nm wavelength
has a RED
background
User Interface
• 532nm wavelength
has a GREEN
background
User Interface
• 1064nm wavelength
has a VIOLET
background
User Interface
• Each wavelength has
an Applications dropdown menu
• Press Applications
• Select Application
User Interface
• Once Application is
selected, a default
setting for that
Application will appear
• If these parameters are
acceptable, press
calibrate
User Interface
• Confirm selected
parameters and
depress foot pedal to
begin calibration
process
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Identification, Use & Cleaning for
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Alex
TriVantage / Alex 2
– Second
level
• Third level
Distance Gauges
– Fourth level
» Fifth level
*NEW Multi-Spot Distance Gauges
• Compatible with ALL
wavelengths
• Compatible with ALL spot
sizes
• Improved treatment area
visibility
• Application and Removal
are a “Snap”
Multi-Spot vs Old LPL Distance Gauges
• New Multi-Spot DGs
replace older LPL DGs
• First set of Multi-Spot DGs
are FREE (will be received
in the mail)
• Old LPL DGs will be
obsolete
• May be best to discard old
LPL DGs
*NEW Multi-Spot Distance Gauges
• Laser neutral materials
and colorant prevent
gauges from heat build up
• A 2.5 cm source to skip
distance ensures optimal
755nm beam focus
• A smooth molded surface
finish makes cleaning and
disinfection easier.
New Distance Gauge Maintenance
• O-ring keeps protective lens
locked into position
• O-ring can be removed
similarly to other distance
gauges
• DG window should be cleaned
or replaced as described in the
“Alex2/Alex TriVantage DG
window cleaning &
replacement procedure” (850200-0916 Rev C. or later)
Multi-Spot DG
Multi-Spot DG
Protective Window
O-ring
Distance Gauge Differences
755nm “Fingernail type”
Distance Gauge
532/1064nm LPL “Ring Type”
Distance Gauge
DG Window Differences
ALX-44-LPWN
ALX-44-07WN
ALX-44-XXXX (Multi-Spot)
**THESE ARE NOT INTERCHANGABLE
Most reliably
sorted by their
size, the glass
window inserts
for the two
distance gauges
are different and
cannot be mixed.
755nm Distance Gauges
• The 755nm Distance Gauges (DGs)
have a finger nail like probe
• These DGs fit inside the end of the hand
piece
• Older AlexLAZR DGs do not have a
protective window.
• Newer AlexLAZR and ATV DGs have a
protective window
• The same 755nm DGs can be used with
the 2mm, 3mm and 4mm hand pieces
LPL Distance Gauges
• The 532/1064nm LPL Distance
Gauges (DGs) have two legs and
target ring at the tip
• The LPL DGs fit over the end of the
hand piece
• They have protective windows that
must be cleaned periodically
• They fit all spot sizes: 2mm, 3mm,
4mm, and 5mm hand pieces
Important Notes
• The Laser Pumped Laser (LPL) distance gauges are designed to
be used only with the 532nm & 1064nm hand pieces
Important Notes
• When using the 755nm hand piece, the fingernail DG
should always be used
• This DG has a window that improves reliability of the
delivery system by protecting the 755nm HP optics
• This window must be cleaned to maintain proper system
output
Alex TriVantage vs AlexLAZR
• The AlexLAZR distance gauge DID
NOT have a window
• Many practitioners may not be used
to cleaning or maintaining these new
windows.
• DG window should be cleaned or
replaced as described in the
“Alex2/Alex TriVantage DG window
cleaning & replacement procedure”
(8502-00-0916 Rev C. or later)
Warning!!
• It is important to inspect and clean the DG window frequently so
debris does not get burned into its surface
• If the optical coating on the DG window develops burn marks, the
amount of energy reaching the treatment area may be significantly
reduced or the laser beam may be deflected resulting in the HP or
DG becoming damaged
• Burn marks on the coating may occur due to several reasons:
– Dust/debris collecting on the surface and then being burned on
via the laser beam
– Debris collected during normal attachment of the DG to the HP
body (keep the DG clean)
Identifying Burn Marks
• Hold the DG at an angle such that light is reflected off
the window surface
• Burn spots will appear as small discolored rings/spots
on the surface
• Their size (specks of dust to a pencil point) will vary
depending on the extent of debris build up and the time
burning has occurring
• Minor burn marks may be cleaned off. If unable to
remove, further rapid degradation at these spots should
be expected to occur
Adverse Consequences of Burn Marks
• Reduced delivered fluence to the treatment area as
more energy is deflected or absorbed by the burn area
and therefore not reaching the treatment area
• Increased heat build up noted in the HP possibly
resulting in frequent or unexpected system faults
• Burn marks can cause rapid degradation of the DG
window
Inspection Procedure
• Wear dustless gloves to prevent smudges or fingerprints
on the window
• Place the laser in stand-by and remove the DG from the
HP assembly
• Look through the DG window while pointing the DG’s far
end towards the ceiling light
• Rotating the DG at this position will cause debris on the
window to rotate, making it more apparent
Removing the Window
• Working over a clean surface, remove the O-ring that is holding
the window in place
• Use tweezers, or a pointed object in notch to gently pull the O-ring
towards the center of the window until the O-ring is free from the
groove
• Turn the DG upside down allowing the window to fall out (if
needed, gently tap the side of the DG with your finger)
Cleaning the Window
• When cleaning used windows, use a 10% bleach &
water solution, mild soap & water or alcohol
• Rinse thoroughly with clean water and dry with a lint
free tissue
• Re-inspect the window and compare with the window
Acceptability Chart (see next slide)
• If unacceptable, replace the window
Window Acceptability Chart
Acceptable window Examples:
Unacceptable window Examples:
Replacing the Window
• Grasp the window by the edges and place it back into
the DG so it is resting flat on the ledge
• Re-insert the O-ring into the groove.
• Use tip of tweezers or pointed object and gently push
the O-ring fully into the groove being careful not to
touch the window
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– Second level
Thank You
• Third level
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» Fifth level