Syneron Training - Operational Excellence
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Transcript Syneron Training - Operational Excellence
VELASMOOTH PRO
CLINICAL PRESENTATION
January 2010
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Subcutaneous Tissue
Anatomy & Histology
Superficial plane: <15 mm from skin surface
(this area includes dermal and sub-dermal zones)
VelaSmoothPro
II, LipoLite
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LipoLite
Liposuction
Subcutaneous Tissue
Anatomy & Histology
A person’s body layout depends on:
Pattern of adipocytes distribution
Increased size of fat cells (hypertrophy)
Enlargement of the number of adipocytes (hyperplasia)
Fat-cell replication by postadipocytes
Eating and exercise habits
Poor lymphatic drainage
Major human fat depots-
white adipose tissue
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What is the etiology?
Atrophic degeneration of the hypodermal and dermal zones:
Hypertrophic and hyperplasic changes
of the fat cells
Poor blood flow and lymphatic drainage
Glycation of collagen and hypertrophic septae
Resulting in
Favorable environment for fat cells having a relatively
low metabolism
Cycle of atrophy leading to
- Increased circumferences
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- Bumpy appearance (cellulite)
Fat cells swell and push skin upwards as septae are rigid
Blood and lymph vessels are compressed
Accumulation of intercellular fluids and physiological waste
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Cellulite and Circumference
Heredity
Hormones
Smoking
Lack of exercise
Poor diet
Physiological status
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Factors inducing Cellulite
Classification of Cellulite
Class 1:
No spontaneous dimpling
Pinch test positive for dimpling
Class 2:
Spontaneous dimpling
while standing
Class 3:
Spontaneous dimpling while
standing and lying
(morbid obesity or menopausal)
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Regulatory Clearance
Indications For Use
FDA, CE
The VelaSmoothPro II is indicated for:
Temporary reduction in the appearance of cellulite
Temporary reduction of thighs circumferences
Temporary improvement in the local blood circulation
Relief of minor muscle aches and spasms
Additional treatment programs:
Post-liposuction treatment via circumferential reduction
Post-baby treatment via circumferential reduction
* CE only
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Body contouring*
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Features and Benefits
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VelaSmoothPro Platform
What is VelaSmoothPro?
More powerful - RF energy increased by 75% to 35 Watts
Higher efficacy
Faster patient’s turnover
Disposable applicator Covers – ‘per patient’- Large: 16H / Small: 4H
Optimize treatment results
Eliminate cross contaminations
Improved quality and reliability
Higher patient comfort
Easier and more comfort for operation
Diagnostic Terminal
Better control of patients treatment protocol
Monitors device’s activity and performance
Intuitive feedback for user
Service diagnostics
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The Technologies
Vacuum (Suction)
Infrared (IR)
Radiofrequency (bipolar RF)
Mechanical massage (Rollers)*
*Large appl. only
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Applicators Specifications
Small
Applicator
RF Power
Up to 35W
Up to 8W
IR electrical power
Up to 35W
Up to 20W
Spot Size
40x40 mm
30x30 mm
Penetration
5-20 mm
Wavelength
700-2000 nm (Broad Band IR)
Vacuum
Pulsed 180-380 mbar
Disposable covers
16 hrs
4 hrs
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Large
Applicator
The Technology
Large
Applicator
Small
Applicator
RF
IR
Vacuum
Massage (Rollers)
-
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VelaSmoothPro Applicators
VelaSmooth / VelaSmoothPro
Specs.
RF electrical power
VelaSmoot VelaSmoothP
h
ro
20W
35W
35W
35W
?
420 mbar
30 hrs/10 hrs
16 hrs/10 hrs
8W
8W
20W
20W
?
340 mbar
10 hrs
(cover with filter)
4 hr/4 hr
Alternate filter for every
treatment
Communicatio
n Terminal
-
+
Dual
Connector
-
+
IR electrical power
Large
Vacuum
Disposable covers/filters
RF electrical power
IR electrical power
Small
Vacuum
Disposable covers/filters
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Applicator
Consumables
Large covers
5 pack
Bundle box
1 large 5pck+ 1 small 5pck
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Small covers
5 pack
Applicator’s operating panels
Treatment Mode
Description
IR mode
Continuous infrared light energy is applied
RF mode
Radio frequency current is applied
Vacuum mode
Applicator cover indicators
Pressing this button activates the vacuum pump
Green LED: cover is operative and installed properly
Red LED: cover is expired or not installed properly
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Button
Communication Terminal
Communication Terminal Messages:
Ready – the applicator is connected, the
treatment level configured, but the trigger
is not yet pressed.
Treatment - the applicator is connected,
the treatment level configured, and the
trigger is pressed.
Not Available – the applicator is not
connected.
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Also various Maintenance or Error
messages will be displayed, these appear in
the troubleshooting guide in User Manual.
Communication Terminal – info button
System Type – VelaSmoothPro
VelaSmoothPro - System S/N – the
system's factory serial number.
LA/SA S/N – the Large applicator or
Small applicator type and factory serial
number.
LA/SA Working Hours – the total
number of hours already performed by
the connected Large or Small applicator.
Disposable Status – how much time
remains to operate the disposable
covers.
System Freq: 50 or 60 Hz – the system's
electrical frequency
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VelaSmooth Treatment Mechanism
Vacuum Effects
Improved blood supply:
90% of vessels are compressed at normal atmospheric
pressure
Vacuum also enables deeper penetration of RF
Fibroblast stimulation
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Applying negative pressure → vessel dilation and blood flow
↑↑
VelaSmoothPro Treatment Mechanism
Mechanical Effect of Rollers – Massage
Mechanical massaging effect enhances drainage of
trapped intercellular fluid to lymphatics
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VelaSmoothPro Treatment Mechanism
Deep Heating by IR + RF
IR light heats the tissue down to the deep dermis
RF heats tissue down to the subcutis
Parabolic
reflector
Lamp
Infrared filter
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RF electr odes
VelaSmoothPro Treatment Mechanism
Heating Effect On Oxygen Diffusivity
Oxygen Diffusivity in Water
Temperature,
˚C
Viscosity of H2O,
centipoises
Diffusivity of O2,
cm2/s
20
1.002
1.97x10-5
40
0.653
3.24x10-5
50
0.547
3.99x10-5
Heat increases oxygen diffusivity →
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delivering more oxygen from capillaries to fat cells
VelaSmoothPro Treatment Mechanism
Heating Effect On Metabolism
Deep heat is produced by IR/RF in dermal blood vessels
→ Oxygen dissociation from Oxy-Hb ↑↑
→ Extravasation of nutrients and oxygen ↑↑
Fat metabolic reactions in fat cells ↑↑
Extended use of stored energy from fat cells (lipolysis)
results in shrinkage of cells themselves
Stimulation of fibroblasts for collagen synthesis ↑↑
Collagen shrinkage for overall skin surface improvement
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• The septae, and consequently the fat chambers, shrink
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The science of Vela – Biological Model
Clinical Procedure
Pre-Treatment
Proper patient selection
Aligning expectations
Pre-treatment :
Exfoliate the skin
Avoid anticoagulants if medical condition permits
(advisable)
Weigh patient, photograph and measure circumference
Define treated areas, and set treatment parameters
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Shave hair (advisable)
Clinical Procedure
Patient Selection
Skin type I-VI
No medical contraindications to IR/RF/Vacuum treatment
Not recommended to treat:
Varicosity
BMI > 30
Marginal results with:
Obese patients
Patients with edema due to lymphatic drainage problem
Avoid thyroid area if there are thyroid pathologies
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Clinical Procedure
Patient Selection
Aligning expectations
Improvement – not elimination
Temporary results – maintenance is essential
Skin tightening by RF may occur
Not for excessive loose skin
Stretch marks may improve – not always
Diet and exercise may improve results – not essential
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Weight gain may worsen results
Clinical Procedure
Defining Treatment Areas
Large:
Treatment area: thighs / buttocks / abdomen
Each area divided into strips
Each strip: ~30 cm long and as wide as the Large applicator
Small:
Arms / calf / bra-line / flanks
Curved areas and localized fatty deposits
~15x20 cm (large hand palm)
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Possible to combine Large and Small
Clinical Procedure
Recommended Treatment Motions
Large Applicator
Work in motion to achieve best contact:
Backward & Forward/ Forward: preferred motion
Possible with Small
Circular, Zig-Zag: reinforcement motions
Small Applicator
Stacks: preferred motion
Possible with Large, when movement and seal are difficult,
Zig-Zag
Stacks
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Backward & Forward
Forward
Circular
Clinical Procedure
Large Applicator& Small Applicator
Applying the applicator:
In a perpendicular orientation to the skin
With slight pressure for good contact
10-20% overlap
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Release trigger before lifting applicator from skin!
Clinical Procedure
Desired Endpoint
Immediate response:
Persistent radiant heat (>40-42˚C) for at least 5-10 min
Can be felt ~5 mm above the skin or using IR thermometer
Erythema/edema accompany heating but are not the endpoint!
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Dermal Skin
Skin Surface
45˚C
40˚C
Clinical Procedure
Large Applicator Treatment Procedure
Reaching end-point on an anatomical area:
Treat 1 strip repeatedly until endpoint
Move to adjacent strip and treat similarly
Reinforce: cross-hatched pass on all previous strips,
following each new strip, to sustain heat
Enhanced mode:
Step 1: reach endpoint in a certain anatomical area (~10 minutes)
Step 2: treat another anatomical area till endpoint (~10 minutes)
Step 3: return to first anatomical area (after ~10 minutes)
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and repeat procedure till reaching endpoint again
Clinical Procedure
Small Applicator Treatment Procedure
Reaching end-point on a small area:
Treat the whole area with “Stacking”
(up to 15 pulses on each spot)
Reduce number of stacked pulses each successive pass*
Enhanced mode:
Step 1: reach endpoint in a certain small area (~5 minutes)
Step 2: treat another area till endpoint (or wait) (~5 minutes)
Step 3: return to first anatomical area (after ~5 minutes)
and repeat procedure till reaching endpoint again
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* According to patient tolerance and skin response
Treatment Parameters
Recommended Parameters
For both applicators
Desired Treatment
Cellulite
Improvement
(Upper Hypodermis)
Circumference
Reduction (Deep
Hypodermis)
IR
2-3
1
RF
3
3
1-2
2-3
Vacuum*
IR + Vacuum ≤ 5 (For Safety)
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* Vacuum levels may be reduced according to patient’s tolerance
Treatment Parameters
Selecting And Adjusting
IR
Reduce for deep treatment (to avoid superficial heating)
Reduce on very dark or tanned skin, or when stacking pulses
RF
Set at highest level tolerated
Gradually increase in subsequent sessions
Increase for deep treatment
Reduce on sensitive areas (e.g., inner-thigh), or on loose skin
Adjust according to skin response and patient tolerance
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Vacuum
Clinical Procedure
Short-term effect:
Transient skin texture improvement – after each session
Circumference reduction improvement (before)
Cellulite improvement (later)
8-12 sessions
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Long-term effect:
Clinical Protocol
Treatment protocol is individual:
8-12 sessions
Twice a week
Maintenance treatment:
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One maintenance treatment in the month following the initial
series of VelasmoothPro treatments, followed by once in 2–3
months and then with decreasing frequency as needed.
Combination Treatments with Other Modalities
Alternate with mesotherapy (if same session- Vela first)
5 weeks with meso 1/w and Vela 2/w
Other protocols
Combined Vela with deoxycholate treatment
4 sessions 6 weeks apart
For circumference reduction only
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4-6 weeks post liposuction for homogeneous healing
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Patient Record
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Cellulite and Body Contouring
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Progressive Results
Photos Courtesy of J. Shaul, M.D.
Post 10 Treatments
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Before and After
Before and After
Before
After
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7 days after 11 treatments
Before and After
Before
After
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1 week post 4 treatments
Body Contouring
Post 8 treatments
Photos courtesy of Gerald Boey, MD, Canada
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Before
Cellulite Reduction
Post 7 treatments
Photos courtesy of Gerald Boey, M.D., Canada
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Before
Skin Tightening via Body Contouring
Post 3 treatments
Photos courtesy of Moshe Lapidot, MD, Israel.
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Before
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Thank You
& Good Luck