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
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Blood and lymph vessels are compressed
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Accumulation of intercellular fluids and physiological waste
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Cellulite and Circumference
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Heredity

Hormones

Smoking
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Lack of exercise
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Poor diet
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Physiological status
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Factors inducing Cellulite
Classification of Cellulite

Class 1:
 No spontaneous dimpling
 Pinch test positive for dimpling
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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
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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
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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
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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

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 IR
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 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
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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
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Stimulation of fibroblasts for collagen synthesis ↑↑
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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
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Proper patient selection
 Aligning expectations
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Pre-treatment :
 Exfoliate the skin
 Avoid anticoagulants if medical condition permits
(advisable)
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Weigh patient, photograph and measure circumference

Define treated areas, and set treatment parameters
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 Shave hair (advisable)
Clinical Procedure
Patient Selection
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Skin type I-VI

No medical contraindications to IR/RF/Vacuum treatment
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Not recommended to treat:
 Varicosity
 BMI > 30
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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:
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Backward & Forward/ Forward: preferred motion
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Possible with Small
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Circular, Zig-Zag: reinforcement motions
Small Applicator
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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)
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Step 2: treat another area till endpoint (or wait) (~5 minutes)
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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
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Increase for deep treatment
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Reduce on sensitive areas (e.g., inner-thigh), or on loose skin
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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)
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Cellulite improvement (later)
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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