SHR_IPL HAIR REDUCTION tRAINING MANUAL.pdf

Intense Pulsed Light (IPL)TRAINING Hair Reduction SHR/IPL History IPL stand for Intense Pulsed Light. — First practical laser system was demonstrated in 1960, since then laser and IPL has developed rapidly. — Albert Einstein came up with the theory of light interaction and matter. — Dr Theodore...

Intense Pulsed Light (IPL)TRAINING Hair Reduction SHR/IPL History IPL stand for Intense Pulsed Light. — First practical laser system was demonstrated in 1960, since then laser and IPL has developed rapidly. — Albert Einstein came up with the theory of light interaction and matter. — Dr Theodore Maiman built the first practical laser, this laser took 3 hours to warm up and only a few treatments could be done per day. — IPL technology has come a long way now represents a technological breakthrough for the treatment of various benign skin conditions including unwanted hair, facial blemishes, signs of sun-related aging, broken vessels and Acne. The Interaction between light and skin Light Absorption by Chromophores 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. Skin therapy using IPL consists primarily of creating sufficient heat in the red or brown sundamaged structures of the skin to reduce their appearance or to eliminate them completely. — This result is achieved by light absorption in the melanin of the mottled pigmentation and the oxyhaemoglobin in fine blood vessels. What is light? An IPL machine produces light. But what is light?. •Light is a type of energy from a wide range of energies which are called the Electromagnetic spectrum. •Electromagnetic radiation can be described as a stream of photons, which are mass less particles, each travelling in a wave like pattern and moving at the speed of light. •Each photon contains a certain amount of energy, and all types of electromagnetic radiation consists of these photons. Electromagnetic EMR Electromagnetic radiation — Electromagnetic energy is measured by its wavelength. — Wavelength is the distance from a point on one cycle to same point on next cycle. — Wavelength is a measure of distance, but it depends on the size of the waves as to what the form of measurement is. Light is measured in nanometers nm but smaller waves like gamma and x-rays are measured in picometers, large waves like radio are measured in meters. Wavelength — Wavelength – — Tells us whereabouts in the EM spectrum the energy sits — Determines the colour of the IPL beam. — Is related to the amount of energy the photons carry. — Determines how a beam will interact with tissue. — Determines the depth of penetration into the skin. Filters Most IPL machines come with fixed filters in their handles for treatments such as hair removal and photorejuvenation. You get each of the following filters as standard on your machine: — 420-1200nm - ACNE and (possibly) vascular — 510-1200nm - Photorejuvenation, pigmentation, vascular — 560-1200nm - Photorejuvenation, pigmentation, vascular — 610-1200nm - Hair reduction and deeper pigmentation — 640-1200nm - Hair reduction — 690-1200nm - Hair reduction (darker skin types) — 755-1200nm - Hair reduction (dark skin types) We know that not every person is the same - that is why there are a range of filters that allows you to treat your customers more effectively based on your knowledge of their needs. Hand piece How IPL works Based on the principle of selective photothermolysis, the IPL system emits pulses of filtered light that are attracted to melanin, a pigment found in hair. The light is absorbed by the melanin and transformed into heat, selectively destroying the germinating cells that feed the hair follicles for growth. By eliminating these cells, the hair then dies and begins to fall out, inhibiting future growth. — Similarly, for photorejuvenation, the transmitted light applies heat to the skin, promoting the creation of collagen and elastin fibers to replenish the cells that comprise the skin layers; this process produces a filling effect by thickening and realigning the skin from the inside out. — For pigmentation and blood vessels, Intense Pulsed Light uses light to absorb melanin (the dark pigment in your skin) and haemoglobin (the red colour in your blood vessels). This light converts to heat, which damages the target cells without disrupting the skins surface. How IPL works The light of an IPL system is generated within the treatment head. It contains a flashlamp, filters, reflectors, quartz block and water cooling system. — — — — — — — — Energy from a power source is pumped into a flashlamp Flashlamp is filled with xenon gas This produces photons when stimulated Xenon gas produces broad spectrum light Spectrum ranges from 200-2000nm without filters Filters are used to select wavelengths for specific treatments Reflectors are used to guide the light to the quartz block Light is delivered through a sapphire/quartz Wavelength • • • Frequency is how fast the wave vibrates or goes up and down. Wavelength is the distance between two peaks of the wave. Frequency and wavelength are inversely related meaning that a low frequency wave has a long wavelength and vise versa. Spot size Difference between laser and Intense Pulsed Light FEATURE IPL LASER Colour Polychromatic-many wavelengths produce light made up of several colours which are bent to various degrees. Monochromatic- light is composed of photons all the same wavelength. Direction Divergent- a light bulb emits light in all directions at once. Low divergence- light is emitted and travels as a narrow beam with all beams parallel to each other. Coherence Incoherent- no relationship or order between wavelengths. Coherent- the waves are highly ordered in space and correlated in time. can be focused to a very small spot size. Power Low power density- power density is the power divided by the area of the beam. Focused beam- laser beam can be focused into a very small area which increases its intensity. High density. Light and tissue interaction When light falls on tissue it interacts in a number of ways. Selective Photothermolysis For selective destruction of the target without thermal injury to surrounding tissue, the following requirements are needed: — Light of a specific wavelength is selectively absorbed by the target chromophore § Sufficient fluence(energy) reaches the chromphore to cause the desired effect § Exposure (pulse width) is limited to less than the thermal relaxation time of the chromophore. § RESULT= selective destruction of the target without thermal injury to the surrounding tissue Wavelength — Light at different wavelengths penetrates the skin to different depths. If the area to be treated is deep or shallow you must use a different wavelength of light so that you can penetrate the skin to the correct depth. — The roots of underarm and pubic hair grow deeper than chest or facial hair. It therefore makes more sense to use a filter that will penetrate deeper into the skin for pubic hair than it does for facial hair for example. — Pigmentation is an example where you might like to try the 510 and 560 filter on the first treatment to see which has the best effect as judging how deep the pigmentation is can be difficult to gauge by eye alone. — The same is true for almost every treatment you will perform so having a choice of filters available to you can be invaluable in getting the absolute best results for your client. Contraindications — Skin cancers — Metal plates in treating area — Pregnancy — Keloid or hyper-tropic scarring — Sun exposure 6 weeks before — Tattoos or permanent make up in treatment treating area — Medication causing sun sensitivity — Skin trauma, lesions, sores or — Auto immune diseases such as lupus and Epilepsy — Pace maker open wounds — Contagious skin diseases: not always contraindicated but requires special preparation — Tan or Fake Tan on surrounding — Hypo-pigmentation i.e. vitiligo skin — Recent sunburn — Unrealistic expectations Safety — Treatment room — Consultation — Safety gear — IPL device — Treatment programs and settings — Documentation Eye Safety — The pigmented iris absorbs light in the same wavelength range of IPL — The fact that IPL is not a laser may give people a false sense of security regarding damage to the eye — Permanent eye damage to the pigmented intraocular structures has been noted in cases where the therapist treated within the periocular area — It is imperative for treating clinicians to be aware of these hazards and use appropriate eye protection to prevent ocular damage both for their clients and themselves Pre treatment checklist — Client consultation form filled out — Before photo taken — Work out skin type per the fitzpatrick skin type chart — Test patch — Educate client on pre and post care Pulse output Pulse width Fluence — FLUENCE- fluence is a measurement of total energy delivered to tissue over a given area. (joules/cm2) Joules=wattsxtime Cm2=size of treatment head x size of light guide block. Ø PULSE WIDTH- Pulse width is the amount of time (ms) that the shot of light is on for. The shot can be made up of a single pulse or a series of pulses. The pulse width needs to be regulated to take the thermal relaxation time of the target into account. It also has an affect on the safety of the epidermal skin. Ø Thermal relaxation time TRT- thermal relaxation time TRT is the time required for a given volume of tissue to fall to 50% of its maximum temperature whilst being irradiated. if the pulse width (length of time)of the shot of light is shorter than the TRT of the target then only the target will be heated. If the pulse width of shot of light is greater than the TRT then adjacent tissues can be heated by conduction Skin type Hair Eyes Skin Freckles Sun sensitive Degree of tan 1 Red/ blonde Blue/green Milky +++ Always 0 2 Blonde/ med Light to med Clear ++ Always Light tan 3 Chestnut Med to dark Matt + Freq Dark tan 4 Brown Dark Matt 0 Rare Dark 5 Brown Dark Very matt 0 Exceptiona Very dark l 6 Black Dark Black 0 0 Black Burns Burns Complications — Prolonged redness and swelling lasting up to 4 days may occur. Darker patches of pigment on the skin may occur a couple of weeks after treatment. This can last from 2 weeks up to 1 year. However post treatment care and pretreatment preparation are ideal for minimizing scarring and pigment formation. You are more at risk of this occurring if you have a darker skin type. (this is not the immediate darkening of pigment we expect when treating pigmentation). — Hypo pigmentation(loss of pigment) can occur. This can last several weeks or years although also has the potential to be permanent. You are more at risk of this occurring if you have a darker skin type. — Blistering rarely occurs and will usually take a few days to settle. If you do get a blister, is important that you don't pick the blister let it naturally heal it as it may leave a scar. Test patching Look for positive clinical endpoints: Vascular Lesions: Disappearance of the vessel Any vascular changes (darkening, brightening, smudging) Pigmented Lesions Darkening of the lesion Hair Reduction Peri follicular odema and erythema Immediate purpura, pronounced odema, blistering, graying of the skin or excessive discomfort are indications that the parameters are too aggressive. Patch testing procedure guide for IPL treatments — Client to fill Consultation form including the Fitzpatrick scale sheet — Take a Photo of the area you are treating — Choose the area to patch test – test where you intend to treat — Ideally do 3 shots — Retake photo — Prep machine — Choose Filter and use gel on skin — Perform 3 shots at 3 different levels going up by 2 (Choose skin of similarity or within the area you will be treating — Check skin response (immediate reddening or pigment change) – . • Waiting of response time can vary with skin types • Record information • Clean off skin • Apply soothing gel and sun protection. — Ideally Client can return after 6 hours or day after. Processing of treatment test outcome usually is within a 30 min/or up to a 6 hour frame. This totally depends on what you are treating. — make notes … Ask client to give you feedback between 1-5 (5 is high) as to skin temperature and sensation What can we treat with IPL? — Flat, benign pigmented lesions (freckles, sunspots and general pigmentation) — Facial vascular lesions (spider veins, red spots and capillaries) — Diffuse redness, rosacea and red scarring — Poikiloderma (redness, pigmentation and a spotty look to the neck and/or décolletage) — Unwanted dark facial and body hair — Uneven skin colouring — Sun damage — Aging — Fine lines/laxity — Acne Pre and post treatment recommendations Pre treatment Discontinue sun exposure 4 weeks prior to your treatment. Do not use fake tan 1-2 weeks prior to your treatment. Use an SPF 30 daily. If having IPL hair removal, do not wax, tweeze or pluck the hair for 4 weeks prior to your treatment. Shaving is fine and you will need to shave the treatment site before your IPL session. If you have a history of herpes close to the area being treated, it is recommended that you take antiviral medication before the treatment. (This will be available from the chemist). post treatment A sunburn-like sensation is expected for about 2-5 hours after the treatment. If this is uncomfortable apply cold compresses to the treated area. Your skin maybe temperature sensitive for the following 2 days, so do not use very hot water or your shower or bath. protect you skin from the sun! Do not exfoliate the skin for 1 week after the treatment. Your skin may be more sensitive to certain skin care products so please use the products provided to you. Do not pick blisters or skin crusting as this may lead to a scar! Hair Reduction Hair Reduction — Great for preventing ingrown hairs — Safe and relatively pain free — Treatments are 4-6 weeks apart A lot of hair removal clinics are promoting their IPL hair removal treatments as being 'permanent hair removal'. This is incorrect and misleading. No technology has been shown to completely and permanently remove hair. Laser and IPL hair removal can result in lasting hair reduction for up to 90%, but it is usually necessary to have occasional 'top-up' treatments to maintain good results. Phases of hair growth! — — — — — Hair on the face and body has several stages of development Anagen – The growing phase Catagen - The transition phase Telogen – The resting phase Hair can only be treated successfully in the Anagen phase and intervals of anywhere from 4 – 8 weeks between treatments are required to reduce the hair. Effect of one treatment BEFORE- 2 hairs in Anagen phase DURING-destruction of the Anagen hairs 6 WEEKS LATER- 2 hair follicles destroyed How IPL targets hair — As light travels into skin it is absorbed into melanin rich substances like a hair shaft. As the hair absorbs the light, heat will be produced as a reaction(thermal tissue interaction). — As soon as the hair shaft becomes hot it will radiate heat out into the surrounding follicle tissue. The rate which the hair loses heat into surrounding tissue is called thermal relaxation time. (TRT) — Heating tissue to 70 degrees will cause protein in the cell walls to be denatured. The aim is to heat the germinating cells in the follicle wall destroying the follicle thus preventing or reducing further hair growth, without damaging surrounding tissue. — More energy will be needed in subsequent treatments as it is harder to destroy lighter, thinner hair. — After a week the hairs will start to loosen from the damaged follicle then they will shed out. This shedding process can take a few weeks to complete. — There is a minimal skin reaction following treatment. — The clinical end point is mild erythema sometimes with some peri follicular oedema. Reaction with treatment Peri Follicular Odema Peri Follicular Odema Causes of excessive hair growth — Medication — Hereditary — Hormones — Stress — Disease — Blood supply SHR- Super Hair Removal — SHR combined with “In Motion” represents a breakthrough in semi permanent hair reduction with light technology. The treatment is more pleasant than with the conventional systems and your skin is better protected. — Traditional laser or IPL technologies employ short impulses of approximately 2-300 milliseconds, applying a vast amount of energy (12-120 Joule on one square centimeter). Energy is transported to the hair root through melanin, where warmth of 65-72° Celsius is produced. Energy reaches the root of the hair follicle solely through melanin. Skin and red blood cells have a similar absorption coefficient as melanin and therefore also absorb the high levels of energy produced by the laser and IPL methods. — SHR technology, on the other hand, utilizes the melanin path only partially (50%), and combining In-Motion technology, gently warms the skin helping penetrate down to the follicles which produce hair growth. — Conventional devices, not using SHR technology, merely transport energy along the melanin to the follicles. — SHR gently transports the energy through the skin and through the melanin to the hair follicles. Research has shown that a slower, but longer heating process is considerably more effective for hair reduction than high and short levels of energy. Therefore, when using SHR, the device is passed over the tissue multiple times (in motion) using low energy but a high rate of repetition (up to 10Hz, i.e. 10 times per second) instead of using the traditional method with single, high-energy impulses. Thus, the hair and melanin, as well as the tissue of the stem cells, is heated with low energy at a slow pace and over a longer period of time to a comfortable temperature of 45° Celsius. SHR filter — 690-950 nm — It is very important only to use this filter for SHR treatment. — SHR can only be used with the large hand piece ( 15 x 35 ), it will not work in any other hand piece. SHR treatment guideline — Mark out area — Apply gel — Perform one pass , check for erythema, and/or swelling of follicle. — Increase joules as needed — Perform second pass then check for desired response — Move onto next area Face hair — 4 week intervals — 6-8 sessions — At the beginning it is important to regulate hair growth if client has been waxing and/or plucking. — If there is a hormonal issue then this will be a maintenance treatment as long as hormones are fluctuating. — Important to discuss outcomes with client. — Although still good results for PCOS( with maintenance treatments). Under arms and Bikini — 4-6weeks — 6-8 sessions — Important only to shave between treatments — Large spot size for deeper penetration. — 610,640,690 filters. — Hairs lay deeper so deeper filters may work better. Legs, back and chest — Slower hair growth cycles — 6 weeks – 8 weeks — 8-10 treatments — Shave between treatments — Increase energy as hair becomes thinner — Space out treatments as needed — Filters 610,640,690 — End point slight erythema. Areas not to be treated — Eyebrows — nostrils — Inner ear — Inner labia — scrotum Treatment plan — Stage 1- Face 4 weeks Under arms, bikini, 4-6 Legs, back, chest 4,6 or 8 weeks Only extend the time between treatments when there is not enough hair returning to warrant treatment. Don't extend too soon as you may miss anagen hair growth stage. — Stage 2- maintenance sessions – maybe months apart important to plan on individual basis. No waxing or plucking hairs amongst treatments. 5 treatments, 4 weeks apart client with PCOS Consultation Guide — Ask if the client has ever had a treatment before (this gives you an idea of how in depth you will need to go into your consultation) — Confirm what treatment they will be having and what their concerns are. — Introduce Machine and technology. This is our Spectrum 2000 IPL system, this technology allows us to treat Pigmentation/Redness/Skin Rejuvenation, Acne and Hair reduction. This prompts them to ask questions regarding other treatment options. — Prepare client that you will start your consultation and then answer any questions they may have at the end. (This allows you to get through your spiel without too much interruption), as most questions they will have you will be answering. — Explain process of how the IPL Treats Hair /Pigmentation/Vascularity (what the process is; Such as light being attracted to the target Chromophore) — Things you need from them and why. i.e. no sun exposure/tan/shaving/hat/sunscreen ect — Contraindications, Meds, heat, Sun exposure. — Double check ethnic background. — Explain the sensation they will feel, the intensity of the light ect. — Post treatment care (this will be reiterated again at the end of the treatment before they leave, along with their post treatment care pamphlets) — Treatment packages and cost . Realistic expectations of treatment course.