Introduction: Come Towards The

Light

For those of you who have not the time to recover from nor the epidermal
capacity to withstand lasers -- High Intensity Pulsed Light Therapy may be for
you. This promising new procedure is also known as Intense Pulsed Light
Therapy, computer controlled light therapy, Light Laser, MultiLight, Photo Laser or
by various trade and service marks, FotoFacial ™, PhotoFacial ™, PhotoDerm ™,
EpiLight ™, MultiLight ™, PlasmaLight, and I am sure, soon-to-be others.

It is phenomenal new mini-procedure capable of diminishing or fully ridding one of

age/liver spots, fine wrinkles (rhytids), facial flushing, redness, broken capillaries,
telangiectasia (Teel-ann-ject-AZE-yah) which are purple or blue veins on the face,
hemangiomas (sacs of red, purple or blue blood vessels resembling a blister, aka
strawberry hemangiomas), freckles, minor sun damage, port wine stains, tattoos,
varicose veins, spider veins, flat birth marks, hypo-pigmentation and even hair
removal! And the best part? NO downtime! Intense Pulsed Light Therapy gives
you the benefits of a medium depth laser or chemical peel or other type of
resurfacing/rejuvenation procedure without the blisters, burns and long recovery
time. Not only that, it is the only proven therapy to help with redness (rosacea,
flushing, etc)! And to boot, many patients report a reduction in pore size,
smoother skin, and less wrinkles!

What Is High Intensity Pulsed Light Therapy or IPL?

This incredible new therapy was pioneered by Dr. Patrick Bitter Jr. and is based on
emitting high intensity pulses of light (not lasers) to penetrate the skin and rid
you of various complaints. There are different machines for different levels or
types of penetration. It is also knows as IPL Photorejuvenation. For instance,
PhotoDerm as the PhotoDerm VL (vascular lesions) {VascuLight/MultiLight},
PhotoDerm PL (pigmented lesions) or PhotoDerm HR (hair removal). PhotoDerm
and PhotoFacial™ intense pulsed light systems are expensive! ESC Medical
Systems in Needham, Massachusetts, costs around $130,000. ESC is an innovator
in all kinds of high-end medical equipment and is a trusted leader in the medical
profession.

• PhotoDerm VL (vascular lesions): With this machine, the light

pulses are directed at the spider and varicose veins as well as vascular
birth marks. The tissue targeted is the hemoglobin in the blood.

Hemoglobin <he*mo*glo*bin>
(noun) : an iron-containing respiratory pigment of red blood cells that
functions primarily in the transport of oxygen from the lungs to the tissues
of the body.

A highly advanced computer regulates the light pulse to a specific

wavelength range, which in turn heats the visible, targeted blood
vessel(s). Thereby damaging or otherwise destroying the targeted lesion
while sparing the surrounding healthy or normal tissue. The penetration
depth and degree of heat is highly controlled so that most complications
contributed to these specific factors are not an issue with Pulsed Light
Therapy.
• PhotoDerm PL (pigmented lesions): With this machine, the light
pulses are directed at the age spots, freckles, flat pigmented birthmarks
and other types of discolorations. The tissue targeted is the melanin in the
epidermis.
 Melanin <mel*a*nin>
(noun) 1 : any of various dark brown or black pigments of animal or plant
structures (as skin or hair) .

The melanin is then heated and damaged or destroyed - thereby ridding

you of the unwanted hyper-pigmentations.
• PhotoDerm HR and EpiLight (hair removal): This machine
makes it possible to rid one of unwanted hair, supposedly permanently.
The pulsed light is controlled via the computer and with the use of special
filters the theory of Selective Photo Thermolysis is what damages the
follicle and causes it to fall out. Sort of like the PhotoDerm PL above, the
pulses of light target the melanin in the hair shaft and travel to the follicle,
heating and destroying it. The hair production cells themselves are
damaged or destroyed making permanent hair removal, well, possibly
permanent.

Now, hair grows in cycles and some follicles lie dormant and begin to grow
again after a time. So, it may seem when you try any type of hair removal
system or even shaving that some hair grows back faster than the others.
Unfortunately as I said, this is a cycle and a vicious one at that. The Light
therapy must affect the hair follicle during its growing phase to work
properly. When you notice these hairs when they fall out and then see a
few weeks or days later, hair emerging, don't automatically think that it
didn't work. The follicles must be caught during this growing phase for
them to be destroyed.

According to a lecture I listened to by Dr. Robert A. Weiss, the assistant professor

of dermatology at the University of John Hopkins School of Medicine in Baltimore,
Maryland by on intense pulsed light treatments:

It is quite possible to actually shrink sebaceous glands (oil glands), pore size, with
repeated treatments. Although at this time it is unknown just how many
treatments this result would require. Also hyper and hypopigmentation is
possible. Other than that the lecture covered the same info of which I already
knew and covered.

Are You a Candidate For HI Pulsed Light Therapy?

If you are prone to keloids, hyper or hypo pigmentation, are dark-skinned, darkly
tanned or do not react well to burns you may not be an ideal candidate for High
Pulsed Light Therapy. Also, if you have ethnicity (like Greek, Italian or African
American, etc.) in your biological family, you may be prone to hyper or hypo
pigmentation resulting from the procedure. An ideal patient would be of white
European descent with elastic, non-oily skin. Although many other types of skin
are treated successfully. Only a qualified doctor or dermatologist can determine if
you are eligible for treatment.

If you have lesions such as age/liver spots, broken capillaries, telangiectasia

(purple or blue veins on the face), hemangiomas (sacs of red, purple or blue blood
vessels resembling a blister, aka strawberry hemangiomas), freckles, port wine
stains, tattoos, varicose veins, spider veins, flat birth marks or hypo-pigmentation
you may be a candidate for HI Light Pulsed Light Therapy. HI Pulsed Light
Therapy can even remove fine wrinkles, facial flushing, rosacea, redness, minor
sun damage, and even hair removal!

If you are a insulin-dependent diabetic, you can not be treated. Insulin-dependent

diabetics run the risk of wound-healing and infection problems. Although
diabetics who take prescription oral-medication, to be treated, you must provide a
letter from your primary care physician, written on his medical office stationary
stating that you are, indeed, approved for HI Pulsed Light Therapy.

Also, you should discontinue the use of any blood thinners such as Coumadin®,
Heparin®, aspirin or other types of anti-platelet or anti-coagulant herbal remedies
including and not limited to...

• Garlic, Ginger, Cayenne, Papaya and Bilberry Tablets/Supplements,

have anti-platelet properties and may inhibit vital clot formation. These
medications are normally taken to remedy edema (fluid retention).
• Gingko, Gingko biloba, & Selenium are powerful anti-coagulants. It
is considered to be 3 times stronger than Vitamin E, which should also be
avoided.

...for 10 days prior to your patch test and treatment. You are also not a candidate
if you have a blood clot-forming disorder (i.e. excessive bleeding). Although you
may have seen information on some websites stating that HI Pulsed Light
Treatment does not emit radiation of any kind and is safe for treatment during
pregnancy -- it is mentioned by the company that treatment should not be
undergone while pregnant and to wait until after delivery to even have a patch
test or spot treatment.

What To Expect At Your Consultation

Once you find a respectable clinic or practice in your area and decide to make a
consultation appointment, you will meet with the doctor or dermatologist and he
or she will determine if you are a candidate to receive treatment. He or she will
discuss your health, examine your skin and prior scars, ask you a million
questions regarding your family history (answer them honestly and disclose all!)
and explain to you what can and essentially what cannot be successfully treated.
Prepare to pay for a spot test or test patch if it is decided you are eligible. The
hefty price of about $75 bucks will cover several areas that represent what will be
treated. A wrinkle here, a capillary there, you get the picture. He or she will also
advise you on approximately how many treatments and pulses per treatment that
will be needed to achieve your desired goal.

After your test patch/spot treatment you will wait and watch the test area for any
negative reactions such as blistering, hyper- or hypo-pigmentations, rashes,
persistent redness, etc. and report them to your technician/doctor. If all is well
you may schedule an appointment and you will be instructed on what and what
not to do for the next two weeks before your first full treatment. For instance if
you are taking any of the above supplements or medications you will have to
discontinue them until a few days after treatment or until instructed otherwise.
You will also be instructed not to tan as hypo-pigmentation (patches of skin lighter
in pigment than your normal tone).

How HI Pulsed Light Therapy Is Performed

Your technician or doctor will ascertain your comfort and if desired a topical
anesthetic may be applied. After the treatment area is numb a cold, soothing gel
will be applied and a glass prism (pyramid) will then be placed over the gel and
treatment area. An intense flash of light, or pulse, is flashed through the prism
where it is directed at the treatment area to rid you of your complaints. This
initial treatment may not be as aggressive as your following treatments so as not
to possibly damage the skin and to determine your skin's tolerance for further
intensive treatment. Treatments are usually performed every 3 to 4 weeks.

The Road To Recovery

Since there is no real downtime you may resume your normal activities after a
Pulsed Light treatment. However you must protect your treatment area from UV
light, be it natural sunlight or tanning beds. You may be slightly pink or red
directly after your treatment as well as have mild swelling. This should subside in
a few days and if not you should inform your doctor/technician.

Risks & Complications of HI Pulsed Light Therapy

Although rare, blistering or slight bleeding is possible as is hypo- or hyper-
pigmentation (lightened or darkened areas of skin). If pigmentation problems
occur, it may be anywhere from 3 to 12 months before normal skin tome returns.
This is especially so with hypo-pigmentation (lack of color). Be aware that some
patients may experience permanent skin pigmentation changes. Scarring is
possible although it too is a rare occurrence.

Frequently Asked Questions About HI Pulsed Light Therapy

Coming soon! Please check back!

The Least You Need To Know

• This incredible new therapy was pioneered by Dr. Patrick Bitter Jr.
and is based on emitting high intensity pulses of light (not lasers) to
penetrate the skin and rid you of various complaints.
• Not everyone is a candidate for HI Pulsed Light Therapy. Only a
qualified doctor or dermatologist can determine if you are eligible for
treatment.
• An ideal patient would be of white European descent with elastic,
non-oily skin. Although many other types of skin are treated successfully.
• HI Pulsed Light Therapy is capable of diminishing or fully ridding
one of age/liver spots, fine wrinkles, facial flushing, rosacea, redness,
broken capillaries, telangiectasia (purple or blue veins on the face),
hemangiomas (sacs of red, purple or blue blood vessels resembling a
blister, aka strawberry hemangiomas), freckles, minor sun damage, port
wine stains, tattoos, varicose veins, spider veins, flat birth marks, hypo-
pigmentation and even hair removal!
• If you are prone to keloids, hyper or hypo pigmentation, are dark-
skinned, darkly tanned or do not react well to burns you may not be an
ideal candidate for High Pulsed Light Therapy. Also, if you have ethnicity
(like Greek, Italian or African American, etc.) in your biological family, you
may be prone to hyper or hypo pigmentation resulting from the procedure.
• Prepare to pay for a spot test or test patch if it is decided you are
eligible. The hefty price of about $75.US will cover several areas that
represent what will be treated. Thereafter treatments are approximately
$10. per pulse with a minimum of $100.US per visit.
 • Since there is no real downtime you may resume your normal
activities after a Pulsed Light treatment. However you must protect your
treatment area from UV light, be it natural sunlight or tanning beds.
• Although rare, scabbing, blistering or slight bleeding is possible as
is hypo- or hyper-pigmentation (lightened or darkened areas of skin).

Intense Pulse Light

Intense Pulse Light (IPL) is a non-invasive procedure that uses pulse of visible light
to improve the appearance of the aging skin. It is most often performed on the
face, neck, chest, and hands to erase the signs of aging.

(before & after)

Among these signs of aging are fine lines, red blemishes, mottled coloration,
broken blood vessels, pigment discoloration such as freckles and age spots,
enlarged pores, coarse or rough skin, loss of skin tone and elasticity, and general
sun damage. A series of Intense Pulse Light (IPL) treatment brings a more
youthful, smooth and revitalized skin appearance, with no downtime.

Intense Pulse Light (IPL) is clinically shown to reduce wrinkles and improve the
tone of the skin by non-invasively stimulating new collagen production.

The type of response heard from patients after having Intense Pulse Light (IPL) is
that they feel like their skin is lifted. There is a decrease in pore size, their skin
feels tighter, and there is a reduction in fine lines and wrinkles.

What are the benefits?

Intense Pulse Light (IPL) Treatments are beneficial for the following:

-Improve appearance of aging or sun damage skin (fine wrinkles, freckles,

pigmentation)
-Smoothen skin and reduce pore size
-Improve skin tone or tightness
-Reduce redness, flushing or Rosacea
-No recovery time

Am I a candidate for Intense Pulse Light?

The Best Candidates for Intense Pulse Light (IPL) are:
• People with early skin aging changes and sun damage who desire healthier
more youthful skin
• People who suffer from Rosacea and experience flushing and redness of their
skin
• People who don't want to take time off to heal from laser resurfacing or
chemical peels
• Active people who want to improve their skin, but do not want to interfere with
social or outdoor activities.

How does Intense Pulse Light (IPL) work?

A specialized medical device delivers a series of pulses of light to the skin using
settings that are customized to skin type and skin color. A series of five or more
IPL treatments are performed at three-week intervals. The benefits of Intense
Pulse Light (IPL) are consistent, visible changes from the first session, with little
discomfort and minimal risk.

The light is changed to heat energy as it reaches to the level of the collagen
beneath the skin surface. Red blemishes from broken blood vessels and brown
spots of pigment from sun damage respond to the gentle, yet, Intense Pulsed
Light.

What areas can be treated with Intense Pulse Light?

Intense Pulse Light can be used on any part of the skin. IPL is especially effective
for improving the appearance of the face, neck, and chest and hands.

What results can I expect from IPL?

The effects of Intense Pulse Light (IPL) are cumulative. People with visible aging
skin from the sun can expect to see smoother skin with a decrease in fine
wrinkles, reduction in pore size and fading of sun spots. Others can expect to see
a gradual decrease in overall redness, flushing and dilated capillaries. Many
people with Rosacea can see improvement in the number of breakouts and are
able to decrease or discontinue their medications.

Why are multiple treatments of IPL necessary?

Depending on the number of conditions you are treating, and the severity of the
individual problems, a series of five or more treatments of IPL, spaced three
weeks apart, is our standard recommendation. You can return to work the same
day and resume all regular activities. By dividing the full program into several
treatments, the procedure provides gradual improvement with very low risk - and,
it preserves the wonderful "no downtime" feature people appreciate so much.

Are there any side effects from Intense Pulse Light (IPL)?
Immediately following the procedure you may experience some redness and/or a
slight darkening of pigmented areas. The redness usually dissipates within 24
hours; however, darkened pigmentation may persist and peel lightly for up to two
week. Makeup can be applied to the treated area immediately, if necessary.
Additionally, tattoos may be lightened and hair growth may be impaired in the
treated area, although it is not the intended purpose of this particular treatment.
It is extremely important to wear sun block and avoid sun exposure on a daily
basis to reduce any potential side effects.

What are the IPL treatments like?

Each Intense Pulse Light treatment takes approximately 15 to 30 minutes. People
with more sensitive skin may prefer to use a topical anesthetic cream applied 30-
60 minutes before the treatment. After treatment, there is no discomfort - you
can return to your normal routines and activities immediately. Occasionally, there
may be signs of treatment such as redness or blotchiness that last for a few
hours. You will see gradual improvement from each session, resulting in a
dramatic improvement by the end of your treatment program. Results are long-
lasting, usually a year or longer.

I'm interested - What do I do next?

WHEN LIGHT IS DEDICATED TO BEAUTY

For over a few years now, technological progress in the field of light ray use
has opened up new scopes of application for medicine in general and aesthetic
treatment in particular.

Enhanced control and safety has made light an indispensable vector for certain
treatments such as laser, Pulsed Light, ultra-violet, chromotherapy etc...

In the specific field of aesthetics, unwanted hair, blemishes or signs of skin aging
and skin or vascular stains can be attenuated or eliminated simply by repeated
exposure to a flash of natural light that is filtered and made safe.

You too can benefit from state-of-the-art Pulsed Light (SPL™) technology
for perfect customer satisfaction

Intense pulsed light therapy

Intense pulsed light (IPL) or flashlamp therapy is a non-invasive and non-ablative

treatment that uses high intensity pulses of visible light to improve the
appearance of vascular lesions including spider naevi, port wine stains, broken
facial veins, rosy cheeks, thread veins of the legs, mild acne spots, freckles and
age marks, and facial lines and wrinkles. The procedure of rejuvenating aged skin
is referred to as photorejuvenation and may consist of a series of IPL treatments.
Treatment of unwanted hair works best when the hair is deeply pigmented.
How does it work?

IPL systems work on the same principles as lasers in that light energy is absorbed
into particular target cells with colour (chromophores) in the skin. The light energy
is converted to heat energy, which causes damage to the specific target area. IPL
systems are different to lasers in that they deliver many wavelengths (or colours)
in each pulse of light instead of just one wavelength. Most IPL systems use filters
to refine the energy output for the treatment of certain areas. This enhances
penetration without using excessive energy levels and enables targetting of
specific chromophores (these are skin components that absorb light).

IPL therapy is considered a non-ablative resurfacing technique, which means that

it targets the lower layers of skin (dermis) without affecting the top layers of skin
(epidermis). The results are not as dramatic as ablative resurfacing where both
the dermis and epidermis are injured to produce a much more noticeable overall
outcome. The advantage of IPL therapy is its minimal downtime – a patient can
often have the procedure done in their lunch break and return to work
immediately afterwards.

What IPL machines are available and what do they do?

There is a range of IPL machines including LumenisI® Quantum IPL® (the

successor to PhotoDerm®), EpiLight® and Ellipse®. Individual machines may be
specially designed to focus on certain problems but may not be equally effective.

• For the treatment of spider and thread veins, and some

vascular birthmarks.
Vascular
lesions • Light pulses targeted at the red-pigment (haemoglobin)
in the blood which heats and destroys the pigment without
affecting the skin or other tissues.

Pigmente • For the treatment of age spots, freckles, flat pigmented

d lesions birthmarks and other skin discolouration problems such as
melasma / chloasma and erythromelanosis of the neck
(poikiloderma of Civatte).

• Light pulses targeted at the melanin in the skin’s surface

which heats and destroys melanin to remove the discolouration.

Hair • For the treatment of unwanted hair.

removal
• Light pulses targeted at the hair follicle causing the hair
to fall out and prevent further growth. Generally ineffective for
light coloured hair.

Effect of IPL on a freckle

Close-up Dermoscopy

What does the procedure involve?

Prior to the procedure your specialist practitioner should explain the process to
you and clearly define your expectations of the treatment. They should be able to
tell you whether or not the results you are looking for will be achievable using this
method. It is important that the correct diagnosis has been made by your doctor
prior to treatment.

IPL treatments are normally straightforward. Make sure the technician has been
properly trained and is experienced in IPL therapy.

• Avoid sun exposure in the days and weeks before and after
treatment.
• A topical anaesthetic may be applied to the area but is not usually
necessary.
• Cold gel is applied to the area being treated. IPL devices often have
integrated cooling systems.
• The smooth, glass surface of the IPL treatment head is applied to
the skin, delivering precise pulses of light to the area being treated.
• Treatment sessions usually last about 20 minutes. A course of 4-6
sessions every 3-6 weeks may be needed to achieve desired results.
• Most patients can return to work immediately after treatment.

Throughout the treatment session the patient must wear protective eyewear. IPL
treatments are relatively painless compared to other facial rejuvenation
techniques. The sensation has been likened to a light pinch or the snap of a
rubber band, but some people find it distressing.

Are there any side effects?

Side effects are minor and include:

• Pain druing treatment (reduced by contact cooling and if necessary,

topical anaesthetic)
• Skin turning pink and a little sore immediately after the procedure.
• Sensation of a mild sunburn (redness, peeling, swelling) that may
last a few days after treatment.
• Rarely, skin pigment may absorb too much light energy and
blistering can occur.
 • Sometimes the pigment cells (melanocytes) can be damaged
leaving darker or paler patches of skin. White patches or scars are rarely
permanent.
• Hair loss may occur.
• Bruising affects up to 10% of patients

Facial lines and wrinkles

Ageing skin droops and develops wrinkles, lines and furrows. The severity of these
changes in an individual depends on genetic tendency, skin phototype and
exposure to environmental factors.

Dermatologists and cosmetic surgeons often use Glogau's classification when

describing these ageing changes.

Mild – Few wrinkles, requires little or no make-up for coverage

Moderate – Early wrinkling, sallow complexion, requires little makeup
Advanced – Persistent wrinkling, skin discolouration with broken blood vessels and
solar keratoses, often wears make-up
Severe – Severe wrinkling and furrows, solar keratoses, often wears make-up but
it may not hide the ageing changes

The Fitzpatrick classification of facial lines refers to the degree of wrinkling around
the mouth and eyes:

Class I: Fine wrinkles

Class II: Fine-to-moderately deep wrinkles and moderate number of lines
Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds

How do facial lines and wrinkles form?

Facial lines and wrinkles (rhytides) form because of the following factors:

• Ageing processes
• Sun damage
• Muscle movement
• Gravity
• Injury
• Surgery
 • Acne
• Other skin diseases with a tendency to scar (e.g. discoid lupus)
• Smoking

There is often a degree of asymmetry to the lines, as people tend to smile or

frown more on one side than the other, or consistently sleep on the right or the
left cheek.

Fine lines
Fine lines and wrinkles arise because of irregular thickening of the dermis and
because of a decrease in the amount of water held by the epidermis. This is
mainly caused by sun damage and exposure to environmental toxins such as
tobacco smoke.
Furrows
Deeper lines or furrows are classified as dynamic or static. Dynamic lines appear
with movement i.e. the activity of facial muscles. Static lines are unchanged with
muscle movement. Eventually dynamic lines become static.

• Crow's feet around the eyes are due to smiling and activity of the
eyelid muscles (orbicularis oculi).
• Worry lines on the forehead are due to contraction of the frontalis
muscle when raising the eyebrows
• Frown lines between the eyebrows are due to contraction of
corrugator supercilii muscles and procerus muscle when concentrating or
angry

Facial lines and wrinkles

Dynamic lines in smiling Static lines (crow's feet) in Worry lines

teenager 40's

Extensive perioral lines Deep furrows Hollow-looking eyes

Sags and bags

Skin laxity or drooping is caused by several factors:

• A reduction of the fat cells under the skin (subcutaneous tissue)

• Loss of collagen and elastin fibres in the dermis reducing cutaneous
strength and elasticity
• Gravity, which allows the lax tissue to sag

The result is:

• Brow ptosis (the forehead sags so the eyebrows drop over the
eyelids, which then feel heavy)
• Eyelid ptosis (the upper eyelid drops, sometimes obscuring the
pupil)
• Baggy upper and lower eyelids
• Sagging lower eyelids, revealing the reddened mucosal surface
(ectropion)
• Hollow look to the eyes
• Tired-looking eyes with a prominent groove beside the nose (tear-
trough deformity)
• Jowls (loss of jaw line)
• Loss of neckline
• Elongated earlobes
• Dropping of the tip of the nose
• Thinning of the upper lip

What treatment is available?

Remarkable changes in facial appearance can be obtained, giving a younger

appearance and improving complexion. Often combinations of different cosmetic
procedures are required for the best results.

It is most important to protect the skin from the sun life-long using sunscreens on
exposed areas daily, and to avoid smoking and exposure to second-hand smoke
or other pollutants.

Moisturisers
Ageing skin feels and looks better when moisturisers are applied regularly. These
improve the water-holding capacity of the skin. Choose one that feels nice to
apply, doesn't sting or burn or provoke acne.

• Use tepid or warm tap water and a non-soap cleanser to wash your
face twice daily.
• If you will be outdoors even briefly, include UV-protection as part of
your morning regime.

Anti-ageing formulas
Many face creams may include so-called anti-ageing ingredients. These may
include anti-oxidants and/or exfoliants including:
 • Topical retinoids
• Vitamin c
• Alpha hydroxy acids
• Polypeptides
• Various plant extracts

With the exception of the topical retinoids, the effectiveness of many of these
anti-ageing ingedients is unproven.

Resurfacing
Resurfacing refers to various techniques in which the top layers of the epidermis
are peeled off using chemical or mechanical means. Peels may even out
pigmentation and improve skin texture. They can improve fine lines and static
furrows but have no effect on dynamic lines.

• Superficial and medium-depth chemical peels

• Dermabrasion and microdermabrasion
• Neodynium:YAG or carbon dioxide laser resurfacing
• Non-ablative laser, intense pulsed light or thermal resurfacing
including thermage

Implantation
Individual lines and furrows can be lifted up with implants, i.e. temporary or
permanent fillers or grafts. They can also be used to improve the appearance of a
thinning lip.
Botulinum toxin
Botulinum toxin is most useful for dynamic lines. It can be used to paralyse the
muscles that are responsible for frown lines, crow's feet and forehead lines. It can
also be used to change the shape of the eyebrows and to soften so-called
smoker's lines around the lips, among other uses.
Cosmetic surgery
Cosmetic facial surgery involves repositioning facial tissues (rhytidectomy) and
altering the structure of the sagging tissues.

• A facelift or mid-face lift remove excessive skin and tighten

underlying muscles of the lower two thirds of the face (cheek and neck).
• A forehead or brow lift, and mid-temporal lift reduce static lines and
lift up drooping eyebrows.
• Rhinoplasty may lift up the tip of the nose, reshape it or thin out
excessive tissue due to rhinophyma
• Upper and/or lower blepharoplasty removes redundant skin and fat
pads from the eyelids.
• Correction of platysmal bands in the neck by an open plication
technique improve the appearance of a sagging neck.
• Brown spots and freckles

Freckles

Freckles are small flat brown marks arising on the face and other sun exposed
areas. They are most often seen in fair skinned people, especially those with red
hair, but they are an inherited characteristic that sometimes affects darker skin
types as well.
The medical term for this type of freckle is ephilis (plural ephilides). The colour is
due to pigment accumulating in the skin cells (keratinocytes).

Skin pigment (melanin) is made by cells called melanocytes. They don't produce
much melanin during the winter months, but produce more when exposed to the
sun. The melanin is diffused into the surrounding skin cells, called keratinocytes.
The colour of ephilides is due to localised accumulation of melanin in
keratinocytes.

Ephilides are more prominent in summer but fade considerably or disappear in

winter as the keratinocytes are replaced by new cells.

As the person ages this type of freckle generally become less noticeable. Apart
from sun protection, no particular treatment is necessary.

Freckles

Lentigines

Larger flat brown spots on the face and hands arising in middle age also result
from sun damage exposure. Unlike freckles they tend to persist for long periods
and don't disappear in the winter (though they may fade). Commonly known as
age spots or liver spots, the correct term for a single lesion is solar lentigo (plural
lentigines).

Lentigines are common in those with fair skin but are also frequently seen in
those who tan easily or have naturally dark skin. Lentigines are due to localised
proliferation of melanocytes.

It is important to distinguish the harmless solar lentigo from an early malignant

melanoma, the lentigo maligna. If the freckle has arisen recently, is made up of
more than one colour or has irregular borders or if you have any doubts, see your
dermatologist for advice.

Lentigines
Other brown marks

If the brown marks are scaly, they may be solar keratoses (sun damage) or
seborrhoeic keratoses (senile warts). In this case there is a proliferation of
keratinocytes.

Other brown marks

Solar keratosis Solar keratosis Seborrhoeic keratosis

Treatment of brown marks

Brown marks may fade with careful sun protection, broad spectrum sunscreen
applied daily for 9 months of the year. Regular applications of anti-aging or fading
creams may also help. These may contain hydroquinone, or antioxidants such as:

• alpha hydroxy acids

• vitamin-C
• retinoids
• azelaic acid.

However, brown marks may be removed more rapidly and effectively by chemical
peels, cryotherapy or certain pigment lasers that target melanin in the skin.

Suitable green-light devices include:

• Flashlamp-pulsed tunable dye laser

• Frequency doubled Q-switched Nd:YAG laser (neodynium:yttrium-
aluminium-garnet)
 • KTP laser
• Krypton laser
• Copper bromide laser

Suitable red light devices include:

• Q-switched Alexandrite
• Q-switched Ruby

Intense pulsed light has a similar effect. Carbon dioxide and Erbium:YAG lasers
vaporise the surface skin thus removing the pigmented lesions.

Results are variable but sometimes very impressive with minimal risk of scarring.

With superficial resurfacing techniques, there is minimal discomfort and no down-

time but several treatments are often necessary. Unfortunately the treatment
occasionally makes the pigmentation worse. Continued careful sun protection is
essential, because the pigmentation is likely to recur next summer.

Effect of treatment

Before (left) and after (right) Before cryuotherapy After cryotherapy

green laser light

Beyond Lasers: Pulse-Light Therapy for That Fantasy Face

July 27, 2000 -- It's not as if Tina Huoso needed a face-lift. At age 31, she was
essentially wrinkle-free. A handful of superficial acne scars, reminders of her teen-
age years, were just about her only blemishes.

But the brown sun blotches that began appearing on her forehead, and especially
one above her lip, made Tina self-conscious. "I put a lot of concealer to blend it in,
but I really don't like wearing a lot of makeup," she tells WebMD. "It looked like I
was covering something up."

Huoso is an assistant to Atlanta facial plastic surgeon Seth Yellin, MD. She took
advantage of the newest technology -- intense pulse-light therapy -- to smooth
her imperfections. "People commented," she tells WebMD. "They said I looked
great, that I glowed." As for the blotches, "They're gone."
It's the new way to keep aging at bay.

Growing numbers of dermatologists are now using intense pulse-light therapy --

instead of lasers -- to smooth and soothe facial woes. With this new magic wand,
they can delete fine-to-moderate lines and wrinkles, remove unwanted facial hair,
and erase a whole array of pigment problems, including sunspots. Doctors say it
actually tightens up those unsightly pores -- perhaps permanently.

And for many people with an embarrassing condition called rosacea -- a facial
redness caused by spider veins and acne-like outbreaks -- this may be the first
true treatment, doctors say.

Best of all, there's no "downtime" as there is with laser treatments. "It's truly a
lunchtime therapy," says Yellin, who is assistant professor of facial plastic surgery
at Emory University School of Medicine.

Intense pulse-light skin therapy won FDA approval for hair removal five years ago.
In the past few years, dermatologists have discovered many more uses for this
technology, which involves pulsed multiple lengths of light rays, explains Yellin.

While it may sound like a laser treatment, "it's not a laser," Yellin tells WebMD.
"We can select from multiple wavelengths of light [whereas lasers use one
continuous light wavelength.] We can enter into the computer the skin color, body
area, skin type to generate specific settings. During treatment, multiple
wavelengths of light are entering the skin, concentrating their energy at different
levels. That allows us to treat many, many different problems."

"In terms of superficial problems, it works great," says Ronald Moy, MD, editor-in-
chief of the journal Dermatology Surgery. "I've treated famous movie stars, a
pretty particular crowd. For those in their 40s and 50s who don't have deep lines,
there's really no down side." Moy is also an associate clinical professor at UCLA.

Two years ago, dermatologist Patrick Bitter Sr., MD, of Los Gatos, Calif.,
developed the first treatment for rosacea. In over 20 years of practice, he had
seen no good solutions for this common but complex disorder. "People have tried
various laser treatments, but they never were very successful," Bitter tells
WebMD.

In his study of 57 patients with an assortment of problems -- photo aging, scars,

wrinkles, and rosacea -- Bitter found 89% patient satisfaction with the level of
clearing. "Patients were thrilled with it, especially when it came to the redness of
rosacea," he tells WebMD. "People suffer from that for years ... it makes a huge
difference to them." As for pore problems, Bitter says, genetics rule. "It will not
decrease pores beyond the genetic limitations," he says. "But they will be
substantially smaller."

During treatments, Yellin explains, "light energy is sent through the outer skin --
the epidermis -- and energy is concentrated on the dermis, the deeper part of the
skin. Because the light generates heat, it stimulates cells in the body that go on to
form more collagen, as much as 20% more."

Because it "plumps the skin, it's like giving yourself a collagen injection but using
your own collagen," says Yellin.

There's no down time because no healing is involved, he says. "Unlike laser

therapy, it attacks the problem from the inside. It leaves the outer skin completely
intact, so there is no visible damage to skin. Because skin is left completely intact
-- because it is not damaged -- it doesn't need to heal."

"The vast number of patients cannot tolerate any down time, don't want the
stigma of the red face that comes with lasers," Yellin tells WebMD. "When you
laser someone, they may be red for six weeks to six months. There's a week of
real peeling, where you have to cover your face with Vaseline and hide. It's a
significant disruption in someone's lifestyle."

"You don't want a shotgun to kill a fly," he adds. For relatively small problems,
"pulse-light therapy is fabulous."

Facial therapy procedures take about 45 minutes, whereas hair removal times will
vary depending on the area being treated. Afterward, there is "just a flush, not
really redness," Huoso says. "It goes away in an hour or two. You can apply
makeup right afterwards. I had it done on my lunch hour and went right back to
work."

Typically, six treatments are necessary for most problems with a pricetag of a
little more than $2,000 for a the series.

While Huoso says she doesn't think the treatments hurt, some might find them a
bit painful, she says. She had her procedures done without anesthetic but says
some patients may opt to have some anesthetic applied to the skin. "You'd be
surprised," she says. "Your face is less sensitive than you would think ... You just
feel a bit of heat."

Intense pulse-light therapy won't work with deep wrinkles. "It's not a panacea for
everything. But we've replaced almost all other laser treatments with [this
technology]."

Light Therapy is a treatment method which uses lasers, leds, fluorescent lamps
for a limited time to the spot.

The method has a proven efficiency on Acne vulgaris and SAD.

Which Acne Alternative Treatment Is Right For Your Acne?

If you suffer from acne then you already know that there are hundreds of acne
alternative treatments being sold in stores and online. In fact if you do a search
for acne alternative treatments using the Internet you will find a myriad of
websites that are stuffed full of testimonies from former acne sufferers who have
used the latest zit and pimple treatments in order to eliminate their irritating skin
blemishes. Unfortunately what these testimonies can't do for you is guarantee the
elimination of your acne because every individual that has acne could very well
need a different type of acne fighting solution. The actual proof is in the pudding
so to speak. You won't know 100% for sure if an acne alternative treatment will
cure your blackheads until you actually try it out on your acne.

For many consumers that have successfully eliminated their acne it only came
after they had gone through a lineup consisting of acne topical treatments, a dose
of pimple fighting antibiotics and in the most serious acne cases a prescribed
treatment using Accutane. If these are considered the traditional methods of
treating your acne then what about the alternative or nontraditional acne fighting
solutions? Can they effectively prevent an acne outbreak from happening on your
skin? Just like the routine ways of fighting zits, you won't know if an alternative
method will work until you actually try it for yourself.

Before trying any alternative acne treatment it is highly recommended that you
become an educated consumer. You can accomplish this task by asking around
with your family and friends, chances are one of them is suffering from acne or
has recently cured their acne outbreak. Check to see if they used any type of
alternative means or methods to clear their skin up. If they did, then use that
combination of prescribed treatment on your own acne to see if you can duplicate
the same results. I'm sure you already know this, but traditional acne remedies
are rather expensive. Fortunately many of the active acne fighting ingredients are
the same in the cheaper alternative solutions. It may be worth it to experiment
with the lesser priced creams and zit cleansing solutions in order to cure your
acne at a reasonable price.

One aspiring method of alternative acne treatment involves the use of a

naturopath. This professional specializes in the use of gentle cleaners made from
herbs and vitamins to treat you acne. In fact, they have been known to clear up
acne by prescribing a simple treatment plan consisting of regular dosages of
Vitamin A, which is what the more expensive Accutane is derived from.

Another very promising method of alternate acne treatment focuses on the use of
red and blue ultraviolet rays of light. This regiment of light therapy treatment can
be done in the comfort of your own home with a laser that safely emits the
required light rays. For a more powerful application you can seek outside help
from a trained esthetician who specializes in using a more power light emitter too
cure your acne.

The reality is even if traditional means of curing acne don't truly work on your
eliminating your unsightly skin blemishes you don't have to despair. There are
many different acne fighting alternative treatments that you can easily and safely
try out to see which one is right for curing your zits and pimples.

Introduction to Phototherapy
Light therapy has been used by ancient cultures (Greeks, Egyptians, Chinese) for
thousands of years. It is only recently that science has been able to explain these
healing principals and apply them in a manner that is safe and efficient for
healing and anti-aging purposes.

Phototherapy is the scientific application of light, to specific points of the body to

activate or produce particular physiological results. There is often some confusion,
when discussing the behavior or light in tissue. When light is generated, and
travels through air, it can be described as being comprised of electro-magnetic
waves, measured in nanometers (nm). However, it is the "energy" that we are
most interested in. It is the proper combination of energy output, type of light
wavelength and absorption of energy in the cell that assists in skin rejuvenation
and anti-aging.
The activities caused by phototherapy increase vascularity in the formation of
new capilaries as well as help to replace damaged ones. Certain wavelengths of
light also stimulate the production of collagen. The chemical comound ATP
(adenosine triphosphate) is a major carrier of energy in cells and its release allows
for a faster acceptance of nutrients in cells and the removal of toxins when
stimulated by phototherapy. Increases in lymphatic funciton also occur with the
application of phototherapy.

The Benefits The Procedure

• Increases collagen The LightWave Skin Rejuvenation System allows

production by 50% thus therapeutic light waves to penetrate the
reducing wrinkles. epidermal layers of the skin enabling increased
• Creates more skin circulation by escalating the formation of new
moisture to help fill out capilaries. New capilaries speed up anti-aging
the skin. processes by supplying additional oxygen and
nutrients needed for cellular healing.
• Increases
circulation, providing a
healthier skin tone. The photothearpy application of the LightWave
• Restores the skin’s Skin Rejuvenation System increases RNA and
natural cellular (collagen) DNE synthesis helping damaged cell components
activity. to be replaced more rapidly. It stimulated the
production of collagen which allows the skin to
• Reduces melanin
maintain elasticity and a wrinkle free appearance
production, which causes
brown ages spots.

• Promotes
nutritional elements
existing within the skin.
Because it plumps up the
skin, its like giving
yourself a collagen
injection…but using your
own collagen.

Beyond Laser” Pulsed-Light Facial A Breakthrough Treatment“

Successful Treatment of Redness & Flushing

Rosacea is a common complexion disorder, which causes facial redness,

flushing of the nose, cheeks, forehead, chin & neck, dilated capillaries and acne.
As many as 13 million Americans, usually over the age of 30, are affected by this
condition. Up until now, lasers have been used to treat the capillaries, but there
has been no treatment to control the embarrassing & uncomfortable flushing &
redness.

Now, a new treatment has been developed, based on research by a

dermatologist in California. It uses pulses of light to eliminate the redness &
flushing of rosacea. In a study of 16 patients with rosacea, facial redness was
treated using intense pulses of light from a PhotoDerm™ (ESC Medical). This
laser-like medical device allows the doctor to precisely set the characteristics of
light energy for each patient’s skin, permitting exact treatment of the dilated
blood vessels and redness without injuring the remainder of the skin. With this
treatment, the entire face (or the affected part) is treated in 8-10 minutes using
repetitive flashes of light from the PhotoDerm™. Then, after healing,
microdermabrasion will be considered. No anesthesia is necessary. Patients
experience only mild redness immediately after the treatments. All patients are
able to return to their full activities immediately.
Every patient saw improvement in eliminating redness, flushing & capillaries
immediately. Maximum benefit occurred after 3 treatments. Flushing was reduced
at least 80%. 100 percent of patients achieved much smoother skin, and smaller
pores. It has been observed that the pimple-like breakouts disappeared or even
stopped entirely when the flushing was eliminated. Some patients were even able
to

discontinue dermatological medications they had taken for years. Redness of

the neck & chest is also treatable by this method. No adverse reactions or
scarring was observed. With pulse light treatment, people no longer need to suffer
the embarrassment of red faces, red necks, red chests, or the discomfort of
flushing. The PhotoDerm not only treats the redness of rosacea but also shows
promise as a possible cure for rosacea. Few things are as dramatic as the
elimination of a red face that a person has suffered from for years.

WRINKLES BE GONE!

• Intense Pulsed Light Treatments for Aging Skin

• Pulsed Light: An Alternative to Laser Resurfacing

Over the past six years, laser skin resurfacing has gained great popularity in
the treatment of facial lines and wrinkles. The disadvantage with laser skin
resurfacing is the lengthy “downtime” and persistent redness following the
procedure, lasting from 3 weeks to 3 months. Now there is a nonsurgical
alternative to laser skin resurfacing using intense pulses of light. A series of three
to five 15 minute treatments requires no anesthesia a results in dramatically
smoother, softer skin that has few wrinkles, smaller pores and less redness.
Patients are able to return to work immediately following treatments.

The treatments are effective for the aging of non-facial skin where laser
resurfacing of these areas poses a much greater risk of scarring. PhotoFacials™
are especially beneficial for younger patients with fine lines and early signs of
aging who are not candidates for laser resurfacing. PhotoFacials™ involves less
expense, discomfort and downtime. They are the ideal treatment for individuals
with early aging changes and for redness and flushing.

Answers About the Pulsed-Light Facial Using Intense Pulse Light

The treatment involves a unique pulsed light rather than the intense hot laser
beam, which improves the appearance of sun damaged and aged skin, as well as
reducing facial & neck redness and flushing. PhotoFacial treatments result in a
more youthful-appearing skin

The Ideal and 1st Long-Lasting Treatment

Seventy million Americans have an undesirable redness and/or sun damage of

the face. The causes are: Rosacea, sun exposure, alcohol, medications, stress,
emotional causes, time and aging of the skin. It occurs most commonly in fair-
skinned individuals of northern European descent. Some of these individuals have
a condition called Erythrophobia - a morbid fear of having a red face. In severe
cases, emotional & social problems occur.

The New Treatment for Redness, Wrinkles & Dilated Facial Blood
Vessels

An intense light is emitted in a series of gentle pulses at intervals of

approximately three weeks for a series of five treatments. This is different than
laser treatments, which emit light over many wavelengths, allowing the light to
penetrate To all the levels of the skin where abnormal easily dilated vessels can
be destroyed. Lasers do not work because they use only a single wavelength of
light, which is limited in depth of penetration.

It Works Well if There is General Skin Redness

The intense light, because of its unique nature of emission, attacks the tiniest
of vessels, which can only be seen by a microscope.

Most Patients Have 75-95% Improvement - On Average, a 90%

Improvement is Seen

It will also help patients who suffer prematurely from excess sun exposure,
pigmentation (Age Spots), irregularities of skin texture, and it can improve mild
acne scars, reduce large pores and dark circles around the eyes and helps reduce
fine lines, especially around the eyes and mouth.

Most people require 3-5 treatments, and, if necessary, a follow-up

treatment in 2 or more years to maintain the “fresh” look, and to avoid
the likelihood of future treatments.

This treatment won’t help frown lines, especially the forehead and between the
brows and eyes, or next to the nose. This requires Botox cosmetic injection
therapy, or a surgical face lift. It is not a substitute for a face-lift and will not help
baggy or sagging skin, or puffiness around the eyes. This requires Kool Touch
laser therapy or blepharoplasty. It is not a treatment for skin cancer. It won’t
remove bumpy moles, but can remove their pigment. It will remove, however,
acquired freckling. genetic freckles usually return after treatment. It won’t remove
those strands of deep parallel blood vessels occasionally seen on lower cheeks,
which can be removed in other ways. It will not remove seborrheic keratosis
including the tiny genetic ones on the upper cheeks and around the eyes
sometimes called dermatosis papulosa nigra. It also won’t remove sebaceous
hyperplasias, a benign growth of some oil glands in mid-life.

The Contraindications for This Procedure

• Connective tissue damage or auto-immune disorders

• Pregnancy
 • Recently sun-tanned skin (or in those who will receive excessive sun
exposure for a few weeks following treatment

• Usage of Accutane, or for 6 months after stopping Accutane

• Active acne cysts and large pustules

• Severe active rosacea

Most medications such as antibiotics, anti-anxiety, sulfa drugs, birth control

pills and anti-hypertensive medications are not a contraindication. Care must be
taken in patients who get fever blister attacks on the face. An anti-herpes
medication can be taken, thus avoiding the problem.

The most common side effects are mild and of short duration, which can
consist of short-term discomfort. There is redness immediately following
treatment, lasting less than 24 hours. (Rarely, it may last up to three days.) Mild
blistering and bruising is possible but in our experience occur in less than 1% and
usually clear very quickly. Post treatment pigmentation, or hypo-pigmentation,
has been noted on occasion, but is highly treatable and fortunately very rare.
Scars or infections of the skin after treatment have not been reported in the
research, but they can occur. Swelling of the face for 3-5 days occasionally occurs
and is most common in severely sun-damaged skin due to reduced quality of
connective tissue around the blood vessels.

To receive this treatment it is necessary for the patient to complete a general

medical questionnaire on the nature of the skin to properly evaluate the correct
settings for their skin condition and skin type. Pre-treatment, mid-treatment and
post-treatment photos will be taken. An informed consent sheet and photographic
permit form must be signed. All questions must be asked and answered by the
patient prior to treatment.

If you have a low pain threshold or sensitive skin ....

A topical cream can be applied 30-60 minutes prior to the treatment,

eliminating most discomfort. This is only required in 50% of patients who have
sensitive skin.

Each treatment takes approximately 15 minutes. It is important to remove all

make-up or creams. Men will be asked to shave on the day of treatment. Eye
shields/goggles will be applied to protect the eyes. A soothing gel will be placed
on the skin prior to treatment, which will help reduce discomfort. After the
procedure, ice may be applied to the area, and any additional post-treatment
instructions will be given.

This is superior to laser resurfacing because laser resurfacing does not affect
or remove blood vessels or flushing. In fact, it can worsen this condition, and is
unsightly and requires time away from work and your usual everyday activities for
two week up to a few months.
 With space age intense pulsed light, you can have glowing, smooth, blush-free
skin with NO DOWN TIME from work or play. You can usually go to work the same
day or the following day without the stares of friends and strangers. No procedure
has ever been developed that can accomplish so much with such low risk and no
down time. The treatment is based on research and development by dermatology
and varicose vein treatment specialists.

The same results cannot be achieved with chemical peels, microdermabrasion

(Power Peel™, Parisian Peels™, DermaPeel™) alone. It must be used combined
with intense pulsed light, not laser.

Contrary to what some doctors say, there is no laser that can duplicate the
efforts of intense light therapy. The laser cannot reach all the levels of the skin in
a manner similar to intense light. There is no alternative to this exclusive mode of
treatment. Acne scars will be improved with pulsed light therapy

Especially the shallow scars including fine lines will be improved, but ice pick
type acne scarring and deep scars will not be helped. Laser resurfacing or
dermabrasion may be indicated here. If the scars are milder and do not respond
to PhotoFacial alone then we often add another procedure called
microdermabrasion to the treatment schedule.

Other parts of the body can also be treated successfully, much like the face. It
is especially noticeable in getting rid of the “V-neck” effect of sun damage that
has accumulated in these areas from years of sun exposure. Scientists who treat
rosacea believe that there is hope to control the embarrassing blushing that gets
worse with age and time. Breakouts from rosacea can be diminished in frequency.
Some rosacea patients are able to stop taking antibiotics they have been taking
for years, and the need is reduced for topical cortisone creams.

1. What is Intense Pulsed Light?

This incredible new therapy was pioneered by Dr. Patrick Bitter Jr. and is based on
emitting high intensity pulses of light (not lasers) to penetrate the skin and rid
you of various complaints. There are different machines for different levels or
types of penetration. It is also knows as IPL Photorejuvenation. For instance,
PhotoDerm™ as the PhotoDerm VL (vascular lesions) {VascuLight/MultiLight},
PhotoDerm PL (pigmented lesions) or PhotoDerm HR (hair removal).

2. When can Intense Pulsed Light be performed?

There is no decisive age regarding this therapy.

3. What does a typical Intense Pulsed Light consultation entail?

Once you find a respectable clinic or practice in your area and decide to make a
consultation appointment, you will meet with the doctor or dermatologist and he
or she will determine if you are a candidate to receive treatment. He or she will
discuss your health, examine your skin and prior scars, ask you a million
questions regarding your family history (answer them honestly and disclose all
information) and explain to you what can and essentially what cannot be
successfully treated. Prepare to pay for a spot test or test patch if it is decided
you are eligible. He or she will also advise you on approximately how many
treatments and pulses per treatment that will be needed to achieve your desired
goal.

After your test patch/spot treatment you will wait and watch the test area for any
negative reactions such as blistering, hyper- or hypo-pigmentations, rashes,
persistent redness, etc. and report them to your technician/doctor. If all is well
you may schedule an appointment and you will be instructed on what and what
not to do for the next two weeks before your first treatment. For instance if you
are taking any of the above supplements or medications you will have to
discontinue them until a few days after treatment or until instructed otherwise.
You will also be instructed not to tan as hypo-pigmentation (patches of skin lighter
in pigment than your normal tone).

4. How is Intense Pulsed Light performed?

Your technician or doctor will ascertain your comfort and if desired a topical
anesthetic may be applied. After the treatment area is numb, a cold, soothing gel
will be applied and a glass prism (pyramid) will then be placed over the gel and
treatment area. An intense flash of light, or pulse, is flashed through the prism
where it is directed at the treatment area to rid you of your complaints. This
initial treatment may not be as aggressive as your following treatments so as not
to possibly damage the skin and to determine your skin's tolerance for further
intensive treatment. Treatments are usually performed every 3-4 weeks.

5. What should I expect after my Intense Pulsed Light treatment?

Since there is no real downtime you may resume your normal activities after a
Pulsed Light treatment. However you must protect your treatment area from UV
light, be it natural sunlight or tanning beds. You may be slightly pink or red
directly after your treatment as well as have mild swelling. This should subside in
a few days and if not you should inform your doctor/technician.

6. Does Intense Pulsed Light hurt?

Although all pain thresholds are different -- you may feel anything from a
sensation of warmth to a sting as if a rubberband has been snapped against your
skin. Some patients may wish to use an EMLA cream beforehand.

7. When will I be able to see the results?

After one or two treatments you should see results depending upon the complaint
-- However, some problems may take several to see any results. Only a
consultation with a qualified physician can determine this factor.

8. What are the risks of Intense Pulsed Light?

Although rare, blistering or slight bleeding is possible as is hypo- or hyper-

pigmentation (lightened or darkened areas of skin). If pigmentation problems
occur, it may be anywhere from 3 to 12 months before normal skin tome returns.
This is especially so with hypo-pigmentation (lack of color). Be aware that some
patients may experience permanent skin pigmentation changes. Scarring is
possible although it too is a rare occurrence.
9. What is Arnica montana or Bromelain, I have heard that these
homeopathics reduce swelling and bruising? Which is the best kind to
take?

also known as: Mountain Tobacco, Mountain Arnica, Common Arnica, Leopard's
Bane and Sneezewort
plant family: Asteraceae
type: Herbaceous perennial
parts used: Roots and flowers
description: Arnica montana or Leopard's Bane is a perennial herb, growing
close to the ground. The leaves form a flat rosette, from the center of which rises
a flower stalk, 1 to 2 feet high, bearing orange-yellow flowers. The rhizome is dark
brown, cylindrical, usually curved, and bears brittle wiry rootlets on the under
surface.
habitat: Indigenous to Central Europe, in woods and mountain pastures, although
it has been found in England and Southern Scotland.
warning: This herb should NEVER be taken in raw form. This plant, like many
medicinal plants if ingested, can cause intestinal bleeding, abdominal cramping
and sickness. Homeopathy is the medicinal use of tinctures and suspensions using
herbs and other plants and should never be consumed without proper
preparation. Only respectable homeopathic remedies and tinctures should be
consumed.

from the plant of the: Pineapple

also known as: Ananas, Nanas, Pina
plant family: Bromeliaceae
type: herbaceous perennial
parts used: mostly in the stems of pineapples, but some fruit is used as well.
description: 2 1/2 to 5 ft. high with a spread of 3 to 4 ft. The plant is like a thick
stem with a rosette of wide, waxy leaves. These pointed green, red, and white/off
white striped leaves are approximately 18 - 70 inches long and graced with a
spiny needle-like tip. The plant produces a sweet to tangy and sometimes sour
fruit that is yellow to white in color. The unpeeled fruit is brownish with a hard,
spiky covering and a large green sprout from it crown. The fruit is shaped like a
coffee can with rounded ends and is about 10-12 inches long usually when
considered prime and may even weigh up to 10 lbs.

habitat: Indigenous to southern Brazil and Paraguay, The fruit is now grown all
over in green houses and in the fields of Spain, Guatemala, Hawaii and more. The
pineapple is a tropical plant and thrives in hot, humid places. Although it can
survive cold snaps, it is not recommended for the more northern areas if intended
to be grown outdoors.

Bromelain is an anti-inflammatory formula containing the proteolytic enzyme from

the stems of pineapples. Proteolytic enzymes are capable of dissolving proteins. It
is most often used after sports injuries, to relive edema and after surgical
procedures to help with swelling.

ALWAYS ASK YOUR SURGEON FIRST BEFORE TAKING ANY MEDICATION.

*Enhancement Media has NO financial ties to Alpine Pharmaceuticals, SinEcch,

and merely suggests it for your convenience and post-operative ease.*

10. Are the results permanent?

Depending upon your habits (sun exposure, skin care, use of sublock, medication
use, etc), hyperpigmentations may be fully eradicated. Collagen replacement due
to the thermal wound response is subject to natural aging as the rest of your
collagen. The longevity is complaint-specific and only a qualified physician can
determine this factor.

What is Intense Pulsed Light?

Intense Pulsed Light (IPL) also known as photo-facial, fotofacials, and photo
rejuvenation is a state-of-the-art system and the latest technique in photofacial
therapy. The IPL system delivers high intensity, smooth and powerful pulses of
light (not lasers) that greatly enhances the results of your skin rejuvenation. For
skin therapy, IPL stimulates new collagen growth resulting in smoother, more
even, healthier skin.

How Does it Work?

A highly advanced computer regulates the light pulse to a specific wavelength

range, which in turn heats a portion of the skin. This removes the unwanted tissue
while it spares or avoids the surrounding healthy or "normal" tissue. The
penetration depth and degree of heat is highly controlled to minimize
complications. With IPL fotofacial rejuvenation, the light pulses are directed at the
blood vessels, age spots, freckles, flat pigmented birthmarks and other types of
discolorations.

An additional bonus is that the treatment causes inflammation of tiny blood

vessels in the skin which stimulates the production of new collagen.

It is possible to shrink sebaceous glands (oil glands), and pore size, with repeated
treatments. The number of treatments necessary to achieve this result varies
from patient to patient.

How is the IPL Photo rejuvenation different from CO2 or Erbium Laser
Resurfacing?

IPL photo rejuvenation is a noninvasive, safe method to improve the look and feel
of the skin without undergoing the pain and downtime associated with deep laser
resurfacing. Deep laser resurfacing removes the entire epidermis leaving the skin
vulnerable to infection and requires 3-4 weeks of patient downtime and an even
longer time to complete healing.

We also combine Fotofacials with Levulan in a procedure called Photodynamic

Skin Rejuvenation. This is the ideal treatment for moderate to severely sun-
damaged skin. If you have pre-cancerous skin lesions (Actinic Keratoses), this is
an excellent way to improve your skin.

Who is a Good Candidate?

IPL is an excellent choice for women and men of all ages considering treatment
for various skin problems including:

• Brown or age spots.

• Facial spider veins.
• Rosacea.
• Abnormal Skin pigmentation.
• Large Pores.
• Enlarged oil glands (sebaceous hyperplasia)

You should NOT have IPL Fotofacial treatments if you have:

 • Lupus.
• A tendency for form thick scars after you heal (keloids).
• A tendency to develop increased or decreased skin pigmentation
when healing.
• A dark skin colour (South Asian, African).
• A dark tan.
• Porphyria (A blood disorder that makes you sensitive to light).
• Extreme sensitivity or allergy to light

What are the advantages of IPL treatments?

• The treatment is gentle.

• There is no interruption of routine activities.
• There is often no recovery time required or time needed to be
taken off work.
• There are no stitches, cuts or bleeding to worry about.
• Improvement is subtle. In this way, your friends, family and spouse
don't have to know that you're having treatments, unless you want them
to.

What are the risks?

• Some mild swelling or bruising may occur. Swelling is more

common in patients with very red or pink toned skin that are having
treatments to reduce redness.
• Bruising may occur if many large facial blood vessels are being
treated.

Although rare, blistering or slight bleeding is possible as is hypo- or hyper-

pigmentation (lightened or darkened areas of skin). If pigmentation problems
occur, it may be anywhere from 3 to 12 months before normal skin tone returns.
This is especially so with hypo-pigmentation (lack of colour). Some patients may
.experience permanent skin pigmentation changes

• Scarring has never been reported after an IPL treatment.

• It is impossible to get permanent results. Even though the skin may
be “rejuvenated” for long periods, the aging process continues. The skin
will usually improve with further treatment.
• It might be impossible to remove a lesion forever or get permanent
results. Even though a lesion may be diminished or “disappear” for long
periods of 3-6 months, it might return in the future. The fact that the lesion
responded to treatment but recurred usually means that it will improve
with further treatment

Does it Hurt?

There is discomfort associated with the treatment. Each pulse of the IPL feels like
an elastic band snapping against the skin. Numbing creams such as EMLA and
Maxilene can be used prior to treatment, but are generally not required.

To make the treatment more comfortable the laser is equipped with a chilling tip
that cools the skin prior to treatment.

Furthermore, we have recently acquired a unique Zimmer Cryo Chiller for added
patient comfort. This machine blows cool air onto the treatment area which helps
to reduce discomfort. This makes the procedure significantly more pleasant. Many
offices do not offer this added feature.

How should you select where you should go for Fotofacials (IPL)
treatment?

Unfortunately there are no government regulations as to who can own or operate

an IPL (Intense Pulsed Light) machine. There is no minimal training required by
regulatory agencies and virtually anyone who has the capital can purchase a
machine and start doing treatments. For those reasons, you have to be very
careful where you go.

There are several questions you should ask.

1. Is the clinic a doctor's office or a spa? IPL can be potentially

dangerous if not used by well trained technicians.
2. How long have they been doing treatments?
3. Is there a doctor? Is the doctor someone who is specialized in skin
care and IPL therapy such as a dermatologist? Or is the doctor a family
doctor? Dentist? Chiropractor?

What are the qualifications of the technician who is treating

4. you?.
5. What type of IPL machine are they using?
6. Who will manage any complications is they should happen to arise?
7. Does the technician do a full and in depth consultation with you to
ensure that you understand the pros and cons of treatment, the risks and
benefits?
8. Do they take photographs to help monitor improvement?
9. Does a dermatologist check you first to make sure that you are a
good candidate for therapy?

When will you notice improvement?

You will start to see results after one or two treatments, depending on the nature
of the problem. Some skin problems will require several treatments before you
see any difference.

What areas can be treated?

Any area can be treated. This includes the face, neck, chest, back, hands, arms,
legs and feet.

How many treatments should you have?

A series of 5 treatments is usually recommended for most skin types and body
areas. Treatments are usually done 1 month apart. Dr. Vignjevic will determine
the number of treatments that your specific skin type and condition will require at
the time of your consultation or treatment.

How should you prepare your skin prior to an IPL treatment?

• Absolutely No tan coming into treatment . Treating skin with a tan

can produce white “striping” which can take several months to fade. Your
skin MUST NOT BE TANNED.
• Stop the use of all Retin-A, Reversa, Glycolic acid products and
toners a week before your treatment.
 • If possible, come to your appointment without make-up.

Dr. Vignjevic recommends that even though most people do not have a significant
down time after IPL, that you not plan any major events for 2 to 3 days after your
fist IPL treatment. This will give you a chance to see how your skin reacts and how
easily you can incorporate IPL treatments into your schedule
What is the procedure for IPL-Intense Pulsed Light-Fotofacial therapy?

1. At your first visit an IPL technician will provide a free consultation.

During the consultation, she will discuss the benefits of IPL therapy,
explain the procedure to you and answer any questions that you may
have. Furthermore, she will explain how the procedure works and how
many treatments you will need, and provide you with a price quote. She
will also ask you a series of questions to determine if you are a good
candidate for the procedure and to determine your skin type and
sensitivity.
2. After your FREE consultation, the technician will call in Dr.
Vignjevic. He will assess your skin type and whether IPL would be suitable
for you. In addition, he will answer any further questions that you may
have. You cannot be treated by the technician unless you are assessed by
Dr. Vignjevic first. Dr. Vignjevic will select the treatment protocol that best
suits your skin type.
3. If you decide to go ahead with a treatment, photographs will be
taken of the treatment area. These photographs are strictly for your chart
and will not be released or used without your permission. Your privacy is of
the utmost importance to us.
4. You will be asked to wash your face and to remove any makeup. It
is not necessary to remove mascara, lip stick or lip liner.
5. Your skin will be cleansed and any remaining make-up will be
removed.
6. You may purchase an anesthetic topical cream to be applied prior
to the light exposure. This is usually not necessary.
7. Your eyes are covered with special goggles during the treatment.
8. A cold, soothing gel will be applied and a glass prism (pyramid) will
then be placed over the gel and treatment area. The portion of the IPL
machine that is in contact with your skin is about the size of a quarter. An
intense flash of light, or pulse, is flashed through the prism where it is
directed at the area to be treated. This initial treatment may not be as
aggressive as your following treatments so as not to possibly damage the
skin and to determine your skin's tolerance for further fotofacial
treatments.
9. You may need a spot or test patch to make sure there are no
negative reactions.
10. During the treatment you may feel stinging, tingling, prickling, or
burning of the lesions, but this should go away after the treatment. A
Zimmer Cryo-chiller is used to blow cool air over the skin to make the
treatment more comfortable.

After treatment with Intense Pulsed Light, the gel will be

11. washed off the skin using soap and water. Cicaplast, a healing
cream is applied to the skin, and then a layer of Anthelios 60 sunscreen is
applied last prior to leaving the office.
12. You will be provided with a booklet of after-care instructions and
the technician will recommend specific products to take care of your skin
after the treatment.
13. You will be provided with Doctor V's personal cell phone number
should you have any questions or concerns that arise after office hours.
What should you expect after your treatment?

• There will be redness, and occasionally, mild blistering or bruising

of the treated areas lasting from several hours to 3-14 days. The treated
area might “crust”, “flake”, or look like a “cat scratch.” This will depend on
the sensitivity of your skin and the severity of the problem being treated.
Most people are completely healed within 7 days.
• There may be some mild swelling, crusting or bruising which will go
away after a few days, and if not, you should inform your doctor.
• The dark areas or freckles may crust, turn black and “peel off’. This
is normal and should resolve within 7 to 10 days.
• Your skin will be more sensitive for a few days up to a couple weeks
after your treatment.
• There should be some discomfort, but no significant pain.
• You can return to your normal activities.

What should a person do if they get significant redness, swelling, or pain

after a treatment?

1. Apply very cool or cold compresses to the face every 15 minute.

2. Take Tylenol for the discomfort.
3. Spray La Roche Posay Eau Thermale on the skin after you have
completed the compresses.
4. Apply Cicaplast regularly to the skin.
5. Avoid the sun or bright lights as much as possible.
6. Call the office where you had your treatment. They should be happy
to help you and to answer your questions.
7. If you are concerned that you have had an abnormal reaction, have
a cold sore, or an infection - call your doctor's office immediately.

Precautions for the first seven days after your IPL treatment:

• Avoid contact between hot water and the treated area.

• Keep the area moist and protected with Anthelios 60 sunscreen.
• You should stay out of the sun, ultraviolet light and tanning beds,
especially for the next 48 hours to minimize the risk of getting increased
pigmentation in the skin. If sun is unavoidable, use Anthelios 60 sunscreen
for at least 4 weeks following treatment. For the first 2 days wear a wide-
brimmed had or similar covering of light-opaque material. Sun exposure
may lead to the production of blotchy dark pigmentation which may take
several months to fade.
• Avoid any aggressive skin care products such as scrubs, exfoliants,
alpha or beta hydroxy acid products.
• Avoid excessive heat exposure such as saunas, steam rooms, hot
showers or baths, and strenuous exercising for 24 hours. This prevents the
risk of blistering.
• Keep clothing from rubbing the treated area and avoid other
irritation to the area.
• Do not get hairspray on the treated area.
• Notify the office should you have any prolonged redness, excessive
puffiness, or other unusual side effects.

How should you take care of your skin after an IPL Treatment

Morning
 1. To cleanse your skin, use a small amount of Toleriane Dermo Milk
Cleanser and a soft cloth to remove it. You may use lukewarm water with
it. If your hands or body has been treated, use Lipikar Syndet as a
cleanser.
2. Gently mist La Roche Posay Eau Thermale (Thermal Water) on the
treated area. The antioxidant and anti-irritant properties of the water will
help calm the redness and promote healing.
3. For the first 2 weeks apply Rosaliac to area treated to reduce
redness from treatment. After the first two weeks use:
o Reversa 8% anti-wrinkle cream if your treatment is for
sun damage
o Rosaliac if your treatment if for redness or rosacea
o Toleriane moisturizer if your treatment if for precancerous
sun spots
o Your prescription cream if your treatment is for excess
pigmentation
o 4
o *Important* Apply Anthelios 60 sunscreen to the treated
areas
o
4. 20 minutes before going outside, every day for 4 weeks. Use it even
if there is little or no sunshine out.
5. Apply foundation/make-up.

Evening

1. Repeat steps 1 through 3.

2. for the first two weeks apply Toleriane moisturizer. After 2 weeks
apply:
o Active C cream if your treatments are for sun damage
o Your prescription if your treatments are for rosacea
o Toleriane moisturizer if your treatment if for precancerous
sun spots
o Your prescription if your treatments are for excess
pigmentation

Anthelios 60, Toleriane moisturizer Active C anti-wrinkle cream, Eau Thermale,

Toleriane Dermo Cleanser and Rosaliac are available in my office for your
.convenience

Laser and intense pulsed light (IPL) therapies for acne scars, injury scars
and skin blemishes

Many people have facial scars and blemishes that they would like to reduce. Laser
and intense pulsed light (IPL) therapy can provide an effective acne scar
treatment, as well as being a solution to scarring due to injuries.

Laser and IPL therapies work by targeting intense light onto the skin. Your
specialist will focus the light onto the area around the scar or blemish. The IPL or
laser light then penetrates through the upper layer of your skin, effectively
'burning' it off. The treatment stimulates new skin to grow, and when the treated
area heals, the scar or blemish is usually much less noticeable than before.

Following scar treatment by laser or IPL, your skin will be red and weepy, and
redness will probably persist for several weeks. You'll need to use sunblock on the
area for at least six months after treatment. The full results of your laser or IPL
treatment will not usually be seen until ten to twelve months afterwards. Your
specialist may also recommend further therapy six to twelve months after your
first treatment.

The effectiveness of laser or IPL therapies for acne scar treatment and skin
blemishes depends both on your skin type and on the extent and type of your
scars. Often laser and IPL are used in conjunction with other cosmetic procedures
to achieve the best results. Your specialist will advise if laser treatment is suitable
for you. Lasers can cause an uneven colour in brown and black skins so the
treatment may not be suitable for people with these skin types.

All procedures carry risks as well as benefits. The chance of complications

following scar treatment by laser or IPL depends on the type of treatment and
other factors such as your general health. Your specialist will explain how the risks
.apply to you
LASERS, INTENSE PULSE LIGHT THERAPY,AND RADIO FREQUENCY RESURFACING
Issues involving cosmetic corrective surgical procedures are complicated enough,
but when the topic turns to lasers, intense pulse light (IPL), or radio frequency
resurfacing, what you will find is a clutter of complex, technical information that is
hard to decipher. All this is further complicated by enthusiastic physicians making
unrealistic claims and promises. An article in the Archives of Facial Plastic Surgery
(January-March 2002, pages 6-7), summed up the problem beautifully: "In facial
plastic surgery, many articles written by physicians may read more like
advertisements than science, overestimating the advantages of laser surgery,
while underestimating the disadvantages and complications. Currently, it is
unclear who is benefiting from laser madness in medicine. Is it the patient, the
physician, or the laser company?"

Perhaps the best way to start making sense of cosmetic resurfacing procedures is
to describe the kind of resurfacing methods being used, how they work, and then
explain what machines are employed to perform those tasks.

When it comes to lasers, IPL, or radio frequency resurfacing machines, they

function as either ablative or non-ablative modalities. Non-ablative treatments
target the lower layers of skin (dermis), while leaving the skin's surface
(epidermis) unharmed and intact. Ablative laser resurfacing targets both the
surface and the lower layers of skin by injuring or "ablating" the surface of skin.
Lasers can perform either ablative or non-ablative resurfacing, while IPL and radio
frequency resurfacing are considered non-ablative methods. Which system you
choose depends on the results you are looking for and how much risk you are
willing to take.

Ablative resurfacing can make a significant difference in the appearance of

deep wrinkles, surface wrinkles, and skin discolorations. But there are serious
risks and complications that can occur with ablative resurfacing. These include
swelling, scabbing, oozing, bleeding, flaking, redness, and irritation, and there is
also a risk of longer-term skin discoloration and scarring.

Non-ablative resurfacing has none of the side effects associated with ablative
resurfacing. However, non-ablative resurfacing doesn't produce the same
dramatic or impressive results as ablative resurfacing does. Not only are the
results subtle, but multiple treatments are required for any kind of noticeable
outcome. The advantage for non-ablative resurfacing is its minimal downtime;
women can reapply makeup before leaving the doctor's office and return to work
the same day.

Laser is an acronym for Light Amplification by Stimulated Emission of

Radiation. In essence, lasers work by generating a concentrated and penetrating
stream of pulsed bright light that can be controlled and strategically directed over
the skin. Resurfacing the skin with lasers can work as ablative or non-ablative
procedures depending on the type of laser utilized. An ablative laser literally
vaporizes and removes deep wrinkling and scars from the surface of skin and
penetrates deeper into skin tissue, reorganizing and stimulating production of
collagen and elastin fibers in the process.

Non-ablative lasers can remove some skin discolorations, improve some wrinkling,
and, with repeated treatments, help generate collagen and elastin. (Sources:
American Academy of Dermatology, www.aad.org; and Cosmetic Dermatology,
December 2002, pages 39-43.)
For ablative resurfacing with a laser peel, the quality of the postoperative
techniques is as important as the skill of the physician during the procedure. After
ablative laser treatment, the skin oozes, crusts, and needs to be cleaned and
dressed for about two weeks before you look even vaguely normal. Because the
top layer of skin has been stripped away, the raw, exposed skin needs to be
cleaned and treated very carefully. Patients need to make sure they follow post-
op care instructions precisely, because inconsistency or incomplete care can
cause infection, delay healing, and increase irritation.

The following is a list of the more popular lasers and light-emitting machines in
use for cosmetic resurfacing: (Note: The cost of the various procedures can vary
so dramatically from doctor to doctor that there is no way for me to provide a cost
estimate for these treatments.)

CO2 Pulse Laser (trade names Feather Touch or Ultra Pulse): This is one of
the oldest types of ablative machines around. Although it can create more lasting
and noticeable results than any other laser, it is also associated with the most risk
and potential skin damage. The skin can take one to two weeks to heal and can
be red for one to two months afterward. Risks of scarring, skin discoloration, and
uneven texture must be weighed against the intended outcome, although these
side effects are rare when the doctor is experienced with this kind of procedure
(Sources: Dermatologic Surgery, April 2004, pages 483-487; Lasers in Surgery
and Medicine, May 2003, pages 405-412; and International Journal of
Dermatology, June 2003, pages 480-487).

Erbium:YAG Laser: This ablative laser is far less invasive than the CO2 Pulse
laser and is considered effective for minor or superficial wrinkling. However, if the
intensity of the machine is increased, deeper wrinkling can also be treated.
Another option is the Variable Pulse YAG Laser which alternates frequency with
pulses that heat the skin and cause ablation that resurfaces the skin almost as
effectively as CO2, but with fewer side effects (Sources: Dermatologic Surgery,
August 2004, pages 1073-1076; Archives of Dermatology, October 2003, pages
1295-1299; and Archives of Facial Plastic Surgery, October-December 2002,
pages 262-266).

A combination of CO2 and Er:YAG laser treatments is now gaining popularity. In

this treatment, the Er:YAG laser is first used to remove the epidermis, followed by
use of the CO2 laser to achieve contraction of underlying collagen. This produces
the collagen-tightening benefits of CO2 therapy but with minimal damage to
surrounding tissues (Source: Department of Otolaryngology/Head and Neck
Surgery at Columbia University and New York Presbyterian Hospital,
http://www.entcolumbia.org/laserskinresurf.htm; and Dermatologic Surgery,
February 2000, pages 102-104).
Long-Pulsed YAG Laser (tradenames CoolTouch and Lyra): This non-
ablative laser is often used for wrinkles and reducing the appearance of acne
scars. As is true with any non-ablative laser resurfacing, it takes several
treatments to achieve very subtle results. The CoolTouch has a built-in cooling
device that protects the top layer of skin but it can still feel like a rubber band
snapping against the face as it is used. Types of the Long-Pulsed YAG Laser can
be used for hair removal and removing surfaced capillaries (Sources: Lasers in
Medicine and Science, April 2004, pages 219-222, Seminars in Cutaneous
Medicine and Surgery, December 2002, pages 288-300; and Laser Abstracts from
the 14th Annual Congress of the American College of Phlebology).

Several lasers are used for other cosmetic considerations aside from
wrinkling. These include:

Q-Switched Ruby Laser: This laser is minimally ablative and is primarily used to
selectively remove skin pigment, such as freckling, sun-damage spots, and actinic
keratosis without damaging the surrounding tissue. It is also useful for removing
birthmarks. It usually takes several treatments to see the desired results. One of
the popular uses for the Q-Switched Ruby laser is cosmetic tattoo removal. Many
physicians have noted that impulsive tattoo designs or the poor work from
inexperienced or poorly trained aestheticians who tattoo lip liner, eyeliner, and
eyebrows on women is so rampant that eliminating these constitutes a large
portion of their laser work (Source: American Journal of Clinical Dermatology,
February 2001, pages 21-25).

Pulsed Dye Laser, Short- and Long-Pulsed: This non-ablative laser gives
impressive results in removing surfaced capillaries on the face, port wine marks,
hypertrophic scarring (thick or raised scars), and hemangiomas (red dots on the
surface of skin). It doesn't cause skin damage, but it almost always causes
temporary bruising. Several treatments may be required (Source: Dermatologic
Surgery, January 2004, pages 37-40).

Long-Pulsed Alexandrite Laser (trade names GentleLASE and Cool Pulse):

This non-ablative laser is another option for hair removal and removing surfaced
capillaries and leg veins. This machine quickly covers large areas of skin.
(Sources: Lasers in Surgery and Medicine, May 2002, pages 359-362 and
Dermatologic Surgery July 2001, pages 622-626.)

The following is a summary covering a range of laser machines and the skin
conditions they address. Which one to use depends mostly on the physician you
see, which laser machines they own (or lease), and their skill with those particular
machines.

Laser or Light
Skin Condition
Emitting System
Wrinkles and CO2 (carbon dioxide)
lines Erbium:YAG
CoolTouch Long-Pulsed
YAG
Brown spots CO2 (carbon dioxide)
Nd:YAG
Q-Switched Ruby
Deep pigmented Q-Switched Ruby
lesions Nd:YAG
 Pulsed Dye
Scars and stretch CO2 (carbon dioxide)
marks Pulsed Dye
CoolTouch Long-Pulsed
YAG
Tattoos CO2 (carbon dioxide)
Nd:YAG
Q-Switched Ruby
Hair removal Nd:YAG
Long-Pulsed Alexandrite
Intense Pulsed Light
Long-Pulsed YAG

Intense Pulse Light (IPL): A "light" modality that uses high intensity pulses of
light that are not lasers and are considered to be exclusively non-ablative. Though
similar to lasers in many ways, the IPL's beam of light is limited to the depth of
resurfacing it can produce. This technique is not meant for those with extensive
sun damage and skin discolorations but it can reduce surfaced capillaries or veins,
port wine marks, hemangiomas, brown spots, as well as tighten the skin to some
degree. The number of side effects is minor, but it can take several treatments
(typically 4-6) to see desired results. There are a range of IPL machines including
PhotoDerm VL, PhotoDerm PL, PhotoDerm HR, EpiLight, and Quantum (Sources:
Plastic and Reconstructive Surgery, May 2004, pages 1789-1795; Lasers in
Surgery and Medicine, February 2003, pages 78-87); and www.emedicine.com,
.("Non-ablative Resurfacing," June 30, 2003

Several IPLs are used for other cosmetic considerations aside from
:wrinkling. These include

PhotoDerm VL (for vascular lesions): Light pulses are directed at the spider
and varicose veins as well as vascular birth marks. The tissue targeted is the red-
pigment (hemoglobin) in the blood which is heated by the light pulses destroying
.it without affecting the skin or other tissue

PhotoDerm PL (for pigmented lesions): Light pulses are directed at the "age
spots," freckles, flat pigmented birthmarks and other types of discolorations. The
tissue targeted is the melanin in the skin's surface. The melanin is then heated
.and the resulting damage or destruction removes skin discolorations

PhotoDerm HR and EpiLight (hair removal): Light pulses are directed at the
hair follicle causing the hair to fall out and prevent further growth, but this
.method is not permanent

Radio frequency (RF) resurfacing is neither a laser nor IPL. Rather, it is a form
of electromagnetic energy very similar to microwaves. It is considered a non-
ablative resurfacing treatment. The RF treatment passes radio frequency
electricity through the skin to heat up tissue. This is supposed to make the tissue
contract and, as is true with any injury to skin, it begins making collagen. The
most popular RF machine is known as Thermage. Another device, called the
Aurora, uses IPL and RF together for a unified procedure, supposedly to give the
patients the best of both modalities (Sources: Journal of Cosmetic Dermatology,
January 2002, page 142; and Cosmetic Surgery Times, “New Trends Spur Doctor,
Patient Education,” July 1, 2004,
www.cosmeticsurgerytimes.com/cosmeticsurgerytimes/article/articleDetail.jsp?
.(id=106139
You may have heard claims that RF treatments are painless, have no adverse
effects, or complications, yet the research, though extremely limited,
demonstrates otherwise. First, RF is considered by some as one of the most
painful non-ablative procedures, requiring localized anesthesia because it
intensely heats up the skin (Source: Cosmetic Dermatology, December 2003,
.(pages 28-34

A study published in Lasers in Surgery and Medicine (November 2003, pages 232–
242) reported that "fifty percent (41/82) of subjects reported being satisfied or
very satisfied." Keep in mind that means 50% of the subjects were less than
satisfied or were unhappy with their results. Further, 2nd degree burns did occur
and "Three patients had small areas of residual scarring at 6 months." Scabbing
and edema (skin swelling) occurs in some patients and though it does resolve it
can take six months to do so. Technically the improvement measured in this study
saw an average lift of 0.5mm. Half of one-millimeter is 0.019 inch long. That may
.not be exciting for what can be a costly procedure

Intense Pulsed Light (IPL)- Photofacials

For skin rejuvenation and Rosacea

Photo rejuvenation (photofacial or fotofacial) is a non-invasive skin health and

restoration treatment that erases the damage inflicted on your skin from sun,
aging and biological factors as well as Rosacea. The technology supplies a broad
spectrum of light which reaches deep down within the skin, targeting pigment and
vascular imperfections. The goals of therapy are a more even skin color and
texture.

The IPL corrects a variety of skin conditions such as brown spots and redness of
the face, while offering a safe, non-invasive solution that can be tailored to your
individual condition and skin type. The IPL can treat the imperfections on the face
as well as the neck, chest and hands.

The IPL is one of the most common technologies used to treat Rosacea. After a
series of treatments this technology can significantly reduce the redness and
visible blood vessels on the face. Intense Pulsed Light (IPL) treatments are
comfortable and performed without downtime. We sometimes alternate between
IPL and Pulsed Dye Laser treatments (Vbeam laser) when treating Rosacea.

After a series of IPL treatments, patients also report improvement in the texture
of their skin and reduced pore size. With a series of treatments, IPL Photo
rejuvenation can help restore your skin to a more youthful appearance without
the prolonged recovery.

Examples of Intense Pulsed Light Systems used at Reflections include the Starlux,
Ellipse and Medilux.

What can Intense Pulsed Light Therapy treat?

IPL treats a variety of conditions on the face, neck, chest and hands, including:

• Rosacea
• sun damage
• flushing
• skin texture
• redness
 • broken capillaries
• brown spots
• age spots
• sun-induced freckles on the hands, chest, and face
• broken capillaries around the nose
• fine lines and increased pore size
• ruddy skin

Who performs the IPL treatment and what is the treatment like?

In contrast to many facilities, at Reflections only physicians perform the IPL

treatments. The procedure takes 20-30 minutes and is well tolerated.
Occasionally we will use a topical numbing agent before the treatment. During the
treatment, light energy is delivered to the skin through a series of gentle pulses
and is accompanied by methods utilized to cool the skin during the process.

How many treatments are required and at what interval? Is follow up

necessary?
The number of treatments required depends on several factors including skin tone
and the extent of pigmented and vascular lesions and the degree of sun damage
that exists. Typically a minimum of three treatments (range 3-5) are performed at
monthly intervals for optimal results.

After your initial series of treatments, it is possible to require a follow-up

treatment in two or more years. Patients with rosacea may require regular
maintenance treatments, frequency depends on the severity of the condition. We
will educate you in ways of caring for your skin to help diminish the need for
future treatments.

What can I expect to see after treatment and is there downtime?

Recovery with the IPL Photo rejuvenation is minimal. Your face may be mildly red
for several hours after the procedure but this will subside. Pigmented areas on
your skin will become darker initially, and then flake off over the following week.

You should be able to resume all of your regular activities immediately. By

dividing the full program into several treatments, the procedure provides
progressive improvement with very low risk.

You will need to avoid the sun as much as possible before and after the
treatment, and no treatment should be provided if you are tan. Sunscreen with a
minimum of SPF 40 should be utilized daily, at all times of the year.

How does an IPL differ from a laser?

The IPL emits light over many wavelengths and can therefore have many targets
whereas lasers produce only a single wavelength of light therefore it has only one
specific target. One of the more popular lasers used in combination with the IPL
for the treatment of Rosacea is the Vbeam Pulsed Dye Laser.

What treatments can be combined with IPL?

The following procedures combined with IPL produces excellent results:

• Fillers- to fill out folds & wrinkles, including the area next to the
nose and mouth, to enhance the lips, and to soften the hollows under the
eyes.
• Lasers- to tighten the skin & reduce wrinkles and acne scars

• Botox - to soften and erase lines in the upper face including

forehead, frown and crow’s feet