Alex Trivantage

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(No Transcript)
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Alex Trivantage

• Tattoo Removal Benign Pigmented Lesions

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Patient Selection

• The 532nm and 755nm wavelengths should only be
  used on skin types I-IV as they have greater
  absorption by the skins natural melanin
• The 1064nm wavelength can be used on darker skin
  types IV-VI and test spots are highly
  recommended.
• All patients should avoid sun exposure, tanning
  beds, and sunless tanning products for 1 month
  prior to treatment

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How Does the Laser Work?

• Photo-acoustic vs. Photo-thermal
• Targets colors of tattoo pigment or melanocyte
• Blue/Black/Red/Green/Brown respond well
• Orange/Yellow/Powder Blue/Pink Do Not
• Breaks down pigment into smaller pieces
• Phagocytosis clears the area

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Selective Photothermolysis The Photo-Acoustic
Effect

• 755nm, 532nm, 1064nm emission is highly absorbed
  by melanin and dark tattoo particles
• These wavelengths penetrate from 1 to 4
  millimeters into the skin
• Nanosecond pulse duration is shorter than the
  thermal relaxation times of the smallest
  targets
• Tattoos Pigmented Lesions are affected not
  only by Selective Photothermolysis, but also
  subsequent photo-acoustic shockwaves that
  cavitate the smallest ink particles/melanocytes,
  promoting phagocytosis

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Pigment Absorption
The Shorter the Pulse the Greater the Fracture of
the Tattoo Pigment
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Wavelengths

• 755 nm should be used for GREEN BLUE
• 532 nm should be used for RED BROWN
• 1064 nm should be used for BLUE BLACK

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Alex TriVantage New 1064 532
Hand Pieces

• Laser Pumped Laser
• The laser produces a 755nm wavelength that will
  pass through a NdYAG medium creating a 1064nm
  wavelength
• For the 532nm wavelength it passes through two
  mediums

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Types of Tattoos
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Tattoo Categorization
Tattoo Type Pigment Type Ink Concentration Pigment Depth
Professional Organometallic Dyes Dense Deep
Amateur India Ink (Carbon) Sparse Variable
Cosmetic Iron or Titanium Oxide Sparse Superficial
Traumatic Carbon, Metals, Dirt Variable Variable
Medical India Ink (Carbon) Sparse Superficial
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Tattoo Clearance
Tattoo Type Number of Treatments
Professional 6 to 12
Amateur 2 to 6
Cosmetic 1 to 4
Traumatic 2 to 6
Medical 2 to 6
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Professional Tattoos

• Done by tattoo parlors
• Ink is deposited deeper in dermal layer
• Quality of ink is greater
• Requires far more treatments than other tattoo
  categories

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Amateur Tattoos

• Performed crudely by friends
• May appear grey or blue/black in color
• Variances in amount of ink and depth of
  penetration
• Not particularly clear with clean definition

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Cosmetic Tattoos

• Typically applied by an authorized/certified
  cosmetologist
• Lip liner, eyeliner and eyebrow tattoos are very
  popular
• Pigment is deposited very superficially

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Traumatic Tattoos

• Result of mechanical penetration of a foreign
  body such as glass, metal or dirt
• Can potentially be embedded so deeply that
  removal is tough

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Medical Tattoos

• Tattoos placed for purposes of marking radiation
  ports or for catheter placement
• Appear lighter in color (blue/black or grey)
• Unfortunate reminder to patient
• Physician release recommended prior to treatments

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Clinical Endpoints

• When using the 755nm wavelength
• Start with a low recommended fluence, perform a
  test spot and look for the appropriate skin
  response
• Slight frosting of the skin
• If little or no tissue response is noticed,
  increase the fluence
• If pinpoint bleeding occurs, reduce the fluence

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Clinical Endpoints

• When using the 532nm wavelength
• Start with a low recommended fluence, perform a
  test spot and look for the appropriate tissue
  response
• Slight frosting of the skin
• If little or no tissue response is noticed,
  increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
• Purpura, or bruising is possible due to
  absorption by competing blood vessels

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Clinical Endpoints

• When using the 1064nm wavelength
• Start with a low recommended fluence, perform a
  test spot and look for the appropriate tissue
  response
• Slight raising of the skin appearing opaque
• If little or no tissue response is noticed,
  increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
• Always perform test spots on darker fitzpatrick
  skin types (IV-VI)

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Treatment Intervals

• Time between tattoo removal treatments is
  recommended between 8-12 weeks
• Performing re-treatment too soon may interfere
  with macrophage activity
• It should be noted that increased fluence may
  improve efficacy, however it also increases the
  potential for adverse skin reactions (scarring).

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Benign Pigmented Lesions
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Benign Pigmented Lesions

• Solar Lentigines
• Dyschromia
• Freckles/Ephelides
• Cafe-au-lait/Pigmented Birthmarks
• Nevus of Ota

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Clinical Endpoints

• Endpoints are the same as with tattoos
• Slight frosting of the lesion
• Try to avoid pinpoint bleeding
• If little or no tissue response is noticed,
  increase the fluence
• If pinpoint bleeding occurs, reduce the fluence
• Usually takes fewer treatments (2-3 on average)
  than tattoos as they are more superficial

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Treatment Intervals

• Time between pigmented lesion treatments is
  recommended between 4-6 weeks for most lesions
• Nevus of ota should be re-treated at 8-12 weeks
• Lesions treated with the micro-second pulse
  duration should also be re-treated at 8-12 weeks

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Pigmented Lesions

• The Alex Trivantage at 755nm has the option of
  treating pigmented lesions with a 100 µs pulse
  duration
• Fluences will be higher than those used with the
  50ns
• Judge tissue response accordingly

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Treatment Instructions
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Pre-treatment Instructions

• Topical Anesthetic may be used
• LMX-4, Emla, or a B.L.T. (benzacaine, lidocaine,
  tetrocaine) compound are frequently used
• Area MUST be cleaned prior to treatment

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Post-treatment Instructions

• Clean area
• Apply dressing to treated area
• Apply ointment to keep area moist (Aquaphor,
  bacitracin or even Vaseline are commonly used)
• Cover area and ointment with a non-stick dressing
  (telfa)
• Advise patient to keep clean and to not pick,
  scratch or aggressively wash the treated area

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Operation, Safety Maintenance
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General Specifications

• Repetition rates
• 1, 2, 3, 4, 5 Hz
• Hz pulses per second
• Spot sizes are
• 755 nm 2mm(Gold), 3mm(Black), 4mm(Red)
• 1064 nm 2mm(Gold), 3mm(Black), 5mm(Red)
• 532 nm 2mm(Gold), 3mm(Black), 5mm(Red)

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Wavelength Spot Sizes
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Wavelengths Spot Sizes
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Protective Eyewear

• Since the Alex Trivantage has 3 different
  wavelengths, the appropriate eyewear must be worn
  at all times
• This includes proper Optical Density AND
  wavelength
• The Alex Trivantage has a screen reminding users
  of these requirements

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Eye Safety

• WARNING
• The Alex Trivantage 532nm and 1064nm hand pieces
  contain lasers and require special handling
  considerations for optimum performance and
  safety.
• Unlike the 755nm hand pieces, these hand pieces
  deliver a non-diverging beam. If you pulse the
  laser with the hand piece aimed at the wall,
  floor, or other object several meters away, it
  will create a burn mark
• Always take precaution to ensure that all persons
  in the room, while the laser is in use, utilize
  the appropriate eyewear.

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Appropriate Eyewear

• 532nm _at_ 6.0 Optical Density
• 755nm _at_ 6.8 Optical Denisty
• 1064nm _at_ 5.7 Optical Density

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Other Safety Concerns

• The Alex Trivantage 532 nm and 1064 nm hand
  pieces contain Factory Aligned Lasers and require
  special handling considerations for optimum
  performance and safety.
• The Hand Pieces can break
• SOMEONE COULD GET HURT

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Other Safety Concerns

• DO NOT DROP THE HAND PIECES!
• The internal components are fragile! They are
  factory aligned under strict environmental
  conditions cannot be repaired in the field!

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Handpiece Storage

• ALWAYS store the hand pieces in the top
  compartment of the laser.
• The lid should be kept OPEN after the laser has
  warmed up and close the lid when the laser is
  off.
• Temperature control issues.
• New hand pieces need to be warm before use
• Not too warm as with the cover closed and
  running).

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Foot Pedal Safety

• Prior to performing treatments
• Ensure that all personnel in the treatment room
  are safe by locking the front wheels and visually
  checking that the footswitch air hose is free and
  clear.
• If the laser or anything else rolls on the hose
  while firing the laser, it will continuously
  pulse non-stop unexpectedly.
• The Emergency Stop Button will be your only way
  to stop the laser from pulsing.

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User Interface
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User Interface

• 755nm wavelength has a RED background

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User Interface

• 532nm wavelength has a GREEN background

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User Interface

• 1064nm wavelength has a VIOLET background

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User Interface

• Each wavelength has an Applications drop-down
  menu
• Press Applications
• Select Application

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User Interface

• Once Application is selected, a default setting
  for that Application will appear
• If these parameters are acceptable, press
  calibrate

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User Interface

• Confirm selected parameters and depress foot
  pedal to begin calibration process

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Identification, Use Cleaning for Alex
TriVantage / Alex 2 Distance Gauges
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NEW Multi-Spot Distance Gauges

• Compatible with ALL wavelengths
• Compatible with ALL spot sizes
• Improved treatment area visibility
• Application and Removal are a Snap

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Multi-Spot vs Old LPL Distance Gauges

• New Multi-Spot DGs replace older LPL DGs
• First set of Multi-Spot DGs are FREE (will be
  received in the mail)
• Old LPL DGs will be obsolete
• May be best to discard old LPL DGs

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NEW Multi-Spot Distance Gauges

• Laser neutral materials and colorant prevent
  gauges from heat build up
• A 2.5 cm source to skip distance ensures optimal
  755nm beam focus
• A smooth molded surface finish makes cleaning and
  disinfection easier.

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New Distance Gauge Maintenance

• O-ring keeps protective lens locked into position
• O-ring can be removed similarly to other distance
  gauges
• DG window should be cleaned or replaced as
  described in the Alex2/Alex TriVantage DG window
  cleaning replacement procedure (8502-00-0916
  Rev C. or later)

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Multi-Spot DG
Protective Window
Multi-Spot DG
O-ring
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Distance Gauge Differences

755nm Fingernail type Distance Gauge
532/1064nm LPL Ring Type Distance Gauge
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DG Window Differences
Most reliably sorted by their size, the glass
window inserts for the two distance gauges are
different and cannot be mixed.
ALX-44-XXXX (Multi-Spot)
THESE ARE NOT INTERCHANGABLE
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755nm Distance Gauges

• The 755nm Distance Gauges (DGs) have a finger
  nail like probe
• These DGs fit inside the end of the hand piece
• Older AlexLAZR DGs do not have a protective
  window.
• Newer AlexLAZR and ATV DGs have a protective
  window
• The same 755nm DGs can be used with the 2mm, 3mm
  and 4mm hand pieces

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LPL Distance Gauges

• The 532/1064nm LPL Distance Gauges (DGs) have two
  legs and target ring at the tip
• The LPL DGs fit over the end of the hand piece
• They have protective windows that must be cleaned
  periodically
• They fit all spot sizes 2mm, 3mm, 4mm, and 5mm
  hand pieces

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Important Notes

• The Laser Pumped Laser (LPL) distance gauges are
  designed to be used only with the 532nm 1064nm
  hand pieces

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Important Notes

• When using the 755nm hand piece, the fingernail
  DG should always be used
• This DG has a window that improves reliability of
  the delivery system by protecting the 755nm HP
  optics
• This window must be cleaned to maintain proper
  system output

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Alex TriVantage vs AlexLAZR

• The AlexLAZR distance gauge DID NOT have a window
• Many practitioners may not be used to cleaning or
  maintaining these new windows.
• DG window should be cleaned or replaced as
  described in the Alex2/Alex TriVantage DG window
  cleaning replacement procedure (8502-00-0916
  Rev C. or later)

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Warning!!

• It is important to inspect and clean the DG
  window frequently so debris does not get burned
  into its surface
• If the optical coating on the DG window develops
  burn marks, the amount of energy reaching the
  treatment area may be significantly reduced or
  the laser beam may be deflected resulting in the
  HP or DG becoming damaged
• Burn marks on the coating may occur due to
  several reasons
• Dust/debris collecting on the surface and then
  being burned on via the laser beam
• Debris collected during normal attachment of the
  DG to the HP body (keep the DG clean)

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Identifying Burn Marks

• Hold the DG at an angle such that light is
  reflected off the window surface
• Burn spots will appear as small discolored
  rings/spots on the surface
• Their size (specks of dust to a pencil point)
  will vary depending on the extent of debris build
  up and the time burning has occurring
• Minor burn marks may be cleaned off. If unable
  to remove, further rapid degradation at these
  spots should be expected to occur

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Adverse Consequences of Burn Marks

• Reduced delivered fluence to the treatment area
  as more energy is deflected or absorbed by the
  burn area and therefore not reaching the
  treatment area
• Increased heat build up noted in the HP possibly
  resulting in frequent or unexpected system faults
• Burn marks can cause rapid degradation of the DG
  window

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Inspection Procedure

• Wear dustless gloves to prevent smudges or
  fingerprints on the window
• Place the laser in stand-by and remove the DG
  from the HP assembly
• Look through the DG window while pointing the
  DGs far end towards the ceiling light
• Rotating the DG at this position will cause
  debris on the window to rotate, making it more
  apparent

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Removing the Window

• Working over a clean surface, remove the O-ring
  that is holding the window in place
• Use tweezers, or a pointed object in notch to
  gently pull the O-ring towards the center of the
  window until the O-ring is free from the groove
• Turn the DG upside down allowing the window to
  fall out (if needed, gently tap the side of the
  DG with your finger)

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Cleaning the Window

• When cleaning used windows, use a 10 bleach
  water solution, mild soap water or alcohol
• Rinse thoroughly with clean water and dry with a
  lint free tissue
• Re-inspect the window and compare with the window
  Acceptability Chart (see next slide)
• If unacceptable, replace the window

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Window Acceptability Chart
Acceptable window Examples
Unacceptable window Examples
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Replacing the Window

• Grasp the window by the edges and place it back
  into the DG so it is resting flat on the ledge
• Re-insert the O-ring into the groove.
• Use tip of tweezers or pointed object and gently
  push the O-ring fully into the groove being
  careful not to touch the window

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Thank You