What is Fotona laser?

The acronym ‘LASER’ stands for “light amplification by stimulated emission of radiation”.


A laser works by emitting a wavelength of high energy light, which when focused on a certain skin condition creates heat and destroys diseased cells. Wavelength is measured in nanometers (nm).

Fotona laser is the only laser device that works from inside the mouth (4D face lift and treatment of snoring as well as liplase) and outside on the surface of the skin. Fotona provides two different type of laser with different wavelength in order to provide different treatment options for different areas and change the intensity based on the patient’s goals.

You can treat many conditions from laser hair restoration (HAIRestart), eyelid treatment to resurfacing the skin on the face and body, tight sculpt and treatment of snoring, skin lesions, hair removal, vaginal rejuvenation, treatment of erectile dysfunction, nail fungal infection and many more.

Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12)

People with fair to light skin tones usually have the best response to treatment with the Nd:YAG laser, but with longer wavelengths and pulse durations that lower the risk of skin damage, the laser can be safe and effective for people with brown or deep skin tones. Picosecond mode can also be used with less risk of PIH. Consult with an experienced laser provider who can determine the right course of treatment for you.

Nd:YAG laser has a wavelength of 1064 nm and has the capability to reach deeper layers of skin tissue than other types of lasers.

In Q-switched mode, Nd:YAG produces 2 wavelengths, one in the infrared range (1064 nm) and the second beam of 532 nm wavelength which is useful for superficial skin lesions. Q-switching refers to the technique of making the laser produce a high-intensity beam in very short pulses.

 


Nd:YAG is a crystal that is used as a lasing medium for solid-state lasers. It is the neodymium ion which provides the lasting activity in the crystal, in the same fashion as red chromium ion in ruby lasers.
Laser operation of Nd:YAG was first demonstrated by J.E. Geusic et al. at Bell Laboratories in 1964.

 

What is neodymium YAG laser used for?

The following skin disorders can be treated with Nd:YAG laser beams.  

  • Vascular lesions 
  • Spider and thread veins in the face (cheek, temporal region, nasal dorsum,  forehead) and legs  
  • Vascular birthmark (capillary vascular malformation)  
  • Varicose veins  
  • Facial veins (telangiectasia)  
  • Haemangioma (a vascular tumor)  
  • The laser light pulses target red pigment (hemoglobin). Typical settings employed  for the treatment of facial veins include a 50 milliseconds pulse duration, and  fluence (ie output energy) of 150¬250 J/cm2 (measured in Joules per centimeter  squared).  

 

Erbium: YAG

Increased Er:YAG pulse duration is associated with an increased risk of pigment  changes, potentially because a longer pulse duration deposits more energy per  pulse and thereby causes more thermal damage to surrounding tissue. The use  of a fractionated beam delivery system decreases the risk of pigmentary  changes. Pigmentary changes often fade with time; hyperpigmentation is more  common than hypopigmentation and more likely to resolve. For persistent  hyperpigmentation, 4% topical hydroquinone will help lighten the skin. For  hypopigmentation, which is thought to result from inflammation that compromises  melanocyte function, topical steroids may be helpful. Other options include sun  exposure, blue laser therapy, intense pulsed light, and fractionated CO2 laser  treatments

  

For many years, carbon dioxide (CO2) lasers (wavelength 10,600 nm) were the  only lasers available for laser skin rejuvenation; nowadays, there are many more options, including the solid-state erbium-doped yttrium aluminum garnet Er:YAG  (2,940 nm), diode (810 and 940 nm), and erbium:glass lasers (1,540 and 1,550  nm). 

 

1996 short-pulse Er:YAG lasers were approved, with pulse lengths of 250-350  µs; however, variable and longer-pulse Er:YAG lasers with pulse widths of 500 µs  to 10 ms were subsequently approved in 1999  

 

Er:YAG is absorbed by water in the epidermis and papillary dermis, resulting in  two effects that promote skin rejuvenation. The first is vaporization of the  epidermis, which requires the dermal appendages (hair follicles and sweat  glands) to resurface the skin in order to heal. Secondly, thermal injury in the  dermis stimulates collagen production, which improves the appearance of photo  damaged skin while reducing visible rhytids and scars.  

 

Laser skin rejuvenation treatments are generally classified into two  categories, ablative and non-ablative. Ablative lasers vaporize and/or coagulate  the most superficial layers of skin, which results in rejuvenation via re epithelialization and collagen stimulation. The classic example of an ablative  laser used for skin rejuvenation is the CO2 laser. Non-ablative laser treatments  do not remove the epidermis but nonetheless cause controlled thermal injury,  which stimulates the production of collagen and elastin. Examples include the  diode, erbium:glass, and neodymium:YAG (Nd:YAG 1,320 nm) lasers. While  ablative treatments typically provide more dramatic results, non-ablative lasers  are preferred by many patients because of their lower risk profile and decreased  post-treatment recovery time. However, more treatments with non-ablative lasers  are often required to achieve the same effect as a single treatment with an  ablative laser. The Er:YAG laser is considered an ablative laser.

  

Ablative laser energy delivery is commonly performed in one of two ways: with  full-field therapy or via a fractionated beam. While a full-field approach treats the  entire area of interest, fractionated treatments ablate microscopic vertical  columns within the treatment area while leaving intervening areas that remain  unaffected. This approach leaves uninjured skin and dermal appendages, which  promote re-epithelialization, reduce adverse side effects, and stimulate collagen  production.  

In either case, the goal is to ablate down to the papillary dermis, which will  maximize collagen stimulation and tissue tightening while minimizing scarring.  The depth at which the papillary dermis is found varies throughout the face, with  the eyelids being the thinnest at about 150 µm and the chin being thickest at  approximately 200 µm. Likewise, the thickness of the dermis varies from about  200 µm in the eyelids to approximately 1300 µm in the chin. The neck is the 

thinnest, with an epidermal thickness of roughly 100 µm and a dermal thickness  of approximately 150 µm.  

Fotona 4D , non surgical facelift

The Fotona4D® protocol is a non-invasive laser treatment of both the exterior facial and interior oral cavity, enabling full-thickness contraction of collagen and stimulation of new collagen synthesis (neocollagenesis), for persistent, no-downtime tightening of sagging skin, volumization, wrinkle reduction, improvement in tone and texture, and treats sun damaged skin, without injectables while being safe for all skin types. 

It is performed with the two laser wavelengths Er:YAG and Nd:YAG, in a series of four steps with a comprehensive approach to rejuvenation from four different levels. It targets deeper, medial and superficial connective structures, as well as targeting imperfections in the skin. 

Pre-treatment Instructions

2 Weeks Prior  

  • Avoid sun-exposure, tanning beds, or sunlamps. Patients are unable to be  treated with a tan or a sunburn in the face.  
  • Please do not use perfume, deodorant, waxing or chemical peel on the treatment  area for two weeks prior to the treatment. 
  • Prior to Arrival Make sure the face is thoroughly cleansed. All make up must be  removed. For men, face skin must be clean and fresh shaved.  

 

Post-treatment Instructions

General :  

  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream  (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin).  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm). 
  • Immediately After : Can apply make-up (but best to wait 24 hours).  • After 4-5 Days : Topical treatments and skin care dermo-cosmetic products,  such as retinol and acids can be resumed. 
  • For 7 Days Strict avoidance of sunlight. Erythema should be expected  immediately after the session lasting less than 24 hours, followed by a possible  superficial feeling over the next 48-72 hours.  
  • Immediately after the treatment, freshness and tightness of the treated skin.  Complete results take place gradually, over a time period of 2-3 months.  Continuing improvement for up to six months.

 

Healing And Results

Erythema should be expected immediately after the session lasting less than 24  hours, followed by a possible superficial feeling over the next 48-72 hours.  Immediately after the treatment, freshness and tightness of the treated skin.  Complete results take place gradually, over a time period of 2-3 months.  Continuing improvement for up to six months.  

Frequency of the treatments:

It is recommended to do 1 session per decade of life. For example a 40 year old  needs 4 treatments.  

Complete results take place gradually, over a time period of 2-  3 months. Continuing improvement for up to six months.  

 

  • Treatment sessions: are performed at 4-6-week intervals for a  total of 3-7 consecutive sessions.  
  • Example: Patient in their sixties, as initial package of 6  sessions recommended, followed by yearly maintenance treatment.  

 

  • maintenance treatments:

One session each year.  

Endotight:

The ENDOTIGHT FOTONA LASER treatment is carried out using the FOTONA  SP DYNAMIS PRO device with its R27C FIBER 600µm hand piece.  The primary objective is to provide satisfactory treatment aimed at reducing,  eliminating or preventing wrinkles and skin laxity.  

Skin aging is a natural process that affects all living beings, including human  skin. Over time, our skin loses its elasticity, its firmness and shine, which can  make us look tired and aged.  

Fortunately, thanks to advances in aesthetic medicine, there are many options to  slow down the aging process and regain firmer skin thanks to the ENDOTIGHT  FOTONA LASER Gold Treatment with a ND:YAG 1064nm wavelength.  The procedure:  

Endotight is a non-surgical rejuvenation technique that uses laser technology to  stimulate collagen production in deeper layers of the skin. This procedure is ideal  for patients who want to tighten their skin with regenerative self-stimulation and  without the need for more invasive surgery, such as a facelift.  The Endotight procedure is simple and quick. The treatment is carried out under  local anesthesia and involves inserting a thin optical fiber into the skin. The laser  is then used to heat the deeper layers of the skin, thereby stimulating the  production of collagen and elastin and also the tendons around the SMAS.  This helps tighten the skin, reducing the appearance of fine lines and wrinkles,  and leaving skin looking firmer and more radiant.  

Endotight technology also makes it possible to treat inflammatory scars and  keloids as well as cellulite. 

FOR WHOM AND FOR WHAT PART OF THE BODY?

The innovative technology of Endotight works on all parts of the body and face  affected by sagging skin such as the cheeks, the oval of the face, the double  chin, the eyelids, the neck, décolleté but also the abdomen, thighs, arms,  knees…  

Endolift laser treatment applies to both women and men who wish to reshape  their face.

HOW DOES AN ENDOTIGHT SESSION TAKE PLACE?

It takes between 45 and 60 minutes for an Endotight face session, and 1 to 2  hours for a body session.  

Endotight laser treatment is an outpatient procedure, which can be performed  without anesthesia or with local anesthesia depending on the area to be treated  and the sensitivity of the patient.  

After disinfecting the skin and marking the areas to be treated, the doctor  introduces the microfiber into the hypodermis without making incisions since it 

passes through the skin like a fine needle. The fiber inserted into the hypodermis  for approximately 5cm, the laser can then be activated to heat the tissues.  You will need to wear protective glasses or special shields to protect your eyes  against possible accidental exposure to laser light. On the day of the session,  you will be asked to remove your jewelry and glasses.  

The treated areas will be photographed.  

A single session is normally sufficient, but it can be supplemented with a second  between 6 and 12 months after the procedure.  

The rejuvenation carried out lasts for several years. The natural aging process  continues, which may require an on-demand maintenance session.  

SIDE EFFECTS AND AFTER CARE:

The consequences of Endotight are very mild with a short convalescence.  Return to normal activities is possible immediately after the session.  Please wait for 10 days to go back to exercise, bath and sauna. Shower the next  day is ok. The side effects are minimal, including some bruising, redness,  hematomas or transient tingling in the treated area. The skin remains superficially  sensitive for one to two weeks. A feeling of numbness is possible in case of  action on the oval of the face.  

A small remark should be made for the eyes: if the bags and dark circles are very  significant, the intensity of the session must be increased and the consequences  may in this case be more significant. It will therefore take 7 to 10 days of swelling  under the eyes.  

Slight pain is possible, but there is no bleeding. Treatment of platysmal bands  (vertical neck bands) can be followed.  

Fractional Peel :

Fractional peels are performed using ablative Er:YAG (2940nm) to  drill micro holes into the skin to induce skin repair over a fraction of  the surface of the skin. The benefits of fractional peels compared to  full field peels are being able to reach the dermal layer of the skin  and induce damage and repair in those layers while minimizing risk  and patient downtime. This procedure will help improve the tone  and texture of the skin.  

With the adjustability of the Fotona Er:YAG it is possible to perform  a wide range of fractional peels from shallow/superficial cold peels  to deep hot peels and everything in between to customize the  treatment to patients skin type, needs, and capacity to tolerate 

Pre-treatment Instructions

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • Avoid perfumes, deodorants, waxing, chemical peels or collagen injections in  the treatment area.  
  • 3 Days Prior Discontinue the use of Aspirin. This can increase the risk of  bleeding. 

Post-treatment Instructions

    • Apply a re-epithelizing cream as often as needed to improve the healing  process.  

    Cream recommendations to select from are: Bariederm Cicacream (Uriage)  Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin) Apply broad  spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • Immediately After If history of HSV, take 1 gr. of Valtrex, and continue once a  day for 3 more days.  

    • After 3-5 Days Can apply make-up.  
    • For 5-7 Days Patients with darker skin, use topical soft steroid to improve the  healing process and avoid PIH, twice a day for 5 to 7 days.  

    Prednicarbate cream 0.25% Methylprednisolone Aceponate cream 0.01%  • After 7 Days Can resume topical treatments and skin care dermo-cosmetic  products.  

    • For 7-15 Days Strict avoidance of sunlight.  

Healing and Results:

Edema, erythema and small scabs should be expected to last 7-15 days,  depending on aggressiveness of the treatment.  

Frequency of the treatment:

On average we need 1-4 sessions, 4-8 weeks intervals to see the best results.

Full field peel :

Full field peels are performed using ablative Er:YAG (2940nm) to take off  a varying depths of the epidermis to remove imperfections such as sun damage, 

wrinkles, and dull skin. Full field means that 100% of the skin surface is affected  during the peel in contrast to a fractionated peel which only affects a  small percentage of the treated surface area. This procedure will help improve  the tone and texture of the skin. With the adjustability of the Fotona Er:YAG it is  possible to perform a wide range of full field peels from shallow/superficial cold  peels to deep hot peels and everything in between to customize the treatment  to patients skin type, needs, and capacity to tolerate downtime.  The settings provided below are general guidelines and due to differing skin  thicknesses from patient to patient to achieve a true medium or deep peel  clinical endpoints must be observed which are illustrated below. The color of the  debris indicates which depth has been achieved. Pinpoint bleeding is the  deepest layer that should be reached with full field treatment as going deeper  can lead to hypopigmentation, scarring, and other adverse effects. 

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps.  Patients are unable to be treated with a tan or a sunburn in the face.  • Avoid perfumes, deodorants, waxing, chemical peels or collagen injections in  the treatment area.  
  • 3 Days Prior Discontinue the use of Aspirin.  This can increase the risk of bleeding. 

Post-treatment Instructions:

General:  

  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream  (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin)  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • Apply a gentle moisturizer when the skin feels dry and tight; as many times a  day as needed; apply barrier cream and sunscreen over the top.  • Avoid active topicals, such as retinol, until fully healed.  
  • For 7-15 Days Strict avoidance of sunlight.  

Frequency of the treatment:

On average 1-4 sessions, 4-8 weeks apart.

A series of photos showing the different stages of a dog's skin.

Smooth eye ( Extra-ocular / Intra-ocular) non-surgical eyelid tightening

Overview:

Eyes and the periorbital region are probably the most important aesthetic unit  in the human body. The SmoothEye® protocol is a one step non-ablative  treatment for tightening the periocular region and reducing the presence or  periorbital wrinkles.  

It is done with the SMOOTH® mode, which produces a controlled, but intense  surface tissue heating, stimulating collagen remodeling in order to produce  an improvement in the skin elasticity, overall structure and volume, with little  to no downtime.  

Treatment intervals:

4 sessions every 4-6 weeks

Post-treatment Instructions:

  • General:  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • In rare cases swelling can be present; patients can take antihistamines such  as Claritin/Zyrtec to alleviate symptoms.  
  • After 3-5 Days : Topical treatments and skin care dermo-cosmetic products  can be resumed.  
  • For 7 Days Strict avoidance of sunlight.  

Healing And Results:

General:  

  • Report any changes in: Swallowing (Dysphagia) , Alterations in taste,  Alterations in sense of smell , Changes in speech, Practice good sleep  hygiene.  
  • Maintain a balanced diet and exercise.  
  • Immediately After Drink at least 8 oz of room temperature water.
  •  Up to 2-4 Hours After the procedure Avoid cold or hot drinks.  
A photo of a person's eyes.

Nightlase , non-invasive treatment of snoring

Overview:

NightLase® is a thermally mediated treatment that uses focal  Nd:YAG and Er:YAG laser energy to cause collagen remodeling and  conversion to type I and III collagen in the tissues. The improvement  in snoring and obstructive sleep apnea is based on the opening of  the airway as a result of this contraction and also the increased  resistance to collapse. It is a safe, successful, minimally invasive  treatment with no need for anesthesia or special arrangements,  either pre- or post-therapy. The procedure takes 30-35 min.

Pre-treatment Instructions:

General :  

  • Ideally patient has a sleep study performed before treatment start and 3  months post-treatment series for evaluation of treatment success.  • Hydration is important. During the procedure the patient will feel some heat in  their throat.

Post-Treatment Instructions:

General:  

  • Report any changes in: Swallowing (Dysphagia) , Alterations in taste,  Alterations in sense of smell , Changes in speech, Practice good sleep  hygiene.  
  • Maintain a balanced diet and exercise.  
  • Immediately After Drink at least 8 oz of room temperature water. 
  • Up to 2-4 Hours After the procedure Avoid cold or hot drinks.  

Healing And Results:

• After the treatment, you may feel a mild sore throat for 2 days. 

• Immediate results after the first treatment (average of 50% reduction in snoring  volume and tone).

Treatment frequency:

  • 3 plus treatments 21 days apart.
  • Long standing CPAP use may require a 4th or 5th treatment, due to the effect CPAP has on the loss of tone of the oropharyngeal tissues (may apply to smokers also). 

Maintenance:

  • Every year for pure snorers.
  • Every 6 months for OSA (Obstructive sleep apnea) patients.
  • Maintenance at 6-12 months as necessary. 

Neck Tightening

Overview:

The neck area represents a common and challenging aesthetic  concern. The protocols will outline different treatment options that  can be used all together to essentially resemble a neck “4D” or each  step can be performed separately for a less time consuming and  lower cost treatment to patients. 

Neck tightening is in 4 steps, using both Nd:YAG and Er. YAG laser with different  settings in each step to work on superficial and deeper layers of the skin.  3-7 sessions, every 4-6 weeks. 

Pre-treatment Instructions:

Two weeks prior, ask the patient to avoid sun-exposure, tanning beds, or  sunlamps since they are unable to be treated with a tan or a sunburn in the  face. 

Post-Treatment Instructions:

Patient Instruction:  

  • Apply a re-epithelizing cream to improve the healing process; patients to apply as often as needed. Cream recommendations to select from are: Bariederm Cicacream (Uriage), Cicaplast (La Roche Posay), Cicalfate (Avenne)  Aquaphor(Eucerin).  
  • Immediately after (but best to wait 24 hours), can apply make-up.4-5 days after, topical treatments and skin care dermo-cosmetic products, such as retinol and acids can be resumed.  
  • For 7 days, strict avoidance of sunlight.
  • patients should apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).

 

Healing and Results:

  • Erythema should be expected immediately after the session lasting less than 24 hours, followed by a possible superficial feeling over the next 48-72 hours.  
  • Immediately after the treatment the patient is going to be able to see freshness and tightness of the treated skin.
  • Complete results take place gradually, over a time period of 2-3 months.
  • Continuing improvement for up to six months.

Treatment Frequency:

  • Treatment sessions are performed at 4-6-week intervals for a total of 3-7 consecutive sessions.Example: Patient in their sixties, as initial package of 6 sessions  recommended, followed by yearly maintenance treatments. 
  • It is recommended to do 1 session per decade of life.  
  • Complete results take place gradually, over a time period of 2-3 months.  • Continuing improvement for up to six months.

Liplase, lip augmentation without filler or surgery

A three step non-invasive lip enhancement treatment with no  downtime, no puncturing of the skin, with minimal discomfort, and  no known adverse outcomes. Liplase enhances the lip to give a fuller  and smoother appearance with a thermal effect that results in a  collagen remodeling and initiating new collagen synthesis  (neo- collagenesis). 

Pre-treatment Instructions:

  • If history of HSV, prescribe 1g. of Valtrex 3 days prior, immediately after the  procedure, and continue once a day for 3 days post.
  • All patients that don’t have a history of HSV with 1g Valtrex Day of procedure. 

Post-Treatment Instructions:

  • General:  
  • Immediately After It is recommended to continually apply Vitamin E, coconut oil,  Vaseline or Aquaphor after the treatment to minimize the extent of the peeling.  • Ensure to stay hydrated. 
  • If history of HSV, take 1 gr. of Valtrex, and continue once a day for 3 more  days.  
  • For 3 Days Avoid pigmented lipsticks, vinegar and spicy food. 

Healing and Results:

  • Inflammation should be expected immediately after the session lasting 24  hours.  
  • Surface peeling on the border of the vermillion can occur, lasting 2 to 3 days.  • A superficial scab is expected over the vermilion’s border for 3 to 5 days.   The collagen formation starts immediately after the session and continued  improvement can be seen for up to several months.  

Treatment Frequency:

  • 4 sessions, 4 weeks intervals 

Rosacea

Rosacea is a chronic inflammatory skin condition characterized by  transient and non-transient facial flushing, erythema, and telangiectasia  that worsen during flares.  

Four distinct subtypes have been recognized,  

  1. erythematotelangiectatic (subtype I), 2. papulopustular (subtype II), 3. phymatous (subtype III), and 4. ocular rosacea (subtype IV).

This protocol outlines how to treat the two more common subtypes I and  II.  

  1. Erythematotelangiectatic rosacea is characterized by non-transient episodes of flushing and persistent central facial erythema with overlying telangiectasia.  
  2. On the papulopustular subtype, in addition to the features  seen in subtype I, patients experience transient papules or pustules in a  central facial distribution. 

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • Erythema should be expected immediately after the session lasting 24 hours 

Post-Treatment Instructions:

  • General:  
  • Apply Arnica cream/gel over the treated area with a gently massage, 2-3 times  a day as to improve the appearance of petechiae.  
  • Apply a re-epithelizing cream as often as needed to improve the healing  process.  
  • Cream recommendations to select from are: Bariederm Cicacream (Uriage)  Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin)  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • Immediately After If history of HSV, take 1 gr. of Valtrex, and continue once a  day for 3 more days.  
  • After 3 Days Can apply make-up.  
  • After 3-5 Days Topical treatments and skin care dermo-cosmetic products, such  as retinol and acids can be resumed.  
  • For 7 Days Strict avoidance of sunlight. 

Healing and Results:

Erythema should be expected immediately after the session lasting 24 hours.  Petechiae over the treated telangiectasias can be expected to last 5 to 7 days. 

Treatment Frequency:

Treatment sessions are performed at 2-week intervals for a  total of 4 sessions. 

Erythema keratitis and erythema psoriasis.

Pigmented lesions, age spots, flreckles

Nd:YAG laser can be used to remove brown age spots  (solar lentigines), freckles, naevus of Ota, naevus of Ito, lumbosacral melanocytosis, Hori nevus, and café-au-lait-macules. 

Light pulses target melanin at variable depth on or in the skin.

Hair removal

Nd:YAG laser may be used for hair removal in any location including underarms,  bikini line, face, neck, back, chest and legs.  

Nd:YAG laser is generally ineffective for light-coloured (blonde/grey) hair, but  effective for treating dark (brown/black) hair in patients of Fitzpatrick types I to III,  and perhaps light-coloured type IV skin.  

Extreme caution is recommended in tanned or darker-skinned patients, as the  laser can also destroy melanin, resulting in white patches of skin (leukoderma).  

The longer-pulse (millisecond) 1064-nm Nd:YAG laser system has been shown  to be more effective in safely removing hair than has the Q-switched  (nanosecond) Nd:YAG system.  

 

Dentistry

Nd:YAG dental lasers have also been shown to be effective at treating and preventing  dental hypersensitivity, as an adjunct for periodontal instrumentation, and for the  treatment of recurrent aphthous stomatitis. 

Stress incontinence / vaginal rejuvenation

In the International Journal of Urogynecology in 2020, there was a study on women with  female stress urinary incontinence ( SUI) treated by Er:YAG laser. ( PMID: 31828400 )  The conclusion was: Intra-vaginal laser therapy led to cure/improvement for SUI I and  SUI II, but not for severe SUI III. Outcome was better after four to five laser sessions  than after two laser sessions. Follow-up data 6 months and 2 years after laser intervention  showed sustainability of the treatment. 

Acne Scar :

Acne Vulgaris is a chronic inflammatory disorder of the pilosebaceous unit  with a high prevalence among adolescents, and often continues to  adulthood. Scarring often results early with a negative psychosocial  impact on patients.  

Acne scars are classified into atrophic, hypertrophic, or keloidal with  atrophic being the most common. Atrophic scars are further subdivided  into icepick, boxcar, and rolling scars. These types can additionally be  erythematous, hyper-pigmented, or hypo-pigmented. 

Pre-treatment Instructions:

  • 2 Weeks Prior : Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • 3-5 Days Prior : Discontinue using skincare products that contain Vitamin A  derivatives. Tretinoin Differin Retinoids Glycolic acid Exfoliants such as AHAs,  BHAs Skin lightening creams such as hydroquinone and kojic acid Alcohol based products

Post-Treatment Instructions:

General :  

  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne)  Aquaphor (Eucerin)  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  
  • Immediately After If history of HSV, take 1 gr. of Valtrex, and continue once a  day for 3 more days.  
  • After 3-5 Days Can apply make-up.  
  • For 5-7 Days Patients with darker skin, use topical soft steroid to improve the  healing process and avoid PIH, twice a day for 5 to 7 days. Prednicarbate cream 0.25% Methylprednisolone Aceponate cream 0.01%  • After 7 Days Can resume skincare products that contain Vitamin A derivatives.  • For 7-15 Days Strict avoidance of sunlight.  

Healing and Results:

  • Edema, erythema and small scabs should be expected to last 7-15 days,  depending on aggressiveness of the treatment.  
  • If history of HSV, prescribe 1 gr. of Valtrex immediately after the procedure, and continue once a day for 3 more days.

Treatment Frequency:

4 to 6 sessions every 4-6 weeks are required to see the best results.

Active Acne

Acne Vulgaris is a chronic inflammatory disorder of the  pilosebaceous unit. Conventional oral and topical therapy is still the  number one treatment, but newer therapeutic modalities such as  multimodal laser treatment using Nd:YAG and Er:YAG wavelength  has been developed offering improvements in acne lesions.  Through Nd:YAG, decreases local inflammation by photo selective  thermal absorption of the affected pilosebaceous unit, causing  shrinking and damage of the overactive sebaceous glands. Also,  reduces the production of cytokines and VEGF (Vascular Endothelial  Growth Factor) diminishing the inflammation cascade. Furthermore,  it stimulates collagen synthesis and remodeling. On the other hand,  with the Er:YAG wavelength, creating small holes, allowing the  comedo extraction.  

Pre-treatment Instructions:

  • At Least 1 Month Prior Discontinue Acutane.  
  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • 1 Week Prior Discontinue light sensitive medications.  
  • 3-5 Days Prior Discontinue using skincare products that contain Vitamin A  derivatives. Tretinoin Differin Retinoids Glycolic acid Exfoliants such as AHAs,  BHAs Skin lightening creams such as hydroquinone and kojic acid Alcohol based products.  
  • 3 Days Prior Discontinue the use of Aspirin. This can increase the risk of  bleeding.  

Post-Treatment Instructions:

  • General Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2  pm).  
  • Immediately After If history of HSV, take 1 gr. of Valtrex, and continue once a  day for 3 more days.  
  • After 3 Days Can apply make-up.  
  • After 4-5 Days Can resume skincare products that contain Vitamin A  derivatives.  
  • For 7-15 Days Strict avoidance of sunlight. 

Healing and Results:

  • Edema, erythema and small scabs should be expected to last 5-7 days.If comedo extraction is performed, scabs should be expected for 5-7 days.If history of HSV, prescribe 1 gr. of Valtrex immediately after the procedure,  and continue once a day for 3 more days.  

Treatment Frequency:

  • For initial treatments 4 sessions every 2 weeks are required to see the best  results.  
  • Maintenance sessions can be performed as needed.

Scar Revision

Scars are caused by an alteration of the normal configuration of the  skin, secondary to different processes such as traumatic, surgical  wounds and burns.  

Available treatments to date, show a limited effectiveness no matter  what modality is used. Here is a highly effective treatment modality  using a combination of Er:YAG and Nd:YAG wavelength available in  SP Dynamis.  

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • Avoid perfumes, deodorants, waxing, chemical peels or collagen injections in  the treatment area.  
  • 3 Days Prior Discontinue the use of Aspirin. This can increase the risk of  bleeding 

Post-Treatment Instructions:

  • General:
  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream  (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin)  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • For 7-15 Days Strict avoidance of sunlight.

Healing and Results:

  • Edema, redness, and pinpoint bleeding to be expected post treatment.  • pinpoint bleeding can sometimes take 10-15 minutes to appear post procedure.  • Edema, erythema, and small scabs should be expected to last 7 to 15 days,  depending on aggressiveness of the treatment.  

Treatment Frequency:

  • 4 sessions every 4 weeks are required to see the best results. 

Seborrheic Keratosis:

Overview:

Seborrheic keratosis is the most common type of skin tumor. The  incidence of this benign epithelial proliferation increases with age  and exposure to ultraviolet light.  

It has a remarkable variability in its clinical presentation raising from  differential diagnosis. It can easily be confused with a malignant  pigmented lesion such as Melanoma, or Pigmented Basal Cell  Carcinoma. That is why it is very important to be sure that these lesions  are benign. We need a letter from a dermatologist confirming the diagnosis  before treatment. 

A close up of a black spot on a piece of wood.

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • Avoid perfumes, deodorants, waxing, chemical peels or collagen injections in  the treatment area.  
  • 3 Days Prior Discontinue the use of Aspirin. This can increase the risk of  bleeding.  

Post-Treatment Instructions:

  • General :  
  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream  (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin)  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • For 5-7 Days Patients with darker skin, use topical soft steroid to improve the  healing process and avoid PIH, twice a day for 5 to 7 days. Prednicarbate  cream 0.25% Methylprednisolone Aceponate cream 0.01%  
  • For 7 Days Strict avoidance of sunlight.  

Healing and Results:

  • After the procedure, a small scab is expected for at least 7 days.

Treatment Frequency:

A single session is sufficient for a total elimination of the  lesion.  

Skin Tags

Skin tags, also called acrochordons are noncancerous growths that  typically develop in skin folds and are a result of the skin rubbing  against itself such as the neck, armpit, and groin. They may also  occur on the face, usually on the eyelids. They tend to be the same  color as the skin or hyper pigmented lesions and can vary in size  depending on the location. With age, they can increase in size and  number.  

They have a high incidence of 50-60% among general population  but several studies have shown association with obesity, diabetes,  hypertension and metabolic syndrome. The surface of an  acrochordons may be smooth or irregular in appearance and is often  sessile, meaning it is raised from the surface of the skin.  

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • Avoid perfumes, deodorants, waxing, chemical peels or collagen injections in  the treatment area.  
  • 3 Days Prior Discontinue the use of Aspirin. This can increase the risk of  bleeding.  

Post-Treatment Instructions:

  • General
  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream  (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin)  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm). For 5-7 Days In patients with darker skin, use a topical soft steroid to improve  the healing process and avoid PIH, twice a day. Prednicarbate cream 0.25%  Methylprednisolone Aceponate cream 0.01%  
  • For 7 Days Strict avoidance of sunlight.  

Healing and Results:

  • After the procedure, a little bleeding is expected for a few minutes, make sure to apply pressure with a clean gauze.
  • After the procedure, a small scab is expected for at least 7 days. 

Treatment Frequency:

A single session is sufficient for a total elimination of the  lesion.

A close up of a small pink speck on a person's skin.

Vascular Lesions/ Telangiectasis

Telangiectasias are small, widened blood vessels in the skin. They  may develop anywhere within the body, but they are most easily  seen on the face and legs, and usually, even if they do not cause  symptoms, they do not look good.  

This protocol outlines how to treat the four distinct types, depending  on the size, color, and how deep they are located in the skin. The  successful treatment of vascular lesions requires a wavelength that is  able to penetrate deeply enough to reach the blood vessel such as  Nd:YAG wavelength, have sufficient energy to achieve coagulation,  and a pulse duration long enough to coagulate the blood without  damaging the skin or surrounding tissue.  

Pre-treatment Instructions:

None

Post-Treatment Instructions:

  • General:  
  • Apply Arnica cream/gel over the treated area with a gentle massage, 2-3 times  a day to improve the appearance of petechiae.  
  • An aloe vera-based gel can be used to sooth the skin.  
  • For 3 Days Use elastic bandaging (e.g. ace wraps) for better results.  • Avoid hot baths.  
  • May shower (lower temperatures are recommended).  
  • Ensure the elastic bandaging is reapplied afterwards.  
  • Avoid exercising. For 3-5 Days  
  • Can apply hydrocortisone 1% twice daily.  

Healing and Results:

• Cool immediately after with cold air cooling and/or ice.

• Perivascular edema and erythema should be expected immediately after the session lasting 5-15 minutes.
• Petechiae and/or bruising over the treated telangiectasias can be expected to last 7 to 15 days.

Treatment Frequency:

  • Follow-up treatment at 4-6 weeks.
  • The patient should expect multiple treatment sessions if complete clearing of unsightly blood vessels is desired (usually up to three) with at least a 4-6 weeks interval between sessions.
  • Reoccurrence is possible.

Stretch Marks/ Linelase ( Striae)

Striae distensae (SD), also known as stretch marks, are permanent,  undesirable dermal lesions that have a significant psychosocial and  therapeutic challenge. There are two types of stretch marks depending on  the evolution time. The acute phase, that appear as red/violaceous lesions  called Striae Rubra, and the chronic form (striae alba), that shows  hypo-pigmented dermal depressions. Because of their high prevalence and  impact on patient ́s quality of life, there is a great demand for an effective  treatment.  

Nowadays, technology is ever evolving and in the current day and time  there are a several treatment modalities available for both types of stretch  marks, ranging from topical products to more invasive methods such as  laser therapy. Although complete elimination of them is impossible,  improving the appearance is an excellent option. Contraindications  include patients with unrealistic expectations, pregnancy, and the  presence of infectious or inflammatory lesions in the region. Mature white  striae are much more difficult to achieve satisfactory results and patients  need to be aware that it is possible to not see any improvement  regardless of what is done.  

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face.  
  • Avoid perfumes, deodorants, waxing, chemical peels or collagen injections in  the treatment area.  
  • 1 Week Prior Discontinue taking light sensitive medications. 
  • 3 Days Prior Discontinue the use of Aspirin. This can increase the risk of  bleeding.

Post-Treatment Instructions:

  • General
  • Apply a re-epithelizing cream as often as needed to improve the healing  process. Cream recommendations to select from are: Bariederm Cicacream  (Uriage) Cicaplast (La Roche Posay) Cicalfate (Avenne) Aquaphor (Eucerin)  
  • Apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).  • For 3 Days Wear loose clothing for a few days to avoid friction and pain.  • For 7-15 Days Strict avoidance of sunlight.  

Healing and Results:

Edema, erythema, purpura, bullae or crusts can be expected to last 7 to 15 days,  depending on aggressiveness of the treatment.  

Treatment Frequency:

20 to 60 percent improvement in the appearance after 4 to 6  sessions with one session every 4 weeks. 

Tightsculpting

TightScuplting® is a proprietary non-surgical, minimally invasive  body contouring procedure. This two-step procedure not only  reduces fat, it also tightens the skin, smooths cellulite, and  rejuvenates sagging tissue. This is made possible by combining the  dual wavelengths that the SP Dynamis Pro offers. The first step  utilizes the ultra-long PIANO Nd:YAG pulse modality to achieve  hyperthermic injury to adipocytes. The second step uses the unique  Er:YAG Fotona SMOOTH mode pulse to remodel the epidermis and  achieve skin tightening effects.  

This treatment can be used anywhere on the body such as abdomen,  flanks, thighs, and sub-mentum. Patients selection is important and is 

ideal for patients that are below a BMI of 25 and have stubborn  areas of fat.  

This protocol uses the abdomen as an example, but the same  parameters and concepts are used when treating different areas of  the body such as the obliques, lower back, and thighs.  

Post-Treatment Instructions:

  • Encourage patients to drink water.
  • 20 minutes of sustained light to moderate cardio immediately post procedure to mobilize the fatty acids that are released during the procedureMake sure to tell the patient the importance of keeping a balanced diet and  exercise since this will be crucial to see results.  
  • For 1-2 weeks, strict avoidance of sunlight to avoid PIH.

Healing and Results:

• There is no downtime with this procedure.

• Patients will most likely develop some erythema that will pass within a few hours.

Treatment Frequency:

  • Subsequent maintenance treatments can be scheduled based on patients goals.
  • Recommended an initial treatment package of 4 -6 sessions spaced 4 weeks apart.

Milium Cyst

Milium cyst are millimetric yellowish-white, asymptomatic, benign  papules located on the face. They are originated from the hair  follicles or the eccrine ducts glands, where there is an accumulation  of keratin beneath the surface of the skin. The milium cyst are often  found in groups called Milia.  

Post-Treatment Instructions:

  • Apply a re-epithelizing cream to improve the healing process; patients to apply as often as needed. Cream recommendations to select from are:  Bariederm Cicacream (Uriage), Cicaplast (La Roche Posay),Cicalfate (Avenne)  Aquaphor (Eucerin).  
  • Can apply make-up immediately after procedure; best if they can wait 24 hours.
  • 2-3 days after, topical treatments and skin care dermo-cosmetic products, such as retinol and acids can be resumed.
  • For at least 7 days,strict avoidance of sunlight.
  •  Patients should apply broad spectrum sunscreen, 3 times a day (7 am,  12 pm and 2 pm). 

Healing and Results:

After the procedure, a small scab is expected for at least 7 days.

Treatment Frequency:

A single session is sufficient for a total elimination of the  lesion.

Vector lift ,eyebrow lift, fox eyes

The Fotona VectorLift® protocol was designed to provide a non-invasive  eyebrow lift and eyelid rejuvenation using SMOOTH mode hyper stacking. This  protocol can be used to either lift only the tail of the eyebrow or provide clients  with a full brow lift. This is achieved through the tightening of the skin on the  forehead and brow as well as the deeper connective structures.  

Pre-treatment Instructions:

  • 2 Weeks Prior Avoid sun-exposure, tanning beds, or sunlamps. Patients are  unable to be treated with a tan or a sunburn in the face. 

Post-Treatment Instructions:

  • Apply a re-epithelizing cream to improve the healing process; patients to apply as often as needed. Cream recommendations to select from are: Bariederm Cicacream (Uriage) Cicaplast (La Roche Posay), Cicalfate (Avenne)  Aquaphor(Eucerin).  
  • Immediately after, can apply make-up; best if they can wait 24 hours.4-5 days after, topical treatments and skin care dermo-cosmetic products, such as retinol and acids can be resumed.  
  • For 7 days, strict avoidance of sunlight to avoid PIH.
  • Encourage patients to apply broad spectrum sunscreen, 3 times a day (7 am, 12 pm and 2 pm).

Healing and Results:

  • Erythema should be expected immediately after the session lasting less  than 24 hours, followed by a possible superficial feeling over the next 48-72  hours.  

  • Complete results take place gradually, over a time period of 2-3 months.  Continuing improvement for up to six months.

Treatment Frequency:

    • Treatment sessions are performed at 4-6-week intervals for a total of 3-4 consecutive sessions.
    • Complete results take place gradually, over a time period of 2- 3 months. Continuing improvement for up to six months.
A woman's face is shown before and after treatment.

Renovalase / treatment of vaginal atrophy

RenovaLase® is an innovative and unique, non-invasive 2940 nm Er:YAG laser  therapy for the symptoms of vaginal atrophy.  

It is based on non-ablative photo-thermal treatment of the vaginal canal. Clinical  studies show that it is an efficient, easy-to-use, quick and safe procedure,  eliminating the need for long-term estrogen administration. The latest scientific  results presented by Dr. Marco Gambacciani1 and Dr. Adrian Gaspar clearly  show a noticeable improvement in the symptoms of vaginal atrophy. Results  show favorable changes in the tropism of the vaginal mucosa, with increases in  collagen and vascularization as well as in the glycogen level and the epithelial  thickness. There was no ablation of the tissue or thermal damage and no  adverse events. The positive effects were long lasting as results were sustained  at follow-up 6 months after the treatment. With no need for long-term estrogen  treatment, RenovaLase® is also appropriate for patients with estrogen dependent cancer (such as endometrial cancer, breast cancer, etc.) or with a  family background of such cancers, as shown in clinical studies by Dr. Bojanini  and Dr. Gambacciani .The RenovaLase® treatment is based on laser-induced  controlled mild heating of the vaginal tissue, which stimulates angiogenesis,  fibroblast activity and new collagen formation, without thermal or ablative  damage. The final result is increased epithelial thickness as well as  vascularization of the lamina propria, along with a reduction of symptoms such as  dryness, itching, irritation and dyspareunia.  

Source: Fotona 

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