SmartXide DOT - Clinical User Manual v.2.2.pdf

1

Laser Technologies

for Dermatology

& Cosmetic Surgery

SmartXide DOT

Clinical User Manual

Version 2.2 - September 2008

I

Index

1 Disclaimer ............................................................................... 1

2 Introduction............................................................................. 2

2.1.1 Traditional Skin Resurfacing ................................................ 2

2.1.2 Non-Ablative Photorejuvenation ........................................... 3

2.1.3 Fractional Photothermolysis ................................................ 4

3 SmartXide DOT Technical Features................................................ 6

4 Hi-Scan DOT - Technical Features ................................................... 7

4.1.1 Scanning Areas ................................................................ 8

4.1.2 Scanning Modes ............................................................... 9

4.1.3 Smart Pulse Emission........................................................10

5 Clinical Procedure ....................................................................11

5.1 Pre Treatment Care..............................................................11

5.1.1 Patient Examination & Contraindications ................................11

5.1.2 PIH prevention ...............................................................12

5.1.3 Infection prevention.........................................................12

5.2 Anaesthesia Indications..........................................................13

5.2.1 Anaesthesia Techniques ....................................................13

5.2.2 Fractional Skin Resurfacing ................................................16

5.2.3 Traditional Skin Resurfacing ...............................................16

5.3 Treatment Procedure ............................................................17

5.3.1 FRACTIONAL MODE : Indications & Clinical Protocol..................17

I

II

5.3.2 Traditional Skin Resurfacing: Clinical Protocol..........................23

5.3.3 TRADITIONAL MODE: Indications & Clinical Protocol ...................25

5.4 Post Treatment care .............................................................28

6 Clinical Cases ..........................................................................29

6.1 Fine wrinkles, Textures and Spots .............................................29

6.2 Wrinkles...........................................................................32

6.3 Acne Scars ........................................................................34

6.4 Keloid..............................................................................35

6.5 Epidermal Linear Nevus.........................................................36

6.6 Epidermal Pigmented Lesion...................................................36

6.7 Lentigo Simplex ..................................................................37

6.8 Beckers Nevus....................................................................37

6.9 Melasma...........................................................................38

II

1 SmartXide DOT Clinical User Manual- Version 2.2 - September 2008

1 Disclaimer While the information contained in these pages has been compiled from sources believed to

be current and reliable, DEKA cannot be held responsible for any errors, omissions, defects

in, or the accuracy, completeness, timeliness or usefulness of, the information supplied to

users on this document.

The following materials are presented for educational purposes only. Methods described may

not be the only or best method in every case. DEKA specifically disclaims any and all liability

for injury or other damages of any kind for any and all claims that may arise out of the use of

any drug, device or technique described in these pages, whether such claims are asserted by

a physician or any other persons.

Information on this document may contain technical inaccuracies or typographical errors.

DEKA takes no responsibility for the consequences of error or for any loss or damage suffered

by users of any of the information published on any of these pages. Such information does not

form any basis of contract with readers or users of these pages.

Furthermore, DEKA will not be liable to users of any for any damages, claims, demands or

causes of action, direct or indirect, special, incidental, consequential or punitive, as a result

of the use of this document or any information obtained from it.

Information may be changed or updated without notice. DEKA may also make improvements

and/or changes in this document at any time without notice.

All information contained within this document is the property of DEKA. Copyright 2008.


2 Introduction The natural ageing process together with exposure to the sun and pollution

leads to a gradual deterioration of the skins structure and function. This is

mainly evident at the level of the epidermis and the upper papillary dermis,

with a tissue laxity and skin that appears more lined, often accompanied by

telangiectasias, wrinkles, and dark spots.

2.1.1 Traditional Skin Resurfacing

Resurfacing with pulsed CO2 laser has always been considered the first choice of

treatment for rhytids and photo-damaged facial skin1-6. However, due to the

lengthy recovery times and frequent complications7-8, not all patients agree to

undergo this type of operation9-10.

Traditional Skin Resurfacing. Skin Healing Process.


Besides the usual recovery time required for oedema, burning, scabs and

erythema which may often last for months11-12, there is also a high incidence of

complications connected with hyper-and hypo-pigmentation, HSV infection,

outbreaks of acne, milia formation, and dermatitis13-18.

Cases of HSV infection and outbreaks of acne, after traditional resurfacing with pulsed CO2 laser.

2.1.2 Non-Ablative Photorejuvenation

Over recent years, the market has therefore been orientated towards less

invasive and less problematic systems and methods. This has led to a wide-scale

production of a myriad of non-ablative devices for reducing wrinkles and

improving photo-damaged skin with the consequent passing over from skin

resurfacing to skin rejuvenation. However, a critical review of the literature

inherent to these methods has revealed that in terms of efficacy, none of the

results obtained with these non-ablative methods can be compared with the

resurfacing results achieved with the CO2 laser19-23. Moreover, these types of

treatment are usually quite expensive for the patient, the devices themselves

are also costly for the medical practitioners, and the results obtained are not

always satisfactory.


2.1.3 Fractional Photothermolysis

This situation has stimulated the search for new methods and protocols that are

more efficient in combining quick recovery and minimal post-op risks with

greater treatment efficacy. The advent of Fractional Photothermolysis, initially

introduced with non-ablative methods, has given rise to the development of a

new method that manages to effectively combine all the needs of both medical

practitioners and patients, and namely, the Fractional Laser Skin Resurfacing

with CO2 laser24-28

.

Fractional laser treatment allows to

obtain remarkable results with

minimal downtime.

The CO2 laser energy, applied in a

fractional way, creates very thin and

spaced columns of thermal damage

which penetrate deep into the

dermal skin layer and stimulate a

new collagen production. The tissue

between the columns of thermal

damage is spared, resulting in a faster healing process.

Various CO2 lasers with fractioned emission are currently available on the market.

Despite the fact that all these systems are based on the same principles, they present

significant differences with regard to output power, dwell-time, distance between the

dots, varying scanner shapes and the laser beam profile. These differences may

produce clinical results that differ greatly between one device and another.

1. Manuskiatti W et al. Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin. J Am Acad Dermatol. 1999;40:401-11.

2. Fitzpatrick RE et al. Pulsed carbon dioxide laser resurfacing of photo-aged facial skin. Arch Dermatol 1996;132:395402.3.Schwartz RJ et al. Long term assesment of CO2 facial laser resurfacing: Aesthetic results and complications. Plast Reconstr Surg. 1999; 103:592-601.

4. Lent WM, David LM. Laser resurfacing: a safe and predictable method of skin resurfacing. J Cutan Laser Ther. 1999;1:87-94.

5. Fitzpatrick RE. Maximizing benefits and minimizing risk with CO2 laser resurfacing. Dermatol Clin. 2002;20:7786.

6. Hruza GJ, Dover JS. Laser skin resurfacing. Arch Dermatol 1996;132:451455.


7. Bernstein L et al. The short and long term side effects of carbon dioxide laser resurfacing. Dermatol Surg 1997;23:519525.8.Alster T, Hirsch R. Single-pass CO2 laser skin resurfacing of light and dark skin: Extended experience with 52 patients.J Cosmet Laser Ther 2003;5:3942.

9. Trelles MA, et al. The origin and role of erythema after carbon dioxide laser resurfacing: a clinical and histologic study. Dermatol Surg. 1998;24:25-30.

10. Burkhardt BR, Maw R. Are more passes better? safety versus efficacy with the pulsed CO2 laser. Plast Reconstr Surg. 1997;99:1531-1534.

11. Sullivan SA, Dailey RA. Complications of laser resurfacing and their management. Ophthal Plast Reconstr Surg.2000;16:41726.

12. Berwald C et al.. Complications of the resurfacing laser: Retrospective study of 749 patients. Ann Chir Plast Esthet. 2004;49:3605.

13. Alster TS. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg. Feb 1999;103(2):619-32.

14. Alster TS. Side effects and complications of laser surgery. In Alster TS: Manual of Cutaneous Laser Techniques, ed 2. Philadelphia, Lippinco. 2000;pp 175-187.

15. Alster TS, Lupton JR. Treatment of complications of laser skin resurfacing. Arch Facial Plast Surg. Oct-Dec 2000;2(4):279-84.

16. Sriprachya-Anunt S et al. Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin. Dermatol Surg. 1997;23:527-36.

17. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24:315320.

18. Sadick NS. Update on non-ablative light therapy for rejuvenation: A review. Lasers Surg Med. 2003;32:1208.

19. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24:315320.

20. Sadick NS. Update on non-ablative light therapy for rejuvenation: A review. Lasers Surg Med. 2003;32:1208.

21. Williams EF III, Dahiya R. Review of nonablative laser resurfacing modalities. Facial Plast Surg Clin North Am. 2004;12:30510.

22. Grema H et al. Facial rhytides subsurfacing or resurfacing? A review. Lasers Surg Med. 2003;32:40512.

23. Bjerring P. Photorejuvenation an overview. Med LaserAppl. 2004;19:18695.

24. Le Pillouer-Prost A, Zerbinati N. Fractional laser skin resurfacing with SmartXide DOT. Initial Results. J Cosmc and Laser Ther, 2008;10(2):in press.

25. Matteo Tretti Clementoni et al. Non sequential fractional ultrapulsed C02 resurfacing of photoaged skin. J Cosmc and Laser Ther, 2007;9(4):21822.

26. Hantash BM et al. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Laser Surg Med. 2007;39:87-95.

27. Hantash BM et al. In vivo histological evaluation of a novel ablative fractional device. Laser Surg Med. 2007;39:96-107.


3 SmartXide DOT Technical Features

Type of Laser CO2

Wavelength 10.6 m

Power to Tissue 30 W (max)

Repetition Rate from 5 to 100 Hz

Pulse Length from 0.2 to 80 ms

Delivery System Articulated Arm with 7 Mirrors

Aiming Beam Diode Laser, 3 mW@ 635-670 nm

Scanning Mode Traditional & DOT-Fractional

User Interface LCD Colour Touch Screen

Aiming Beam Diode laser 635 nm

Power Supply 230 Vac / 1.8 A (max) / 50-60 Hz

Dimensions 48 cm (W) x 55 cm (D) x 120 cm (H)

Weight 30 Kg


4 Hi-Scan DOT - Technical Features

Scanning Area Max: 15 x 15 mm Min: 1 x 4 mm

Spot Size

Stimulative Effect

Ablative Effect

350 m 120 m

Scanning Mode Traditional & DOT-Fractional

Pulse Emission

Dwell Time from 0.2 to 2 ms (DOT) from 0.2 to 20 ms (Std.)

DOT Pitch from 200 to 2000 m


4.1.1 Scanning Areas


4.1.2 Scanning Modes

Normal

Interlaced


4.1.3 Smart Pulse Emission

The first part of the pulse has high peak power for few tens of microseconds

that allows for rapid ablation of the epidermis and the first layers of the derma,

while the second part of the pulse has low peak power allowing for targeted

heating of the deeper areas of the skin.

Smart Pulse Emission

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PPoowweerr

PPuullssee DDuurraattiioonn


5 Clinical Procedure

5.1 Pre Treatment Care

5.1.1 Patient Examination & Contraindications

First of all it is important to proceed with the visit and the anamnesis of the

patient.

A persons history should be compiled by establishing the following:

Sun and UV lamp exposure: avoid them before (at least 1 month), during and after treatment. Apply SPF50 sunblock before and after the treatment.

Make sure that the patient is not taking incompatible drugs as: o Anticoagulants (as acetylsalicylic acid, heparin, etc),

o Retinoids these drugs can cause problems in the healing process with possible scar results - (as isotretinoin, etc),

o Photo-sensitizers (as tetracycline [antibiotic], naproxen [NSAD], auranofin [antirheumatic], estrogens and progestins [oral

contraceptive], cloroquine [antimalarial], etc.)

Suspend the administration according to the specific drug so that its effect is

expired before the treatment.

Recent exfoliation treatment (peels, scrubs, retin-A) and surgical treatment (as lifting, etc.).

Past skin disorders. History of herpes virus infection. In order to ensure a positive outcome with laser treatment, the patient must

strictly follow a pre-operative protocol to help prevent the two main possible

complications: Post-inflammatory Hyperpigmentation (PIH) and infection.


5.1.2 PIH prevention

Especially with darker phototypes (III, IV, V and VI) and Asian phototypes, it is

recommended to apply a topical cream every day for four weeks before the

treatment for inhibiting melanin production.

It is possible to use cream containing hydroquinone or, as alternative lighteners,

arbutin, azelaic acid, kojic acid or stabilized vitamin C.

This procedure is highly recommended with darker and Asian skin types, while

for photo type I and II it is just a suggestion.

5.1.3 Infection prevention

The drugs used fall into two main categories:

antiviral drugs (aciclovir, valaciclovir, etc) It is suggested to start the antiviral prophylaxis 6 days before the treatment

in subjects with a positive anamnesis of herpes virus infections history.

The antiviral treatment can start 2 days before the treatment in subjects

without previous experience of herpes infections.

It is recommended to continue the antiviral drugs at routine doses for 5-15

days after the intervention.

antibiotic drugs (macrolides, cephalosporins, etc) The doctor may consider prescribing antibiotic drugs as well, starting 6 or 1

days before the treatment (according to the patient anamnesis) and

continuing for 7-8 days after the procedure.

Remark: It is not necessary to prescribe antibiotic drugs in all cases. It is

often enough the application of a topical antibiotic cream or ointment (like

gentamicin) after the procedure.


5.2 Anaesthesia Indications

Dermal treatments with laser may give rise to a painful sensation described as

similar to an elastic band being pinged against the skin, or the pain caused by

burns.

The anaesthetic protection for CO2 laser skin therapies becomes necessary in specific cases,

such as:

Traditional CO2 laser skin resurfacing; The treatment of extensive skin areas; The treatment of deep lesions;

Patients with a low pain threshold; Non-compliant patients; Paediatric patients.

5.2.1 Anaesthesia Techniques

Irrespective of the anaesthetic method used, several indispensable precautions are necessary:

A careful clinical assessment (if an anaesthetist is necessary this will be their exclusive responsibility), with particular attention to cardiovascular, pulmonary, and neurological

pathologies, hypertension, diabetes, allergic phenomena and/or any idiosyncratic

reactions to the medicinal products to be administered;

Instrumental assessment (ECG, chest X-ray, etc.) wherever indicated; Detailed indications regarding the administration, modification or discontinuation of

therapies in progress (in the current condition and in relation to the type of

intervention/treatment, the assessment will mainly concern the anticoagulant therapy);

Pre-op fasting (6 hours for solids, 2 hours for liquids); Informed consent; Outpatient safety devices;


Preventive insertion of peripheral venous cannula.

The following anaesthesia techniques may be used:

Transdermal anaesthesia;

Infiltrative anaesthesia; Peripheral blocks;

Locoregional blocks; Local anaesthesia techniques associated with sedative analgesia; General anaesthesia.

Transdermal Anaesthesia (Topical Anaesthesia) A number of local anaesthetics are available for topical use in various types of preparation

that usually all provide efficacious analgesia albeit of brief duration. Among the various

preparations, a product which is marketed worldwide, namely EMLA (containing lidocaine

2.5% + prilocaine 2.5%), has to be applied 1 hour before the treatment.

Infiltrative Anaesthesia

While the use of this type of anaesthetic does not necessarily require the presence of the

anaesthetist, monitoring of the vital parameters is obligatory, as well as the presence of all

the aids for coping with possible emergency situations. Any type of local anaesthetic may be

used for the infiltration. The onset of the action is extremely rapid with nearly all agents,

irrespective of whether used intradermically or subcutaneously. Epinephrine considerably

prolongs the duration of the block via infiltration.

Both intradermal and subcutaneous infiltration may be painful, above all due to the acid pH

that characterises all local anaesthetics. The problem can be attenuated with suitable

administration techniques and the addition of NaHCO3 in a 10-15% ratio.

The intradermal and subcutaneous infiltration techniques foresee the use of fine needles (30

G) for the initial pomphus, after which larger gauge needles can be used (25-23 G) for

achieving an optimal anaesthesia in the area to be treated, and by always taking care to

inject the preselected solution very slowly.


Peripheral nerve blocks

Whereas with transdermal and infiltrative anaesthesia techniques the presence of the

anaesthetist is not considered indispensable - except in the case of elderly patients (when

sedative methods are required) or those with psycho-pathological problems their presence

will be necessary for performing peripheral nerve blocks. In the majority of cases it will be

the anaesthetist who personally performs the block, and they must always be present for

correct intra and perioperative assistance.

The blocks used in the cervico-facial district consist of:

TRIGEMINAL Central blocks:

- ophthalmic bundle-branch

- maxillary bundle-branch

- mandibular bundle-branch

Peripheral blocks:

- supraorbital nerve

- infraorbital nerve

- mental nerve

The local anaesthetics used for peripheral nerve blocks are the same as those used for the

infiltrative techniques.

Anaesthesia techniques associated with sedative analgesia

The aim is to reach a level of sedation in which the patient is calm and relaxed while still

continuing to be responsive to the team carrying out the procedure. Sedative analgesic

techniques are normally used in association with locoregional methods. Ample multicentre

studies have demonstrated that while the sedative techniques are very safe if performed by

expert anaesthetists, they could be hazardous in inexperienced hands, especially if performed

without adequate monitoring systems.

The drugs used for these methods are:

CERVICAL PLEXUS

Superficial C.P.

Deep C.P.


SEDATIVES:

Benzodiazepine

Ketamine

Major sedatives

Hypnotics

General anaesthesia

The indications for general anaesthesia are restricted to paediatric and non-compliant

patients. The presence of the anaesthetist is indispensable, and the anaesthetic may be

performed in authorised structures including outpatients.

5.2.2 Fractional Skin Resurfacing

In case of fractional resurfacing with SmartXide DOT it is usually enough to

apply a topical anaesthetic 1 hour before the treatment.

In case of quite superficial action, to use the SmartCryo skin cooling system

during the treatment can be a possible alternative to the topical anaesthetic.

5.2.3 Traditional Skin Resurfacing

Patient discomfort can vary widely in case of traditional laser skin resurfacing.

Many patients find the topical application applied one or two hours prior to the

treatment and combined with regional nerve blocks provides appropriate

analgesia.

Other patients prefer to undergo intravenous sedation because they find laser

resurfacing to be uncomfortable.

ANALGESICS:

Ketorolac

Tramadol

Opiates

Anaesthetics


5.3 Treatment Procedure

The face is divided into five aesthetic

units: right malar, perioral, left malar,

forehead and periorbital-nasal areas. In

case of laser skin resurfacing (both

fractional and traditional) full face

treatment is performed on each aesthetic

unit sequentially, with care being taken

to avoid overlapping.

5.3.1 FRACTIONAL MODE : Indications & Clinical Protocol

Topical anaesthetic has to be removed just before the treatment.

Set the SmartXide DOT system in DOT mode according to patient phototype, the

area to be treated and the application.

Usually we recommend performing a full-face and single passage treatment to

obtain a better colour and texture uniformity.

SmartXide DOT offers the possibility to adapt the procedure according to the

expectation of the patient: more or less aggressive treatment corresponds to

longer or shorter down time after every session.


The quantity of fluence (density of energy measured in J/cm2) delivered with

the scanner is correlated with the effect provoked on the skin. The following

formula allows to calculate the fluence level delivered in DOT mode:

As a simple result of the formula above, reducing the Power and/or the Dwell

Time and/or increasing the Spacing, it is possible to reduce the fluence and to

control the thermal effect on the skin.

5.3.1.1 Skin Resurfacing

Phototype Power (W) Dwell Time (s)

Spacing (m)

Nr. of Sessions

Nr. of Passages

I 30 2000 750 2 1

II 30 2000 1000 3 1

III 30 2000 1200 3 1

IV 25 2000 1200 3 1

V-VI 25 1500 1200 3 1

Fluence (J/cm2) =

Power (W) * Dwell Time (ms) * 105

[ Spacing (m) + 350 ]2


5.3.1.2 Chronoaging


Spacing (m)

Nr. of Sessions

Nr. of Passages

I 30 1000 750 4 1

II 30 1000 1000 6 1

III 30 1000 1200 6 1

IV 25 1000 1200 6 1

V-VI 25 750 1200 6 1

Fair Asian Skin type

30 300 300 3 1

Dark Asian Skin Type

25 300 350 3 1

5.3.1.3 Acne Scars & Hypertrophic Scars


Spacing (m)

Nr. of Sessions

Nr. of Passages

I 30 2000 1000 2-3 2

II 30 1500 1000 3 2

III 30 1000 1000 3-4 2

IV-VI 30 750 1000 3-4 2


30 800 800 3 2


25 800 800 3 2


5.3.1.4 Keloid


Spacing (m)

Nr. of Sessions

Nr. of Passages

I 30 2000 800 2-3 1

II 30 1500 800 3 1

III 30 1000 800 3-4 1

IV-VI 25 1000 800 3-4 1


30 800 700 3 1


25 800 700 3 1

5.3.1.5 Superficial Pigmented lesions


Spacing (m)

Nr. of Sessions

Nr. of Passages

I 30 500 500 1-2 1

II 30 400 500 1-2 1

III 30 300 500 1-2 1

IV 25 300 600 1-2 1

V 20 300 800 1-2 1


25 300 650 1-2 1


20 250 650 1-2 1


5.3.1.6 Melasma


Spacing (m)

Nr. of Sessions

Nr. of Passages

I 20 500 500 4 1

II 20 400 500 4 1

III 20 300 500 5 1

IV 15 400 500 5 1


20 400 500 4 1


20 300 500 4 1

5.3.1.7 Special Care: Periocular Area

This area is very delicate. A common side effect is to have swelling and oedema. It is recommended

to decrease the fluence 30% less.

Dwell Time


5.3.1.8 Special Care: Perinasal & Perimandibular Areas

In the perinasal area (where there are many sebaceous glands) and in the submandibular area

(where there are few sebaceous glands) the risk

of post treatment scars is higher. It is

recommended to decrease the fluence 20% less.

Dwell Time

5.3.1.9 Special Care: Neck Area & Dcolletage

In the neck area and in the dcolletage the skin is thinner. It is recommended to decrease the

fluence 30% less.

Power Dwell Time


5.3.2 Traditional Skin Resurfacing: Clinical Protocol

Each aesthetic unit has to be treated in its entirety avoiding overlap.

Set the Hi-Scan unit in DOT OFF mode. Choose the appropriate shape and size

of the scanning area. Set Power and Dwell Time according to the area to be

treated. Please remember that with darker (III, IV, V and VI) and Asian

phototypes, fractional skin resurfacing is strongly recommended.

Moist saline-soaked gauzes are used to remove debris during the procedure.

This should be done gently to minimize additional tissue trauma. Debris removal

is necessary to avoid a heat-sink phenomenon, which results in more thermal

irritation of tissues.

Most areas are treated with a second pass. Approximately 30% of the time, a

third pass is employed, a fourth is used in less than 5% of patients.

The endpoint of treatment is gauged to be ablation of wrinkles or visual

estimation to have reached the basal layer.

Skilled surgeons could use more power and more dwell times than recommended

in the protocol, avoiding multiple passes. In this case, please remember that

skin removal is not proportional to the power increase whereas thermal damage

is.

The neck

As in phenol-based exfoliation, the neck is not treated. The pilosebaceous

density in the neck is such that deep vaporization can lead to scarring.

However, the perimeter can be treated with a single pass at the mandibular

margin to avoid a frank line of demarcation between laser-resurfaced and non-

resurfaced skin.


Malar areas

For these areas the suggested setting is: Power= 17 W and Dwell Time= 400 s. Normally a second laser pass is used to treat the malar area, this should be done

transversely with respect to the previous one.

Perioral Area

In the perioral area, laser resurfacing is carried on to the vermilion border.

Great care is taken to avoid allowing the laser beam to strike teeth. Some

surgeons prefer to use a protective mouth-piece. Be careful because it could

distort the perioral tissue. Initial parameters should be: Power=13 W and Dwell

Time= 400 s. Forehead

When treating the forehead area, the hair is moistened and metal shields or

moist towels are used to protect the eyes. Care is taken to avoid lasering the

hairline or eyebrows. Initial parameters are: Power= 15 W and Dwell time= 400

s. Periorbital area

Because the eyelid tissue is so delicate, reduced fluence is used: Power=10 W

and Dwell Time= 400 s. The eye to be treated is anaesthetized with two drops of tetracaine. A glass or metal eye shield is inserted under the lid to protect the

globe. It is better to use a spherical protector to be sure that the surface is

smooth and free of any irregularities. Resurfacing is carried no closer than 3 to 4

mm from the ciliary margin to minimize oedema and possible thermal irritation

to the meibomian glands in the eyelid area. Multiple passes may be used to

treat deep wrinkles in the lateral canthal area. For the upper eyelid, treatment

is carried down to the superior tarsal fold.


5.3.3 TRADITIONAL MODE: Indications & Clinical Protocol

Set the SmartXide DOT system according to the patient phototype, the area to

be treated and the application.

TREATMENT EMISSION

MODE

LEVEL* FREQUENCY

(Hz)

REMARKS

Acne Scar PW 0.5-3 10-20 DOT treatment suggested. Topical anaesthesia.

Actinic Cheilitis PW 0.5-5 10-20 Topical anaesthesia.

Actinic Keratosis (superficial)

PW 1.5 10 Topical anaesthesia. Spiral movements starting from the edges to the centre.

Actinic Keratosis (tick)

PW 5 50

Angiokeratoma PW 1.5-5 10-20 Topical anaesthesia.

Balanitis Xerotic Obliterans

PW 2.5 20 Topical or infiltrative anaesthesia according to the lesion size.

Basal Cell Carcinoma

PW 0.5-8 10-50 Indications: Nodular carcinoma with


TREATMENT EMISSION

MODE

LEVEL* FREQUENCY

(Hz)

REMARKS

Haemangioma PW 4-10 80 Not elective treatment. High risk of scar results. It is better to use a vascular laser as Dye laser.

Hidrocystoma Apocrine

PW 0.5-2 10

Hypertrophic Scar PW 0.5-3 10-20 DOT treatment suggested. Topical anaesthesia.

Keloid PW 0.5-3 10-20 DOT treatment suggested. Topical anaesthesia.

PW 0.5-3 10-20 Topical anaesthesia. Keratosis (Seborrheic Keratosis) PW 0.5-2 10

Lentigo Maligna PW 0.5-3 10-20 Perform the incisional biopsy.Infiltrative anaesthesia.

Leukoplakia PW 0.5-5 10-50 Perform the incisional biopsy.

Lymphangioma PW 0.5-3 10-20 Only circumscribed lesion.

Molluscum Fibroma PW 0.5-3 10-20 Topical anaesthesia.

Neurofibroma PW 0.5-2.5 10-20 Infiltrative anaesthesia (in case of big size).

Nevus Sebaceus PW 1.5-10 10-20 Infiltrative anaesthesia.

Pagets Disease PW 0.5-3 10-50 Infiltrative anaesthesia. Perform the incisional biopsy.

Queyrats Disease** PW 2 20 Infiltrative anaesthesia. Perform the incisional biopsy.

Rhinophyma 1 PW 2.5-10 50-100 Rough-shape phase. Infiltrative anaesthesia.

Rhinophyma 2 PW 2.5-5 20 Finishing phase. Infiltrative anaesthesia.

Sebaceous Adenoma*

PW 1.5-2.5 10-20 Topical anaesthesia.

Spider Nevus PW 3-8 80 Not elective treatment. High risk of scar results. It is better to use a vascular laser as Nd:YAG.

Spinocellular Carcinoma

PW 2.5-8 20-50 Only selected cases. Perform the incisional biopsy. Infiltrative anaesthesia.


TREATMENT EMISSION

MODE

LEVEL* FREQUENCY

(Hz)

REMARKS

Superficial Pigmented Lesions**

PW 1.5 10 DOT treatment suggested.

Syringoma PW 0.5-2.5 10-20 Infiltrative anaesthesia.

Trichoepitelioma PW 0.5-5 10-50 Infiltrative anaesthesia.

Tuberous Angioma PW 4-7 50-80 Better if used in combination with Nd:YAG or Dye laser. Infiltrative anaesthesia.

Verruca 1 (Verruca Vulgaris)

PW 4-15 10-100 Topical anaesthesia.

Verruca 2

(Verruca Plana)

PW 0.5-2 10-20 Infiltrative anaesthesia.

Verruca Pedis** CW 8-10 Watt

Infiltrative anaesthesia.

Xanthelasma PW 0.5-3 10-20 Infiltrative anaesthesia.

Zoon Balanitis** PW 1-2 10-20 Topical or infiltrative anaesthesia according to the lesion size.

*: In the LEVEL column the suggested ranges for the level setting are shown.

Consider that usually, the procedure starts setting higher level value (which

corresponds to a deeper skin ablation effect) for the rough-shape phase. At

the end of the procedure the level value is reduced to perform more precise

final touches.

**: Treatment not included in the Treatment Menu of SmartXide DOT system.


5.4 Post Treatment care

Operations carried out with CO2 laser devices generate abrasion or ablation of

the skin which makes daily care of the wound essential.

The aim is to achieve healing, preventing the formation of scabs in the middle

and on the inner edges of the area treated, and thus guaranteeing an adequate

cleanliness and softness (above all with regard to the skin site).

In order to reduce the oedema and the inflammation that may occur after the procedure, we recommend applying on the skin, just after the treatment,

cool compression or wet gauzes cooled using the SmartCryo air jet.

As post-treatment care, we suggest open-type medication with accurate gentle skin cleansing, cold packs compression which must always be carried

out with sterile gauze and physiological solution. We recommend that the

patient re-applies every time emollient and/or antibiotic and enzymatic

ointments, especially after cleaning and showers. This procedure has to be

performed 3-4 times per day until the clinical healing is observed (4-7 days).

After this time, apply a normal skin-care moisturizer and a sunblock

protection (for 2-5 months according to the skin phototype and the

environmental conditions).

It is suggested to wait for 1 day before having a shower (avoid hot water on the treated area until healing is complete).

Avoid topical exfoliation for at least 4 weeks. The use of active Vitamin C-based creams, useful for maintaining the

uniformity and compactness of the new tissue and reducing any possible

deterioration, may be continued for unlimited time.


6 Clinical Cases

6.1 Fine wrinkles, Textures and Spots

Before and after 4 sessions. Courtesy of Dr Anne Le Pillouer-Prost Marseille France.




Before and after 2 sessions. Courtesy of Dr Nicola Zerbinati Pavia Italy.


Before and 21 days after 1 session. Courtesy of Dr C. William Hanke Indianapolis, IN USA.

Before and 17 days after 1 session. Courtesy of Dr C. William Hanke Indianapolis, IN USA.


6.2 Wrinkles




Before and after 1 session. Courtesy of Dr Patrick Treacy Dublin - Ireland.

Before and 6 days after 1 session. Courtesy of Dr Hee-Jin Han Seoul - Korea.

Before and 14 days after 1 session. Courtesy of Dr C. William Hanke Indianapolis, IN - USA.


6.3 Acne Scars

Before and after 1 session. Courtesy of Dr Nicola Zerbinati Pavia Italy.

Before and after 2 sessions. Courtesy of Dr Jahanara Ferdous Khan - Dhaka Bangladesh.


Before and after 1 session. Courtesy of Dr Hee-Jin Han Seoul - Korea.

6.4 Keloid



6.5 Epidermal Linear Nevus


6.6 Epidermal Pigmented Lesion



6.7 Lentigo Simplex


6.8 Beckers Nevus



6.9 Melasma



2

Deka M.E.L.A. srl, 2008

All rights reserved. All other brands and product names are trademarks or registered

trademarks of their respective holders.

DEKA M.E.L.A. s.r.l.

Via Baldanzese, 17 50041 Calenzano (FI) Italy

Tel +39 055 8874942 - Fax +39 055 8832884

e-mail: [email protected]

web: www.dekalaser.com

Documents

SmartXide DOT - Clinical User Manual v.2.2.pdf