THEORY COURSE NOTES

WHAT IS LIGHT AND HOW DOES IT WORK? [Page 3]

• “Light” is just one particular type of energy from a much wider range or spectrum of energies. 

• UV photons of light are far more energetic than infrared photons and therefore do more damage to cells. Then X-rays, then gamma rays

• For the light emitted from IPL, the energy is too low and therefore does not affect DNA of cells

• “ White Light” from the visible spectrum consists of a mixture of all colours and appears white to human eyes. IPL or flash lamp systems emit “White” light and use filters* to selectively transmit just the wavelengths (colours) required for treatment so different filters* are used depending on what you are treating. These filters* also block the harmful UV component and the upper IR end that causes unspecific thermal effects.

DIFFERENCES BETWEEN LASER AND IPL

LASER 

• Monochromatic 

Beam consists of photons of a single narrow wavelength, made up of a single pure colour 

• Collimated 

The beam does not spread out like the beam from a torch would therefore the beam can be focussed very precisely. 

• Can be pulsed 

This is extremely useful in controlling the effects in human tissue

IPL 

• Polychromatic 

It contains a wide range of wavelengths and emits light over a wide spectrum. Therefore it is not monochromatic. However, filters are used to absorb the unwanted parts of the spectrum. 

• Divergent 

Light is divergent (not running parallel like laser). However it is possible to direct the beam towards the targeted area 

• More flexible in terms of variation of pulse output, this combined with the larger beam size is an advantage e.g. Hair removal

SUMMARY

IMPORTANT TERMS TO UNDERSTAND

Chromophore [page 6]

The light absorbing target. In terms of hair removal, the melanin in the hair is the absorbing material 

Selective Photothermolysis [page 9] 

Targeting a specific chromophore to absorb light energy, which in turn creates heat, breaking down and damaging the proteins in the target without causing any damage to the surrounding tissue 

Pulse duration [page 6]

The length of time the pulse in “on”

Short pulses [page 8]

(between 10-50 nanoseconds) 

Induce mechanical damage by causing a shockwave effect and gives insufficient time for conduction of heat to take place. 

Long pulses [page 8] 

(between 1-50 milliseconds) 

Induce thermal damage, as in the SkinBase IPL system. The length of pulses can be very useful in controlling the effect on human tissue. Parameters in the SkinBase IPL system can be altered such that the follicle is destroyed without causing damage to the skin

Fluence [page 6]

(J/cm2) Energy Density. The amount of energy going into the skin per flash 

Thermal Relaxation Time [page 6] 

The time taken for the target to cool 50% of the initial temperature rise in tissue 

HAIR TYPES AND THE HAIR GROWTH CYCLE [pages 10 + 11]

• Only terminal hairs respond well to laser/IPL treatment

• Treatment using light energy will only be successful when treated in the anagen growth phase.

• All the hair on our bodies goes through these phases or cycles, but each phase can be different depending upon the body site. It is important to understand, and be able to explain, the hair growth cycle in terms of the success of the treatment.

• A good practitioner will explain in simple terms, the importance of following a course of treatments and that there are no guarantees for permanence. On the positive side, the treatments are proving themselves invaluable at reducing hair growth and solving the problem of unwanted hair for many people.

FITZPATRICK SCALE [page 17]

• The Fitzpatrick classification was never intended as a tool for laser/IPL treatments but was based upon a person’s response to sun exposure in terms of the degree of burning and tanning

• This system is not exact, but serves as a useful guide to finding initial treatment settings

MANAGEMENT OF CLIENT CONSULTATION [page 23]

The Waiting Room 

• Ideally this should be a small private area. 

• There should be a 5 minute ‘settle in’ period, this allows the client to ‘absorb’ and become informed through brochures, posters, guides and product displays etc

The Treatment Room 

• “ local rules” – provided by us 

• Should be well decorated, clean, well ventilated and at a comfortable temperature 

• Remember to respect privacy and protect the modesty of your client 

• Even when treating intimate parts of their body, most clients prefer to be covered by a towel or gown when possible

Pricing Plans – See Handout

INFORMATION LEAFLETS 

• Most of what is said to clients in consultations is not retained 

• Clients may be in some state of anxiety. It is often only when the consultation is over and the treatment is being anticipated that the client begins to seriously consider the implications of what they are taking on. 

• Written information is vital to go alongside the consultation 

• Clients must be clearly told that information is available and that they should read it, and ask questions should they require clarification 

• We will provide pre-prepared information sheets which are useful to use. However, taking the time to prepare your own sheets may give your client more accurate and relevant information

• Accurate record keeping is an essential part of good clinical care 

• Should report consultation process, information given to the client and any treatment recommended.

• Facilitates good care and ease of follow-up 

THE CLIENT CONSULTATION 

• Critical part of your client treatment plan 

• Managing expectations 

• Important to interact with the client 

• You must accurately record your client’s medical history. You may need to rely upon these  notes in the unfortunate event that something should go wrong with treatment or outcomes 

• You must discuss the effectiveness of treatment and how it works and therefore why you cannot make any guarantees of success 

• You must explain how the treatment may feel and what happens before, during and after treatment 

• You must explain the treatment plan and pre and post treatment care

PRE AND POST TREATMENT PHOTOGRAPHS

• We provide laminated templates

• The value of a good quality photographic record cannot be underestimated. Clients often forget what their condition looked like before

• Useful for assessing progress and for client reassurance

• A good quality photograph will demonstrate objectively that treatment has reached a realistic outcome

• Photos will be part of their confidential record. For intimate areas, only a close up image will be taken

• With permission, a portfolio of before and after photos will be an invaluable marketing tool to prospective clients 

IN SUMMARY 

You have the most sophisticated equipment available on the market today but without trained and dedicated staff, a clean and comfortable environment in which to treat, a wide client base, good marketing and advertising – your practice will never succeed. 

Accurate records, client reassurance and practitioner competence can help ensure complications do not arise

Photorejuvenation

A relatively recent treatment option driven by widespread use of IPL systems with claims of “no downtime” treatment for: 

• Improving skin tone, rosacea, broken blood vessels, red and blue facial veins 

• Reducing facial wrinkles and fine lines 

• Treating sun damage age spots and brown pigmentation, solar lentigines 

• Providing a smoother appearance to skin

The primary aim of photorejuvenation is to bring about wound healing and new collagen formation. Techniques that induce a dermal wound without epidermal ablation should theoretically lead to cosmetic improvement of photodamage

Miscellaneous Pigmented lesions 

• Diagnosis should always be carried out only by those qualified to do so 

• Pigmented skin has a much higher incidence of adverse pigmentation response following treatment and great caution should be exercised in clients with darker skin types

Vascular Lesions

Use of IPL systems for treatment of vascular lesions has been mostly limited to superficial telangiectasia and rosacea. All laser systems emit in the millisecond domain to produce thermal damage mechanisms required. The response to treatment is more dependent on tissue repair mechanisms. Treatment outcome and endpoints should not induce damage to the epidermis. 

Typical endpoints include: 

• Erythema 

• Darkening of lesions 

• Mild discomfort 

• Mild swelling (histamine response)

Clients must be advised that results are “subtle” and that a course of treatments (typically 4-6) will be required for collagen remodelling.  Skin should be thoroughly cleansed prior to treatment

How IPL treatment eliminates vascular lesions:

When the pulsed light is absorbed by a spider vein, the light converts to heat and coagulates the vessel. Vessels may darken initially and then the body will remove the vessel over time.

Depending on the area treated, vessels may disappear immediately (face) or within a few days subsequent to the initial treatment. 

The deeper, thicker vessels (spider veins) often found on the lower legs will take longer, (up to 10 weeks in some cases) to disappear completely.

For the larger vessels that need re-treating, we give the body adequate time to respond and we usually re-treat at 10 -14 days later. 

However, these treatments are very effective in both areas.

Pulsed light systems are not designed to treat large leg or varicose veins and typically will NOT resolve veins effectively which are greater than 2mm in diameter and at greater than 2mm depths. 

Natural Acne Remedy - How IPL treats acne:

The Intense Pulsed Light system releases yellow, green and red light that is emitted in a series of short pulses. The yellow / green light destroys the P. Acnes bacteria that live in the skin and cause inflammation, while the red light directly targets the overactive sebaceous glands that cause outbreaks of pustules.

This targeted heating deep in the skin causes shrinkage of the inflamed sebaceous glands and helps to prevent over-production of excess sebum. The light also stimulates collagen production to help resolve the acne scarring.

IPL, “Intense Pulse Light” is one of the safest acne treatments available ... proven to be extremely effective on moderate inflammatory acne. With the IPL system having FDA clearance for the treatment of acne, this new light-based therapy is now revolutionizing the treatment of it.