Erythema (redness) and slight edema (swelling) are very normal after having a laser treatment and usually resolve after a day or two. However, patients receiving treatment for benign pigmented lesions and “laser peels” may experience micro crusting or even sloughing of the skin for a week to ten days.
Because many of the lasers made by Candela have absorption by melanin/pigment, we advise that patients avoid ANY sun exposure, tanning beds, and sunless tanning products for at least 2 weeks prior to treatment and 2 weeks after. The only treatment that can be performed on patients with a tan is laser hair reduction and should only be performed using the GentleYAG laser. Still, patients should avoid sun exposure and tanning beds for 1 week prior to treatment and 2 weeks after. The GentleYAG has no absorption of sunless tanning products.
Bruising, or purpura, is typically caused by energy being delivered into the skin too quickly. Particularly with the Vbeam and GentleYAG for vascular anomalies. Also to be considered are medications or herbal supplements such as, ibuprofen, aspirin, vitamin E and fish oils. We also advise that patients avoid being treated soon after exercise. Vascular dilation creates more targets that may bruise.
The difference is the diameter. Finer hair has a lesser diameter than coarser hairs. This is important when determining the pulse duration of the treatment parameters. Remember we select our pulse duration dependent on the TRT or thermal relaxation time. The larger the structure, the longer the thermal relaxation time, thus the longer pulse duration required.
The number of treatments required is dependent on several factors. First, what is the indication being treated? Hair requires more treatments than vascular lesions for example and what body area being treated for hair will also play a factor in number of treatments. Also, every patient responds differently therefore Jane Doe may need more treatments than Jill Doe.
Micro–crusting is a result of heating the epidermis. When treating benign pigmented lesions, the object is to heat the abnormal pigment (dark spot) and as a result the pigment is cooked and turns a darker color. This result is the micro–crusting. Please remember that patients need to keep these areas moist with an ointment and to avoid picking, scratching, or aggressively washing the area.
The pulse duration selection is dependent on the TRT, or thermal relaxation time of a structure. When treating hair, you should notice that hairs will have different diameters. The greater the diameter, the longer the thermal relaxation time, thus the longer pulse duration being required. Most practitioners will use 10ms for the first couple of treatments in most areas before moving to a shorter pulse duration of 3ms. The 20ms pulse duration is almost exclusively used for PFB (pseudo-follicular barbae).
It is not necessary to smell a burnt hair odor. The clinical endpoint practitioners should look for is peri–follicular edema.
As treatments progress, hairs that grow will usually be lighter, finer and maybe a little tougher to treat. Usually increasing the fluence to achieve greater absorption by these lighter hairs will be more effective. Always remember to judge a patients skin type to assist in determining an effective, but safe fluence.
There are no clinical studies showing that the DCD has ever caused Cancer.
It is very important to utilize a smoke evacuator when performing laser hair reduction treatments. The plume is a carcinogen that should not be inhaled. There have been no reports of HSV or HIV as a result of laser hair reduction treatments; however HPV can become an aerosol and inhalation should be avoided.
There have been studies that have shown that too low of a fluence can stimulate limited hair growth.
Shaving does not activate an anagen cycle. The mechanical action of shaving is to remove the hair above the skins surface. It has no effect on the hair follicle or surrounding structures.
All of the lasers from Candela have some photorejuvenation properties. Heat created by these devices will stimulate the bodies own ability to produce collagen. What can be differentiated is the fact that different wavelengths have different depths of penetration into the skin. 1064nm would penetrate the deepest and 1450nm the shallowest. The rest fall in between.
No due to the limited depth of penetration neither the organs or lymph nodes should absorb the laser light
It depends on the medication and the topical being used by the patient. Patients should be off of Accutane for at least 6 months prior to laser treatments. Other medications should be examined and a test spot be performed if there is any concern of an adverse reaction. Retinoids should also be ceased 3–5 days prior to laser treatment as they can create excessive redness. A list of photosensitizing drugs can be found here: (0920–23–0011)
Practitioners should avoid treating inside the orbital rim.
When using a scleral/corneal shield the eye is protected; however we advise that only experienced practitioners treat in this manner.
If light sensitivity is a concern then this should be discussed with the patient.
Each state has its own regulations on who can and cannot utilize a laser. Please contact your state’s board of health or board of medical examiners.
This is something that we are looking into.
While compression stockings are common post sclerotherapy treatment, they are not absolutely necessary after treatment of leg veins.
Yes, but begin with lower fluences and perform a test spot to determine the appropriate energies.
There are a number of medications that are considered photo sensitizing. This list can be located here: (0920–23–0011) If light interacts with any of these medications, a test spot should be performed to judge the skin’s reaction.
There are several on the market. LMX–4 can be purchased over the counter. EMLA is similar option but requires a prescription. Many accounts are having their own topical anesthetic compounded at their local compounding pharmacies.
It is quite common to check the laser once a month or even more often depending on the amount of use. Even if it isn’t checked, a warning fault will alert you for the need to add additional distilled water.
Replacement of lenses is dependent on the practitioner keeping them clean. Preventing dust or hair residue from collecting on these lenses should allow them to last a great deal longer.
Prices on all treatments will vary from region to region.
Test spots should be performed for considerations of both; how the skin is going to respond and what energy is going to be the most effective. Most practitioners will perform test spots on an inconspicuous area of the patient’s body. Some are performed under the chin, behind the ear or even on the buttocks.
Yes, since the eyeliner has no color, there should be no absorption by the laser light.
It is quite common for a patient to experience welts. This is usually a good sign of an inflammatory response that can indicate efficacy of LHR treatments. Patient who experience welts can be given cold compresses and/or an over the counter anti–inflammatory drug per standard of care if necessary.
The lenses for the GentleLASE and the GentleYAG should never be interchanged. Each has properties for its own wavelength that can affect the other wavelengths efficacy as well as how the unit runs. This also applies to the delivery systems and distance gauges.
We would suggest that each indication be treated individually and on separated days. 1–2 weeks apart would be sufficient
It is advisable to wait to see how the lesion is going to respond. Pulse stacking at too high of a fluence can result in pigmentary changes.
Patients should not experience purpura when using sub–purpuric settings. Medications can increase the possibility of bruising; aspirin, ibuprofen, vitamin E and fish oils thin the blood which can result in purpura.
Candela recommends performing treatments for each indication separately.
Candela recommends treating each indication separately.
There is no limit of treatments a patient can receive. They must understand that there will be a limit on their improvement and this should be discussed during the patient consultation. If the patient and practitioner choose to continue with treatments, Candela is not aware of any contraindications in doing so.
The size of the structure will determine the setting for pulse duration. The larger the structure, the longer the pulse duration, thus the longer pulse duration required; and vice versa.
Most practitioners will begin treatments using the larger spot sizes. As treatments progress the necessity for higher fluence will require a drop down one spot size to achieve additional energy.
The largest possible size should be used on the upper lip. Most patients cannot accommodate the 18mm spot size in this area; however the 15mm or the 12mm should be able to be used.
Hair can take up to two weeks to shed after treatment of the GentleLASE and nearly three weeks after treatment with the GentleYAG.
Hair reduction: re–treatment will be dependant on the area being treated. The face, axilla, and bikini areas are treated every 4–6 weeks; Trunk (chest/back) every 8–10 weeks; and extremities 10–12 weeks.
Benign Pigmented Lesions: re–treatment is recommended at 4 week intervals.
Vascular Treatments: re–treatment is dependant on the area being treated. The face and upper body is typically every 4–6 weeks and for lower extremities or leg veins, every 10–12 weeks.
The depth of penetration will be dependant on the laser’s wavelength. The longer the wavelength, the deeper the penetration into the skin.
Candela recommends that each indication be treated individually and on different days.
It is advisable that each treatment be treated separately and on different days.
So long as the treatment is non–ablative, 2–3 hours is the recommended period of time.
Yes, all areas being treated for hair reduction should be shaved the day prior to treatment. Any hair that is above the surface of the skin will absorb light that is intended for the hair follicle.
For treatments with the GentleYAG, patients should avoid sun exposure and tanning bed for 1 week before and 1 week after treatment. For all other Candela devices, patients should avoid the sun for at least two weeks prior and two weeks after.
There are many different things that can be applied to the skin after a laser treatment. Most common are aloe vera, cold compresses, and most importantly a 30+ spf sun block.
It is not absolutely necessary; however if there is any concern regarding the surrounding skin response a hydro–quinone (bleaching cream) can be used.
Using good judgment in determining vessel size, color and parameter selection. Try to remember that structure size and thermal relation time will affect the pulse duration. Selecting the appropriate pulse duration is the key.
Yes, however not all patients will respond with excessive edema. For those patient’s who react with edema, they can be given a cold compress and even an antihistamine, per standard of care, to alleviate the swelling. Patients should also be advised to sleep in a semi–recumbent position.
Post treatment care is very important after tattoo removal treatments. Patients should be advised to keep the area clean. Application of an ointment and non–stick dressing is very important. Remind patient NOT to pick, scratch or aggressively wash the area to prevent scarring.
A thick moisturizer can be applied to the skin after a SmoothPeel treatment. Another option is a very think layer of ointment.
It is recommended that patients shave their legs the day prior to having laser hair reduction treatments. This is done to alleviate any irritation to the lower legs. Shaving the day of treatment increases the likelihood of itching, swelling and red welts. It is unknown what the mechanism that causes these symptoms. Patients that experience this can apply cool compresses and take an antihistamine to resolve the issues.
Patients should avoid exercise the day of treatment and for 5 days after the treatment of leg veins. Also to be avoided are excessively hot baths and showers, steam rooms or saunas, alcohol, and any medications that may thin the blood.
Some patients may experience a phenomenon where all present hair follicles will become “in phase” and grow at the same time.
Purpura is a reaction caused by laser energy entering a vessel in a rapid fashion thereby rupturing the vessel allowing blood to escape creating the bruise. Any vascular discoloration caused by excessive suction of the Serenity Pro is similar to a hicky.
Unfortunately there are no guarantees in laser hair reduction. There are clinical studies showing improvement of up to 80–90% but that every patient will respond with this amount of efficacy. Patients should be told during consultation that results will vary from patient to patient.
While side effects are quire rare, the possibilities are erythema, edema, bruising, welting, hyper or hypo–pigmentation and blisters.
Common endpoints are erythema or redness, and edema or swelling.
Because each laser has their own specific wavelength, they each are attracted to different chromophores or targets.
Hair: The laser light is attracted to the melanin in the hair follicle; particularly in the bulb and bulge. Heat is collected there damaging the cells lining the hair follicle with the potential to also damage the vascular matrix preventing future hair from growing.
Leg Veins/Facial Telangiectasias: Depending on the modality in use the vessel will either be ruptured, coagulated, or luminal stenosis
Due to the nature of the human body, it may take multiple treatments for improvement. For hair, there are several cycles of hair growth and a certain number of hairs may only be growing at a particular time. For vessels, they may need to be shrunk over a number of treatments. And wrinkle treatments are a result of the laser stimulating the body to produce or reorganize collagen.
Typically most treatments are 4–6 weeks apart. However, depending on the indication being treated and where on the body the treatment is being performed. Treatments on the trunk should be done at 8–10 week intervals and extremities at 10–12 weeks.
Absolutely. During a patient’s consultation, it important to obtain information on any medication a patient may be taking. There is a list of these photosensitizing drugs at this link.
If there is a question regarding photosensitivity, or pigmentary changes while the patient is taking antibiotics, there are two course of action which the clinician can take:
– Test spot
– Abstain from treatment until the patient has completed their antibiotics.
– Refer to Medications / Photosensitivity List which is found in this website.
It is possible that performance enhances might impact hair reduction treatments. If the performance enhancers have components which increase testosterone production, the increase in hormonal activity might interfere with efficacy.
In order to optimize leg vein treatments certain activities should be avoided:
– Abstain from running, jogging, lifting weights for approximately 5 days.
– Abstain from baths, hot tubs, saunas, long showers, or any activity which will make you sweat.
– If your physician has recommended use of compression stockings, please follow their instructions for use.
– Because alcohol can cause vasodilation, abstaining from alcohol is recommended for approximately 5 days.
There is great variability in the timeframe hyperpigmentation resolves from person to person. The average amount of time can be from a few weeks to 1 year or longer.
Treat the vascular component first, then the pigment second.
There are several options to choose from:
The Dr. Taylor Method instructs 3 passes.
Dr. Key Method for the face : uses 6 consecutive passes.
Dr. Key Method for the abdomen : uses 3 consecutive passes.
Dr. Key Method for the thighs : uses 3 consecutive passes.
Using the 3x10mm spot size for the treatment of leg veins allows for better clearance of the vessel. The 3x10mm spot is designed for linear vessels.
– Laser Hair Reduction: Peri–follicular edema is the ideal endpoint. The darker/coarser the hair the more noticeable it is. For lighter finer hair, peri–follicular erythema is the endpoint
– Vascular Lesions: Depending on the laser that is used, endpoints may be different. For vessels treated with the Vbeam or GentleLASE, a vascular spasm occurs where the linear vessels will darken and return to normal over a matter of seconds. When treating with the GentleYAG, the vessels should virtually disappear.
– Pigmented Lesions: Depending on the color of the lesion, a “snap” is generally heard during the treatment. The darker the lesion, the louder the “snap”. It is not uncommon for lesions to initially “frost over” and darker over a period of 5–10 minutes
– Skin Tightening/Wrinkle Reduction/Acne: Generally erythema and slight edema are the clinical endpoints.
– Tattoos: When treating tattoos, practitioners will notice a “popping” sound and frosting over the areas treated. If pinpoint bleeding is noticed, the energy or fluence should be reduced.
– Laser Peels: When using the SmoothPeel practitioners should look for an Escher or “frosting”. If pinpoint bleeding is noticed, the fluence or energy levels should be reduced.
ANSI Standards do not address this concern and Candela is not aware of any published studies on this subject. Since no known studies providing guidance on these risks are known, Candela recommends the following precautions: Defer the laser treatment during pregnancy; particularly laser treatments in the abdominal and pelvic areas. Other factors such as hormone changes, vascular proliferation, fluid retention and excessive hair growth may also affect procedure efficacy. Consultation with and approval by the physician or healthcare practitioner managing the pregnancy is advised.
ANSI Standards do not address this concern and Candela is not aware of any published studies on this subject. Since no known studies providing guidance on these risks are known, Candela recommends the following precautions: Consultation with and approval by the physician or healthcare practitioner managing the pregnancy is advised and the decision is at their discretion.