Advanced Laser Education Content - Part 6 ND:YAG and Alexandrite

This page contains treatments advanced education content about laser and treatments. 


Best uses for ND: Yag (1064)

  • Tissue tightening
  • DCD Spray is turned off for this procedure
  • Use paint method when treating
  • Hair reduction for higher Fitzpatrick types
  • Deeper vascular lesions
  • Hair Reduction for lower Fitzpatrick skin types
  • This is ideal wavelength for hair destruction
  • Pigmented lesions

Functions of hair

  • Helps maintain warmth
  • Alerts the body topresence of insects on the skin
  • Guards the scalp against minor injury and abrasion
  • Protection against sunlight and UV radiation
  • Dry lubrication
  • Eyebrow prevents sweat from running into the eyes
  • Nose and ear hairs filter dust from the air
  • Cosmetic

Definition of permanent hair reduction

  • Significant and stable loss of hair for a period longer than the complete natural hair growth cycle (usually 1 year)
  • Hair reduction

Hair reduction

  • Clean area before treating
  • Area must be clean shaven that day or night before
  • DCD spray is on
  • Distance gauge is flush and perpendicular to surface
  • Zimmer may be used but be aware that is skin is too cold, PIH is more likely to occur
  • If topical numbing cream is used, wipe with alcohol prior to treatment
  • Apply cool gel packs or wet cloths to area to reduce surface temperature
  • Use Alexandrite for Fitzpatrick skin types I and II. If you want to use it for Fitz III, be sure to do a test spot first.
  • Do not use 755nm wavelength for Fitz IV-VI. This will cause PIH (post-inflamatory hyperpigmentation)
  • ND YAG is ideal for skin types IV-VI
  • Perform test spots on skin types III through VI
  • Remember pulse width needs to be equal to or longer than the TRT of the epidermis (about 3 ms)
  • Remember that the correct length of time between treatments will assure better results and a more satisfied patient
  • Using the correct settings will also significantly affect the results
  • Hair reduction does no work on blonde, white or gray hair
  • Whether using the Alexandrite or the ND: Yag; the patient must not have a recent tan.
  • Spray tans are not an exception

Timing of treatments according to body site

  • Face: four weeks
  • Neck: four to six weeks
  • Trunk: six to eight weeks
  • Back: six to eight weeks
  • Arms: six to eight weeks
  • Legs: eight to ten weeks, sometimes twelve weeks

What to expect during treatment

  • Discomfort is increased with

Increased laser fluency

  • Increased follicle size
  • Increased hair density
  • Increased melanin in epidermis

Discomfort can be minimized by

  • Pre-cooling
  • Topical anesthetic cream
  • Decreasing fluency of laser

Tissue tightening of face and neck

  • Skin must be heated to 41-43 degrees Celsius (105.8-109.4 degrees Fahrenheit)
  • Use infrared thermometer to assure that temperature is maintained
  • DO NOT use feel of skin as indicator of temperature
  • DCD spray is off and the distance gauge is hovering above the surface of the skin about 2 cm.
  • Distance gauge is perpendicular to skin to have as little reflection of laser light as possible
  • Exlis, Refurfix, Fraxel treatments – good for wrinkles, sagging and stimulating collagen

Settings for Tissue Tightening

  • Settings will be the same for all Fitzpatrick skin types
  • Use 10 mm spot size
  • Pulse width: 0.5 ms
  • Hertz: start with 10Hz and decrease to 7Hz - 5Hz if necessary for patient comfort
  • Fluence: 10j/cm2 , decrease to 8j/cm2 – 6j/cm2 as needed when you have reached temperature
  • Decrease parameters peri-orbital and forehead
  • Separate face into three areas

Timing for most effective treatments

  • Patient compliance is important for best results
  • Seven to ten days are ideal for time between treatments
  • Four weeks will work but results may take longer to see
  • Four to six treatments will be needed depending on the amount of un damage of the beginning of the treatments
  • Photos are very important with this procedure

What to expect during treatment

  • Patient will feel heat and warmth
  • They may feel slight burn, so patient feedback is essential
  • If patient complains about heat laser fluency may be turned down nut the temperature bust be maintain
  • Appling pressure all alleviate discomfort
  • There will be mild erythema post treatment and slight edema
  • Patients are normally very pleased directly after treatment. It is important to let them know that tissue will relax

What to expect after treatment

  • Redness at the follicle for 4-6 hours after treatment
  • Hair appear to grow for several day and hair falls out around 10-14 days
  • Hair reappears 4-10 weeks until all phases of hair have been treated