Epsilon
Nd:YAG Laser and Intense
Pulsed Light system
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Leading Manufacturer
• Established in 1978, located in Italy
• Available in over 46 countries
• Leading manufacturers of medical and aesthetic devices
• All systems made in Italy
• 25% of annual turnover invested in research and development
• Advanced Esthetics Solutions are Sole UK Distributor for
EvLaser
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What makes Epsilon unique?
The EvLaser Epsilon system is a perfect pairing of
two light based technologies:
Nd:Yag & IPL
This is a versatile platform capable of treating a
vast range of indications, while allowing safe
delivery of effective results for
all Fitzpatrick skin types.
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IPL
Safely treats up to skin type 4
Uses filter cuts (interchangeable, rather than several handpieces)
Built in sapphire cooling system (requires no gel application)
Large spot size for speed of treatment –(7.5cm2)
Touchscreen
Both pre-set & manual parameters for optimal results
Adjustable pulse widths (T1’s & T2’s)
Adjustable thermal relaxation time
Treats a variety of imperfections:
Hair removal
Skin rejuvenation (collagen boost/anti-ageing)
Pigmentation removal
Acne management
Rosacea management
Vascular lesion removal (superficial)
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Nd:YAG
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Safely treats up to skin type 6
Uses two telescopic hand pieces (2-4mm) & (4-10mm)
Utilizes scanning method for speed of treatment
Touch screen
Manual & pre-set parameters for optimal results
Treats a variety of imperfections:
Hair removal
Pigmentation removal
Vascular lesion removal (including blue veins)
Skin tag removal
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Introducing the machine...
• On / Off switch & key port [also EMERGENCY STOP]
• Touch screen control panel
• Foot pedal & pedal holder
• Optical Fibre
• Nd:YAG Hand piece (How do you change the spot size
and hand piece?)
• Nd:YAG lenses (How do you remove and clean lenses?)
• IPL Hand piece (How do you change the filter cut?)
• Water ports (How do you fill and empty device?)
• Brake pedal
• Door safety interlock
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The Electromagnetic Spectrum
This is a term used to describe the entire range of
light radiation, from gamma rays to radio waves.
When we can see light radiation it encompasses an
array of colours that make up optical or visible light.
This is measured in wavelengths, also known as
nanometers (nm).
Electromagnetic waves can not only be described by
their wavelength, but also by their energy and
frequency. The electromagnetic spectrum includes,
from longest wavelength to shortest: radio waves,
microwaves, infrared, optical, ultraviolet, X-rays, and
gamma-rays.
Visible light waves are the only electromagnetic
waves we can see. We see these as the colours of
the rainbow. Each individual colour has a different
wavelength, measured in (nm). Red has the longest
wavelength (low associated energy) and violet the
shortest (high associated energy). When all the
waves are seen together, they make white light.
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The Electromagnetic Spectrum
For IPL we use visible light
Nd:YAG uses near infrared
Different wavelengths are
associated with different
colours e.g. in IPL hence filter
cuts
Each colour has different
depths of penetration (see
left) with an optimal target
structure e.g. Blue light for
acne as most superficial
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Light Energy
A laser creates light by energy being put into material. This
can be electricity or another light source. This energy makes
the material go into an ‘excited state’. Every material is made
up of atoms which hold electrons. This newly ‘excited state’
means electrons in the material have extra energy, and will
eventually lose that energy. When they lose the energy they
will release a PHOTON (a particle of light). The type of optical
gain medium used will set what colour (wavelength, nm) will
be produced. The release of photons is the "Emission of
Radiation" part of laser.
Many things can radiate light e.g. a light bulb, but the light
will not be organised in one direction. By using an electric
field to control how the light is created, this light will now be
going in one direction. This is the "Stimulated" Emission of
Radiation.
At this point, the light is still weak. The mirrors on either side
bounce the light back and forth, and this hits other parts of
the optical gain medium, causing those parts to also release
photons and the light builds up ("Light Amplification"). When
all of the optical gain medium is producing light it creates a
very intense continuous beam of light at a very narrow
wavelength, which we would call a laser beam.
Light
Amplification by
Stimulated
Emission of
Radiation
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Selective Photothermolysis
This is the principle upon which light based treatments work: the Selective Heating
through the Absorption of Light.
PHOTO – THERMO-LYSIS
(Light – Heat – Destroy)
Allows us to target specific structures (selective).
The treatment needs to reach a temperature of 70OC to ensure permanent
denaturing of proteins, e.g. destroying the hairs capability of regrowth if hair is the
target structure.
We also refer to our target structure as CHROMOPHORES. These are tiny
substructures that are able to absorb light. They are spectrally selective, meaning
they have a preference to absorb different wavelengths of light.
For treatment to be successful there must be a chromophore to treat. Having an
optimal target structure helps minimises possible side effects.
There are three main chromophores: Melanin, Blood & Water
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Units of measurement
Wavelength
The length of light travelling in waves, measured in Nanometers (nm). Whereas a
laser will only have one specific wavelength (selective), IPLs will always have a
range of wavelengths from 410nm to 1200nm.
Pulse Length
The pulse length is the duration of the laser pulse. Also known as ON Time, Pulse
Width or Pulse duration. This is measured in milliseconds (m/s).
Power
The strength of the light beam, this is measured in Watts (W). The power used by a
hair removal laser is determined by the skin type. For a light skin type you can use
higher power than on a dark skin type.
Energy
This is the energy that is delivered to the skin, measured in Joules.
Pulses
Energy (J) is delivered across the selected number of pulses
e.g.
30j 5 pulses
30 ÷ 5
= 6 joules per pulse
Too many pulses can WEAKEN the energy too much, making it less effective
Too few pulses will make the treatment more aggressive
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IPL ‘Pulse Train’
30J
On
time
P
P
Off
time
P
P
P
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Thermal Relaxation Time (TRT)
TRT is the time it takes for a structure to lose 50% of it’s
increase in temperature
TRT of hair is 40-100 milliseconds
TRT of skin (epidermis) is 3-10 milliseconds
We must remember TRT when selecting our OFF TIME between
pulses in IPL
In Laser TRT is effected by the frequency (speed of treatment)
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What is the difference between IPL & Laser
IPL
Laser
• Unique pulsing ability (hence
IPL)
• Flashlamp, polychromatic, noncoherent
• Typically larger spot size
• Filter cuts for different
wavelengths specific to various
chromophores
• Range of wavelengths
• Monochromatic, single colour,
coherent
• Scanning method application
• Bypasses pigment in epidermis
so suitable for darker skin types
• One wavelength (selective)
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Fitzpatrick Skin Scale
The Fitzpatrick Skin Scale is a way of identifying skin type to safely treat people with aesthetic applications.
GENETIC DISPOSITION
Score
0
Eye Colour?
1
2
3
4
Light blue, grey or green
Blue, grey or green
Dark Blue
Dark Brown
Brownish Black
Natural hair colour?
Sandy red
Blonde
Chestnut or dark
blonde
Dark Brown
Black
Your skin
colour (non-exposed areas)?
Reddish
Very Pale
Pale with Beige or
olive tint
Light Brown
Dark brown
Freckles (unexposed areas)?
Many
Several
Few
Incidental
None
If you stay in the sun too
long?
Painful redness, blisters,
peeling
Mi1d blisters, peeling
Burn, mild peeling
Rarely burns
Never had burning
Do you turn brown?
Never
Seldom
Sometimes
Often
Always
How easily do you tan?
Don’t tan
Light colour tan
Reasonable tan
Tan easily
Turn dark brown
quickly
Is your face sensitive to the
sun?
Very sensitive
Sensitive
Normal
Very resistant
Never have a problem
When was your last tan?
+ 3 months ago
2 – 3 months ago
1 – 2 months ago
Less than a month ago
Less than 2 weeks ago
Did you expose the area to
be treated?
Never
Seldom
Sometimes
Often
Always
REACTION TO SUN EXPOSURE
TANNING HABITS
Sum of columns
Total of columns sum
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NUMERICAL CALCULATION OF FITZPATRICK SKIN TYPES
Compute your client's score by recording a zero for each answer in the first column,
a 1 for each answer in the second column,
a 2 for each answer in the third column,
a 3 for each answer in the fourth column
and a 4 for each answer in the fifth column.
Add the individual scores together to give a sub-total for each column.
Use your client's total score for all columns to determine their Fitzpatrick Skin Type
and select their Fitzpatrick Skin Type according to the score:
Total score from above table
Fitzpatrick Skin Type
0-7
Type I
8 - 16
Type II
17 - 25
Type III
26 - 30
Type IV
Over 30
Type V, VI
Make sure you evaluate only the skin over area to be treated and record values.
Each area must be sectioned using a white eye liner pencil and the appropriate predicted fluence applied to that area.
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Hair removal
Hair growth is a continuous
cycle in three stages as follows:
• Anagen – this is the ‘active’
growing stage
• Catagen – this is the
‘transitional’ stage - where the
lower part of the hair stops
growing but is not yet shed.
• Telogen – this is the final
‘resting’ stage - the hair falls out
ready for new hair growth.
The Hair Growth cycle for Head Hair
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Hair growth cycles
Duration of
Telogen
Duration of
Anagen
Follicles per
sq. cm
Approx.
Depth of
Terminal
Anagen
Follicle
3-4 months
2-6
years
350
3-5 mm
% Resting
Hairs
Telogen
% Growing
Hairs
Anagen
% Catagen
%
Dystrophic
or uncertain
Scalp
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85
1-2
1-2
Eyebrows
90
10
3 months
4-8 weeks
Ear
85
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3 months
4-8 weeks
30-50
50-70
Beard (chin)
30
70
10 weeks
Upper Lip
35
65
Axillae
70
30
Body Area
Cheeks
2-2.5 mm
880
2-4 mm
1 year
500
2-4 mm
6 weeks
16 weeks
500
1-2.5 mm
3 months
4 months
65
3.5-4.5 mm
70
2-4.5 mm
3.5-4.75
mm
Trunk
Pubic Area
70
30
12 weeks
Months
70
Arms
80
20
18 weeks
13 weeks
80
Legs & Thighs
80
20
24 weeks
16 weeks
60
2.5-4 mm
Breasts
70
30
65
3-4.5 mm
Note: Many factors affect these figures but they do serve as a useful guide. Our early research indicates
that the percentage of telogen hairs on cheeks, beard (chin) and upper lip may be much higher than
indicated on the table by some of the other earlier investigators. More research is required
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Hair removal explained
The use of Lasers and IPL sources to remove hair depends on the absorption of laser light by the melanin
contained in the hair in preference to absorption by melanin in the skin. It is essential that the hair is
darker than the skin for preferential absorption to occur.
Cooling the skin before, during and after treatment can reduce damage to the epidermis.
Hair in the early ANAGEN growth phase is most susceptible to permanent damage.
Laser light of the correct wavelength is absorbed by the melanin in the hair root, which lies between
2mm and 7mm into the skin.
This laser light causes the hair follicle to heat rapidly, leading to destruction of the hair shaft and its
feeding components (cells).
The cells responsible for re-growth of the hair are heated above 70 degrees C and destroyed.
As only a % of hair can be in the ANAGEN stage at any one time for optimal results, clients must undergo
a course of treatments – typically between 6 and 12 sessions.
Medical and Hormonal influences can affect results – therefore setting clients expectations that this may
be a maintenance course for them is recommended.
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Hair removal continued
• Hair must be trimmed
for treatment (ideally a
few days before)
• Only hair with pigment
can be treated
• Affected hairs will fall
out within 14 days
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Skin Rejuvenation
The body’s largest organ is our skin. It is made up of 75% collagen which
is constantly under pressure from environmental factors and ageing.
Collagen depletes by 1.5% per year from the age of 25 and we stop
producing collagen at the age of 67.
IPL can be used to excite (stimulate Fibroblasts) therefore encouraging
further collagen production and wound healing.
Before treatment
(wrinkle)
After treatment
(shallow wrinkle)
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Acne Management
P.acne bacteria is anaerobic therefore cannot survive in an oxygenated environment.
IPL causes an oxygen reaction on the skin – flooding the affected area with oxygen
and disturbing the P.acne bacteria in its ideal living conditions.
Heat energy associated with IPL treatment creates changes in the sebaceous glands,
reducing the amount of oil produced, therefore helping prevent further outbreaks.
As per skin rejuvenation it also encourages healing, therefore aiding in preventing
further scarring.
Grade 1 – Mostly open and closed comedones with an occasional pimple.
Grade 1 acne is typical of a teenager just beginning puberty.
Grade 2 – Very large number of closed comedones, with occasional pustules
or papules.
Grade 3 – Large number of open and closed comedones and many papules
and pustules. Very inflamed and red.
Grade 4 – Commonly referred to as cystic acne, with many deep cysts and
scar formation.
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Pigmentation
Age spots and pigmentation contain a naturally produced product called melanin.
Pigmentation is the over production of melanin that gives the skin a darker
appearance. Typical causes can be excessive sun exposure or other inflammatory
responses such as PIH – Post Inflammatory Hyper pigmentation.
In order to successfully treatment pigmentation, the colour of pigment must be a
much darker contrast to the surrounding area. This is to safely and specifically treat
the pigmentation and minimize risk to the healthy skin around it. If the pigmentation
is due to trauma – we would not recommend treatment. Melasma & Chloasma does
not respond well.
An ideal treatment program would be to combine Laser/IPL treatment with the use of
a tyrosinase inhibitor – to further reduce the over production of melanin coming to
the surface of the skin. This will also act as your safety net for treatment and reduce
the chances of further pigmentation as a side effect.
The Laser/IPL light emitted targets the particles of excess melanin heating them
rapidly until they fragment into smaller particles that can then be removed by the
bodies natural processes (the lymphatic system) or they will slough away at the
surface OR a combination of both.
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Pigmentation
• Melanin absorbs heat from
Laser/IPL device
• This breaks up the pigment
which will slough away from
the skin’s surface and also be
removed as a waste product
lymphatically
• Skin MUST be protected
from further damage with a
good AOX product and broad
spectrum SPF
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Vascular Lesions
Vascular lesions can appear in a variety of ways and from various causes.
These causes can include:
• Ageing – thinning/ fragile skin emphasizes appearance of veins
• Hereditary
• Pregnancy
• Environmental damage e.g. windburn / extreme weather conditions / pollution
• Repetitive pressure or trauma to an area e.g. manual comedone extraction around nasal
corners
• Weight Increase
• Smoking
In treating veins, we are aiming to use light energy either from the IPL or Laser to create heat
in the chromophore – that being haemoglobin. This heat causes a mini trauma, causing the
capillary cell wall to collapse and be removed lymphatically by the body as a waste product.
Immediately after a successful treatment the lesion should appear darker with a ‘smudged
appeared’ similar to a small bruise.
The surrounding skin should hardly be effected as it is the lesion itself being selectively
targeted.
When treating Rosacea – you would treat the vascular component of the condition. You
would only use IPL to do this and it would be classed as a management treatment.
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Vascular Lesions
Following the treatment the damaged vessels are absorbed by the body and removed as
waste by the lymphatic system.
The number of treatments will depend on the anatomic site of the thread vein and
severity/colour of the lesion.
The max. diameter of a vessel that can be treated with IPL is – 0.3 – 0.4 mm. These will
appear red and with more of a ‘blushed affect’.
Purple and blue veins with the diameter of up to 3.8mm can be treated with N:d YAG.
We can check suitability for treatment by completing a pressure test. If we press the vein and
it disappears and refills we cannot treat. This indicates it is a ‘live’ and working lesion.
IPL – indication for treatment
LASER – indication for treatment
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Contraindications to treatment
Oral acne medication in the last six months (Accutane/ Roaccutane)
Certain Medication (as per medication sheets given)
Photosensitivity
Auto Immune Disease
Semi-permanent make-up in area
Pregnancy
Epilepsy
Active cold sores / herpes virus
Keloid scarring
Pace-maker
Infectious disease
Haemophillia
Special body areas: Lips / nipples / inside eye orbital / scalp / directly over genitalia
History of cancer / current cancer
Tanned skin (real or fake)
Malignant or suspicious tissues
Diabetes
Open wounds to area
Active eczema or psoriasis
Vitiligo
Use of St Johns Wort
Tattoo over treatment area
Raised Moles or Skin lesions including undiagnosed lesions
Any strong anti-inflammatory medication
* Please See contra –indication sheets*
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Patch Test Procedure
Why do we perform a Patch Test?
Patch Testing is an essential component in safely treating clients with IPL/LASER devices. It
is vital practitioners show they have carried out all aspects of care in safely treating their
clients to ensure potential side effects are considered unlikely and to gage how the clients
skin responds. A Patch Test will also give clients a realistic indication as to how treatment
will feel, prior to commencing a full treatment session. For insurance purposes, Patch
Testing is nearly always a mandatory requirement.
• Always perform a thorough Consultation with every new client
• Assess the area's to be treated and ensure there is an indication for treatment
• Explain the procedure, possible side effects and set your clients expectations to the patient of
the likely results of treatment
• Recommend appropriate aftercare
• Ensure you have written consent and your client is medically sound to receive treatment
• Photograph the treatment sites for the patient's records
• Using your pre-set protocols Patch Test an area of the body immediately adjacent to the intended
treatment area. Ensure you are not placing your applicator directly over any raised lesions, tattoos,
severe pigmentation or long hair
• A typical Patch Test should include at least 3 shots with the IPL/LASER. You are looking to ensure
there is no Adverse Reaction
• 24 hours should be left between Patch Test and Initial treatment. 48 hours is recommended for
darker skin types as they can be more sensitive
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Adverse Reactions
There can be occasions where a clients skin may respond negatively or unexpectedly. This
may appear as:
•
•
•
•
Prolonged erythema
Hypo / hyper pigmentation
Light scabbing
Small water blisters
All incidents of adverse reactions should be investigated to understand possible cause and
avoid further potential reactions.
In the event of an adverse reaction
Stop treatment
Cool area with cold compress
Apply Aloe Vera gel
Advise client of home care
Fill in adverse incident report
Try to identify root cause of reaction
If suitable and when reaction has completely healed – re-patch test prior to recommencing
treatment.
Log all client notes and findings, including action taken and advise to client
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Treatment Room Safety
The most common safety rules are as follow:
• Keep reflective and shining objects to a minimum in the treatment room
• Label the designated treatment room with an IPL/LASER sign
• Keep flammable objects in the room to a minimum
• Make sure the room is well ventilated and well lit for treatment
• Don’t allow any extra persons in the room while treating a client
• Make sure eye protection and other protective equipment is used at all times
• Make sure the treatment couch is well positioned for each practitioner for
treatments
• Ensure there are no electrical wires that could be classed as tripping hazards
• All windows should be blocked completely from possible light that could escape
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Pre Treatment Advice
◊ Stay out of the sun for at least 3-4 weeks prior to treatment, and use SPF30+
when exposed to sunlight
◊ Do not use self-tan or solariums for at least 2-3 weeks prior to treatment
◊ Do not wax or pluck hairs for at least 3 weeks prior to treatment
◊Do not bleach or use depilators for at least 1 week prior to treatment or
perfumed/aromatherapy products for 24-48 hours before treatment
◊ Please shave or clip the area to be treated. This will make the procedure much
more effective
◊ Please ensure you remove any make-up prior to treatment
◊ Some women may experience an exaggerated skin sensitivity prior to and
during their monthly period
◊ Avoid swimming in strong chlorinated water immediately before treatment
◊ Avoid wearing tight clothing when attending the treatment
◊ Keep the area clean and dry
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Post Treatment Advice
◊ Always use a SPF 30 plus daily and reapply frequently
◊ Avoid sun exposure and sun beds while undertaking your series of treatments
◊ Keep the area clean
◊ Avoid use of irritants or stimulant solutions or creams on the area
◊ Avoid heat e.g. hot baths/showers, steam room, saunas and spas etc for 48-72 hours
after treatment
◊ Do not use any other form of hair removal except shaving during your treatment
programme and shave no earlier than 2-4 days after treatment
◊ Should area appear red or tender, apply recommended aftercare gel or use of ice or
cooling gel packs can improve comfort and reduce redness and swelling
◊ Do not use fake tanning products for two weeks prior to treatments including spray
tanning and tinted moisturisers
◊ Do not exfoliate the area for 3 days following the treatment
◊ Do not shave for 48 - 72 hours after the treatment
◊ Do not use bleaching creams or perfumed products for 24 - 48 hours
◊ Do not pick or scratch the treated area.
◊ Avoid wearing tight clothing such as leggings or tights
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Treatment procedures
1. Carry out a thorough consultation with your client and perform a patch test.
Wait 24-48hrs prior to commencing first treatment
2. Treatment area should be free from cosmetic make-up and cleansed thoroughly
3. Grid the treatment area with white kohl pencil
4. Using IPL use pick and place method with complete and reasonably firm contact to
the skin. For Nd:YAG you can use scanning method or pick and place, always
perpendicular in application.
NB: For Age spots with IPL, cut whole in white card and only expose intended skin
area to treat. Use the white card to ‘block-out’ surrounding skin. You can also use
white card in this way to navigate the hairline, lips and areolas.
For veins with Nd:YAG start at the beginning of the vessel and leave a ‘spot-sized’ gap
between each zap of the Laser until you reach the end of the vessel.
5. After the whole area is treated apply Aloe Vera and broad Spectrum SPF. Post
cooling may be required.
6. Clients should be advised of home care and subsequent treatment timings.
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Clinical End Points
Photo-rejuvenation (collagen boost/skin revitalisation) – a warming sensation should
be felt. Mild erythema possible. This treatment uses low energy so should not feel
overly uncomfortable
Pigmentation should look darker than its original colour. It will sometimes even turn
black and may crust soon post treatment. This can also appear slightly raised and may
feel stingy by way of sensation.
Vascular lesions will appear smudged. They can also appear bruised and will be
similar in sensation as pigmentation. Occasionally, small white bubbles of skin may
trace the treated lesions, and tiny superficial scabs may form.
Rosacea can initially appear mildly inflammed – this should subside within 24hours
with gradual continued improvement. Remember this is a management program.
Hair Removal can sometimes result in hair immediately ejecting from the follicle. This
is more typical of Nd:YAG. It can take up to 14 days for a % of hair to fall out. There
may be mild follicular erythema. Follicles should not retain excessive heat- if so, post
cooling is recommended.
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Treatment Intervals
Hair reduction : facial areas 4- 6 week intervals
body 6-8 weeks intervals
Pigmentation / thread veins (face): 4-6 week intervals
Collagen stimulation / rosacea / acne: 2 week interval between
the 1st & 2nd treatment and 4 weeks thereafter. Acne
treatment is particularly effective in 3 weekly intervals
Pigmentation / thread veins (body) : 6-8 week intervals can
prove to be an effective course of treatment. This allows for the
lymphatic system to collect and disperse of thread
vein/pigmentation which can be known to be a longer process
on body areas
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