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LIGHT
The sun is a natural source of light. There are
other sources of light, such as a candles or
incandescent lamps. Light may also be called
white light, or the visible light spectrum.
Light moves in waves. If we observe a light source
face on, we notice that it is diffused in concentric
circles that resemble waves on the surface of
water. If we dissect these concentric circles, we
can see the crests and troughs of the waves.
The distance between two crests is called the
wavelength.
A wavelength is measured in a
submultiple of the metre that’s called a nanometre.
Waves exist in various lengths, which are
measured according to the distances between the
crests.
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Light is not the only natural phenomenon that
occurs in waves. Just like Ultra Violet, X-rays,
gamma rays, Infra Red, micro waves, and radio
waves, light belongs to the electromagnetic
spectrum. All of these electromagnetic waves
undulate when they move. The shorter waves are
shown on the left and the longer waves are on the
right.
Light, or the visible spectra, only occupies a narrow
strip of this spectrum, between 400 and 800
nanometres, bordered on the left by Ultra Violet
and Infra Red on the right. We can see therefore
that light is made up of approximately 400 different
wavelengths.
White light is actually made up of a multitude of
colours. We can deconstruct light by shining it
through a prism. The beam of light thus separated,
or dispersed, into a rainbow of 7 primary colours.
Each colour has its very own wavelength. Each
shade of colour corresponds to a different
wavelength.
White light is made up of
approximately 400 wavelengths or, more simply
put, of 400 different colours.
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Light is also made up of particles that contain a
large quantity of energy. These particles are called
photons and they move about randomly in the
beam of light.
Light sources are not always exclusively made up
of visible light. The sun radiates UV (Ultra Violet)
and IR (Infra Red) rays. Similarly, most xenon
flash lamps emit UV and IR rays in variable
quantities. Each light source has its own spectra
that may be modified using filters. This is why, it’s
important to know what type of light beam a lamp
gives off so that it is used in an entirely safe
manner.
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PULSED LIGHT
Pulsed Light is often confused with Laser. While
the basic technology is similar, the composition of
the beam of light is totally different.
A laser is a monochromatic light source, which
means it has only one colour or wavelength. Pulsed
light is polychromatic, which means it is composed
of several colours or wavelengths.
In dermatology there are 4 principal types of lasers
in common use : Ruby, Alexandrite, Diode, and
Yag. Together, these four lasers represent only
four wavelengths, whereas pulsed light on its own
can cover a specra about 150 times as broad.
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A laser beam is coherent meaning all its waves are
identical in length and synchronized with each
other. A pulsed light beam is incoherent because it
is made up of waves of various lengths.
And lastly, the laser beam is focused, meaning it is
concentrated on a small surface, whereas pulsed
light can treat a wider surfaces simultaneously.
Pulsed light is emitted in bursts that last a few
milliseconds called pulses. The pulse duration
must be adjustable. The energy from the light beam
is called ‘fluence’ and it is measured in joules per
square centimetre.
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THE SKIN
The skin is outermost organ of the body.
Its colour, texture and the quantity and quality of
hair growth allows us to tell people apart from one
another. This is genetically coded information.
The outward appearance of this coded information
is called a person’s skintype. When we use this
system or code, we sort people into six categories.
This classification system is called the Fitzpatrick
system. It’s based on the analysis of five criteria :
skin colour, eye colour, body hair colour, the
presence of freckles and how the skin reacts when
exposed to the sun. Skintype 1 corresponds to blue
or green eyes with blond or red hair, and skintype 6
corresponds to dark African coloring.
The skintype of an individual does not change over
time. However, pigmentation can vary according to
the time of year or geographic zone. Such is the
case when a tan darkens the skin in order to
protect it from the damaging effects of the sun’s UV
rays. This type of pigmentation is temporary. It is
therefore important not to confuse an individual’s
skintype with the temporary pigmentation of certain
areas that have been exposed to the sun.
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The skin is made up of 3 different layers.
epidermis.
e
The most external layer is called the epidermis.
Its thickness varies according to where it found on
the body.The primary active cells are the
keratinocytes that produce keratin and melanocytes
producing the melanin, protective pigmentation.
The further away the cells are from the foundation
layer, or in other words from the skins deepest
layer, the more they fill up with keratin and then die
which means they’re completely impenetrable.
These cells are lost naturally about 40 days later,
because underlying cells grow and cause skin cells
to shed. The epidermis does not contain any blood
vessels.
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The second layer is called the dermis. It contains
various glands : the sweat glands that produce
sweat and the sebaceous or oil glands that produce
sebum, the oily layer of the skin. The dermis
contains a great number of capillaries. The matrix
of the dermis contains many collagen and elastin
fibers, produced by fibroblasts that give the skin its
perfectly smooth appearance. As we age, the
number and quantity of these fibers starts to
diminish and their regrowth starts to slow down as
well. This explains the gradual loss of elasticity
and firmness of the skin.
And lastly, body hair is rooted in the skin and held
inside a root sheath or tiny tubular hole in surface
of the epidermis.
The last layer is the hypodermis. This layer mainly
contains the adipocytes or fat storage cells. These
cells are distributed all over the body and are more
concentrated in certain areas according to the sex
of the person.
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The skin performs multiple duties. It serves as a
protective mechanism, a chemical protection and
as protection against the sun’s UV rays. At the
same time, the skin has a major metabolic role
because it synthesizes vitamin D, which is
absolutely essential to the human organism.
The skin also regulates body temperature by
producing sweat and by vascular dilation of the
capillaries.
And lastly, thanks to the presence of a multitude of
sensitive receptors throughout the skin’s layers, the
skin plays a major role in relating to our
surrounding environment.
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BODY HAIR
Body hair that’s visible on the surface of the skin
actually originates in the dermis, even though it is
considered part of the epidermis. It is primarily
made of keratin and of melanin, which gives it
colour. The hair follicle, where the hair itself
originates, is rooted deep in the dermis, 6 or 7 mn
from the surface. The hair follicle is made up of four
layers.
We differentiate between two types of hair.
•
Vellus hair or ‘peach-fuzz’, grows from a hair
follicle near the surface. It contains a small amount
of melanin.
•
The thick ‘terminal’ hair has a deep hair follicle
and it generally contains a high concentration of
melanin.
Vellus hair can become a terminal hair, but only
under the influence of a hormonal change. When
vellus hair is shaved off, it does not become a
terminal hair. It remains vellus. So, how do we
explain why a shaved hair seems to grow back
faster, larger and stiffer ? Body hair is rooted in the
skin on an angle, or on the bias. When it is shaved
off, the hair is cut on the bias at skin level. So, it
grows back quickly, in 1 or 2 days. It seems to
grow back faster than usual. The tip that appears
is pointy and stiff, and at first the hair stands up
straight. It becomes supple again when it reaches a
certain length. This is why re-growth seems to be
stiffer and thicker. The opposite is true when body
hair is plucked because it is pulled completely out
of its sheath. The follicle must therefore regenerate
a new hair. The new hair seems finer and appears
to grow more slowly.
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Body hair grows according to a well-defined cycle.
This cycle has been divided into three phases.
1. The first phase is called the anagen, or the
growth phase. During this phase the hair grows
until is reaches the surface of the skin. The hair
will then continue to lengthen. The duration of this
phase is variable depending on the ethnic origin of
the individual, the person’s lifestyle and
surrounding environment as well as on where the
hair is found on the body. Growth can take several
months for underarm or leg hair, or several years
for hair on a person’s head.
2.
The second phase called the catagen phase,
during which the hair stops growing, is very short.
It lasts one to two weeks. During this phase the
bulbous part at the bottom of the hair comes away
from the hair follicle.
The hair is therefore
progressively shed from its sheath.
3. The final phase is called the telogen phase.
During this phase the hair follicle is at rest and
dead hair starts to fall out. Hair loss is often
finalized when new body hair starts to grow
underneath, as the next anagen phase begins.
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In one area, at any given time, visible hairs are not
all in the same phase of the hair growth cycle.
Some are in the anagen phase, and others in the
telogen phase. The distribution of these hair growth
cycles varies according to where the hair is on the
body. For example, 90% of the living hairs on a
person’s head are in an anagen phase and only
10% in the telogen phase. However, only 20% of
leg or arm hair is in an anagen phase and 80% in a
telogen phase.
For humans, unlike animals, the hair growth cycles
are not synchronized.
Many hair follicles are dormant but may produce a
hair at any time. At the base of a hair there are in
fact 3 hair follicles but usually, only one is working
at a time. However, in certain cases, several hairs
can be seen coming out of one pore or opening.
This often occurs after depilation by waxing
because the process desynchronizes the hair
growth cycle.
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INTERACTIONS BETWEEN SKIN AND LIGHT
When a ray of light hits the skin there are three
possible reactions :
1. Part of the light is reflected by the skin. This
means that the original energy contained in the
beam of light is partially lost, which therefore
causes the surface of the skin to heat up. The
amount of light reflected varies depending on the
angle at which the initial light beam arrived on the
skin and on the distance it traveled through the air
beforehand. To avoid reflecting light and to avoid
surface burns, it is necessary to use a layer of clear
ultrasound gel, or cooling gel.
2.
Part of the light penetrates into the skin. As it
penetrates, the light is diffused in the skin which
causes the original light ray to lose energy. The
depth of penetration depends on two factors :
• First of all, on the size of the initial beam of
light, because even at a similar power level, the
wider the beam is, the more deeply it will penetrate
and the more efficient it will be deep down.
•
Secondly, on the way the light diffuses, which
depends on the size of the wavelength : waves
closer to the UV part of the spectrum don’t
penetrate as deeply as the waves closer to Infra
Rouge.
3. Lastly, once the light is inside the skin, it is
drawn to the pigments present in that area. The
beam of light is attracted to the pigments, which
point the beam of light heats up. This phenomenon
is called absorption. Therefore, when we expose a
white surface to the sun it does not heat up since
white reflects all of the light. The opposite occurs in
the case of a black surface because it will absorb
all of the light.
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The pigments in the skin are part of a group of
molecules that give an object colour called
chromophores. For human’s, the pigments are
named melanin, and these give colour to skin and
hair ; whereas hemoblogin is the pigment in red
blood cells and in water.
When we look at the rate of absorption of
chromophores, we see that melanin is absorbed
particularly well between 300 and 400 nanometres.
This explains why it plays such an important role in
protecting skin against the UV rays of the sun.
Therefore, skin that has little or no melanin is
poorly protected against the harmful effects of the
sun. Hemoglobin is absorbed in a series of crests,
or at high-points, the best of which are found at
400, 540 and 570 nanometres. Water absorbs the
infra-red beam best from 1000 nm. Due to the fact
that cells are composed of more than 60% water, if
the number of IR rays is too high, heating will
become too intense and create the risk of cell
destruction.
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It seems therefore that there are certain targets in
the skin that draw light. This is why in many cases
the target is an indirect target. And if the target
does not contain pigment, the chromophore, or
coloured portion, of a neighbouring object becomes
the target instead. Heat generated by light hitting a
chromophore is transferred simply by being in
contact with the neighbouring target.
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The rate of heat transfer is very important. This
notion is called thermal relaxation time or tissue
cooling time. It varies according to the type of
tissue and the duration of the pulse, as well as the
amount of energy in the pulse. We can compare
heat transfer to what happens when we try to fill a
container that has a hole in it. If we fill the container
more slowly than the rate at which the liquid is
emptied, the container will not fill up. If however
the rate at which the liquid enters the container is
greater than the rate at which it leaves, the
container will only fill to a certain level. This level
corresponds to a state of equilibrium that will not
change as long as the filling and emptying rates
remain constant.
The same thing applies to a target and heat. If the
cooling rate is slower than the heating rate, the
heat will remain concentrated on the target and
overheating or burns may occur. On the other
hand, if cooling occurs more quickly than heating,
the target will not be able to remain hot and nothing
or very little will occur. This is why for best results it
is important to vary the pulsewidth as well as to
regulate the power levels so the different targets
will all be treated correctly.
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PHOTOREJUVENATION
SKIN AGING
The skin aging is a natural process. It starts around the age of 25. The skin modifications
concern :
• The skin texture
• Colour
• Relief
• Moisturising
The skin aging can be genetic (or chronological) or environmental :
The genetic or chronological aging is linked to the age and/or some hormonal modifications.
It is genetically programmed It causes the thinning of the skin layers, a slowing down of the
cellular activity, and a reduction of the capacity to store water. The result is a dry skin, thin
layers, a reduction of elasticity and tone.
The environmental aging is linked to external factors like the sun, tobacco or pollution. It
causes some skin texture modifications, a modification of the activity of melanocytes, a
weakening of superficial vessels, and a fibres depletions (or abnormal fibres). The result is
some age spots, wrinkles and telangectasia.
REJUVENATION
Several rejuvenation solutions exist :
• Creams
• Massages
• Dermabrasion
• Chemical peeling
• Laser resurfacing
CONSUMER’S REQUEST
Consumers ask for a treatment :
• Atraumatic
• Pain-free
• Without side effects
• Quick
• With quick results
• Affordable
WHAT CAN BE TREATED ?
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Pigmentation (sun damage)
o Hyperpigmentation, lentigines, freckles, melasma
Benign vascular lesions
o Telangectasia, rosacae, diffuse redness
Skin relief
o Dilated pores, loss of elasticity, lines and wrinkles
HOW IT WORKS
PIGMENTED LESIONS
Light
VASCULAR LESIONS
Light
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WRINKLES
Modality 1
Fibroblasts
Modality 2
Fibroblasts
Modality 3
Fibroblasts
PATIENTS SELECTION
•
•
•
•
It is necessary to be sure to understand the patient request
You have to select the skin types. You can not proceed to the treatment on skin types 4, 5
or 6.
The patient must not have suntanned three weeks before treatment and mus not suntan
three weeks after.
Your patient has to fill an informed consent.
Patients’ satisfaction is highly dependent on this selection.
CONTRA-INDICATIONS
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Doubtful skin blemishes
History of tumour
Pregnant women
Diabetics
Pace maker
Haemophiliacs
Anticoagulant treatments
Epilepsy
Photosensitising treatment
Skin pathology
PIGMENTED LESIONS
Indications :
•
•
•
•
•
Always start with the lowest fluence (highest pigmentation)
Make a spot test and adapt the fluence if necessary
Treat full face uniformly
Do not pass over the same place twice
Too high fluence may lead to transient hyperpigmentation
•
When treating localized area protect
the peripheral zones :
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In this case two or three shots may be necessary until change in colour
After treatment :
•
•
•
•
•
•
« Dirty Face » on the following days
Exfoliation after ten to fifteen days
Pigmentation disappears or is lighter
Skin is more tonic and smoother
Make an appointment in three weeks time
Do another session if necessary
Warning : beauty spots or suspect blemishes must not be treated
VASCULAR LESIONS
Indications :
•
•
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•
•
2 pulse duration according to the size of vessels
Always start with the lowest fluence (highest pigmentation)
Make a spot and adapt the fluence if necessary
Assess vessel size accurately
Too thick or too fine vessels can not be treated
Treat only the area
Do not pass over the same place twice
After session there is a slight rash (redness) (maybe few hours)
Some results are immediately visible
Make an appointment in three weeks time
Average of one to five sessions at three-four weeks interval
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LINES AND WRINKLES
Indications :
•
•
•
Deep wrinkles can not be treated
Pass one or twice on the wrinkles
One session every ten days
HINTS
•
•
•
•
Pigmented and vascular treatment will also be active on wrinkle reduction but will be
a more aggressive treatment
The fourth line is a soft treatment (so longer to be active)
Vascular treatment can be combined with wrinkles treatment if on a different area
You can not do vascular and pigment treatments during the same session
SUMMARY
Thick vessels
Select pigmentation in the dark red line (3rd line) and
treat the required zones. See client again in 3 to 4
weeks.
Fine vessels
Select pigmentation in the light red line (2nd line) and
treat the required zones. See client again in 3 to 4
weeks.
VASCULAR
PREDOMINANCE
PIGMENTARY
PREDOMINANCE
LINES & WRINKLES
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Localised
Select pigmentation in the brown line (1st line).
Protect the peripheral zones, carry out 1 to 3 flashes
(the zone changes colour). See client again in 3 to 4
weeks.
Whole face
Select pigmentation in the brown line (1st line). Treat
the whole face. See client again in 3 to 4 weeks.
Localised
Select pigmentation in the "Waves" line (4th line).
Treat the zones in question. Repeat session every 10
days.
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RESULTS
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PROGRAMS DETAILS
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Treatment
Face
Redness 1
Wedness 2
Wrnkles
Pulse
5 ms
15 ms
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Fluence range
5 – 12 J/cm²
8 – 15 J/cm²
15 – 18 J/cm²
6 – 14 J/cm²
TREATMENT SCREEN
When connecting an applicator, model
PL08011570 on the Or-Light device, if this
application is authorized, then the treatment
screen will be the one indicated on the
picture on the right. No other treatment
screen will be possibly displayed.
If the application is not authorized on the
device, a warning message is displayed. No
treatment with this application will be
authorized.
CONFIGURATION
The operator can modify the following parameters :
The patient skintype (referring to Fitzpatrick scale, above)
The fluence or energy in cm² (J/cm²)
The type of treatment
Skintype
Once the skintype of the patient determinate, give this information to the system by
modifying the Skin parameter (+ or -). The operator can select skintypes from I to IV.
The type of treatment
The type of treatment makes the exposure duration (called Pulse duration or simply Pulse)
vary. This duration is expressed in milliseconds (ms).
OR-LIGHT has two pre-programmed pulses for this application : 10 and 15 ms
Shorter the Pulse, more brief and violent is the impact, higher can be the pain sensation.
Conversely, longer the Pulse, less violent is the impact.
Fluence
Once the skintype and the size of hair chosen, the device selects, by safety measure, the
lowest fluence from the authorized range. This default values is not always the optimum
value to obtain satisfying results. To optimize the results, you will have to increase the
fluence. However, it is important to always start a treatment by the lowest fluence, then to
increase progressively the energy according to the experience of the user and to the patient
reaction. If the fluence seems to be high for the chosen skintype, a warning message
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informs the practitioner. A validation is then necessary from the practitioner to be able to
continue the treatment (see pictures below).
It is reminded that the choice of parameters is made under the responsibility of each
user.
Validation of the parameters
Once those three information given to the system, the START button becomes the VALID
button. At this stage, the lamp in the applicator is ON but the shot is not possible (Simmer
mode or Active mode). You must validate the configuration by pressing on the VALID
button in order to start the treatment. Any modification of the parameters during the
treatment needs a new validation in order to be able to pursue the treatment with the new
parameters.
Treatment
The treatment is made with the displayed parameters. The shot is possible only when the
bulb is green and the sound beep has set off. The number of shots made is counted in the
daily counter, and the available credit is updated.
The MENU button becomes the STOP button.
REMINDER
Do not set off a shot if the light guide is not in contact of the area of skin to
treat.
Never use the applicator without optical gel
Never set off a shot in direction of the eyes
Never use on pigmented skins
Wearing of goggles mandatory
Do not use the applicator if the light guide is damaged.
Cessation of the treatment
To stop the treatment, push the button STOP. If the device remains unused for 5 minutes
it will stop the power (equivalent to the pressure on the STOP button). To re-start with
the parameters in process press again on the VALID button.
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CARRY OUT A TREATMENT
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•
•
•
•
•
•
•
•
•
Remove make up
Shave if necessary
Masking of pigmented area (mole, tattoo)
Applying of optical gel
Setting the parameters
Put on the protective glasses
Press the light guide against the skin
Press the trigger button and check the cutaneous reaction without glasses
Adjust parameters if necessary and proceed to the session
Wipe the quartz oh the applicator with a soft cloth to remove any surplus gel
WARNING
A Light Guide in a bad condition (hair, treatment on a non shaved skin, etc) may generate
burns on the patient skin
PRECAUTIONS
•
•
•
Remove regularly your glasses to check the cutaneous reaction
Regularly wipe the light guide
Check the client’s reactions and his/hes sensitivity
AFTER TRAITEMENT
•
•
It may temporary appears :
o Erythema
o Oedema
o Hyper or hypo-pigmentations
o « Dirty Face »
o Unwanted hair removal
It is necessary to avoid exposure to the sun for three weeks or to use a sun screen
(SPF>20)
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INFORMED CONSENT
The aim of the present document is to provide information necessary for the proper
understanding of the photo rejuvenation programme provided by the L800/L900 system.
The desired area is first of all shaved. An optical gel is then applied. The light emitted by the
L800/L900 (flash lamp) boost the production of elastine and collagen that decrease beyond
25 years old. The skin become more tonic, the curve of the face is redraw, tighter pores
During the light emission, you may feel a prickling sensation or heat. This sensation of heat
may persist for several hours. In certain cases there may be a temporary redness and/or
peri-follicular oedema.
During about a week to 10 days after the photo rejuvenation
treatment, a “Dirty Face” aspect can appear. This phenomenal is normal, it is impurities that
come up to the skin surface. These impurities will disappear by themselves. However, a light
peeling 4 or 5 days after the treatment can be done in order to accelerate this phenomenon
and to discover a beautiful and healthy skin.
It is therefore necessary that the skin is not too highly pigmented (dark suntan, dark or black
skin). In cases of doubt, a spot-test can be carried out on a non visible area having the same
pigmentation with examination of the results 15 days later.
Where the following recommendations are respected, it is rare for there appear any:
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hypo pigmentation
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hyper pigmentation
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superficial burn
RECOMMENDATIONS
8.1Before a treatment cycle
8.1
You are advised to get a medical opinion.
Before the session
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No exposure to sun or UV radiation for 15 days before the session
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No photo sensitizing medications
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No creams based on acids, notably hyaluronics or fruits before or after treatment
8.2
After the session
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No exposure to sun or UV rays on the treated area for 15 days
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Use a total screen type sun cream in case of exposure to sun
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CONTRACONTRA-INDICATIONS
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Suspect skin blemishes
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Pregnant women
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Diabetics
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Pace-maker users
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Haemophiliacs
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Epilepsy
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Anticoagulant medication
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Photo sensitizing medication
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Vitiligo
By signing below, I agree that I have read and understood all the written information contained
herein and consider that I have been correctly informed about the process.
I undertake to point out any modifications concerning my physiological state, the taking of
medications or recent exposure to sun.
I freely consent that this treatment is carried out.
Drawn up in two copies, one of which I retain.
Stamp
Surname:
Name:
Date of birth:
Date:
Signature:
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