The MultiWave Approach To

Aesthetic Control of Acne and Acne

DIODE 810 nm
Ndyag 1064 nm
CPL/IPL
Worldwide Top 5 Non Surgical Procedures
BOTOX 32.7%
HYALURONIC ACID INJECTIONS 20.1%
LASER HAIR REMOVAL 13.1%
AUTOLOGOUS FAT INJECTIONS 5.9%
LASER TREATMENT 4.4%

8.9 15.7 3.4 8.3 17.3 3.7

8.2 19 4.3

PHOTOTERAPY

SKIN TIGHTENING
AND BODY
SHAPING

8.9 17.4 4.6 EMERGING SKIN

REJUVENATION

Source: Global Aesthetic Market VIII, Medical Insight, Inc.

Worldwide procedure volume for Light Based aesthetic treatments by application 2009-2016

2009 2016
1.4 Acne Reduction Acne Reduction 3.1
8.9 Skin Rejuvenation Skin Rejuvenation 14.2

3.1 Pigmented Lesions Pigmented Lesions 4.1

Tattoo Tattoo

11.7 Hair Removal Hair Removal 16.4

2.8 Vascular Lesion Vascular Lesion 5.2

Causes of Acne
• The most common acne is the type that develops during the
teenage.
• Puberty causes hormone levels to rise, mainly testosterone.
• These changing hormones cause skin glands to start making more
sebum.
• Acne begins when sebum mixes with dead cells and clogs the
pores. Bacteria can grow in this mixture. Cause infection with
swelling, redness, and pus.
• Certain medicines, such as corticosteroids or lithium, can cause
acne.
• A few conditions of the endocrine system, such as polycystic ovary
syndrome and Cushing's syndrome, can lead to outbreaks of acne.
Common pathogens in Acne

• The most common bacteria that causes acne is

called Propionibacterium acnes, or P. acnes for
short. These bacteria lives on the skin, is an
aerobic. They become a problem only when enter
a blocked pore. This happens when excess sebum
mixes with dead skin cells to form a "plug.“
• Other bacteria may be Staph. Aureus and Proteus
species.
Diagnosis

Classification of patients with acne vulgaris, includes the

following features:
• Comedonal acne: Presence of open and closed comedones
but usually no inflammatory papules or nodules.
• Mild acne: Presence of comedones and a few
papulopustules.
• Moderate acne: Presence of comedones, inflammatory
papules, and pustules; a greater number of lesions are
present than in milder inflammatory acne.
• Nodulocystic acne: Presence of comedones, inflammatory
lesions, and large nodules greater than 5 mm in diameter;
scarring is often evident.
Acne Rosacea
• Rosacea is a common, chronic, incurable, adult acne-like
skin condition that is easily controllable and medically
manageable.
• Rosacea commonly affects the central third of the face,
especially the nose, and has periodic ups and downs (flares
and remissions).
• Rosacea triggers include alcohol, hot or spicy foods,
emotional stress, and heat.
• Rosacea symptoms and signs include
• redness of the face (easy facial blushing or flushing),
• tiny red pimples and fine red lines (telangiectasias) on
the facial skin,
• rhinophyma (enlarged, bulbous red nose).
Factors affecting Acne Rosacea
• exposure to sunlight
• stress
• hot or cold weather
• strong winds
• strenuous exercise
• alcohol
• hot baths
• spicy foods
• hot drinks
• humidity
• caffeine – found in tea, coffee and cola
• menopause
• dairy products
• other medical conditions
• certain medicines, such as amiodarone, corticosteroids and high doses of vitamins B6
and B12
Causes of Acne Rosacea
• Microscopic mites called demodex folliculorum, usually live
harmlessly on human skin
• Helicobacter pylori bacteria are bacteria found in the digestive
system. It's been suggested these bacteria may be a possible
cause of rosacea, although a link hasn't been proven.
• Rosacea seems to be more common in families, although it's not
clear which genes – if any – are involved or how they're passed
on.
• Recent research has shown external triggers such as ultraviolet
(UV) light, spicy food, alcohol (particularly red wine), exercise,
stress, heat and cold can lead to the activation of certain
peptides within the skin.
 Lasers and lights: How well do they treat
acne?
• Lasers and other light devices may seem like the
perfect acne treatment. Just a beam of light which
makes acne disappear.
• Using them is actually a bit more involved and the
results less predictable. Still, these treatments can
be an effective part of an acne treatment plan.
• Studies show that lasers and other light treatments
can reduce acne. Rarely can these treatments alone
clear severe acne. Dermatologist may recommend
another acne treatment, such as local or oral
medication.
• Mild side effects are possible with lasers and other
light treatments. Redness is common after
treatment with many lasers and light treatments.
Some patients say their skin stings or burns. These
are usually mild and disappear within a few hours
or by the next day.
Advantages of light devices in Acne control

• Light based devices for the treatment of acne offer

excellent results without the often severe side
effect caused by some medications such as
isotretinoin.
• They offer antibacterial effect as well.
• Decrease the possibility of scarring, by stimulating
collagen production.
• Minimize pigmentation marks.
• Eliminate couperose associated to rosacea.
CLINICAL DOCUMENTATION

Use of Lasers and Light-Based Therapies for Treatment

of Acne Vulgaris
• Kavita Mariwalla, MD
• Thomas E. Rohrer, MD
• Department of Dermatology, Yale School of Medicine,
New Haven, Connecticut
• Department of Dermatology, Boston University School
of Medicine, Boston, Massachusetts
• SkinCare Physicians of Chestnut Hill, Chestnut Hill,
Massachusetts
A Comparative Study of Intense Pulsed Light Alone and Its Combination
With Photodynamic Therapy for the Treatment of Facial Acne in Asian
Skin

• Chi K. Yeung, MBBS,1 Samantha Y. Shek, MBBS

• Peter Bjerring, MD, PhD,2 Carol S. Yu, MBBS
• Taro Kono, MD, and Henry H. Chan, MD, FRCP1,
• Department of Medicine, Division of Dermatology, University of Hong
Kong, Hong Kong
• Department of Dermatology, School of Medicine, Swansea University,
Swansea, United Kingdom
• Department of Plastic and Reconstructive Surgery, Tokyo Women’s
Medical University, Tokyo, Japan
• Department of Medicine and Therapeutics
• Department of Pediatrics, Division of Dermatology, Chinese University
of Hong Kong, Hong Kong
• Use of Lasers and Light-Based Therapies for Treatment of
Acne Vulgaris. Mariwalla, et al. 2005.
• Acne Treatment With a 1,450 nm Wavelength Laser and
Cryogen Spray Cooling. Paithankar, et al. 2002.
• Sebaceous Hyperplasia Treated With a 1450-nm Diode
Laser. No, et al. 2004.
• The 1,450-nm Diode Laser Reduces Sebum Production in
Facial Skin: A Possible Mode of Action of Its Effectiveness
for the Treatment of Acne Vulgaris. Perez-Maldonado, et al.
2007.
• The 1450-nm diode laser for facial inflammatory acne
vulgaris: Dose-response and 12-month follow-up
study. Jih, et al. 2006.
• Treatment of Inflammatory Facial Acne Vulgaris with the
1450-nm Diode Laser: A Pilot Study. Friedman, et al. 2004.
 THE MULTIWAVE APPROACH
TO AESTHETIC TREATMENTS

Some skin alteration can not be treated with a single technique, because the
involved alteration are complex, therefore combined techniques are needed.

The SEQUENTIAL COMBINATION of 2 or more techniques in the same session or

the CONTEMPORARY EMISSION of different waves lead to better results and less
side effects.

1 + 1 = 3, 4 or 5
COMBINED TECHNOLOGIES
ACTION SYNERGY = BETTER RESULTS
LESS SIDE EFFECTS
TIME SAVING
MULTIWAVE APPROACH

Hair removal all hair and skin type

Diode Facial rosecea
Microvascular lesions

Dark and color tattoos

Qswitched Pigmented lesions
Nd:Yag/KTP Superficial Vascular lesions
Carbon skin peeling (combine it with other wavelengths)

Vascular lesions
Nd:Yag Non ablative skin tightening
Hair removal especially dark skin
Onychomycosis
Photo rejuvenation
CPL/IPL Hair removal
Superficial Vascular lesions
Acne
Erbium Yag Skin resurfacing
Pigmented lesions
COMBINATION LASER 1 + LASER 2
FIRST STEP
Nd:YAG 1064 nm
The photo-thermal effect is focused at 1-3 mm below the skin surface,
therefore inducing a deep disinfection and a shrinkage of sebaceous glands
(reduction in the production of sebum)

SECOND STEP
CARBON PEEL with Q switched Nd:YAG
CONTROLLED PHOTOTHERMAL REACTION: stimulating and
disinfectant ACTION for the skin;
SLIGHT PHOTOABLATION: necessary to remove excess of
keratin and sebum that clogs pilo-sebaceous ducts.
Jae Yoon Jung et al. Journal of the American Academy of Dermatology 2012; 66: 626-633
 Before After 4 sessions spaced 2 weeks apart

Step 1: Long Pulse Nd:YAG 1064 nm 30 ms, Fluence 29 J/cm2, spot 7 mm

Step 2: Carbon Peel with Q-switched Nd:YAG 9 ns, Fluence 2,6 J/cm 2, spot 7 mm
 DIODE laser 810
Chromophore target MELANINE-PORPHIRIN – WATER-
ΗΑΕMOGLOBINE
•Especially effective on patients with grade 1-4 acne vulgaris
 Acne Scarring
From pesky, dark
hyperpigmentation marks, to
red spots, to deep craters–acne
scars are among the most
dreaded skincare issues.

- Improved appearance
- Enhanced self-estee
- Promotion of better skin
health
CONCLUSIONS
COMBINED TREATMENTS

Consecutive treatments in the same session

or
Contemporary emission of two different waves

well tolerated

more effective compared to the single techniques

recovery time have been shown to be shorter