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Summary of Contents for Cutera Excel V
- Page 1 Clinical Training Guide Cutera Inc. World Headquarters 3240 Bayshore Boulevard, Brisbane, CA 94005 USA Tel: +1 415 657 5500 Fax: +1 415 330 2444 www.cutera.com D1091 Rev.M August. 2016...
- Page 2 The following information is supplemental to the excel V Operator Manual. Refer to the Operator Manual for detailed information, including important cautions and warnings, prior to using the laser system. The Cutera excel V is a dual wavelength (532 nm and 1064 nm) laser system that can be used with two interchangeable handpieces.
- Page 3 These treatment guidelines are based on physician feedback and are provided as a guide only. They are not designed to be a substitute for clinical training. The excel V should only be operated by qualified practitioners who have received appropriate training and have thoroughly reviewed the Operator Manual that shipped with the system.
- Page 4 PATIENT ASSESSMENT • Obtain a medical history and signed consent prior to treatment. • Determine skin type to help guide treatment parameter selection. Re-evaluate patient prior to each treatment. Sun exposure may increase melanin content of the skin; treatment settings may need to be adjusted. D1091 Rev.M August.
- Page 5 AVOIDING COMPLICATIONS • Use extreme caution when treating near the eye. o Always treat outside the orbital rim of the eye aiming the beam away from the orbit. o Always use patient eye protection. o Point the sapphire window away from the eye and apply to the skin outside of the orbital rim. •...
- Page 6 EXCEL V USER INTERFACE genesis V User Interface 532 nm User Interface CoolView 532 nm User Interface CoolView 1064 nm User Interface 1. Fluence is the energy measured in J/cm . Press the Up/Down arrows to adjust. 2. Pulse Duration is the length of each pulse measured in milliseconds (ms). Press the UP/Down arrows to adjust.
- Page 7 VASCULAR TREATMENTS WITH 532 NM AND 1064 NM WAVELENGTHS VASCULAR TREATMENT PROCESS • The purpose of the treatment is to selectively treat the target of hemoglobin (chromophore) without causing thermal damage to the surrounding tissue. • Laser light is absorbed by hemoglobin in the veins and the heat produced causes photocoagulation. •...
- Page 8 SELECTING TREATMENT PARAMETERS FOR VASCULAR TREATMENTS Select parameters in the order listed below. Always start with the least aggressive settings for a specific vessel. Observe laser-tissue interaction and clinical response to determine appropriate settings for each patient. 1. Wavelength is measured in nanometers (nm). Selection is based on vessel depth and color. •...
- Page 9 TREATMENT PARAMETERS – 532 NM VASCULAR WITH COOLVIEW HANDPIECE These parameters are provided as a guide only for skin types I-IV, unless otherwise stated. Observe laser-tissue interaction and clinical endpoints to determine appropriate settings. 532 nm is NOT recommended for the treatment of unwanted periorbital veins, venous lakes, reticular leg veins, or purple/nodular port wine stains.
- Page 10 TREATMENT TECHNIQUE – 532 NM VASCULAR WITH COOLVIEW HANDPIECE • WARNING: The red diode aiming beam in the sapphire window should be in full contact with the skin before, during, and after the laser pulse. o Pay close attention when treating over the nose or curved areas to ensure full contact with the sapphire window where the red aiming beam is present.
- Page 11 • Treating off the face: o Use conservative parameters when treating large areas. o Lower the fluence, lengthen the pulse duration, and slow the repetition rate. o More treatments may be required. o Risk of an adverse event is higher. •...
- Page 12 TREATMENT PARAMETERS – 532 NM OTHER WITH COOLVIEW HANDPIECE These parameters are provided as a guide only for skin types I-IV, unless otherwise stated. Observe laser-tissue interaction and clinical endpoints to determine appropriate settings. Example Picture Vessel Type Temp Spot Fluence Pulse Size...
- Page 13 TREATMENT PARAMETERS – 1064 NM VASCULAR WITH COOLVIEW HANDPIECE These parameters are provided as a guide only for skin types I-V, unless otherwise stated. Observe laser-tissue interaction and clinical endpoints to determine appropriate settings. 1064 nm is NOT recommended for the treatment of pigmented lesions, poikiloderma, diffuse redness, matting, or pink port wine stains.
- Page 14 TREATMENT TECHNIQUE – 1064 NM VASCULAR WITH COOLVIEW HANDPIECE • WARNING: The red diode aiming beam in the sapphire window should be in full contact with the skin before, during, and after the laser pulse. o Pay close attention when treating over the nose or curved areas to ensure full contact with the window where the red aiming beam is present.
- Page 15 • Expectations o 2-3 treatments are usually required for 70% resolution on patients with no underlying conditions. o Redness surrounding vessels is expected. o Urticarial reaction (hive-like/bug-bite look) is common with superficial veins. o Bruising may occur and usually resolves in a few weeks. o Small mild blisters are undesirable but may occur.
- Page 16 PORT WINE STAIN TREATMENTS WITH 532 NM AND 1064 NM WAVELENGTHS PORT WINE STAINS: 532 NM OR 1064 NM WITH COOLVIEW HANDPIECE These parameters are provided as a guide only. Observe laser-tissue interaction and clinical endpoints to determine appropriate settings. The treatment of Port Wine Stains (PWS) is an advanced procedure and should only be performed by experienced practitioners.
- Page 17 • WARNING: The red diode aiming beam in the sapphire window should be in full contact with the skin before, during, and after the laser pulse. o Pay close attention when treating over the nose or curved areas to ensure full contact with the window where the red aiming beam is present.
- Page 18 WART TREATMENTS WITH 532 NM AND 1064 NM WAVELENGTHS TREATMENT PARAMETERS – WARTS: 532 NM OR 1064 NM WITH COOLVIEW HANDPIECE These parameters are provided as a guide only for skin types I-VI. Observe laser-tissue interaction and clinical endpoints to determine appropriate settings. Warts (or verrucae) can be treated with vascular lasers – typically at higher energy settings and shorter pulse durations than veins or telangiectasia.
- Page 19 • Do not use gel. • Use the warmest window temperature (20 • Do not place the excel V handpiece in contact with the skin when pulsing the wart. o Hold the handpiece approximately 1 cm away from the wart.
- Page 20 Mosaic Warts • Mosiac warts typically require multiple treatments and less aggressive parameters. • Do NOT treat the entire mosaic wart area in one session. o Only treat the darker/thicker area, usually near the center of the wart. o Do NOT overlap pulses. Place pulses adjacent to one another or spaced out.
- Page 21 BENIGN PIGMENTED LESION TREATMENTS WITH 532 NM WAVELENGTH BENIGN PIGMENTED LESION TREATMENT PROCESS • Laser light is absorbed by superficial melanin in the lesion • Pigmented cells are denatured, darken, rise to the surface and flake off over a couple of weeks. SELECTING TREATMENT PARAMETERS FOR BENIGN PIGMENTED LESION TREATMENTS Select parameters in the order listed below.
- Page 22 TREATMENT PARAMETERS – 532 NM BENIGN PIGMENTED LESIONS WITH COOLVIEW HANDPIECE These parameters are provided as a guide only for skin types I-IV, unless otherwise stated. Observe laser-tissue interaction and clinical endpoints to determine appropriate settings. Do NOT treat over tattoos, hyperpigmentation, dysplastic nevi, or questionable pigmented lesions.
- Page 23 TREATMENT TECHNIQUE – 532 NM BENIGN PIGMENTED LESIONS WITH COOLVIEW HANDPIECE • WARNING: The red diode aiming beam in the sapphire window should be in full contact with the skin before, during, and after the laser pulse. o Pay close attention when treating over the nose or curved areas to ensure full contact with the window where the red aiming beam is present.
- Page 24 ACNE TREATMENTS WITH 1064 NM WAVELENGTH TREATMENT PARAMETERS – ACNE: 1064 NM WITH COOLVIEW HANDPIECE The following parameters are for the treatment of mild to moderate inflammatory acne. These parameters are provided as a guide only for skin type I-III on the face. Treatment protocols have not been developed for skin types IV-VI or off the face treatments.
- Page 25 POST TREATMENT CARE ACNE • Cold compresses or chilled gel packs may be applied post treatment. • If a blister develops, treat as a wound. • Avoid sun exposure and use a broad spectrum (UVA/UVB) sunscreen to minimize the risk of PIH (Post Inflammatory Hyperpigmentation).
- Page 26 • The excel V laser targets the melanin in the hair bulb and bulge; therefore, hair must be brown or black. o The excel V laser does not target and cannot be absorbed by white, gray, or red hair.
- Page 27 It is important to note that though the 1064 nm wavelength can effectively treat hair removal, the excel V system was not designed as a hair removal system; therefore faster treatments at high repetition rates may not always be possible. Use slower repetition rates whenever possible or treat smaller areas.
- Page 28 Skin compression from the contact handpiece also blanches the skin and reduces the distance to the hair target reducing losses. o These effects, for the same displayed settings, result in excel V achieving higher effective intradermal fluence than seen with other cooling technologies.
- Page 29 HAIR REMOVAL TREATMENT STEPS • Inspect the handpiece to ensure the sapphire window and metal surfaces are free of debris and ejected hair prior to and during treatment. o It may be necessary to periodically wipe the bottom of the handpiece with a gauze to remove ejected hair •...
- Page 30 HAIR REMOVAL POST-TREATMENT CARE • Avoid sun exposure, and use a broad spectrum (UVA/UVB) sunscreen. • Avoid heat (hot tubs, saunas, etc.) for 1-2 days. • Avoid skin irritants (products containing tretinoin, retinol, benzoyl peroxide, glycolic/salicylic acids, astringents, etc.) for a few days post-treatment. •...
- Page 31 GENESIS V TREATMENTS WITH 1064 NM WAVELENGTH GENESIS V TREATMENT PROCESS • Gently heats the dermis • 1064 nm wavelength and micro second pulses (0.3 ms) • Preferentially heats very fine vasculature • No epidermal cooling TREATMENT PARAMETERS – LASER GENESIS ND:YAG NON-ABLATIVE SKIN THERAPY WITH GENESIS V HANDPIECE These parameters are provided as a guide only for skin types I-VI.
- Page 32 TREATMENT TECHNIQUE – 1064 NM GENESIS V TREATMENT • Do not use topical anesthetic. Patient feedback is important. • Start with low fluence and slow repetition rate to observe laser-tissue interaction. Adjust to patient tolerance. • Sensitive areas, darker skin types, and areas of dense hair or recent sun exposure may require lower fluences or lower repetition rates.
- Page 33 SKIN TYPE CLASSIFICATION QUESTIONNAIRE SCORE What is the natural color Sandy red Blond Chestnut, dark Dark brown Black of your hair? blond What is the eye color? Light blue, Blue, Gray, Brown Dark Brown Brownish Gray, Green Green Black What is the color of sun Reddish Very pale Pale with beige...
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