Page 66 - Chapter 3 - Fundamentals of Laser/IPL Hair Removal

Chapter 3 – Fundamentals of Laser/IPL Hair Removal 1st Edition
Clinical Endpoints
It is normal with many laser/IPL treatments to expect to see a visual clinical endpoint shortly after the application of the energy to the skin. Such endpoints include:
1. Erythema – a ‘reddening’ of the skin around the target – but not too much!
2. Oedema – a swelling of the area around the target
3. Folliculitis – swelling of the individual follicles – this is not always observed
However, many laser/IPL users are guilty of ‘chasing’ the endpoints! They have been trained that they must see these endpoints, otherwise the treatment will not be successful. This is not always the case.
The fact is that there are many factors which determine whether an endpoint will be visible or not, including:
Fluence, Pulsewidth, Skin colour, Target colour...
Plus time!! Some clinical endpoints take a little time to appear – this may range from a couple of seconds to a few minutes (perhaps even an hour!). Many are trained to increase the fluence if the endpoint is not seen within a short time of application – this is a mistake and will increase the likelihood of unwanted skin damage!
In addition, observing a clinical endpoint does not mean that a good result in guaranteed. This is where the ‘science’ and the ‘art’ diverge! As you may have noticed, this book is heavily into the science – the art is much more subtle. To be frank, the observation of clinical endpoints tends to develop with time and experience. It is virtually impossible to perfectly describe the endpoints you should be looking for, in all cases!!
You must learn to view the treatment areas very carefully – before and after treatments. The best approach is to use a subtle treatment regime – use the lowest fluence which is known to achieve good results for the particular condition – the “threshold” fluences discussed in the next section ‘Threshold denaturation fluences – Four Devices’.
If the endpoint is not observed within a few minutes of a test shot, increase the fluence slightly – by 0.5 to 1 J/cm2, and repeat the test shot. In some cases, no obvious endpoint will be visible shortly after the tests. If this occurs, trust the science!! If you are applying the correct level of fluence and pulsewidth, then you should achieve the desired result.
If no endpoint is visible then you may wish to ask further questions of your client/patient – especially regarding exposure to the sun or sunbeds. Perhaps they have changed/started new medications which may affect their skin’s response. There may be other external influences which you are not aware of. Clients/patients are notorious for not yielding new information
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