SmartXide DOT - Clinical User Manual v.2.2 PDF

Laser Technologies
for Dermatology
& Cosmetic Surgery
SmartXide DOT
Clinical User Manual
Version 2.2 - September 2008
Index
1
Disclaimer ............................................................................... 1
Introduction............................................................................. 2
2.1.1
Traditional Skin Resurfacing ................................................ 2
2.1.2
Non-Ablative Photorejuvenation ........................................... 3
2.1.3
Fractional Photothermolysis ................................................ 4
SmartXide DOT Technical Features................................................ 6
Hi-Scan DOT - Technical Features ................................................... 7
4.1.1
Scanning Areas ................................................................ 8
4.1.2
Scanning Modes ............................................................... 9
4.1.3
Smart Pulse Emission ........................................................10
Clinical Procedure ....................................................................11

5.1
Pre Treatment Care ..............................................................11
5.1.1
Patient Examination & Contraindications ................................11
5.1.2
PIH prevention ...............................................................12
5.1.3
Infection prevention.........................................................12
5.2
Anaesthesia Indications..........................................................13
5.2.1
Anaesthesia Techniques ....................................................13
5.2.2
Fractional Skin Resurfacing ................................................16
5.2.3
Traditional Skin Resurfacing ...............................................16
5.3
Treatment Procedure ............................................................17
5.3.1
FRACTIONAL MODE : Indications & Clinical Protocol..................17

II
5.3.2
Traditional Skin Resurfacing: Clinical Protocol..........................23
5.3.3
TRADITIONAL MODE: Indications & Clinical Protocol ...................25
5.4
6
Post Treatment care .............................................................28
Clinical Cases ..........................................................................29

6.1
Fine wrinkles, Textures and Spots .............................................29
6.2
Wrinkles ...........................................................................32
6.3
Acne Scars ........................................................................34
6.4
Keloid..............................................................................35
6.5
Epidermal Linear Nevus.........................................................36
6.6
Epidermal Pigmented Lesion...................................................36
6.7
Lentigo Simplex ..................................................................37
6.8
Beckers Nevus....................................................................37
6.9
Melasma...........................................................................38
II II
1 Disclaimer
While the information contained in these pages has been compiled from sources believed to
be current and reliable, DEKA cannot be held responsible for any errors, omissions, defects
in, or the accuracy, completeness, timeliness or usefulness of, the information supplied to
users on this document.
The following materials are presented for educational purposes only. Methods described may
not be the only or best method in every case. DEKA specifically disclaims any and all liability
for injury or other damages of any kind for any and all claims that may arise out of the use of
any drug, device or technique described in these pages, whether such claims are asserted by
a physician or any other persons.
Information on this document may contain technical inaccuracies or typographical errors.
DEKA takes no responsibility for the consequences of error or for any loss or damage suffered
by users of any of the information published on any of these pages. Such information does not
form any basis of contract with readers or users of these pages.
Furthermore, DEKA will not be liable to users of any for any damages, claims, demands or
causes of action, direct or indirect, special, incidental, consequential or punitive, as a result
of the use of this document or any information obtained from it.
Information may be changed or updated without notice. DEKA may also make improvements
and/or changes in this document at any time without notice.
All information contained within this document is the property of DEKA. Copyright 2008.
1
SmartXide DOT Clinical User Manual- Version 2.2 - September 2008
2 Introduction
The natural ageing process together with exposure to the sun and pollution
leads to a gradual deterioration of the skins structure and function. This is
mainly evident at the level of the epidermis and the upper papillary dermis,
with a tissue laxity and skin that appears more lined, often accompanied by
telangiectasias, wrinkles, and dark spots.
2.1.1
Traditional Skin Resurfacing
Resurfacing with pulsed CO2 laser has always been considered the first choice of
1-6
treatment for rhytids and photo-damaged facial skin . However, due to the
7-8
lengthy recovery times and frequent complications , not all patients agree to
undergo this type of operation
9-10
Traditional Skin Resurfacing. Skin Healing Process.
2
Besides the usual recovery time required for oedema, burning, scabs and
erythema which may often last for months
11-12
, there is also a high incidence of
complications connected with hyper-and hypo-pigmentation, HSV infection,

outbreaks of acne, milia formation, and dermatitis
13-18
Cases of HSV infection and outbreaks of acne, after traditional resurfacing with pulsed CO2
laser.
2.1.2
Non-Ablative Photorejuvenation
Over recent years, the market has therefore been orientated towards less
invasive and less problematic systems and methods. This has led to a wide-scale
production of a myriad of non-ablative devices for reducing wrinkles and
improving photo-damaged skin with the consequent passing over from skin
resurfacing to skin rejuvenation. However, a critical review of the literature
inherent to these methods has revealed that in terms of efficacy, none of the
results obtained with these non-ablative methods can be compared with the
resurfacing results achieved with the CO2 laser19-23. Moreover, these types of
treatment are usually quite expensive for the patient, the devices themselves
are also costly for the medical practitioners, and the results obtained are not
always satisfactory.
3
2.1.3
Fractional Photothermolysis
This situation has stimulated the search for new methods and protocols that are
more efficient in combining quick recovery and minimal post-op risks with
greater treatment efficacy. The advent of Fractional Photothermolysis, initially
introduced with non-ablative methods, has given rise to the development of a
new method that manages to effectively combine all the needs of both medical
practitioners and patients, and namely, the Fractional Laser Skin Resurfacing
with CO2 laser
24-28
Fractional laser treatment allows to

obtain
remarkable
results
with
minimal downtime.
The CO2 laser energy, applied in a
fractional way, creates very thin and
spaced columns of thermal damage
which
penetrate
deep
into
the
dermal skin layer and stimulate a

new collagen production. The tissue
between the columns of thermal
damage is spared, resulting in a faster healing process.
Various CO2 lasers with fractioned emission are currently available on the market.
Despite the fact that all these systems are based on the same principles, they present
significant differences with regard to output power, dwell-time, distance between the
dots, varying scanner shapes and the laser beam profile. These differences may
produce clinical results that differ greatly between one device and another.
1.
Manuskiatti W et al. Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin. J Am
Acad Dermatol. 1999;40:401-11.
2.
Fitzpatrick RE et al. Pulsed carbon dioxide laser resurfacing of photo-aged facial skin. Arch Dermatol 1996;132:395402.3.Schwartz
RJ et al. Long term assesment of CO2 facial laser resurfacing: Aesthetic results and complications. Plast Reconstr Surg. 1999;
103:592-601.
4.
Lent WM, David LM. Laser resurfacing: a safe and predictable method of skin resurfacing. J Cutan Laser Ther. 1999;1:87-94.
5.
Fitzpatrick RE. Maximizing benefits and minimizing risk with CO2 laser resurfacing. Dermatol Clin. 2002;20:7786.
6.
Hruza GJ, Dover JS. Laser skin resurfacing. Arch Dermatol 1996;132:451455.
4
7.
Bernstein L et al. The short and long term side effects of carbon dioxide laser resurfacing. Dermatol Surg 1997;23:519525.8.Alster
T, Hirsch R. Single-pass CO2 laser skin resurfacing of light and dark skin: Extended experience with 52 patients.J Cosmet Laser
Ther 2003;5:3942.
9.
Trelles MA, et al. The origin and role of erythema after carbon dioxide laser resurfacing: a clinical and histologic study. Dermatol
Surg. 1998;24:25-30.
10. Burkhardt BR, Maw R. Are more passes better? safety versus efficacy with the pulsed CO2 laser. Plast Reconstr Surg. 1997;99:15311534.
11. Sullivan SA, Dailey RA. Complications of laser resurfacing and their management. Ophthal Plast Reconstr Surg.2000;16:41726.
12. Berwald C et al.. Complications of the resurfacing laser: Retrospective study of 749 patients. Ann Chir Plast Esthet. 2004;49:3605.
13. Alster TS. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative
considerations. Plast Reconstr Surg. Feb 1999;103(2):619-32.
14. Alster TS. Side effects and complications of laser surgery. In Alster TS: Manual of Cutaneous Laser Techniques, ed 2. Philadelphia,
Lippinco. 2000;pp 175-187.
15. Alster TS, Lupton JR. Treatment of complications of laser skin resurfacing. Arch Facial Plast Surg. Oct-Dec 2000;2(4):279-84.
16. Sriprachya-Anunt S et al. Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin. Dermatol Surg.
1997;23:527-36.
17. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24:315
320.
18. Sadick NS. Update on non-ablative light therapy for rejuvenation: A review. Lasers Surg Med. 2003;32:1208.
19. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24:315
320.
20. Sadick NS. Update on non-ablative light therapy for rejuvenation: A review. Lasers Surg Med. 2003;32:1208.
21. Williams EF III, Dahiya R. Review of nonablative laser resurfacing modalities. Facial Plast Surg Clin North Am. 2004;12:30510.
22. Grema H et al. Facial rhytides subsurfacing or resurfacing? A review. Lasers Surg Med. 2003;32:40512.
23. Bjerring P. Photorejuvenation an overview. Med LaserAppl. 2004;19:18695.
24. Le Pillouer-Prost A, Zerbinati N. Fractional laser skin resurfacing with SmartXide DOT. Initial Results. J Cosmc and Laser Ther,
2008;10(2):in press.
25. Matteo Tretti Clementoni et al. Non sequential fractional ultrapulsed C02 resurfacing of photoaged skin. J Cosmc and Laser Ther,
2007;9(4):21822.
26. Hantash BM et al. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Laser Surg Med.
2007;39:87-95.
27. Hantash BM et al. In vivo histological evaluation of a novel ablative fractional device. Laser Surg Med. 2007;39:96-107.
5
3 SmartXide DOT Technical Features

Type of Laser
CO2
Wavelength
10.6 m
Power to Tissue
30 W (max)
Repetition Rate
from 5 to 100 Hz
Pulse Length
from 0.2 to 80 ms
Delivery System
Aiming Beam
Articulated Arm with 7 Mirrors

Diode Laser, 3 mW@ 635-670 nm
Scanning Mode
Traditional & DOT-Fractional
User Interface
LCD Colour Touch Screen
Aiming Beam
Diode laser 635 nm
Power Supply
230 Vac / 1.8 A (max) / 50-60 Hz
Dimensions
48 cm (W) x 55 cm (D) x 120 cm (H)
Weight
30 Kg
6
4 Hi-Scan DOT - Technical Features

Max: 15 x 15 mm
Scanning Area
Min: 1 x 4 mm
Spot Size
Stimulative Effect
350 m
Ablative Effect
120 m
Scanning Mode
Traditional & DOT-Fractional
Pulse Emission
from 0.2 to 2 ms (DOT)
Dwell Time
from 0.2 to 20 ms (Std.)
DOT Pitch
from 200 to 2000 m
7
4.1.1
Scanning Areas
8
4.1.2
Scanning Modes
Normal
Interlaced
9
4.1.3
Smart Pulse Emission
The first part of the pulse has high peak power for few tens of microseconds
that allows for rapid ablation of the epidermis and the first layers of the derma,
while the second part of the pulse has low peak power allowing for targeted
heating of the deeper areas of the skin.
P o w er
Ablation
Pulse Duration
Smart Pulse Emission
10
5 Clinical Procedure
5.1 Pre Treatment Care
5.1.1
Patient Examination & Contraindications
First of all it is important to proceed with the visit and the anamnesis of the
patient.
A persons history should be compiled by establishing the following:
Sun and UV lamp exposure: avoid them before (at least 1 month), during and
after treatment. Apply SPF50 sunblock before and after the treatment.
Make sure that the patient is not taking incompatible drugs as:
o Anticoagulants (as acetylsalicylic acid, heparin, etc),
o Retinoids these drugs can cause problems in the healing process
with possible scar results - (as isotretinoin, etc),
o Photo-sensitizers (as tetracycline [antibiotic], naproxen [NSAD],
auranofin
[antirheumatic],
estrogens
and
progestins
[oral
contraceptive], cloroquine [antimalarial], etc.)

Suspend the administration according to the specific drug so that its effect is
expired before the treatment.
Recent exfoliation treatment (peels, scrubs, retin-A) and surgical treatment
(as lifting, etc.).
Past skin disorders.
History of herpes virus infection.
In order to ensure a positive outcome with laser treatment, the patient must
strictly follow a pre-operative protocol to help prevent the two main possible
complications: Post-inflammatory Hyperpigmentation (PIH) and infection.
11
5.1.2
PIH prevention
Especially with darker phototypes (III, IV, V and VI) and Asian phototypes, it is
recommended to apply a topical cream every day for four weeks before the
treatment for inhibiting melanin production.
It is possible to use cream containing hydroquinone or, as alternative lighteners,
arbutin, azelaic acid, kojic acid or stabilized vitamin C.
This procedure is highly recommended with darker and Asian skin types, while
for photo type I and II it is just a suggestion.
5.1.3
Infection prevention
The drugs used fall into two main categories:

antiviral drugs (aciclovir, valaciclovir, etc)
It is suggested to start the antiviral prophylaxis 6 days before the treatment
in subjects with a positive anamnesis of herpes virus infections history.
The antiviral treatment can start 2 days before the treatment in subjects
without previous experience of herpes infections.
It is recommended to continue the antiviral drugs at routine doses for 5-15
days after the intervention.
antibiotic drugs (macrolides, cephalosporins, etc)
The doctor may consider prescribing antibiotic drugs as well, starting 6 or 1
days before the treatment (according to the patient anamnesis) and
continuing for 7-8 days after the procedure.
Remark: It is not necessary to prescribe antibiotic drugs in all cases. It is
often enough the application of a topical antibiotic cream or ointment (like
gentamicin) after the procedure.
12
5.2 Anaesthesia Indications

Dermal treatments with laser may give rise to a painful sensation described as
similar to an elastic band being pinged against the skin, or the pain caused by
burns.
The anaesthetic protection for CO2 laser skin therapies becomes necessary in specific cases,
such as:
Traditional CO2 laser skin resurfacing;
The treatment of extensive skin areas;
The treatment of deep lesions;
Patients with a low pain threshold;
Non-compliant patients;
Paediatric patients.
5.2.1
Anaesthesia Techniques
Irrespective of the anaesthetic method used, several indispensable precautions are necessary:
A careful clinical assessment (if an anaesthetist is necessary this will be their exclusive
responsibility), with particular attention to cardiovascular, pulmonary, and neurological
pathologies, hypertension, diabetes, allergic phenomena and/or any idiosyncratic
reactions to the medicinal products to be administered;
Instrumental assessment (ECG, chest X-ray, etc.) wherever indicated;
Detailed indications regarding the administration, modification or discontinuation of
therapies in progress (in the current condition and in relation to the type of
intervention/treatment, the assessment will mainly concern the anticoagulant therapy);
Pre-op fasting (6 hours for solids, 2 hours for liquids);
Informed consent;
Outpatient safety devices;
13
Preventive insertion of peripheral venous cannula.

The following anaesthesia techniques may be used:
Transdermal anaesthesia;
Infiltrative anaesthesia;
Peripheral blocks;
Locoregional blocks;
Local anaesthesia techniques associated with sedative analgesia;
General anaesthesia.
Transdermal Anaesthesia (Topical Anaesthesia)

A number of local anaesthetics are available for topical use in various types of preparation
that usually all provide efficacious analgesia albeit of brief duration. Among the various
preparations, a product which is marketed worldwide, namely EMLA (containing lidocaine
2.5% + prilocaine 2.5%), has to be applied 1 hour before the treatment.
Infiltrative Anaesthesia
While the use of this type of anaesthetic does not necessarily require the presence of the
anaesthetist, monitoring of the vital parameters is obligatory, as well as the presence of all
the aids for coping with possible emergency situations. Any type of local anaesthetic may be
used for the infiltration. The onset of the action is extremely rapid with nearly all agents,
irrespective of whether used intradermically or subcutaneously. Epinephrine considerably
prolongs the duration of the block via infiltration.
Both intradermal and subcutaneous infiltration may be painful, above all due to the acid pH
that characterises all local anaesthetics. The problem can be attenuated with suitable
administration techniques and the addition of NaHCO3 in a 10-15% ratio.
The intradermal and subcutaneous infiltration techniques foresee the use of fine needles (30
G) for the initial pomphus, after which larger gauge needles can be used (25-23 G) for
achieving an optimal anaesthesia in the area to be treated, and by always taking care to
inject the preselected solution very slowly.
14
Peripheral nerve blocks

Whereas with transdermal and infiltrative anaesthesia techniques the presence of the
anaesthetist is not considered indispensable - except in the case of elderly patients (when
sedative methods are required) or those with psycho-pathological problems their presence
will be necessary for performing peripheral nerve blocks. In the majority of cases it will be
the anaesthetist who personally performs the block, and they must always be present for
correct intra and perioperative assistance.
The blocks used in the cervico-facial district consist of:
TRIGEMINAL
CERVICAL PLEXUS
Central blocks:
Superficial C.P.
- ophthalmic bundle-branch
Deep C.P.
- maxillary bundle-branch
- mandibular bundle-branch
Peripheral blocks:
- supraorbital nerve
- infraorbital nerve
- mental nerve
The local anaesthetics used for peripheral nerve blocks are the same as those used for the
infiltrative techniques.
Anaesthesia techniques associated with sedative analgesia

The aim is to reach a level of sedation in which the patient is calm and relaxed while still
continuing to be responsive to the team carrying out the procedure. Sedative analgesic
techniques are normally used in association with locoregional methods. Ample multicentre
studies have demonstrated that while the sedative techniques are very safe if performed by
expert anaesthetists, they could be hazardous in inexperienced hands, especially if performed
without adequate monitoring systems.
The drugs used for these methods are:
15
ANALGESICS:
SEDATIVES:
Benzodiazepine
Ketorolac
Ketamine
Tramadol
Major sedatives
Opiates
Hypnotics
Anaesthetics
General anaesthesia
The indications for general anaesthesia are restricted to paediatric and non-compliant
patients. The presence of the anaesthetist is indispensable, and the anaesthetic may be
performed in authorised structures including outpatients.
5.2.2
Fractional Skin Resurfacing
In case of fractional resurfacing with SmartXide DOT it is usually enough to

apply a topical anaesthetic 1 hour before the treatment.
In case of quite superficial action, to use the SmartCryo skin cooling system
during the treatment can be a possible alternative to the topical anaesthetic.
5.2.3
Traditional Skin Resurfacing
Patient discomfort can vary widely in case of traditional laser skin resurfacing.
Many patients find the topical application applied one or two hours prior to the
treatment and combined with regional nerve blocks provides appropriate
analgesia.
Other patients prefer to undergo intravenous sedation because they find laser
resurfacing to be uncomfortable.
16
5.3 Treatment Procedure

The face is divided into five aesthetic
units: right malar, perioral, left malar,
forehead and periorbital-nasal areas. In
case of laser skin resurfacing (both
fractional
and
traditional)
full
face
treatment is performed on each aesthetic

unit sequentially, with care being taken
to avoid overlapping.
5.3.1
FRACTIONAL MODE : Indications & Clinical Protocol
Topical anaesthetic has to be removed just before the treatment.

Set the SmartXide DOT system in DOT mode according to patient phototype, the
area to be treated and the application.
Usually we recommend performing a full-face and single passage treatment to
obtain a better colour and texture uniformity.
SmartXide DOT offers the possibility to adapt the procedure according to the
expectation of the patient: more or less aggressive treatment corresponds to
longer or shorter down time after every session.
17
The quantity of fluence (density of energy measured in J/cm2) delivered with

the scanner is correlated with the effect provoked on the skin. The following
formula allows to calculate the fluence level delivered in DOT mode:
Fluence
(J/cm2) =
Power (W) * Dwell Time (ms) * 105

[ Spacing (m) + 350 ]2
As a simple result of the formula above, reducing the Power and/or the Dwell
Time and/or increasing the Spacing, it is possible to reduce the fluence and to
control the thermal effect on the skin.
5.3.1.1
Skin Resurfacing
Phototype
Power (W)
Dwell Time
(s)
Spacing
(m)
Nr. of
Sessions
Nr. of
Passages
30
2000
750
II
30
2000
1000
III
30
2000
1200
IV
25
2000
1200
V-VI
25
1500
1200
18
5.3.1.2
Chronoaging
Phototype
Power (W)
Dwell Time
(s)
Spacing
(m)
Nr. of
Sessions
Nr. of
Passages
30
1000
750
II
30
1000
1000
III
30
1000
1200
IV
25
1000
1200
V-VI
25
750
1200
Fair Asian
Skin type
30
300
300
Dark Asian
Skin Type
25
300
350
5.3.1.3
Acne Scars & Hypertrophic Scars
Phototype
Power (W)
Dwell Time
(s)
Spacing
(m)
Nr. of
Sessions
Nr. of
Passages
30
2000
1000
2-3
II
30
1500
1000
III
30
1000
1000
3-4
IV-VI
30
750
1000
3-4
Fair Asian
Skin type
30
800
800
Dark Asian
Skin Type
25
800
800
19
5.3.1.4
Keloid
Phototype
Power (W)
Dwell Time
(s)
Spacing
(m)
Nr. of
Sessions
Nr. of
Passages
30
2000
800
2-3
II
30
1500
800
III
30
1000
800
3-4
IV-VI
25
1000
800
3-4
Fair Asian
Skin type
30
800
700
Dark Asian
Skin Type
25
800
700
5.3.1.5
Superficial Pigmented lesions
Phototype
Power (W)
Dwell Time
(s)
Spacing
(m)
Nr. of
Sessions
Nr. of
Passages
30
500
500
1-2
II
30
400
500
1-2
III
30
300
500
1-2
IV
25
300
600
1-2
20
300
800
1-2
Fair Asian
Skin type
25
300
650
1-2
Dark Asian
Skin Type
20
250
650
1-2
20
5.3.1.6
Melasma
Phototype
Power (W)
Dwell Time
(s)
Spacing
(m)
Nr. of
Sessions
Nr. of
Passages
20
500
500
II
20
400
500
III
20
300
500
IV
15
400
500
Fair Asian
Skin type
20
400
500
Dark Asian
Skin Type
20
300
500
5.3.1.7
Special Care: Periocular Area
This area is very delicate. A common side effect is

to have swelling and oedema. It is recommended
to decrease the fluence 30% less.
Dwell Time
21
5.3.1.8
Special Care: Perinasal & Perimandibular Areas
In the perinasal area (where there are many

sebaceous glands) and in the submandibular area
(where there are few sebaceous glands) the risk
of
post
treatment
scars
is
higher.
It
is
recommended to decrease the fluence 20% less.
Dwell Time
5.3.1.9
Special Care: Neck Area & Dcolletage
In the neck area and in the dcolletage the skin

is thinner. It is recommended to decrease the
fluence 30% less.
Power
Dwell Time
22
5.3.2
Traditional Skin Resurfacing: Clinical Protocol
Each aesthetic unit has to be treated in its entirety avoiding overlap.

Set the Hi-Scan unit in DOT OFF mode. Choose the appropriate shape and size
of the scanning area. Set Power and Dwell Time according to the area to be
treated. Please remember that with darker (III, IV, V and VI) and Asian
phototypes, fractional skin resurfacing is strongly recommended.
Moist saline-soaked gauzes are used to remove debris during the procedure.
This should be done gently to minimize additional tissue trauma. Debris removal
is necessary to avoid a heat-sink phenomenon, which results in more thermal
irritation of tissues.
Most areas are treated with a second pass. Approximately 30% of the time, a
third pass is employed, a fourth is used in less than 5% of patients.
The endpoint of treatment is gauged to be ablation of wrinkles or visual
estimation to have reached the basal layer.
Skilled surgeons could use more power and more dwell times than recommended
in the protocol, avoiding multiple passes. In this case, please remember that
skin removal is not proportional to the power increase whereas thermal damage
is.
The neck
As in phenol-based exfoliation, the neck is not treated. The pilosebaceous
density in the neck is such that deep vaporization can lead to scarring.
However, the perimeter can be treated with a single pass at the mandibular
margin to avoid a frank line of demarcation between laser-resurfaced and nonresurfaced skin.
23
Malar areas
For these areas the suggested setting is: Power= 17 W and Dwell Time= 400 s.
Normally a second laser pass is used to treat the malar area, this should be done
transversely with respect to the previous one.
Perioral Area
In the perioral area, laser resurfacing is carried on to the vermilion border.
Great care is taken to avoid allowing the laser beam to strike teeth. Some
surgeons prefer to use a protective mouth-piece. Be careful because it could
distort the perioral tissue. Initial parameters should be: Power=13 W and Dwell
Time= 400 s.
Forehead
When treating the forehead area, the hair is moistened and metal shields or
moist towels are used to protect the eyes. Care is taken to avoid lasering the
hairline or eyebrows. Initial parameters are: Power= 15 W and Dwell time= 400
s.
Periorbital area
Because the eyelid tissue is so delicate, reduced fluence is used: Power=10 W
and Dwell Time= 400 s. The eye to be treated is anaesthetized with two drops
of tetracaine. A glass or metal eye shield is inserted under the lid to protect the
globe. It is better to use a spherical protector to be sure that the surface is
smooth and free of any irregularities. Resurfacing is carried no closer than 3 to 4
mm from the ciliary margin to minimize oedema and possible thermal irritation
to the meibomian glands in the eyelid area. Multiple passes may be used to
treat deep wrinkles in the lateral canthal area. For the upper eyelid, treatment
is carried down to the superior tarsal fold.
24
5.3.3
TRADITIONAL MODE: Indications & Clinical Protocol
Set the SmartXide DOT system according to the patient phototype, the area to
be treated and the application.
TREATMENT
EMISSION
LEVEL*
MODE
FREQUENCY
REMARKS
(Hz)
Acne Scar
PW
0.5-3
10-20
DOT treatment suggested. Topical

anaesthesia.
Actinic Cheilitis
PW
0.5-5
10-20
Topical anaesthesia.
Actinic Keratosis
(superficial)
PW
1.5
10
Actinic Keratosis
(tick)
PW
50
Angiokeratoma
PW
1.5-5
10-20
Balanitis Xerotic
Obliterans
PW
2.5
20
Topical or infiltrative anaesthesia

according to the lesion size.
Basal Cell
Carcinoma
PW
0.5-8
10-50
Indications: Nodular carcinoma

with <1 com or wide superficial
carcinoma. Infiltrative anaesthesia.
Bowens Disease
PW
20
Chondrodermatitis
Nodularis Helicis
PW
1-2.5
20-50
Topical or Infiltrative anaesthesia

Condyloma
Acuminatum
PW
1.5-10
10-20
PW
4-7
50-100
Infiltrative anaesthesia.
Cyst
PW
2.5
20
Dermal Nevus
PW
0.5-4
10-20
Epidermal Nevus
PW
0.5-3
10-20
Facial
Telangiectasia
PW
3-8
80
Granuloma
Pyogenicum
PW
2.5-8
20-50
Haemangiofibroma
PW
1.5-3
10-20
Better if used in combination with

Nd:YAG or Dye laser.
Topical
anaesthesia.
Spiral
movements starting from the edges
to the centre.
Perform the incisional

biopsy.
Not elective treatment. High risk

of scar results. It is better to use a
vascular laser as Nd:YAG.
25
TREATMENT
EMISSION
LEVEL*
MODE
FREQUENCY
REMARKS
(Hz)
Haemangioma
PW
4-10
80

vascular laser as Dye laser.
Hidrocystoma
Apocrine
PW
0.5-2
10
Hypertrophic Scar
PW
0.5-3
10-20

anaesthesia.
Keloid
PW
0.5-3
10-20

anaesthesia.
Keratosis
(Seborrheic
Keratosis)
PW
0.5-3
10-20
PW
0.5-2
10
Lentigo Maligna
PW
0.5-3
10-20
Perform the incisional

Leukoplakia
PW
0.5-5
10-50
Perform the incisional biopsy.
Lymphangioma
PW
0.5-3
10-20
Only circumscribed lesion.
Molluscum Fibroma
PW
0.5-3
10-20
Neurofibroma
PW
0.5-2.5
10-20
Infiltrative anaesthesia (in case of

big size).
Nevus Sebaceus
PW
1.5-10
10-20
Pagets Disease
PW
0.5-3
10-50
Infiltrative anaesthesia. Perform the

incisional biopsy.
Queyrats Disease**
PW
20
Infiltrative anaesthesia. Perform the

incisional biopsy.
Rhinophyma 1
PW
2.5-10
50-100
Rhinophyma 2
PW
2.5-5
20
Finishing
phase.
anaesthesia.
Sebaceous
Adenoma*
PW
1.5-2.5
10-20
Spider Nevus
PW
3-8
80

vascular laser as Nd:YAG.
Spinocellular
Carcinoma
PW
2.5-8
20-50
Only selected cases. Perform the

incisional
biopsy.
Infiltrative
anaesthesia.
Rough-shape
anaesthesia.
26
phase.
biopsy.
Infiltrative
Infiltrative
TREATMENT
EMISSION
LEVEL*
MODE
FREQUENCY
REMARKS
(Hz)
Superficial
Pigmented
Lesions**
PW
1.5
10
DOT treatment suggested.
Syringoma
PW
0.5-2.5
10-20
Trichoepitelioma
PW
0.5-5
10-50
Tuberous Angioma
PW
4-7
50-80
Better if used in combination with

Nd:YAG or Dye laser. Infiltrative
anaesthesia.
Verruca 1
(Verruca Vulgaris)
PW
4-15
10-100
Verruca 2
PW
0.5-2
10-20
Verruca Pedis**
CW
8-10
Watt
Xanthelasma
PW
0.5-3
10-20
Zoon Balanitis**
PW
1-2
10-20
Topical or infiltrative anaesthesia

(Verruca Plana)
*: In the LEVEL column the suggested ranges for the level setting are shown.
Consider that usually, the procedure starts setting higher level value (which
corresponds to a deeper skin ablation effect) for the rough-shape phase. At
the end of the procedure the level value is reduced to perform more precise
final touches.
**: Treatment not included in the Treatment Menu of SmartXide DOT system.
27
5.4 Post Treatment care

Operations carried out with CO2 laser devices generate abrasion or ablation of
the skin which makes daily care of the wound essential.
The aim is to achieve healing, preventing the formation of scabs in the middle
and on the inner edges of the area treated, and thus guaranteeing an adequate
cleanliness and softness (above all with regard to the skin site).
In order to reduce the oedema and the inflammation that may occur after
the procedure, we recommend applying on the skin, just after the treatment,
cool compression or wet gauzes cooled using the SmartCryo air jet.
As post-treatment care, we suggest open-type medication with accurate
gentle skin cleansing, cold packs compression which must always be carried
out with sterile gauze and physiological solution. We recommend that the
patient re-applies every time emollient and/or antibiotic and enzymatic
ointments, especially after cleaning and showers. This procedure has to be
performed 3-4 times per day until the clinical healing is observed (4-7 days).
After this time, apply a normal skin-care moisturizer and a sunblock
protection (for 2-5 months according to the skin phototype and the
environmental conditions).
It is suggested to wait for 1 day before having a shower (avoid hot water on
the treated area until healing is complete).
Avoid topical exfoliation for at least 4 weeks.
The use of active Vitamin C-based creams, useful for maintaining the
uniformity and compactness of the new tissue and reducing any possible
deterioration, may be continued for unlimited time.
28
6 Clinical Cases
6.1 Fine wrinkles, Textures and Spots
Before and after 4 sessions. Courtesy of Dr Anne Le Pillouer-Prost Marseille France.
29
Before and after 2 sessions. Courtesy of Dr Nicola Zerbinati Pavia Italy.
30
Before and 21 days after 1 session. Courtesy of Dr C. William Hanke Indianapolis, IN USA.
Before and 17 days after 1 session. Courtesy of Dr C. William Hanke Indianapolis, IN USA.
31
6.2 Wrinkles
32
Before and after 1 session. Courtesy of Dr Patrick Treacy Dublin - Ireland.
Before and 6 days after 1 session. Courtesy of Dr Hee-Jin Han Seoul - Korea.
Before and 14 days after 1 session. Courtesy of Dr C. William Hanke Indianapolis, IN - USA.
33
6.3 Acne Scars
Before and after 1 session. Courtesy of Dr Nicola Zerbinati Pavia Italy.
Before and after 2 sessions. Courtesy of Dr Jahanara Ferdous Khan - Dhaka Bangladesh.
34
Before and after 1 session. Courtesy of Dr Hee-Jin Han Seoul - Korea.
6.4 Keloid
Before and after 2 sessions. Courtesy of Dr Nicola Zerbinati Pavia Italy.
35
6.5 Epidermal Linear Nevus
6.6 Epidermal Pigmented Lesion
36
6.7 Lentigo Simplex
6.8 Beckers Nevus
37
6.9 Melasma
Before and after 5
sessions. Courtesy of Dr Nicola Zerbinati Pavia Italy.
38
DEKA M.E.L.A. s.r.l.

Via Baldanzese, 17 50041 Calenzano (FI) Italy
Tel +39 055 8874942 - Fax +39 055 8832884
e-mail: info@dekalaser.com
web: www.dekalaser.com
Deka M.E.L.A. srl, 2008

All rights reserved. All other brands and product names are trademarks or registered
trademarks of their respective holders.

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SmartXide DOT - Clinical User Manual v.2.2 PDF

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Laser Technologies

Version 2.2 - September 2008

Traditional Skin Resurfacing ................................................ 2

Non-Ablative Photorejuvenation ........................................... 3

Fractional Photothermolysis ................................................ 4

SmartXide DOT Technical Features................................................ 6

Hi-Scan DOT - Technical Features ................................................... 7

Scanning Areas ................................................................ 8

Scanning Modes ............................................................... 9

Smart Pulse Emission ........................................................10

Clinical Procedure ....................................................................11

Pre Treatment Care ..............................................................11

Patient Examination & Contraindications ................................11

PIH prevention ...............................................................12

Anaesthesia Techniques ....................................................13

Fractional Skin Resurfacing ................................................16

Traditional Skin Resurfacing ...............................................16

Treatment Procedure ............................................................17

FRACTIONAL MODE : Indications & Clinical Protocol..................17

Traditional Skin Resurfacing: Clinical Protocol..........................23

TRADITIONAL MODE: Indications & Clinical Protocol ...................25

Post Treatment care .............................................................28

Clinical Cases ..........................................................................29

Fine wrinkles, Textures and Spots .............................................29

Acne Scars ........................................................................34

Epidermal Linear Nevus.........................................................36

Epidermal Pigmented Lesion...................................................36

Lentigo Simplex ..................................................................37

Traditional Skin Resurfacing

Traditional Skin Resurfacing. Skin Healing Process.

, there is also a high incidence of

complications connected with hyper-and hypo-pigmentation, HSV infection,

Fractional laser treatment allows to

dermal skin layer and stimulate a

3 SmartXide DOT Technical Features

Articulated Arm with 7 Mirrors

Traditional & DOT-Fractional

LCD Colour Touch Screen

Diode laser 635 nm

230 Vac / 1.8 A (max) / 50-60 Hz

48 cm (W) x 55 cm (D) x 120 cm (H)

4 Hi-Scan DOT - Technical Features

Traditional & DOT-Fractional

from 0.2 to 20 ms (Std.)

from 200 to 2000 m

Smart Pulse Emission

Patient Examination & Contraindications

contraceptive], cloroquine [antimalarial], etc.)

The drugs used fall into two main categories:

5.2 Anaesthesia Indications

Preventive insertion of peripheral venous cannula.

Transdermal Anaesthesia (Topical Anaesthesia)

Peripheral nerve blocks

Anaesthesia techniques associated with sedative analgesia

Fractional Skin Resurfacing

In case of fractional resurfacing with SmartXide DOT it is usually enough to

Traditional Skin Resurfacing

5.3 Treatment Procedure

treatment is performed on each aesthetic

FRACTIONAL MODE : Indications & Clinical Protocol

Topical anaesthetic has to be removed just before the treatment.

The quantity of fluence (density of energy measured in J/cm2) delivered with

Power (W) * Dwell Time (ms) * 105