General

Can patients on anti-coagulants be treated?

For treatments that have oxy-haemoglobin and haemoglobin as a target chromophores (vascular lesions and photo rejuvenation) anti-coagulants are contraindicated as the risk of purpura is increased.

Can patients taking isotretinoin (Accutane) tablets be treated?

Isotretinoin (in most countries branded Accutane) is used for treatment of acne. It can slow down the wound healing process. Experts agree that although there is little or no risk, treatment should be postponed until minimum three months after discontinuation of isotretinoin.

Why is gel used?

A thin layer of gel is applied to the skin prior to treatment to ensure the best possible transmission of light from the applicator to the skin. To remove bubbles in the gel the applicator is moved back and forth a few times in the gel before the treatment is started.

Is it necessary to cool the gel?

It is recommended to keep the gel at room temperature as cold gel applied to the skin will result in a contraction of vessels and produce inferior results.

Is it possible to treat patients suffering from psoriasis?

Ellipse cannot treat psoriasis, but the light has a healing effect on the plaques, so it is not dangerous to treat over it. Beware of the stronger absorption by haemoglobin if the plaques are red in colour.

Is it safe for the operator to carry out SWT treatments while pregnant?

Yes, the light will maximum penetrate 3,5mm into the skin and only if the light guide is applied directly to the skin as you would do in a treatment. So even if you were receiving a treatment the light would not reach the baby.

When you are preforming the treatments the light guide is pointed away from you and your clothes will furthermore prevent the light from reaching your skin.

Is it safe to perform Ellipse treatment in patients with thyroid problems?

Yes, treatment is safe provided that patients are not on medication where photosensitivity is contraindicated.

Why do some patients get a hyper-pigmentation?

Hyper-pigmentation is not a common side effect, but has been observed. It can be striped (if a build-up of gel is allowed) or will follow the shape of the applicator, or that part of the applicator in touch with the skin (both of these tend to be rectangular).
If too aggressive energy settings are used – especially in the forehead and on the jaw line, hyper-pigmentation may occur lasting around one month.
Less commonly hyper-pigmentation can occur following treatment with a dirty applicator that may have hairs, gel and dust stuck on the glass prism.
Hyper-pigmentation can also occur if adequate sun-protection is not used 30 days after treatment.

Acne Vulgaris

How does Ellipse acne treatment work?

Energy from the light source is absorbed by the target chromophore (oxy-haemoglobin and haemoglobin) in the blood. The filters used ensure the best possible uptake by oxy-haemoglobin, with minimal absorption by melanin and water.
The light energy is converted into heat energy. The purpose is to reduce the blood capillaries that are supplying the sebaceous glands and thereby slow down the overproduction of oil that leads to acne.

How many treatments are required?

A typical course of therapy includes four treatments, three weeks apart.

Is any pre-treatment necessary?

A doctor may discuss that one month prior or at least from the start of Ellipse treatment, you apply adapalene (in most countries branded Redap® / Differin®) cream or gel on the acne affected area every evening.
Adapalene makes the skin thinner and thereby helps opening the sebaceous ducts enabling secretion of oil and fatty acids produced by the sebaceous glands.

Is any post-treatment necessary?

Patients who have been treated in the upper part of the therapeutic window may benefit from a cold moist cloth to be held against the skin immediately after the treatment.
Because the acne bacteria are difficult to eradicate completely, a doctor may recommend you use a mild topical retinoid such as adapalene cream or gel for some months after the Ellipse acne treatment has ended. Should you suffer from future acne outbreaks, the Ellipse treatment can be repeated.

What are the side effects?

Immediately after treatment a stinging sensation and erythema are common. On day two and three oedema may be present. Also during the first day a “dirty look” of mottled superficial brownish pigmentation may appear. This peels off spontaneously after 3-14 days depending on how severe the melanin pigmentation was before the treatment. This pigmentation consists mainly of photo-oxidised melanin and may be covered with make-up. (Histology reveals a phototoxic reaction in the vesicles that contain melanin).
Show pictures of this pigmentation effect to prepare patients, otherwise they may come back worried after a few hours.

What is the clinical endpoint when performing acne treatments?

Normal skin will become erythematic following a treatment.

Hair Removal

Can patients suffering from Polycystic Ovary Syndrome be treated?

Yes they can, but they need more treatments – up to 20 due to the hormone levels.

Does the patient need to shave prior to treatment?

It is better if the patient arrives with the areas to be treated unshaved. The hairs need to be at least 1mm long to be seen clearly. This enables the area needing treatment to be marked out, using a red pen. The area to be treated should then be shaved before starting treatment, to ensure best results. Remove the shaved hairs from the skin to ensure that they do not stick to the applicator.

How many treatments are needed for permanent hair removal?

No-one can guarantee permanent removal of all hairs. It is possible to remove the hairs, but not the reason that hairs grow. It is better to think of hair reduction (hair management) than hair removal. Only hairs in the growing phase can be treated, successfully with Ellipse. The length and timing of the growth cycles are affected by numerous factors such as body site, hair density, thickness, ethnic origin, hormonal level and age. Usually 3 – 6 treatments are needed and the intervals between treatments are typically 1 – 3 months.

Is any post treatment care necessary?

Generally the answer is “no”. Many physicians suggest that patients with sensitive skin may benefit from a single application of glucocorticoid cream immediately after treatment and antiseptic cream for a few days.

Is hair removal possible if the client is pregnant?

If a client is pregnant, it is suggested that she waits until 2-3 months after she has given birth to begin treatment. At this time hair growth is synchronised, which means that she has an increased number of visible hairs, making the treatment much more effective.

Is it possible to remove male back hair?

It is possible to remove the hair, but not the reason that future hair will grow. High testosterone levels mean that many men will continue to form new hair until their late thirties. This may result in new hair appearing after treatment. Consider hair management to remove the existing hair on a regular basis.

Is permanent hair removal possible?

Ellipse has conducted a 10 year follow-up study which indeed documents the long term efficacy of our patented Selective Waveband Technology for hair removal. See our white paper on this.

Hair management and hair reduction are increasingly the terms used. After the first treatment most patients get significant reduction in hair density. Hairs which re-grow tend to become finer and lighter in colour. It is important to know and to inform patients that the first treatment is believed to synchronise the growth phase of the non-growing hairs. This causes what seems to be re-growth – but what happens is that the remaining “resting” hairs start growing at the same time.

Is vitiligo a contra-indication?

Vitiligo is not a contraindication. However, in some cases the de-pigmentation occurs both in the skin and in the hair; if the hair contains no melanin, it cannot be permanently removed.

Can patients suffering from Vitiligo be treated?

Yes, they can. However, in some cases the de-pigmentation occurs both in the skin and in the hairs. If the hairs contain no melanin, they cannot be permanently removed.

What is the clinical endpoint when doing hair removal treatments?

Perifollicular erythema and oedema are generally observed in patients with fair skin (Fitzpatrick I – III). For darker patients, wait at least 15 minutes to see how the skin reacts. It may turn darker around the follicles rather than red. If no skin reaction is observed carefully increase the energy until a skin reaction is seen or until the patient finds the pain unacceptable. Remember that the pain threshold varies between patients. However, many patients have successful treatment results without these post treatment signs.

Which patients can be treated?

Black hairs are most easily treated due to the large concentration of melanin in these hairs, which gives an optimal absorption and conversion of light energy to heat. Fair hairs have less melanin and consequently less heat is produced with less certainty of permanent destruction of the hair follicles. Grey (white) and red hairs have no or very low content of melanin, and cannot be efficiently treated.

The upper skin layer, the epidermis, also contains melanin and the concentration increases when the skin is exposed to UV-light. It is therefore necessary to treat dark-skinned and tanned individuals with less energy to avoid generation of heat (pain and/or burns). The ideal patient is fair skinned with dark hairs, but the Ellipse computer has pre-programmed treatment suggestions for different hair and pigment types.

Which skin types can be treated for hair removal?

Ellipse systems can remove hair in all skin types (I – VI). The HR and HR-L applicators cover skin type I – V, while the HR-D applicator is specifically designed for dark skin types, i.e. IV – VI.

Why do hairs appear to grow after the treatment?

Unlike laser treatment, hairs are not evaporated during Ellipse treatments. The hair follicles are destroyed but the hairs remain in the follicles and are often attached to the epidermis. They will fall out after 1-3 weeks as the epidermis is renewed. During this period it will seem that the hairs are growing as the epidermis pulls them out. It is possible to show that the hair will fall out, by easily lifting it out with tweezers. This is important information to your patients, and they should be advised not to expect an instantaneous result.

Why do I need to use a red pen?

The dye used in red ink will not absorb the light. For other colours of pens, there is a risk that light will be absorbed by the dye and cause burns to the skin.

Why does Ellipse appears to work slower after long treatments?

After 400 – 600 shots the repetition rate is slightly slower as the flash lamp needs longer time to cool down between each shot.

Photo Rejuvenation

Are there any particular conditions that I should be aware of?

Pigment in the skin (and in Asian skin, the possibility of hidden melasma) should always be investigated using a Woods Lamp (ultra-violet light source) to distinguish between epidermal and dermal problems.

Are there any side effects?

Slight erythema is observed and will disappear after a few days without additional treatment. Cooling the skin with an ice pack may be comforting for the patient.
The pigmented areas will become darker around three days after the treatment. It gives a “dirty look” which will persist for 7 – 10 days after treatment. It can be covered with make-up.

Is any post-treatment necessary?

For patients who have been treated for facial telangiectasias, you may apply a single application of topical glucocorticosteroid or give them a cold moist cloth for enhanced comfort.
To avoid pigmentation changes after the treatment, the treatment area should not be exposed to sunlight for 1-2 months and sun protection cream should be used for a few weeks.

What is the clinical endpoint when performing photo rejuvenation treatments?

For rejuvenation:

  • The sign of a successful treatment is darkening of the solar lentigines after approximately 10 minutes. Normal skin will become erythematic following a treatment.

For facial telangiectasias:

  • A coagulation of the vessels that will turn bluish a few seconds after the shot.

Which conditions can be treated?

The Ellipse photo rejuvenation is indicated for treatment of sun-damaged skin to reduce pigment and vascular disturbances, and to improve skin texture. The following conditions are treatable:

  • Superficial pigmented lesions (ephelides, solar lentigines, epidermal melasma)
  • Facial telangiectasias
  • Poikiloderma of Civatte
  • Facial treatments are most popular, but all parts of the body can be treated.

Who can be treated?

As treatment is based on light absorption in melanin and in haemoglobin, treatments are most efficient in persons with light skin, who are not sun-tanned at the time of the treatment. The unique Ellipse software is pre-programmed for different skin colours and adjusts the energy output to match the requirements of your patients’ skin.
The patients must refrain from tanning (sun, solarium and self-tanning creams) for at least four weeks before the treatment. Inform your patients about chronic sun damage and how to protect themselves in the future with clothes, hats, and the use of strong sunscreens (SPF 60+) and with filters effective in both the UVA and UVB range.
For Fitzpatrick skin types IV – V, the following may be applied:
One month of pre-treatment with a depigmenting cream should be considered. If used, suggestions for treatment are:
Either:
Hydroquinone (4 – 5%)
Or:
“Kligman’s Formula” (tretinoin, dexamethasone and hydroquinone)
Or:
Alpha hydroxide acid (AHA) and Eldoquin 4% cream
for max. six weeks should be used together with the recommended sunscreen (normally min. SPF 60+ e.g. photo-protection 100).
This cream should be discontinued one week before treatment to avoid any erythematous reaction from the creams, which may result in increased light absorption in haemoglobin.

Why does pigment sometimes get worse after a treatment?

The light can effectively eliminate epidermal pigment, but it does not have enough energy to perform treatments of dermal pigment. However, the light is still stimulating the dermal pigment and therefore the melanocytes can be provoked and create more pigment.
It is therefore essential that the patients have no hidden pigment in the dermal layer such as melasma which could get worse if treated without our recommended pre-treatment regimen

Pigmented Lesions

Is any post-treatment necessary?

Consider using a single application of a topical glucocorticosteroid immediately and/or antiseptic cream for a few days.

What is the clinical endpoint?

A normal reaction is that the skin becomes quite red immediately after treatment. Ulceration or crusting of the lesion can be expected. This will clear 1-2 weeks after treatment. In rare cases, temporary pigment changes in the skin might occur, but most patients experience fewer problems than after laser treatment.

Which lesions can be treated?

The pigmented applicator is efficient in treatments of epidermal lesions such as solar lentigines and ephelides. It is extremely important to ensure that the lesion is benign.

Vascular Lesions

Can I combine SWT treatment with sclerotherapy?

When treating leg veins it is suggested to treat the larger vessels with sclerotheraphy, and use Ellipse for the smaller ones, sometimes called spider veins. If a patient has had schlerotherapy wait at least one month before you do an Ellipse treatment.

How does Ellipse work when removing vascular disorders?

Energy from the light source is absorbed by the target chromophore (oxy-haemoglobin and haemoglobin) in the blood. The filters used ensure the best possible uptake by oxy-haemoglobin, with minimal absorption by melanin and water.
The light energy is converted into heat energy, which is conducted to the vessel wall. The vessel wall is heated up to 70°C for at least 1 ms resulting in destruction of its protein.

How does one determine which way the blood flows?

Empty the vessel by pressure of a thumb. When releasing the pressure it is possible to see from which end the vessel is filling up.

How many treatments are required?

The number of treatments depends on the body site and the severity of the thread vein. Usually 1 – 4 treatments are needed and these scheduled about one month apart.

Is any post-treatment necessary?

Many physicians suggest using a single application of a topical glucocorticosteroid immediately after the treatment. Ask the patients to refrain from washing the skin area until the next day. Cooling the skin with a cold moist cloth may be comforting for the patient. Erythema and oedema are normal post-treatment reactions and will disappear after a couple of days without additional treatment.
After treatment of leg veins, compression (surgical) stockings should be worn for two weeks. The treatment area should not be exposed to sunlight for 1-2 months following treatment, and sun protection cream should be used.

What is the clinical endpoint?

A correct response is that the vessel will coagulate i.e. turn bluish in colour immediately after the “shot”. This endpoint is applicable for all vessels regardless of anatomical site. If the vessel turns into a greyish colour, the energy is too high. If you are treating vascular malformations (Port-wine stains), you have to see slight purpura as you are treating the area.

What is the maximum vessel depth that can be reasonably treated?

This depends on the hydrostatic pressure (the fluid pressure in the vessel to be treated). If the pressure is high, the maximum treatable vessel depth is reduced.
– Spider Angioma

What is the maximum vessel diameter that can be reasonably treated?

Vessels up to 0.5 mm can be treated without any combination therapy.