Client Information and Aftercare

Test Patch:

Test patches are carried out to determine the treatment parameters and to judge how your skin might react to a full treatment. A test patch is a small trial in an area with similar hair and skin to the treatment site and allows the practitioner to assess how well the light energy is being absorbed and whether the skin is responding as would be expected.

Clients are asked to make a note of any redness or swelling and how long it takes to reduce following the test patch, also whether or not the skin blisters or feels excessively hot and for how long.

Pre-Treatment Advice

The area to be treated should be free from make-up, perfume, deodorant and body or face creams. Be careful when using spray deodorant prior to treatment.

Avoid waxing, plucking, hair removal creams and bleaching for one month prior to hair removal treatments. Hair should be shaved prior to treatment and no longer than 1mm in length.

There should be no active or fake tan in the area to be treated. Use of sunbeds or prolonged exposure to sunlight is not allowed in the month prior to treatment and an SPF 30 must be used in the area between treatments. Suntans must be left to fade completely before treatment can start. Fake tans must also be completely faded before treatment can commence.

We reserve the right to charge for any appointment booked but abandoned due to active sun-tan or fake tan.

A medical history will be taken at consultation, but we rely on you to inform us of any changes to this. We need to know about any medication you are taking including those bought from a chemist or herbalist. It is your responsibility to inform your practitioner of any changes.

Make sure you arrive in good time for your appointment; this will allow us to pre-cool the skin if this should be required.

Post-Treatment Advice

To minimize skin heating and to reduce the likelihood of skin reactions, the treatment area may be cooled before, during and after the procedure. If the area still feels hot at home you can apply a cold flannel or cool pack. Do not allow ice packs or ice into direct contact with the skin.

Following treatment, the area may appear red and raised and you may experience a tingling sensation. This is completely normal and should settle over the next few days.

Occasionally you may experience swelling or bruising and this can last anything from 1-2 days up to 1-2 weeks. If you experience swelling, it is usually worse 1-2 days following treatment. If it follows a treatment to the facial area, sleeping with your head raised on pillows will minimize its appearance. Cool packs will also help to reduce the swelling. If your skin is particularly sensitive and prone to histamine reactions, you may also wish to consider taking an anti-histamine medication.

Following vascular treatment treatments, a bruise may appear at the treated area. This may last up to 15 days and as the bruise fades there may be brown discoloration of the skin.When larger vessels are treated they may take on a darker colour. Again this may take 1-4 weeks to resolve as the body re-absorbs the damaged vessels.

Make-up can be applied after several hours if the skin is not sore or broken. However, we advise caution if the area is feeling sensitive. Remove make-up carefully as rubbing the skin can cause irritation or infection. If the skin in the treatment area becomes broken, then make-up should be avoided.

Care should be taken to avoid trauma to the treated area for 4-5 days afterwards. Avoid strenuous activities, sauna and steam, excessively hot baths, massage etc.

Wash and bathe as normal but take cool showers rather than hot baths. The skin should be patted dry and not rubbed. Use a light water based moisturiser to keep the area moisturized and the skin protected. If there is any discomfort, treat the area as you would sunburn; cool packs and aloe vera.

Use sunscreen (SPF 30+) and protect the area from sunlight as much as possible between treatments and for at least one month after treatment ends. Failure to do this can lead to sunburn and hyper-pigmentation of the treated area. (Most cases of changes in pigmentation occur when the exposed area has been exposed to sunlight, or in people with darker skin types).

If blistering occurs, contact the clinic immediately for further advice. Keep the area clean and dry and allow it to dry naturally. Do not use any lotions or creams on open skin as this may increase the risk of infection. DO NOT pick grazes or blisters – as this may increase the chance of a scar occurring. Once the skin has healed, a high protection sunscreen should be used daily for 12 months to prevent pigmentation changes to the skin.

If you have any urgent concerns or queries regarding the treated area, please phone the clinic for advice.

Burn Guidelines

If you are at all concerned that the effects of a treatment may have caused a burn, please seek medical attention immediately.

Although rare, it is possible to cause a burn to the skin with an Intense Pulsed Light or laser system. It is important that you can recognize the symptoms of burnt skin and know what action to take. Obvious signs that a burn has occurred include: the presence of blisters or raised skin)this may arise immediately but can also occur up to a period of 24 hours later); a greyish discoloration of the skin; extreme discomfort; severe erythema or any mark/reddening of the skin that occurs in the actual shape of the block or laser beam. If the burn is deep, pressing down on the skin will not result in the blanching effect seen in normal skin. Burns such as these will require urgent medical attention.

As soon as a burn occurred

Stop the burning process (stop using the laser or IPL)

Cool the burn. Hold the burned area under cool running water for 20 minutes (ideal temperature is 15 degrees C) if this is impractical, immerse the burn in cold water or cool it with cold compresses or covered ice packs, changed frequently. Do not use ice or iced water. Putting ice directly on a burn can cause frostbite, further damaging your skin.

Take an over-the-counter pain reliever if required. These include aspirin, ibuprofen, or paracetamol.

Short term Recommendations

It is not necessary (or recommended) to use any creams or lotions.

If the area has small, intact blisters, no dressing is required and exposure to the air is recommended. Do not break small blisters. Fluid -filled blisters are sterile and protect against infection.

• If large blisters form, seek medical attention.

• If the burnt area is open and moist looking, or if blisters have burst, cover the area in paraffin gauze dressing such as Jelonet.

• Dry gauze dressings used with a layer of Vaseline may be substituted if paraffin gauze is not available. Change the dressings every 2-3 days.

• Elevation of the burnt area will help to reduce swelling.

• Do not pick blisters or scabs. This will drastically increase the risk of scarring.

• Long term recommendations

• Massage moisturiser into the skin twice daily until the area has completely healed.

• Newly healed skin can be more sensitive to the sun and may be prone to pigment changes on sun exposure. For this reason, use high factor sun cream or avoid sun exposure on burns that are less than a year old.

• Deeper burns may result in the formation of a scar. If there is evidence of a raised or lumpy scar forming, consult a doctor immediately.

• Minor burns usually heal in about 1-2 weeks without further treatment. Scarring is uncommon in superficial burns but pigment changes in the skin may occur. These changes may be permanent but will often resolve within 12 months. Watch for signs of infection such as increased pain, redness, fever, swelling or oozing. Infection will cause poor healing and further damage. If infection develops, get medical help immediately.

Pregnancy

There is no evidence to show that exposure to laser/IPL radiation is harmful to the foetus or embryo (or expectant Mother). However, it is still not recommended to treat a pregnant woman and it is unlikely that a clinician could obtain insurance cover to do so. Pregnancy can also induce a number of changes such as changes to skin pigment and hair growth, therefore it is recommended to delay treatment until after pregnancy and once breastfeeding has ceased.

Sun tanned/Using sunbeds or fake tan (including gradual tanning moisturisers)

Sun exposure and sun beds must be avoided for AT LEAST 4 weeks prior to treatment. Fake tan and gradual tanning moisturisers must be avoided for 10-14 days prior to treatment. Clients with a tan or recent exposure to the sun have an increased risk of developing blisters and/or pigmentation changes post treatment.

Skin Pigmentation disorder (darkening/whitening) Examples detailed below:

Melasma:

A light based procedure carried out on or near the affected area may result in reactive hyperpigmentation thus treatment is typically NOT recommended.

Vitiligo: Clinic M does not recommend IPL or laser procedures for clients with Vitiligo, despite the use of UV light to treat the condition. People prone to pigmentation disorders may be more at risk of pigment disturbances after treatment.

Skin Cancer:

If a client has a history of Malignant Melanoma, they are contraindicated to treatment.

It is safe to treat a client who has had a Basal Cell Carcinoma (BCC or ‘rodent ulcer’) or a Squamous Cell Carcinoma (SCC) removed over 3 years ago if they had no further treatment other than removal of a lesion. If there is any doubt, we will not treat.

History of Cancer (other than Skin cancer)

Anyone presently under a consultant’s care for cancer is not suitable for IPL/laser treatment. If a client is in remission and no longer under consultant care then they can proceed with IPL/laser therapy.

We also advise against treating the underarm area of a client who has had breast cancer.

Anyone with a history of Cancer of the lymph system (Lymphoma) is contra-indicated for tattoo removal.

Diabetes:

Poorly controlled diabetes can lead to complications with wound healing and caution is advised when treating such clients.

Clients with either Type 1 or Type 2 diabetes are not necessarily contraindicated. However, if there is any doubt about a client’s health, we will not treat them.

We do not recommend treating leg veins or removing tattoos on lower legs for a client who has had diabetes due to the wound healing response.

Epilepsy:

If a client has had a recent seizure in the last 12 months, then their epilepsy is considered a contraindication to treatment. In cases where a client has not had a seizure for a number of years, they should not necessarily be refused treatment (the entire medical history. Health and well-being do need to be considered).

There is often concern as some seizures can be induced by ‘flashing lights’.  This type of epilepsy is referred to as photosensitive epilepsy and fewer than five per cent of people have these types of seizures. Those who are affected by light are only sensitive to light which flickers between 16 and 25 Hertz (16-25 times a second), although some people may be sensitive to other ranges. IPL and laser systems typically do not operate at this frequency. We operate Lynton lasers which have a maximum repetition rate of 10 Hertz, not the frequency which is likely to induce seizures. Epilepsy Action has not had any reports of seizures triggered by laser or IPL treatment for someone with photosensitive epilepsy or any other type of epilepsy. With this in mind it is not necessary to contraindicate treatment for all individuals with epilepsy.

If proceeding with treatment it is worth discussing with the clinical staff a plan of action in the unlikely event a seizure should occur during treatment or in the clinic. You may wish to be accompanied by a friend or relative to your appointment.

Lymphatic/Immune Systems Disorders:

Removal of tattoo pigment is a lymph mediated process therefore, those with a compromised lymph system are contraindicated for laser tattoo removal.

A compromised immune system contraindicates laser/IPL therapy as it can affect a person’s wound healing mechanism and increase susceptibility to infection.

History of Keloid formation/scarring:

It is important to establish whether there is a family or personal history of keloid scarring. We do not recommend treating a client with a personal history of keloid scarring as there is an increased chance of keloid scarring formation after laser or IPL therapy. If there is a family history of keloid formation, we advise treating it with extreme caution, especially if treating the décolleté area as this has a greater risk of keloid formation.

Lupus

Lupus is a serious, chronic, autoimmune disorder characterised by periodic episodes of inflammation of damage to the joints, tendons, other connective tissues, and organs, including the heart, lungs, blood vessels, brain, kidneys and skin. Photosensitivity can occur in some clients and is therefore contraindicated to IPL/laser treatment.

Communicable Diseases (Hepatitis/HIV):

It is important to establish whether a client has had hepatitis, is a hepatitis carrier or whether there is a possibility they have HIV. These diseases can all be transmitted by blood. Treatment with the Q-Switch laser (tattoo removal and pigmented lesions) is typically the only procedure that can produced blood splatter and pin point bleeding.

HIV and Hepatitis do not automatically contraindicate a person from a procedure such as hair removal and could actually be deemed as discrimination to do so. However, stringent infection control procedures need to be in place. Gloves must be worn (especially when shaving) and razors should be disposed of via clinical waste (i.e. in a Sharps Bin).

Porphyria

Porphyria is a genetic disorder in which substances called porphyrins build up in the blood, often causing rashes brought on by exposure to sunlight and reactions to certain drugs. Though rare, in the unlikely event a person suffering from Porphyria seeks IPL or Laser Therapy their condition contraindicates treatment.

Polycystic Ovaries/Hormonal Imbalances

Hormonal conditions do not contraindicate IPL/laser treatment. However, the laser/IPL operators should provide a clear explanation of clinical outcomes. A hormonal condition is likely to be the cause of or a contributing factor to the condition they are seeking treatment for (excess hair, acne). Treatment is often successful but regular maintenance sessions are likely to be required.

Thyroid problems

Thyroid conditions may be a contributing factor to excess hair or acne and the clinical outcome would need to be discussed. We follow the advice as per hormonal conditions such as PCOS. The medication Thyroxine that is often prescribed for those with an under active thyroid does not contraindicate treatment.

Regular Smoker

Smoking is known to have a marked inhibitory effect on new collagen formation. For this reason, many clinics will not carry out photo-rejuvenation therapies on smokers as clinical outcome is compromised. It is advised that clients who do smoke, stop smoking (preferably one month before skin rejuvenation treatment) and are made aware that clinical outcome will be compromised if they do not. It has been shown that the treatment of tattoo removal is less effective on clients who are regular smokers.

Psoriasis/Eczema

Psoriasis and eczema (in the treatment area) would contraindicate light based treatment due to the significant absorption and scattering of light that would arise from the plaques associated with psoriasis/eczema.

Depression/Anxiety

We treat clients who are depressed or anxious with great care. We are aware that such a client’s perceptions may be adversely affected by their depression. Body image may be distorted even if a significant improvement is achieved after treatments and highlights the benefit of a good quality photograph. Dysmorphia, (a body dysmorphic disorder) where a client complains of an imperfection that is more or less invisible to anyone else, is an example of distorted body image. It is estimated that 10-40% of people who seek aesthetic treatment have a degree of dysmorphia. We will not carry out treatment if we do not feel a suitable clinical outcome can be achieved.

Herpes (shingles/cold sores)

It is known that any trauma, or even light can trigger outbreaks of cold sores, (though this is commonly because of sunlight rather than laser/IPL typical treatment wavelengths).

Prophylactic treatment with an anti-viral medication may be beneficial for those who suffer frequent cold sores and can be prescribed by your GP. Medication should start one day before treatment and should be given for four days afterwards.

Treatment should not be carried out over or near an active lesion.

High Blood Pressure

Rarely a contraindication, however, it is useful to gauge a client’s general health and wellbeing. High blood pressure may also have a bearing on the success of any vascular treatment.

Allergies

A person who has several allergies (including antibiotics, creams, tapes, nuts and who have allergic medical conditions such as hay fever, asthma, eczema) have an increased sensitivity to histamine. This histamine reaction has been known to occur post IPL/laser treatment. While such a reaction is short lived it can result in raised, red, itchy wheals. This is more likely to occur if treatment is carried out over a long period of time, therefore it is recommended that a person with a number of allergies only have a small surface area treated in one session (e.g. not hair removal for their full legs, bikini and arms on the same day).

Please make us aware of allergies to latex in which case non latex gloves will be worn.

Alcohol

Alcohol is a vasodilator and may be a contributing factor to broken capillaries. It can also have a detrimental effect on skin rejuvenation procedures.

In addition, issues of informed consent and compliance arise if someone is under the influence of alcohol. Treatment is not recommended if we think a client has been consuming alcohol.

Drug Therapy

There are hundreds of drugs that are known as photosensitisers – most of them reacting to UV light rather than visible and infrared wavelengths used for IPL or laser treatments. Apart from the specific medications or herbal remedies detailed in the British Medical Laser Association Guidelines, most medications are unlikely to cause a photosensitive reaction and do not contraindicate treatment. However, it is advised if a client is taking other medications or herbal remedies of any sort then we will perform a careful initial test patch, wait 1 week for hair removal and tattoo treatments and 4 weeks for skin rejuvenation, vascular, pigmentation and acne treatments. If there are no adverse reactions, we will then treat it as normal.

It is advised that a client who is on antibiotics postpone their treatment until they have finished their treatment and 1-4 weeks have passed (variably depending upon the reason for and the length of the antibiotic course).

Clients seeking vascular or photo-rejuvenation treatments should avoid asprin and anticoagulants such as Heparin and Warfarin as the clinical outcomes may be affected. These medications do not contra-indicate other treatments such as hair removal and tattoo removal.

Clients who have had Gold injections for rheumatoid arthritis i.e. Myocrisin, Sodium Aurothiomalate, Auranofin are contraindicated as they have an increased risk of irreversible hyperpigmentation.

Major Medical Treatment

In general IPL/laser procedures should be carried out on people who are fit and healthy and is therefore not recommended after major medical procedures. An example of a major medical procedure would be organ transplantation or open-heart surgery.

Moles/Birthmarks/Tattoos/Permanent or Semi-Permanent Make-Up

It is not recommended to treat over any moles, birthmarks, tattoos, or permanent make-up (unless treating with the Q-Switch laser in the case of birthmarks and tattoos). Any pigmented lesion will absorb the light and could result in a burn, blister, scarred tissue or a colour shift in permanent make-up (flesh tones are known to turn black). It is recommended to cover any small lesions with a white eyeliner pencil which will help reflect the light away and leave a 1cm gap around any lesion.

Chemical Peel/Botox/Injectable Fillers

Allow 3 months to pass after a deep chemical peel treatment that requires a skin healing time such as a TCA peel before carrying out IPL/laser treatment (to that area). As per the skin rejuvenation protocol the 650 handpiece may be applied after a salicylic, lactic or superficial glycolic peel of 40% or less (depending on skin reaction and skin peel supplier guidelines). However, we would suggest that for the first few treatments, a one-week gap is left to gauge skin reaction, before proceeding with doing treatments on the same day.

For higher percentage glycolic peels allow a minimum of 1 week before IPL/laser treatment but each client will be assessed on an individual basis. If the skin has not returned to normal delay the IPL/laser treatment further.

Allow 14 days after Botox or superficial hyaluronic acid injectable fillers such as Restylane before IPL/laser procedure. We do not carry out treatment over injectable filler product that is considered to be semi-permanent or permanent, such as Radiesse and Sculptra or any we are not familiar with.

If you are unsure about any specific medical conditions, request GP consent before proceeding with any treatment.

Drugs & Lasers/IPLs

Guidance provided by the British Medical Laser Association Issued December 2009

Important

This advice relates to the non-essential aesthetic laser applications and reflects the best data available at the time of this report. Caution should be exercised in interpretation; the results of future studies may require alteration of the recommendations in this document.

The following is a consensus opinion of interested parties from the laser and light source world in the UK and take into account;

1. Personal opinions

2. Theoretical perspectives

3. Evidence from practical use over very large numbers of clients

4. Reporting of adverse events in clinical trials and in post marketing surveillance studies.

Background

There has been a general trend within the industry to provide end-users of laser devices with guidance on which drugs to avoid to minimize the possibility of drug induced photosensitivity reactions. This guidance has often, in the opinion of the authors, been largely based on an inappropriately rigid interpretation of what data exists.

Reports of photosensitivity reactions because of drug administration do occur, but we believe that these reactions have been reported to regulatory bodies with no indication of the wavelength of light that has been responsible. Accurate data are lacking generally.

Phototoxicity generally results from exposure to UVA (315-400nm) radiation with some drugs showing sensitivity into the visible region of the spectrum up to about 460nm. For laser/IPL devices emitting wavelengths above 500nm there is very little likelihood of such a reaction for most drugs.

Other drugs may have an effect on the skin’s healing ability without causing photosensitivity.

Disclaimer

This should not be considered as an exclusive list of drugs that may interact with the laser treatment. It does not replace any advice or instruction issued by a registered medical practitioner, pharmacist or other registered health professional. The information provided is without any implied warranty of fitness for any purpose or use whatsoever.

Practical Advice, Patients should notify the practice of the following:

• Over the counter drugs

• Prescribed drugs

• Herbal remedies

• Photo-sensitising drugs that have CONTRAINDICATIONS to laser therapy and drugs causing marked whole-body sensitivity – wait 6 months

• Drugs administered for systemic Photodynamic Therapy (PDT) e.g Photofrin, Foscan

• Drugs causing marked localized light sensitivity – wait 6 weeks.

• Drugs administered for localized PDT, e.g., ALA, Metvix

• Other drugs that may cause Photosensitivity; if you are unsure please ask your LASER practitioner

• Drugs which may affect the healing of treated areas.

• Any treatment should be performed with caution. We will test carefully and treat small areas initially. If there is any doubt, we will not treat.

• If the client wishes to proceed with treatment, the increased risk of hyperpigmentation/photosensitivity will be emphasized and documented.

• Amiodarone – risk of hyperpigmentation and photosensitivity.

• Minocycline (Minocin) – risk of hyperpigmentation. We recommend stopping 4 weeks prior to treatment or considering a change to alternative.

• St John’s Wort – risk of photosensitivity. We recommend stopping 4 weeks before treatment.

• If taking other medications or herbal remedies of any sort then careful initial test patch will be carried out, we will wait 4-7 days in the case of hair removal and 4-6 weeks in thecaseof vascular/pigmented treatments.

• If a client starts a BNF named photosensitiser then we will repeat the test patch.

• Oral Retinoids – wait 6 months after completion of the drug course

• Isotretinoin (Roaccutane), acitretin (Neotigason), alitretinoin (Toctino)

• Topical Retinoids – stop use 2 weeks prior to laser, recommence once area is healed.

• Tretinoin (Retin-A, Aknemycin Plus), isotetinoin (Isotrexin), adapalene (Differin)

• Oral Steroids – Wound healing impairment is dependent on potency, dose, and duration of use. It is advisable to check with the prescribing physician if laser treatment can proceed safely. When possible wait 4 weeks off drug and avoid use immediately following laser therapy. Recommence use once treated area is healed.

• Betamethasone, cortisone, deflazacort, dexamethasone, hydrocortisone, methyl prednisolone, prednisolone, triamcinolone.

• Topical Steroids – Wound healing impairment is dependent on potency, dose, and duration of use. It is advisable to check with the prescribing physician if laser treatment can proceed safely. Wait 1 week prior to treatment and avoid use immediately following laser therapy. Recommence use once treated area is healed.