Todays IPL Technology and Measuring Key Parameters

Caerwyn Ash School of Medicine, Swansea University Aesthetics Today Birmingham NEC 4th October 2008

Statement of Disclosure
The following potential conflict of interest relationships are germane to my presentation: Salary, equipment, and travel expenses paid by CyDen Ltd.

Intense Pulsed Light Systems How They Work!

Flashlamp based system Visible light heat highly absorbing melanin in hair without heating surrounding tissue matrix. Pulses within a time duration typically 10s milliseconds Optical filters are used to attenuate harmful wavelengths

Intense Pulsed Light Systems

Treatments
IPL systems are becoming increasingly more versatile treatment devices
Acne Vulgaris Hair management now also on dark skin Photodamage Types I, II, (and III with PDT) Vascular lesions Pigmented lesions Psorasis Creams and potions Breast Firming

Absorption of Chromophores

Absorption of Chromophores

Regulations
Because there is no international standard for IPL systems, we dont know: If the stated fluence values are correct or when the IPL lamp is out of tolerance?

If the stated pulse durations are accurate (or relevant)?

If the pulse square (and the spectral footprint constant)?

What the IPL pulse structure means on tissue?

If the cut-off filters are as claimed? If there are any potentially harmful wavelengths?

These published papers expose some of what we dont know:

Measuring key parameters of intense pulsed light (IPL) devices
Town G, Ash C, Eadie E, Moseley H. J Cosmetic Laser Therapy 2007; 9:3:148-160. Relevance of the structure of time-resolved spectral output to light-tissue interaction using intense pulsed light (IPL) Ash C, Town G and Bjerring P. Lasers in Surgery and Medicine 2008; Vol 40:2: 83-92.

Key Parameters
Fluence Energy density (J/cm2)

Spectral Distribution intensities of the range of wavelengths

Pulse duration the total period of light emission

Beam profile is the distribution of discharged energy across the treatment area
Lamp discharge profile - is an important factor as it bears importance to the change in fluence with the pulse duration Time resolved spectral data shows the change in spectral distribution and fluence with time

Measurements made for Comparison Study

18 different devices from 15 different manufacturers and 36 applicators (different cut-off filters) from USA, UK, Israel, Sweden, Switzerland, China and Italy were tested by the authors. Data on fluence, pulse duration, pulse structure, cut-off filters and UV content was gathered on-site between patient appointments over a 6-month period in clinics where devices were in daily use. Manufacturers information was collected from user manuals, company web sites and literature for verification.

Measured Fluence

Fluence measured using an Ophir energy meter Class 4 laser standard states an industry tolerance of +/- 20%

Flashlamp Physics

IPL light source is a handmade flashlamp A flashlamp deteriorates with every discharge Manufacturers limit shot life to prevent energy decreasing to become clinically ineffective

Comparing Fluence Values

30 IPL applicators were measured at maximum fluence of which 11 were more than 20% below and 8 were more than 10% above fluence levels given on the device display or claimed in user manuals, even where brand-new lamps were tested.

Comparing Fluence Values

9 IPL devices out of 18 had applicators that were outside of the standard for medical Class 4 lasers (> +/-20%)

Filter Performance

Good, sharp 530 nm cut-off filter No significant UV. Spectrum analysis of light contains Discrete line structure Continuum radiation. Filter position measured different to that stated

Comparing Average Spectral Output

Of 29 applicators 19 (65%) with cut-off filters that were inaccurate by more than 20 nm versus the claimed cut-off value given by the manufacturer. Only 10 applicators (35%) were within 20 nm of the stated cut-off.

Filter Performance

Patient dissatisfaction can be caused epidermal damage caused by significant UV or blue content. Dichroic filters become damaged through long term use by high energy IPL systems overloading a thin dichroic coating.

Filter Performance

Epidermal damage produced by significant UV / blue spectral content, caused by degraded filter Injury causes pain and discomfort - dissatisfaction to patient Possible legal proceeding against salon/clinic

Measurement of UV Content

Shorter wavelengths in the ultraviolet region of the spectrum may burn the patients skin or may be hazardous to the operators eyes and are therefore removed. Of the 30 applicators tested, 6 IPLs measured more than 1% and two measured more than 2% of unwanted UV output below 400 nm when cut-off filters were set significantly higher.

Comparing Electrical Discharge

Only three systems measured possess a square pulse discharge Three systems proved not to have a square pulse Most systems utilise simple free discharge Others delivery methods stack pulses together to extend pulse duration

Comparing Pulse Duration & Structure

Only 14 out of 29 pulse duration measurements were within 20% of the manufacturers stated or system displayed values.
Photodiode measurements of total pulse duration did not disclose where the effective spectral output occurred during the pulse. Several manufacturers claimed square pulse output without explaining its significance. Several manufacturers stacked sub-pulses to achieve a biological square pulse.

Comparing Pulse Duration & Structure

These images show time resolved profiles of the pulse durations of five well known wavelengths Dye, Ruby, Alexandrite, Diode, and Nd:YAG

Pulse duration is the same for all wavelengths

Decay of energy during the pulse an important factor

Digital Revolution

Comparing Time-Resolved Spectral Output

Time-resolved spectrum sampled every 1 ms using an Ocean Optics HR2000+ spectrometer and SpectraSuite software to demonstrate the stability and efficiency of spectral output for free-discharge vs. square pulse systems

Free Discharge

Square Pulse

Comparing Time-Resolved Spectral Output

25ms Free Discharge Pulse

25ms Square Pulse

time resolved video of 1ms frame capture of the difference in the temporal characteristics of a free discharge and partial discharge pulse system. Slowed in time to observe changes

Free Discharge

Manufacturer claims a 25ms pulse duration but when measured using time resolved spectrometer only circa 3ms of useful energy is present

The anatomical target for hair removal

Effective pulse duration for follicular damage = 20-40ms Melanin heated to circa 70C causes destroys follicular cells Surrounding tissue matrix spared from heating effect Free discharge systems are not optimum in delivering energy within such time regime

Optimum IPL light pulse

Fluence is delivered evenly during the pulse duration A controlled square pulse can produce pulse durations that are biologically effective and efficient All wavelengths in the spectrum are equally represented during the exposure Less adverse reactions

Pulse Stacking

Fluence decays during the pulse duration Pulse stacking is used by certain manufacture to extend total pulse duration Close stacked pulses are effectively a single pulse of decaying energy as the off time between pulses are short Spectral shift is highly present during exposure

Pulse Stacking

Fluence varies of each short pulse during the pulse train due to separate capacitors Pulse stacking is used by certain manufacturers to extend total pulse duration but with long off times, thermal energy that is absorbed by melanosomes is dissipated to surrounding tissue within off times. Greatest number of adverse reactions reported

Summary
Many manufacturers of IPLs make claims for fluence, pulse duration and spectral emission that are not substantiated as measured by this study - This may lead to increased risk of under- or over-treatment or burn injury to the IPL patient Manufacturers operating an ISO 9000 quality system (Medical CE-mark) showed greater consistency of stated and actual values for fluence, pulse duration and spectral cut-off filter accuracy over the stated lifetime of the applicator / lamps Square Pulse Systems: Produce the lowest possible intensity for a given fluence thus minimising discomfort and other side effects such as skin burns Free Discharge Systems: Produce high intensity energy in short pulse durations with spectral shift and less efficient spectral distribution

Summary
A time-resolved Spectral Footprint as shown in these measurements is helpful in determining the true pulse duration and spectral pattern of useful energy for optimized clinical efficiency This first serious attempt to measure IPL performance characteristics provides criteria that should be carried to national representatives of the competent regulatory body (IEC) to promote an international standard for measuring intense light devices

Conclusion: Characteristics of an Optimum IPL System

Energy output level at least within +/- 20% of stated value, medically CE marked systems have a tendency to provide such tolerance Cut off filter should be that stated match the absorbance spectrum of the desired skin chromophore Pulse duration should be within close range of the Thermal Relaxation Time, square pulse technology is greatly suited to provide this Constant energy level during the entire pulse duration is optimum for maximum heating for follicular structure. Lower energies are required than a variable pulse thus greater patient comfort. Patients and operators want professional service choose a business that provides a good experience when using their IPL system

What about home-use IPL and laser devices?

Whats on the Market

1 Spectragenics, Tria 2 Homeskinovations, Silkn 3 Rio, Salon laser 4 Radiancy, No No 5 CyDen, MicroPulse 6 GHT Innovation, Epi Flash 4

Home Use Units - Comparison Data

A Review of Home Use Lasers and IPLs for Hair Removal

Godfrey Town, Caerwyn Ash

Thank you !