皮肤的保健与美容 中国医科大学附属第一医院皮肤病 李远宏.

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1 皮肤的保健与美容 中国医科大学附属第一医院皮肤病 李远宏

2 第一节 皮肤激光的基础知识

3 什么是光？ 光具有两种含义： 粒子性 – 光子 电磁波： 振幅（强度） 波长或频率（Hz) 光速：3 x 108 m/sec（真空）
Light has a dual definition as particles and as waves. Amplitude Wavelength

4 电磁辐射波 λ  电场 磁场 传播方向 C=f λ

5 电磁波谱

6 电磁辐射 是能量的一种基本形式 具有波的特性和粒子特性 电磁辐射波包括：无线电、微波、红外线、可见光、紫外线、X线和伽玛射线

7 激 光 LASER = Light Amplification by Stimulated Emission of Radiation
激 光 LASER = Light Amplification by Stimulated Emission of Radiation LASER medium = Gas (CO2) Liquid (Dye) Solid (Nd:YAG) Semiconductors (Diode) The basis for the laser theory (first laser in 1960 was Ruby laser), is W\Einstein’s quantum theory that electrons wish to be in a stable state.

8 e¯ + + + e¯ + + + e¯ e¯ e¯ e¯ Spontaneous Emission 受激辐射 P1 P1 P1 P1 P2
A photon absorbed by a “stable” electron of the laser material, will excite the electron, which will wish to get rid of the excess energy and become stable again, after releasing the photon. An already excited electron which will absorb another photon, will release 2 photons, in order to go back to a stable state. Repeating this process will result in a release of many photons, yielding a very intense light beam. e¯ P1 P2 + + + e¯ P2

9 激光发生器 Pumping Cavity 激光介质 (i.e. crystal, gas, dye) 全反射镜 R- 100%
The laser medium can be gas (CO2), liquid (dye), solid (Nd:YAG), or semiconductors ( Diode). An energy source, like a flashlamp or electrical current will send photons and excite the electrons of the laser medium to release photons. These photons are able to stimulate other excited electrons to release more photons = amplification. The released photons are reflected by mirrors within the cavity and when the cavity opens after pressing the switch or footswitch, all the photons are emitted together as an intense laser beam. 激发器 (i.e. flashlamp, electric current, laser)

10 Nd:YAG Laser Head YAG - Yttrium Aluminum Garnet
Wavelength micron (1064 nm), near I.R. pulses Pulsed Nd:YAG - Pulsed pumping lamp (flashlamp - e.g. Xe.) Cylindrical Waveguide Nd:YAG Rod Pumping Lamp Gold Coated Pumping Cavity Mirror The excitation energy source is a pumping lamp.

11 激光的分类 激光介质：气体激光 染料激光 固体激光 化学激光

12 Laser Types Alexandrite Holmium CO2 KTP Nd:YAG Ruby Er:YAG Dye Excimer
x-rays cosmic rays Microwaves TV and radio waves Excimer Argon KTP Dye Ruby Alexandrite Nd:YAG Er:YAG CO2 532 755 694 1064 2940 10600 UV VISIBLE INFRARED 400 nm 700 nm Holmium 2100 Various lasers have been employed in medicine and cosmetics, each of them is radiating in one particular wavelength suitable for different lesions. IPL, employs various filters which cut-off the spectrum below and leave the spectrum above up to 1200 nm, depending on the filter (515,550,560,570,590,615,640,645,695,755). IPL with its filters is acting as “many lasers” and is capable of treating various clinical indications at various depths.

13 激光的颜色 波长决定了激光的颜色，不同波长的激光表现为不同颜色的光 为了获取不同波长的光，需要不同的激光介质

14 激光器的分类 连续激光 CO2, 氩，氪，氪离子染料激光 准连续激光或半脉冲激光 铜蒸气激光 脉冲激光 Q-开关激光

15 激光的分类 连续激光 准脉冲激光 脉冲激光

16 激光的特性 单色性 相干性 平行性 高能量和聚焦性

17 激光 普通光 激光与普通光

18 Collimated (non-divergent) Non-collimated (divergent)
Laser White Light Monochromatic Broad Spectrum Coherent Non-coherent These are the main differences between IPL and lasers. Since the laser material emits light of one wavelength only, it is monochromatic. IPL shows a broader range of the spectrum. The laser light is coherent, meaning that all the light waves are in phase (peak together). IPL, having multiple wavelengths, cannot be in phase. The laser beams are parallel to each other, meaning that along a distance there is minimal loss of energy, they can be delivered through an optic fiber and can be focused. IPL light, like ordinary lamp, is divergent, meaning that the longer the distance to the target, the less is the energy density per area. Collimated (non-divergent) Non-collimated (divergent)

19 激光的能量单位 能量(energy):J 能量密度(fluence or dose ):J/cm2 功率(power)：W=
辐射度（Irradiance):W/cm2, J/cm2 / sec

20 激光-组织的作用方式

21 激光/强光与皮肤组织的作用 反射：在激光的防护中具有意义 吸收：只有能量被吸收才具有治疗作用 散射：是影响穿透的重要因素
传导：对组织不起任何作用

22 Blocked by cornea water Not blocked by cornea water
Lasers Blocked by cornea water Not blocked by cornea water CO2 , Er:YAG Mid and far I.R. Diode, Nd:YAG Visible and near I.R. CO2 and Er:YAG are well absorbed by the water in the cornea and do not reach the retina. The visible light and near infra red, which is marginally absorbed by water will reach the retina. If it is a laser it is focused and may cause a damage. If it is IPL it is not focused and will be spread over a larger area of the retina, thus causing irritation only.

23 组织吸收能量 热效应和机械效应 组织作用的温度-时间相关性 热的传导 热驰豫和热驰豫时间(Thermal relaxation time)
荧光 光化学反应

24 组织吸收能量 热弥散 高热区

25 组织变性 时间相关 温度相关

26 物体的颜色 光源：发光体所发射出的光波长决定了光源的颜色。 物体：物体所反射出来的光波长决定了物体的颜色

27 皮肤组织 皮肤是由不同来源的细胞和基质组成，具有不同的光学属性（吸收和反射光能力） 不同皮肤结构能吸收或反射不同波长的光
大多数光是能穿透皮肤的。 皮肤组织这种对光吸收和反射的不同，为我们使用光进行治疗提供了可能性。

28 选择性光热作用 能为色基理想吸收波长的激光 激光照射时间（脉冲宽度） 必需短于色基的热驰豫时间 高能量激光

29 靶组织毁坏机制 光热作用（photothermolysis)： 色基（血红蛋白，黑素或文刺颗粒）吸收光子(photo)能量

30 选择性光热作用的过程 携带足够能量的光子经过皮肤到达色基。 表皮和真皮最小程度地吸收光子能量。 在靶组织中有足够多的光子吸收， 并产生热量。
靶组织中（血红蛋白，黑素）蛋白热变性， 并传递到周围细胞引起损伤。 体内的清除系统（免疫系统）清除。 Reaching the target would be an easy task if the epidermis and dermis where transparent. But, since they are not transparent, light penetration through them can be compared to light trying to penetrate through a curtain on a window. The amount of light transmitted would be determined by the color and the texture of the curtain. The darker the curtain, the more light will be absorbed and the less light will penetrate inside the room. As with the curtain, the darker the skin the more light it will absorb by the melanin in the epidermis and the epidermal/dermal junction, and less photons will reach the target. The photons absorbed in our natural curtain, the skin, will produce heat which may harm the epidermis. The main target chromophores which absorbs the light are the melanin in the pigmented lesions and hair, and hemoglobin in the blood vessels. When aiming for photothermolysis, one is not only attempting to protect the epidermis, but is also interested in minimizing the epidermal melanin absorption as a competition, so that sufficient light energy can reach the target. Following the light absorption, the energy is converted into heat in a photothermal reaction and consequently two processes occur: Coagulation caused by denaturation of proteins (e.g. cooked eggs). Thermally-induced mechanical damage. Thus the blood coagulates and the vessel’s walls disintegrate; melanin granules explode and lyse the cells that harbor them; tattoo’s ink is shuttered into small particles. All these degraded residues are eliminated by Phagocytosis; a process which may take several weeks (unlike the absorption process which take msec). 3

31 波长/穿透深度 皮肤的不同结构对的光吸收存在差异 利用组织对光吸收的差异，选择合适的光源进行治疗，就有可能做到选择性治疗
靶基与周围组织颜色差异越大越好

32 波长/穿透深度 穿透深度：一定能量的激光穿透皮肤组织，能量衰减一半（能量发生明显衰减）时的深度。
穿透深度与组织的性质和波长有关，当组织固定时，一般只与波长有关。 对一个特定波长的光来说，照射特定的组织，其穿透深度是不会发生改变的。

33 波长/穿透深度 治疗深度：治疗激光照射时能引起靶组织变性或销毁时的最大的皮肤深度。
治疗深度与以下因素有关：波长的长短，能量密度大小，光斑大小，皮肤色素的深浅，治疗目的不同，皮肤的保护措施等。 特定波长的激光，当增加能量密度或改变光斑大小，其治疗深度会增加。

34 光斑大小/治疗深度 By Spot Size

35 能量大小/治疗深度 10 20 5

36 波长与穿透深度 因为皮肤中具有不同结构的细胞或成分，对光线具有一定的吸收或散射作用，因此光线在皮肤中会逐渐衰减
皮肤对光的吸收系数：单位长度距离的物体吸收光子的能力，单位cm-1.

37 不同波长的光对皮肤穿透

38 光对组织的穿透深度 0.25 0.2 0.15 Effective Penetration [cm] 0.1 0.05 400 500
As we can see in this slide, the penetration depth of the light is a function of the wavelength. This principle is also employed in laser treatments, whereby each monochromatic wavelength penetrates a certain depth. A wavelength of 400nm penetrates as deep as 0.25mm while a wavelength of 1000nm, penetrates up to a depth of 2.5mm - an increase of factor 10. Using lasers, the penetration depth depends on the laser wavelength. The IPL systems makes use of a wide spectrum of light ( ) and control of the wavelengths is achieved with the aid of filters which cut off part of the spectrum. Basically the long wavelengths which enable deep penetration, are always present (the cut-off is done to the right of the spectrum) but, the higher the filter used (meaning, the closer the cut-off is to the higher wavelengths), the more relative energy is delivered in the higher wavelengths. 400 500 600 700 800 900 1000 Wavelength [nm] 6

39 Light Absorption Into Tissue
Wavelength (Microns) 1.0 0.2 10 20 100,000 10,000 1,000 100 0.1 0.01 0.001 0.0001 Water Melanin Hemoglobin Oxyhemoglobin Absorption Coefficient (per centimeter) CO2 Er:YAG 3.0 This slide demonstrates the absorption capacity of different materials at various wavelengths. We try to adjust the filter to the optimal absorption of the target. It can be seen that water absorption between 0.5 and 1.2 um (IPL spectrum) is low and can protect the tissue from boiling. CO2 and Er:YAG, which are highly absorbed in water are indeed used to ablate and evaporate the epidermis in skin resurfacing techniques. Melanin absorption of light is reduced in longer wavelengths. A compromise should be done between maximal absorption in pigmented lesions or hair and the minimal absorption in the epidermis. Hemoglobin is absorbing well in short wavelengths. When a deeper vein is the target, and a longer filter has to be used to reach it, the low absorption has to be compensated by using high energy.

40 Penetration Depth – Lasers
and for those deeper than 1 mm, Nd:YAG laser of 1064 nm wavelength is used. Er:YAG and CO2 are well absorbed in water, therefore they are absorbed by water in the top skin layers, and do not penetrate deep.

41 热限制/热驰豫时间 选择合适的光源结合不同色基对光吸收的特点，是选择性光热作用（选择性治疗）的第一步。
关键问题是我们还必需将热量限制在治疗的靶位，使治疗本身具有选择性特点。 热量并不具备选择性，它的作用是非特异性的。 治疗的目的是合理地使用光源并将热量限制在靶位。

42 热限制/热驰豫时间 当激光的照射时间（脉冲宽度）小于色基的热驰豫时间时，热能被最大限度地限制在靶位内，而不能有效地传递到周围组织中去 。
能量是守恒的，能量最终会转变为机械能（颗粒崩解）或化学能量（蛋白变性）释放出来。

43 Vessel Diameter Thermal Relaxation Time
热限制/热驰豫时间 Vessel Diameter Thermal Relaxation Time 20 m s 50 m ms 100 m ms 300 m ms 小的色基热量 无论加热还是散热都很快 大的色基热量高 无论是加热还是散热都比较慢

44 吸收/热变性 电磁辐射波中任何一个部分被吸收后均能导致热能的产生。 当温度超过40℃时大多数蛋白质和核酸会发生变性 变性与温度和时间均相关
对蛋白质变性而言，要取得相同的凝固，加热时间每减少10倍，则必需将温度提高10℃ 。

45 吸收/临床 黑色素：显微爆破 血管内皮:凝固性坏死/变性 毛囊组织：凝固性坏死/变性 胶原组织与纤维母细胞：皮肤年轻化
常用的“光源”：激光、IPL、RF

46 IPL = Intense Pulsed Light
简单的说就是光谱为500 – 1200 nm的位于可见光与近红外线这部分的光

47 IPL Head Components Reflector Linear Xenon Flashlamp Filter Coating
The filter coating is a cut-off filter which transmits only wavelengths above the filter number. There is an additional internal filter to ensure that any short wavelengths, like UV, will be screened out. Light Guide

48 IPL Broadband Spectrum with Cut-Off Filters
The longer cut-off filter covers a smaller portion of the available spectrum than the smaller one.

49 Penetration Depth - IPL
Low Filter Shallow mm Medium mm Photons of different wavelengths penetrate to different depths. Since there is a correlation between the size of a blood vessel and it’s depth, in order to reach small vessels, a short wavelength (such as 515 nm) should be used. In order to reach larger vessels which may be deeper, a higher filter should be used. Photons of 550 nm can penetrate deeper and reach medium-size/depth vessels, typically mm. Higher filters are used for deeper vessels. Deep > 0.5 mm High Filter

50 波长与频率 Wavelength Amplitude 短波长 高频率 高能量 长波长 低频率 低能量
The wavelength is defined as the distance between 2 peaks of the wave. Short wavelengths are more frequent in a time unit (sec) and their photons can carry a higher proportion of output energy than long wavelengths. The penetration depth of short wavelengths, as shown in the previous slide, however, is smaller than with long wavelengths. 短波长 高频率 高能量 长波长 低频率 低能量

51 波长 长波长所携带的光能量： 能穿透入深部组织 光子携带的能量较低，治疗比较温和 短波长所携带相同的光能量 穿透较浅
光子携带的能量较高，治疗较强烈。 Thus, the same light energy emitted through a long filter will penetrate deeper, but will be milder than if emitted through a short filter.

52 防护镜 防护镜的标识: 防护的波长范围 该波长的光密度 （Optical density ，OD) 在使用激光和IPL时均要求使用
即便是佩戴了防护镜也不要直接看光束。

53 脉冲类型与热选择性 Selectivity achieved by using different pulse types (number, duration and delays).

54 能量 / 皮肤反应 非常重要! 当深度增加时能量会衰减 能量 深度
The energy decreases as we go in deeper due to loss by scattering and absorption. In order to compensate for this decrease in energy, we must increase the initial amount of energy so that it is effective in the target. The only way to do so without harming the epidermis would be to take the total amount of energy and divide it into pulses. 深度 5

55 脉冲类型 光脉冲 脉冲时组织加热 延迟时组织能确 热控制 能量密度: J/cm2 脉冲类型: 脉冲数: 1-3 脉冲宽度: msec
Pulse Pulse Pulse 3 Delay Delay 2 By using the pulsed mode, one can control the amount of energy delivered, the number of pulses, the duration of the pulses and the delays between the pulses. The choice of the above mentioned parameters is done on the basis of the heat capacity and cooling time of different objects. 17

56 热容量–冷却 热容量 = 物体温度上升或下降 1°C 所需要的能量 冷却时间：热驰豫时间

57 热容量–冷却时间 小的物体（小的热容量） 温度上升或下降较快 如表浅的小的/淡色的损害或表皮 大的物体（较大的热容量） 温度上升或下降缓慢
如深部的大的/黑色的皮损 Objects of different sizes have different heat capacity values and different cooling time values. Smaller objects heat up fast and cool down fast while larger objects will take longer to heat up but longer to cool down. For example, the smaller blood vessels and the epidermis being smaller objects, heat up fast and cool down fast while the larger and deeper lesions will take longer to heat but slower to cool down. 18

58 延迟宽度 当脉冲宽度等于或短于靶组织的热驰豫（冷却）时间 热损害将被严格地限制在靶组织内 当脉冲宽度较靶组织的热驰豫(冷却）时间长时
热将从靶组织内传到出来，结果是：靶组织损伤不足而周围组织的损伤明显加强 脉冲宽度应该等于或短于靶组织的热驰豫时间而应该长于表皮的热驰豫时间。 Cooling time is a physical property of a certain object of certain material and dimensions, which we cannot control. It is referred to as thermal relaxation time (TRT). In the target we have to allow a shorter pulse duration than the cooling time for the heat to be confined and concentrated in the object and do the damage, before the heat is conducted away during the cooling process (may also cause thermal damage to surrounding tissue). If cooling of the object is desirable, like in the epidermis, we should exceed the cooling time of the epidermis, so that cooling occurs simultaneously with heating and no damage is done. To avoid overheating of the surrounding tissue, external cooling is applied.

59 热选择性 小的物体 （表皮） 脉冲宽度 20 ms 大的物体 TRT 80 ms TRT 10 ms

60 热的选择性 Small object Large object
The pulse duration is longer than the cooling time of a small object (epidermis)– object will cool down while heating and will not reach damage temperature (80oC). The area around may have a thermal damage. The same pulse duration is shorter than the cooling time of the large object (target) – all the energy is confined to the target and damage temperature is reached. No heat is conducted to the surrounding tissue before damage temperature is reached.

61 脉冲延迟 脉冲延迟应该较靶组织的冷却时间短，因此靶组织能充分地稽留热量。
同时，脉冲延迟应该等于或长于表皮的冷却时间，这样允许表皮达到最大程度的冷却。 If pulse delay is too long, it may result in target cooling and ineffective treatment. Small objects, like small blood vessels or superficial fine hair will require short delays (10-20msec). In contrast, with large objects we may select a long delay which will not affect the efficacy of the treatment and at the same time will be safer for the epidermis.

62 冷却胶 在治疗时冷却皮肤 有利于光线对皮肤的穿透 改善治疗中的不适 IPL和很多激光在治疗时均需要使用冷却胶:
可以将冷却胶存放在冰箱中 (非冷冻) To enhance epidermis cooling, a cold gel is used. Freezing of gel should be avoided, as the crystals formed will form a non-clear gel and interfere with light transfer into the skin. Blue ultrasound gels are not suitable, as they may cause burns.

63 皮肤/胶接触 具有冷却装置的IPL治疗头通过一薄层胶轻轻地于皮肤接触(在发射Quantum光时)
没有冷却装置的IPL 头需要与皮肤保持1-3mm的间隙 (发射VascuLight光时). 也可以接触皮肤但需要降低能量 室温的胶只在治疗表浅血管时使用，以避免血管的收缩。 Using IPL heads with integral cooling, touching the skin lightly is essential to conduct the cold, but pressure is not recommended. Using IPL heads without integral cooling, retracting away from the skin protects the epidermis from burns. The darker the skin, the thicker the layer of gel, usually 1-3 mm, but with skin type VI, 5 mm may be used. Nevertheless, with reduced fluence, a direct contact is possible. A pressure may be applied when competition from blood vessels is desired, such as in tattoo treatment. In this case adequate pre-cooling and very cold gel should be used. The use of only a thin layer of gel with Nd:YAG is OK, as the chances of burn are very slim. With LighSheer, the treatment is done while pressing the head against the skin and the gel may help in sliding the head over the skin on large areas, but is not essential.

64 Nd:YAG激光头需要一薄层的冷却胶来接触皮肤，偶尔需要压紧皮肤
LightSheer 半导体头可以使用胶也可以不使用，治疗头需要压紧皮肤

65 治疗头

66 如何设置参数？ 根据皮肤和靶组织的反应调节治疗参数： 如果需要强烈一些的治疗效果: 提高能量密度 缩短脉冲宽度 减小脉冲延迟 脉冲数减小
选择短波长滤光镜片 温和的治疗参数：相反的调节 Response of the target will be described in the next presentation. If nothing indicates efficacy, more aggressive parameters should be used. Response of epidermis should be none or marginal, otherwise milder parameters should be used. The longer the duration of the pulse the less aggressive we are; e.g. choosing a long pulse ensures us that the total amount of energy will be distributed over a longer period of time. The same applies to a long pulse delay which will ensure a long cooling time. Similarly, dividing the energy into more pulses will make the treatment milder.

67 Pulse Type on Pulse duration delay off
Selectivity is achieved by different temperatures in the epidermis (below 60oC) and in the target (above 80oC). With each pulse, the epidermis which contains less pigment than the lesion, will heat up moderately and will cool down to normal body temperature during the delay. At the same time, the lesion, which has a higher pigment concentration, will heat up more, will cool down only partially during the delay, and will build up heat with each additional pulse.

68 光斑的作用 治疗深度受光斑大小的影响散 射是主要要考虑的因素 小光斑 由于散射光子大量“丢失 治疗深度浅 大光斑
由于散射光子被“聚合”在一起 治疗深度提高 快速的治疗 Another feature of IPL and some lasers is the use of a large spot size ( e.g. 8X35mm and 10X45mm in VascuLight; 12X12mm in LightSheer). 1.It has the advantage of covering a big area during the treatment. 2. The light photons scattered (which is a loss of energy) in the skin at the end of the light guide are just a small % of the total area. 3. Part of the photons that scatter inside the tissue will re-collect and reach the target due to overlap from all directions. 4. The energy flow into the tissue will result in a large penetration depth by large spot size. 22

69 皮肤对光束散射效果及治疗深度 This Thermograph demonstrates the higher penetration depth of light delivered through the larger spot size. Calculated fluence profiles for 3-mm and 10-mm diameter spot size of equal fluence

70 能量输出: IPL 与激光 激光 激光可以通过不同大小的激光头输出，由于激光管的能量大小是固定的，因此小光斑的能量密度要比大光斑的能量密度高，大光斑的能量密度要低。 IPL 能量密度保持恒定，与光斑大小没有关系。 In lasers, often the permissible energy is restricted in small tips, as the energy density increases in small areas. In IPL, the same fluence used with a smaller light guide may be less painful, as total energy delivered is smaller in small areas.

71 IPL和选择性光热作用原理： 复合光 - 多元化治疗适应症 根据治疗目的的不同可调节波长 多个均匀脉冲 -
完善的热选择性作用，保护周围组织，不但有效而且安全 高能量 - 高能量使得使用大光斑治疗成为可能，因此治疗深度得以加深 治疗速度更快 Multiple wavelengths and pulse configurations enable the treatment of various lesions at various depths to get optimal damage. Yet this flexibility requires training and a longer learning curve than with lasers.

72 激光 与 IPL 激光具有单一波长 (单色性) - 适应症比较单一，尤其在一个特定得皮肤深度 激光得脉冲通常为单一脉冲-
不利于保护表皮，尤其使黑肤色的患者 使用新的长脉冲技术可以改善这一缺点 激光的能量是比较固定的 – 要达到有效的能量密度通常需要缩小光斑大 小，可通过扫描技术来提高治疗速度 Monochromaticity restricts the scope of clinical indications and depths, but parameters can ideally suit a dedicated application. Without the need to manipulate too many parameter changes, treatment is simple. Long pulses used by lasers are often a train of small pulses. New Lasers with long pulses can control the pulse duration and delay, but cannot control the number of pulses. Low energy delivered through a small spot size will have a higher energy density than through a large one.

73 (radiofrequency energy，RF)
射频技术 (radiofrequency energy，RF)

74 电磁波谱

75 什么是射频（RF）？ 射频（radiofrequency energy， RF）是电磁辐射（electromagnetic）家族中的一个重要的但很小的成员。 无线电和微波都是电磁辐射能量，他们统称为射频。 和所有其他波相关的现象一样，RF也具有波长和频率。RF和微波的频率分别为3kHz到3MHz，以及300MHz到300GHz。 C＝f·λ

76 射频在各个领域都得到了广泛的应用 电台、电视、收音机、手机和其他通讯设施，包括卫星通讯等
生活中一个非常常见的例子是微波炉，这种波长的电磁辐射对水有着非常好的作用。 在医学中利用RF具有快速加热机体组织的优势来进行治疗的，组织在较高温度（热量）下能治疗受损的组织或杀伤肿瘤细胞来达到治疗目的的。

77 RF的生物学作用 热学的作用。 RF热作用的程度取决于几个因素：辐射的频率、大小、形态、和照射部位的方位、辐射时间、周围的环境状态、热消散是否有效等。 除了能量大小外，频率也是决定组织是否吸收RF并由此引起热学作用的重要原因。 实验显示机体的吸收以80－100MHz最好。

78 RF对皮肤作用的特点 射频对机体的作用最大的一个特点就是它不受表皮色素的影响。 与皮肤的温度有关，温度越高作用越强。

79 How it Works

80 Electricity will take the shortest path
from the source to the ground Monopolar (Thermage): Through the tissue and through the body to the ground pad Bipolar flush with tissue (Syneron): Across the most superficial layers of tissue Bipolar folded (FACES): Focused through tissue, deep dermal effect

81 单极射频 1 2 3 4 5 mm

82 普通双极射频 单极射频

83 普通双极射频 射频能量在超过双极距离1/2的深度时射频能量明显衰减。 要达到治疗目的，需要加大射频发射能量
由于双极之间的能量最大，构成了治疗中一个不可逾越的高温度屏障区，故具有灼伤表皮的可能性。

84

85 FACES 技术的高效双极射频 负压吸引：将组织吸入电极之间 RF能量完全贯穿通过组织 RF穿透组织时与皮肤间相互作用产生热量，
并作用于真皮深层，表皮不受影响 结果： 皮肤深层加热，几乎没有疼痛感觉 Functional Aspiration Controlled Electrothermal Stimulation

86 FACES Technology

87 Theory of Clinical Mechanism
Collagenesis Heat is deposited in tissue Collagen denatured Healing process begins New & more organized collagen is laid down Plumps the skin Collagen Contraction Immediate gratification Dermal collagen contraction Ligament & tendon contraction

88 Aluma Peri-Oral Region
Before (4/28/04) Mid-Trial( ) End-Trial( ) Before 2 months 6 months

89 DCD冷却 动态冷却 治疗前冷却，过低没有作用，过高会导致皮肤结构发生瞬间改变，散射和反射增多 治疗中（关键的时候）没有冷却 耗材

90 同步冷却 (治疗的全程高效冷却) 接触性：高效 风冷： Zimmer Elektromedizin

91 皮肤同步冷却 意义：保护表皮、镇痛 临床研究： 表皮损伤的温度为60－65℃
实验中将两根同样纤细的电热线圈放在皮肤表面测量皮肤温度，当照射参数为：2.8和6.0ms，延迟时间为20ms, 能量密度24J/cm2，使用冷却时表皮温度只上升到42℃，而不用冷却时表皮的温度上升到65℃。 没有冷却装置的强光要治疗老化性皮肤是不可思议的 60℃

92 激光与IPL的防护 治疗区内张贴警示标志 治疗室需要保持关门状态 治疗室不能透光 无关人员不能随意进出治疗室 治疗室内的人员需要佩戴防护镜
保护患者眼睛。

93 激光/IPL的并发症 即刻型： 疼痛 皮肤灼伤 皮肤紫癜

94 治疗后 感染 愈合不良与瘢痕形成 色素增加/减退 皮肤敏感 痤疮样发疹 文刺改变

95 激光室 光束危害 火灾、工作人员的损害 非光束危害 烟雾、机械、电、血液 清洁 治疗头的保护

96 谢 谢