F.A.Q. - Dr Amber Bocknek

Lasers and light-based devices emit a specific light colour which is preferentially absorbed by the brown pigments in the hair follicle. The hair in the follicle is heated rapidly and transfers the heat energy into the surrounding follicle. The rapid heating and high temperature generated causes significant damage to the hair follicle. This causes the follicle to release the hair.

The follicles themselves go through several phases of growth. If the follicle is in “anagen” or active growth phase, there is far more colour/activity in the follicle, the heating is much stronger, and the follicle in the anagen phase is permanently destroyed.

Phases of hair growth:

On the body, different areas have differing amounts of hair in the anagen phase. With each treatment, the entire hair bearing area is treated with the laser or light device, so all the follicles are heated.
Most of the hair in the area should fall out within 1-3 weeks after the session, but only the hair follicles in anagen are destroyed. In 8-12 weeks (on average), the remaining hair (minus the ones destroyed in the prior treatment) start to regrow, and the next treatment can now be done. Another percentage of hair will again be in anagen and destroyed permanently in the second session of laser treatment, and so on until completion.

2. How many treatments do I need?

The number of treatments needed is determined by your genetics, and the area of your body being treated. Various medical texts quote the percentage of body hair as 12-20% in anagen at any given time. This is how we calculate the estimated number of treatments. If you have 20% of your hair in anagen, then each laser session will permanently destroy approximately 20% of the hair follicles. This means your area may be complete within approximately 5 treatments (20% after treatment 1, 40% after 2, 60% after 3, 80% after 4 and 100% after 5). If you have only 12% in anagen, then up to 8 sessions may be needed. Following the same math: 12% at treatment 1, 24% at treatment 2, and so on until 100% is destroyed by treatment 8. Anagen is a major factor in the number of treatments needed. Other factors that influence the number of treatments are hair coarseness (coarse is actually easier to treat than fine, as it is a more colour dense and larger target), and the darkness or lightness of the hair – dark is a much better target.

3. Is it permanent?

Lasers can permanently destroy the anagen follicles of today, but cannot prevent the formation of future hair. In order to have an effective treatment, the hair must currently be present, in your skin, at the time of the laser session.
In some medical conditions, new hair can be created. Examples of medical conditions causing new hair growth would be: hormonal issues (like polycystic ovaries), thyroid problems, etc. People with these problems can be treated – but, as long as their health issues keep them making new hair, they will be using the laser to keep the hair growth down. Laser and light treatments are permanent – but not preventative. If you have a known health problem where you are making hair, please speak with me further about this. It is important that we go over these issues in detail prior to commencing treatments.
Although excellent results are expected in most, like all areas of medicine, each person responds differently and no guarantees can be given.

4. Can all hair colour and skin colours receive treatment?

Lasers and light devices do not actually see or determine what hair actually is. The laser and light is attracted to melanin, the main pigment in hair. The darker brown the hair is, the easier the hair is to treat. The easiest hair for laser to treat is black, coarse hair. Many shades of brown are well treated, but hair that is much finer will also respond. However, the settings of the laser need to be more aggressive in order to achieve enough heating to damage the follicle in lighter shades of brown and in finer hair.
Blond, white and grey hair is NOT treatable. These colours lack enough melanin and do not heat. Red hair can be difficult to predict. Red that is more auburn is likely going to achieve a better response than red bordering on strawberry blonde.
People who are brunettes as adults, but who were very blond as infants and young children sometimes also have a lesser response to laser. There is likely less overall melanin in their hair than their “brunette-from-birth” peers. If you are in this category, please discuss your situation with me in detail prior to engaging in laser sessions.
Skin colour also plays a role; again, lasers do not specifically see the hair, they see melanin. Melanin is also present in our skin. There is very little in the skin if we are fair, and much more if we are olive toned or more richly pigmented. Greater care needs to be taken with olive and richer skin types. Much more conservative treatments are required, and subsequently, more treatments may be needed to achieve the desired reduction. If the skin colour and hair colour are extremely close (minimal or negligible contrast in colour between skin and hair), then laser and light treatments should be avoided all together, as the risk of heating and burning the skin becomes very high. A private consultation with me is necessary, along with a test patch in advance of a full treatment for all individuals with more richly pigmented skin tones. Safety is always the first priority.

5. Does it hurt?

Most people would not describe the newer lasers as painful. But, there is some sensation associated with the heating of the follicles. The denser the hairy area, the more the sensation will be felt, and the sparser the area, the less it will be felt. First sessions, with maximum hair present, always have the most sensation associated with them. Each follow up session, with less hair present, becomes less and less feelable. Traditional (older) lasers hurt – quite a bit. They felt like a hot elastic repeatedly being snapped on your skin – hundreds of times.
I work with a very advanced set of laser and light systems – I have 3 different laser and lights (Nd YAG for my very richly pigmented patients [very dark Fitzpatrick 6], diode laser for fair to medium dark skins, and also AFT light). The Nd YAG still functions in the “elastic snap” mode, but for any individual with light to medium dark skin types, I can treat them with the new mode diode (Soprano ICE) and the AFT (Harmony pro). The latter 2 laser and light systems can deliver their energy differently. The delivery feels much like a hot stone massage – and in very coarse hair it feels like a hot stone massage with prickles. Although you can feel it, it is far more comfortable than the old delivery methods. Rarely, freezing cream is needed today with the Soprano Ice and the Harmony Pro AFT. In the “old days” we used freezing cream for most people.

A video of the laser in motion (this video is from the Soprano ICE’s predecessor, the Soprano XL): https://www.youtube.com/watch?v=P7NUyrKSbQU

6. How do I prepare for treatment?

Please shave the area to be lasered the day before or the morning of your treatment. The laser will lock on to the small dots of stubble that remain. We do not want any real length of hair left on the skin surface, as any remaining length of hair will be heated in the process, and can burn/injure the skin underneath it.
Please do NOT wax, pluck or thread your hair in the 3-4 weeks before your laser session. Any of the “pull-out” type of hair removal techniques will remove the stub of hair from the follicle. If the follicle is empty – there is nothing for the laser to heat, and those follicles will be missed in that treatment session.
If you bleach, please stop bleaching 1 week before laser and convert over to shaving.
The only acceptable hair control technique before and between laser sessions is shaving. Shaving does NOT make hair coarser. This is a common misconception. The hair feels coarse because shaving cross-cuts the hair shaft, making a bristly edge. The regrowth in pull out techniques feels softer, as the hair grows in from the root with a soft taper on the end. Once you get started with your laser sessions, you should have transient reductions in the amount of hair growing between your sessions – it will be much easier to maintain, even during your series, from after the first session onwards.
Please avoid tanning or using artificial tanning creams in the treatment area. Any additional colour generated can attract the laser’s heat and increase burn risks. Further, UV light exposure activates the melanocytes (the colour producing cells in the skin) and they can react poorly to the laser – producing undesired excess pigment or reduce their pigment causing light spots. These effects can last for weeks or months, and with good UV protection and avoidance are preventable.

7. Are there any side effects?

Most people will get a few red “goose bumps” around the hair follicles for several hours up to 2 days post session. This can be a very normal part of the treatment and is a direct result of the heating process.
True side effects include folliculitis (an inflammation of the hair follicles that may require follow up, and treatment, but it does resolve). Less common can be overheating injuries of the surrounding skin. These are skin burns – they can appear as skin redness, skin tenderness, lasting a few days to a week. More severe burns would result in crusting or scabbing – this would warrant follow up and treatment. Pigment disturbances (excess or reductions) can also follow, and sometimes this can last weeks or several months. From burns, occasionally infections can arise in the skin, and if left untreated can result in scarring.
As a medical doctor, any concerns about after effects, burns, or any other problems should be brought immediately to my attention. Safety and good care is always the priority.

8. Do I have to take any special precautions when I am doing treatments?

Please do not tan or sun expose the area if possible. It this does occur please let me know so that we can adjust your treatment schedule
Please let me know if your health changes or if you become pregnant during your sessions
Please do not use any pull-out technology (wax, thread, etc.) to remove your hair.

Photofacial

1. What kind of skin problems can be treated?

Photofacials are light based treatments used to reduce red and brown colour issues. Red problems are produced by blood vessels – flushing, little visible distinct blood vessels, red dots (angioma). Brown problems – sun damage, sun spots. “Photofacial” can be done on necks, chests, hands, arms, legs, as well as faces. Certain problems – such as melasma (mask of pregnancy, hormonal pigment) or any “symmetrical” pigment marks need to be evaluated prior to treatment. An alternate type of treatment (Clearlift – a q switched Nd YAG laser) may be more effective in these hormonally induced pigment situations. My clinic has multiple types of lasers and light based treatments. At consultation, your personal concerns, heath history, and skin will be reviewed and the best light based treatment will be selected to match your unique needs.

2. How does Photofacial work?

Lasers and light based devices emit a specific light colour which is preferentially absorbed by the brown and red pigments in the skin. The brown spot, or blood vessel is heated rapidly and in the case of brown spots, an amount of the brown cells are destroyed. When treating the blood vessels, the red gets heated and the walls of the blood vessels are injured, and some are destroyed with each treatment.

Within about 1-3 days, the brown spots temporarily become darker. It almost appears as if there were coffee grounds within the brown spots. The coffee ground appearance will last 7-14 days, and then the coffee grounds will fall off. The remaining spot will be considerably lighter in colour and will be targeted again in the next treatment.

Coffee grounds look like this:

When we treat the blood vessels, they can sometimes become flushed around the blood vessels and there can be some mild localized swelling around the treated blood vessels. The flushing and swelling is normally gone in 2-4 days. The body will gradually reabsorb and remove the treated tissue. The clearing of the treated vessels takes 2-3 weeks and repeat sessions to advance the improvements can be done monthly.

3. How many treatments do I need?

Most people need between 3-5 treatments in the original series to get control over their red or brown problem. Maintenance is a single or pair of treatments every 6-12 months. The frequency of maintenance is strongly affected by how much UV exposure you receive. UV rapidly worsens these problems. Ongoing sun avoidance is your best anti-aging intervention
People flush for different reasons. Some health issues (rosacea, hereditary factors, etc.) cause the flushing and blood vessel formation. Although the lasers help to control the problems, they do not cure the underlying cause, and thus maintenance is also required.
Although excellent results are expected in most, like all areas of medicine, each person responds differently and no guarantees can be given.

4. Does it hurt?

Most people would not describe the newer lasers as painful. But, there is some sensation associated with the heating of the red and brown pigments. The more intense the colour problem, the more the heat sensation. First sessions, with maximum colour present, always have the most sensation associated with them. Each follow up session, with less colour present, becomes less and less feelable. Traditional (older) lasers hurt – quite a bit. They felt like a hot elastic repeatedly being snapped on your skin – hundreds of times.
I work with a very advanced set of laser and light systems – I use the Alma Harmony Pro AFT system. The delivery of the light is done gradually, accumulating heat and energy over time. This means treatments are more comfortable, and the risk of complications are lower.

5. How do I prepare for treatment?

Please avoid the sun (use sunscreen, hats, sun protective clothing for body areas). Please come with a fresh clean face (or body area), and you can apply makeup after. If you are coming from work, we can remove your makeup just prior to treatment. Just bring some to apply after if needed.

6. Are there any side effects?

The coffee ground appearance of the brown spots and the transient increase in flushing and minor swelling with the blood vessels are normal, and expected after each session.
True side effects are quite uncommon and predominately are skin burns. They can appear as skin redness, skin tenderness, and last a few days to a week. More severe burns would result in crusting or scabbing, and follow up would be needed. Pigment disturbances (excess or reductions) can also follow, and sometimes this can last weeks or several months. From burns, occasionally infections can arise in the skin, and if left untreated can result in scarring.
As a medical doctor, any concerns about after effects, burns, or any other problems should be brought immediately to my attention. Safety and good care is always the priority.

7. Do I have to take any special precautions when I am doing treatments?

Please do not tan or sun expose the area if possible. It this does occur please let me know so that we can adjust your treatment schedule

Please let me know if your health changes or if you become pregnant during your sessions

Textural Problems – Clearlift, and Erbium Pixel

1. What kind of skin problems can be treated?

Clearlift is a q switched Nd YAG in either fractional or traditional form. The Erbium Pixel is a resurfacing laser, in a fractional form. They can be used individually or in combination for several different types of problems:
Texture – scars, stretch marks

Anti-aging – pores, wrinkles, laxity
Pigment – Difficult to treat pigment – melasma, photo aging on darker skin types.

2. How does it work?

In texture problems and in anti-aging, the Clearlift laser works by heating the dermis (just below the surface skin). It creates heat in this skin region, high enough to intentionally create small wounds. The “wounding” process stimulates the body to start healing. In doing so, new collagen is laid down in the treatment area. The new collagen firms the skin, softens and plumps wrinkles, acne scars and stretch marks.

Clearlift effect on the dermis

For acne scars and stretch marks, this type of laser is combined with other laser and lights to more aggressively treat these tougher problems. A resurfacing laser (Erbium, Pixel) can also be utilized to retexture the surface (epidermis) in conjunction with the deeper penetrating Clearlight. By combining these 2 laser types, more dramatic improvements can be created.
Additionally, if there is a colour issue (i.e. stretch marks that still are red/pink) a light based treatment with AFT can be used to address the colour component.

If the problem is refractory pigment, then the Clearlift is used to break up the colour particles in the skin.
Here is a link with an explanatory video. The branded name for the combination treatment is Laser 360IQ. https://www.youtube.com/watch?v=nBoMHqQRfiM

3. How many treatments do I need?

Most people need between 4-6 treatments in the original series to get control over their texture problem. For the anti-aging patient (wrinkles, tone and laxity) maintenance is a single or pair of treatments every 6-12 months. The frequency of maintenance is strongly affected by smoking and how much sun a person has on their skin (UV rapidly worsens these problems). Ongoing sun avoidance and smoking cessation are your best anti-aging interventions
People who have a texture problem such as old acne scars and stretch marks who no longer have flares in their acne, or are no longer growing and their weight is stable, and they have finished having children do NOT require maintenance. These issues developed in response to a problem which is no longer active, thus corrections are complete once the initial series is complete
Although excellent results are expected in most, like all areas of medicine, each person responds differently and no guarantees can be given.

4. Is it permanent?

Sadly, aging is an ongoing problem. We lose collagen every day, and our skin is damaged as we travel about exposed to UV, pollutants, etc. Time marches on, so skin will continue to age. Ongoing maintenance is needed.
For stretch marks and acne scars, the results are permanent as long as the problem does not return.

5. Does it hurt?

Clearlift, the q switched fractional Nd YAG for the dermal stimulation is extremely comfortable. Most people feel nothing at all. At most, in the very delicate areas (eye area, for the eye skin crepe, or upper lip for the lip lines, or on the neck bands) the patient might perceive the tiniest brief burst of warmth.
The Erbium Pixel resurfacing laser feels like hot pin pricks, and feels like a bad sunburn for the first 24-48hrs after treatment. Often we discuss using freezing cream in preparation for this laser, if it needs to be used as part of the treatment plan.

6. How do I prepare for treatment?

For the Clearlift, preparation is simple. Please avoid the sun (use sunscreen, hats, sun protective clothing for body areas). Please come with a fresh clean face (or body area), and you can apply makeup after. If you are coming from work, we can remove your makeup just prior to treatment. Just bring some to apply after if needed.
For the Erbium Pixel, there is more preparation needed – often freezing cream. For those individuals who have ever had a cold sore, a prescription medicine is given to prevent outbreaks.

7. Are there any side effects?

For the Clearlift, side effects are very uncommon. For most people there is a mild amount of redness, lasting minutes to a few hours. Sometimes, if the eye region has been treated aggressively, there can be some puffiness, particularly upon waking up in the mornings, for a few days.
True side effects are quite uncommon and predominately are skin burns – they can appear as skin redness, skin tenderness, lasting a few days to a week. More severe burns would result in crusting or scabbing – and follow up would be needed. Pigment disturbances (excess or reductions} can also follow, and sometimes this can last weeks or several months. From burns, occasionally infections can arise in the skin, and if left untreated can result in scarring. As a medical doctor, any concerns about after effects, burns, or any other problems – should be brought immediately to my attention. Safety and good care is always the priority.
For the Pixel Erbium, it is EXPECTED that there will be redness, sun burn feeling, and mild swelling, for 2-3 days, followed by scabbing and rough texture for 10-14 days. This is a normal after effect from the resurfacing laser. True side effects are uncommon, but development of infection while the skin is wounded would be the most significant risk. This would require follow up appointments and prescription medication would be issued. Pigment disturbances and scarring are an exceptionally rare end outcome of severe infection.

8. Do I have to take any special precautions when I am doing treatments?

Please do not tan or sun expose the area if possible. It this does occur please let me know so that we can adjust your treatment schedule
Please let me know if your health changes or if you become pregnant during your sessions If you have ever had a cold sore, please inform me so that I may give you a prescription for medications to help prevent a cold sore outbreak.

Tattoo reduction and eradication

1. How does it work?

A Q-switched Nd YAG laser is used at 2 different wavelengths: 532nm and 1064nm. This type of laser is called Q-Switched. The q-switching is important, as this is a photo (light) acoustic (shock wave) type of laser. The light energy is emitted in short bursts. These very brief bursts of light create a shock wave that breaks up the very large ink particles (which cannot be absorbed by the body) into much smaller particles. With each session, some parts of the larger ink particles get broken into smaller ones. The small ones are absorbed by the white blood cells and removed from the body. Over a series of sessions, the tattoo is reduced and often eliminated.

2. What colours can it reduce and eliminate?

Some colours are easier than others to breakdown and remove: black, brown, navy blue, and red are the easiest. Any colours mixed with white (pastels) are very difficult as are yellow inks and green inks. Black can often be the easiest, but in uncommon situations it is highly refractory to treatment. The white, yellow, green and some black ink can be impossible to remove. Permanent make up pigments are often fraught with difficulties – if they are mixed with iron oxides, then they can turn black. In general permanent makeup tattoos are best left alone.
Although excellent results are expected in most, like all areas of medicine, each person responds differently and no guarantees can be given.

3. How many treatments do I need?

The number of treatments varies widely. Black ink is often the easiest of them to reduce or remove, but even black will need several sessions. A typical range is 4-8 sessions. The colour, amount of ink and depth where the ink was deposited all impact the effectiveness of the laser.

4. Does it hurt?

Yes. This is uncomfortable for most people. Tattoos hurt going on and coming off. If you have no allergy to freezing cream, then preparing with freezing cream can be very helpful.

5. How do I prepare for treatment?

If pain is your concern, and you do not have allergies to freezing, you can pick up Emla cream from the pharmacy. For best results, it is important to cover with a thick layer (like cream cheese on a bagel), and then, cover the cream with a piece of saran wrap. It is important to have the cream on and covered for a minimum of 45-60minutes.

6. Are there any side effects?

There can be redness and swelling in the region of the tattoo and extending from the tattoo. It can feel tender like a sunburn.
True side effects are skin infections post treatment, pigment disturbances can follow treatments. Rarely, the laser process can expose allergenic components in the ink and an allergic reaction can happen. If any of these problems occur, follow up would be strongly encouraged.

7. Do I have to take any special precautions when I am doing treatments?

Please do not tan or sun expose the area if possible. It this does occur please let me know so that we can adjust your treatment schedule.
Please let me know if your health changes or if you become pregnant during your sessions.

Body contouring and Cellulite reduction

1. How does it work?

The Accent Ultra uses 2 types of energy to treat cellulite and pockets of body fat. It uses ultrasound to break the walls of the fat cells (the adipocytes). This results in the breakdown of those fat cells. The fat that was collecting in that region is released from the damaged fat cells, is collected in the lymphatic ducts, brought to the liver and broken down/excreted.
The 2nd energy applied is radiofrequency. The radiofrequency causes deep tissue heating, increased local circulation, stimulates collagen production and tightens skin.
Please view this video link for a detailed explanation:
https://www.youtube.com/watch?v=UVUmkui93v8

2. How many treatments do I need?

Most individuals need 4-6 treatments, spaced 4 weeks apart. A few individuals need up to 8 sessions.
Although excellent results are expected in most, like all areas of medicine, each person responds differently and no guarantees can be given.

3. Is it permanent?

In body contouring, if you can remain stable with your weight, then no maintenance is required and the treatment is considered complete. However, it is very important to know:
a) If you gain weight – fat cells are designed to store the excess fat. You absolutely can accumulate fat in treated areas if you put weight on.
b) You can always consume far more calories by eating than the amount of fat liberated in the body contouring session. The treatments are not a substitute for controlling your caloric intake.
In cellulite, hormonal and local circulatory factors are always active. In keeping, cellulite cannot be “cured”. These treatments are meant to reduce the cellulite.
However the processes driving the cellulite production carry on, unfettered. Thus, cellulite treatments always require maintenance. Maintenance is 1 session every 6-12 months.

4. Does it hurt?

The ultrasound phase is without any sensation, other than the movement of the probe on the skin surface.
The radiofrequency feels similar to a hot stone message. The majority of the session time is very comfortable. Some regions will heat more than others. When the probe passes over the warmer regions, it can be transiently uncomfortable for 1-2 seconds.

5. How do I prepare for treatment?

There is no special preparation. You can come from work, or the gym – in addition, you can return to your regular activities after. It is recommended that you drink 2L of water daily for 2-3 days after each session. It is important to try to avoid becoming dehydrated in the first 2-3 days after treatment, so for highly physically active people, water intake in excess of 2L is recommended, and avoiding alcohol (as it is a diuretic and causes a degree of dehydration) is also recommended.

6.Are there any side effects?

The most common side effect is 1-3 day of being a bit swollen or bloated feeling in the treatment area. The skin can sometimes feel dry after and moisturizing creams can be used liberally. Rarely, the skin can be overstimulated by the radiofrequency component of the treatment and result in a skin burn that would require extra care.

7. Do I have to take any special precautions when I am doing treatments?

Unlike the laser treatments, sun/UV exposure and skin type have no interaction with this treatment and no sun avoidance is necessary. However, with the radiofrequency – if you have a pacemaker, an ICD or other implanted electrical device you MUST NOT be treated. The radiofrequency can cause interference with these devices. If you have a large metal implant (dental, hip) in the region that we will be treating – this needs to be discussed prior to making a treatment decision. Some implants because of size and location will be safe to do treatments and others will not.

PRP for hair restoration

How do I know if I am a good candidate for PRP? Talk to your physician for a proper diagnosis and to create a treatment plan.

How many treatments are required? Treatment will vary based on your need. Initially, your provider may recommend several treatments spaced 1 month apart. After the initial treatment, many physician suggest by maintenance treatments 2-3 times per year.

Is the PRP for hair restoration process time consuming? No, collecting the PRP usually only takes 10-15 minutes. And the PRP treatment itself is even faster. It often takes as little as 3-5 minutes.

Does the procedure hurt? There may be some sensitivity. However, most physicians utilize effective anesthetic solutions, such as cold ambient air or a topical analgesic to minimize any potential discomfort. Talk to your physicians about the right option for you.

Is there any recovery time? There is no downtime or a long recovery process. You may take a warm shower the evening of the treatment. In addition, it is advised to avoid using any harsh dyes or chemicals on your hair for 48 hours.

Is this a cure for baldness? PRP is not a cure for baldness (Androgenic Alopecia). The genetic medical problem will always remain.
However, there is great evidence that regular treatments can significantly slow down the effects of Androgenic Alopecia and even works to increase hair density. Ask your provider for more details and if PRP is right for you

PRP for skin rejuvenation

What is Platelet-Rich Plasma?
Platelet-Rich Plasma, also known as PRP, is a high concentration of your own platelets in a small volume of plasma.
How does a provider harvest PRP?
Step 1: Utilizing a specialized blood collection tube from the Eclipse PRP® kit, a practitioner draws a small amount of blood similar to what is required for a basic lab test.
Step 2: The tube is then placed into a centrifuge which spins the blood at a very high speed, causing the platelets to separate from the other components of the blood.
Step 3: Once the platelets are concentrated into the plasma they can be applied to the patient. Activation causes platelets to release essential growth factors and signaling proteins, which are responsible for the wound-healing process.
How long does the PRP process take?
The blood draw takes just a couple of minutes, followed immediately by a 10-minute centrifugation. The time involved in the application varies based on which procedure is being performed
How many PRP sessions are required?
Your medical professional can create a treatment plan based on your individual needs.
Can a PRP procedure be painful?
Eclipse PRP® is close to a physiologic pH, which means the product is less likely to cause a stinging or burning sensation. There may be some temporary discomfort or possible redness and inflammation at the application site, but quickly resolves.
Is PRP safe?
Since the autologous Platelet-Rich Plasma (PRP) is produced from a patient’s own blood, there is virtually no risk of an allergic reaction or rejection.

Injectable Fillers (Revanesse Dermal Fillers)

1. The Revanesse Family of Dermal Fillers

The Revanesse family is a collection of injectable dermal fillers that are used to treat signs of aging.

The Revanesse line of products can be injected into the skin to:

• Fill in wrinkles and folds
• Increase volume
• Shape and contour facial features
• Hydrate and moisturize
• Create balance and symmetry

For added patient comfort, Revanesse products are available with Lidocaine. This combination will help to ease
discomfort during a treatment.

2. Areas of Treatment

3. The Science Behind the Beauty

The Revanesse line incorporates Thixofix® cross-linking technology, resulting in high quality, safe and long-lasting dermal fillers. The products are biodegradable and non-animal, using the highest concentration of hyaluronic acid (HA) available in the market in addition to the rejuvenating properties of non cross-linked HA.

HA is a naturally occurring sugar found in the body and facilitates the skin’s ability to retain water and stay moisturized. The absorption of water creates volume and elasticity in the skin. As aging occurs the body’s ability to produce HA is reduced. This combined withexternal elements such as sun exposure, diet, and stress causes the
skin to lose volume, sag, and develop lines and wrinkles. Repetitive movement as well as gravity can also contribute to the look of aging skin.

Revanesse products are used to temporarily add volume or fill in wrinkles and folds by injecting HA gel into the skin. The fully absorbable gel integrates naturally into the tissue and allows vital nutrients such as oxygen and hormones to continue to pass through. Over time, the body will naturally break down and absorb the HA.

4. Safety

Revanesse dermal fillers have been proven to be safe and effective.
This line of fillers is completely free of all animal products, making it safe, even for people with food and animal allergies. Revanesse products are biocompatible and biodegradable and will naturally be absorbed by the body.

The Revanesse family of products is manufactured by Prollenium Medical Technologies Inc.- a Canadian company located in Aurora, Ontario. Revanesse dermal fillers are produced in a state of the art manufacturing facility and are currently being used in over 80 countries around the world. Extensive tests are performed on all raw materials and strict in-process controls are used during the manufacturing process. As a final test, each and every syringe
is visually inspected ensuring that it is safe and effective for use.

5. Side Effects

A Revanesse treatment is generally quick and comfortable. There are very few cases where a reaction has occurred. Side effects may happen immediately after the treatment, but should last no longer than a few days.

Potential side effects at the injection site include:

• Slight swelling
• Redness
• Bruising

It is important to speak with your physician for a complete list of the potential side effects.

6. Benefits

Immediate and long-lasting improvement
Results are instantaneous, and due to the proprietary cross-linking Thixofix technology, are long-lasting.

Minimally invasive and easy to perform procedure
A Revanesse treatment is quick, simple and non-invasive. A treatment can take as little as 15 minutes to complete.

Natural looking results
The gel is smooth and very easy to inject creating natural looking results within the skin.

Safe and effective
The HA used in Revanesse is obtained through non-animal sources and is safe for medical use.

Minimal downtime
A patient is able to get back to their daily routine after a treatment of Revanesse with little to no downtime required.

Reversible
In the rare event that the patient is not satisfied with the results, the use of a simple enzyme can easily and immediately reverse a treatment.

Durability
The Thixofix cross-linking technology creates a gel that is safe, smooth and easy to inject while ensuring maximum durability and longevity.

Patient Comfort
Revanesse dermal fillers are now available with Lidocaine for added patient comfort.

7. Treatment

Before
Before a treatment, makeup and all other cosmetics should be removed to ensure the skin is clean. This can be done with an astringent or facial cleansing lotion. Using cold water will ensure that pores are not dilated. It is strongly advised to not take any anti-inflammatory drugs (e.g. Aspirin, Advil) at least 3 days prior to treatment as they may increase swelling or bleeding at the injection site. It is also recommended to avoid alcohol, fish oil, ginkgo and omegas before a treatment.

After
For the first day or so after a treatment with Revanesse, try to keep the face relaxed by not making any highly expressive facial movements and avoid any strenuous exercise. It is also important not to be exposed to extreme heat (e.g. sauna, tanning bed, etc.) for a few days after the treatment as this may reduce the longevity of the results. Unless instructed to, do not massage the injected area. Makeup can be reapplied immediately after the
treatment.

8. Proven Results

“It’s great that a procedure so easy can make you feel so much better about yourself. I’m happy with my appearance again.”
Elizabeth, 37

"Revanesse has boosted my confidence drastically. I look and feel great, and the best part is that no one can tell why."
Vicki, 48

9. Before & After Pictures

10. Canadian-Made

The Revanesse family of dermal fillers is produced by Prollenium Medical Technologies Inc.- a Canadian company located in Aurora, Ontario. Prollenium focuses its attention on the research, production, marketing, and sales of novel biomaterials that can be used in tissue reconstruction. Prollenium is highly committed to the research and development of safe and effective products.

“Our mission is to address clients’ needs through innovative products. A substantial share of our revenue is invested in research and development into novel applications of new and existing biomaterials. The goal is to ensure a steady flow of new products to the marketplace.”

Prollenium is proud to be the first and only dermal filler manufacturer in Canada. The facility employs a fully automated process in a clean room environment with sterilization, packaging, quality control and R&D taking place in-house. The facility is ISO 13485 registered as well as Health Canada and CE approved.

Femilift

1. What is Femilift?

The femilift is a laser treatment, using a CO2 laser to make small wounds in the mucosa of the vagina in order to stimulate production of new collagen. This helps to reduce the symptoms of dryness, burning, painful intercourse and general discomfort, and with some forms of stress incontinence. The laser is inserted into the vigina, as in the picture below, and the treatment is administered internally.

2. Does it hurt during or after?

No. Treatment is pain free. It is more comfortable then having a smear test.

3. How long after treatment can I have intercourse?

You'll be asked to abstain from penetrative intercourse for 3 days.

4. Will I bleed?

Bring a pantyliner to your treatment. You might have some scant spotting, but nothing heavy like a period

5. Can I have it if I have an IUD?

Yes.

6. What type of equipment is used?

The equipment that comes into contact with patients inside and outside the vagina is a single-use sterile disposable that prevent transmission of infections. The energy that is used to bring about the desired tightening effect or correct urinary incontinence is in the form of a specialized laser that induces new collagen to form in the underlying vaginal tissues. Treatment outcome is complete viginal remodeling and tightening of the vagina tissues. Treatment outcome is complete vaginal remodeling and tightening of the vagina walls with enhanced elasticity. The same kind of laser has been used for many years on the face for rejuvenation and smoothing of wrinkles.

7. Can I get an infection from the treatment?

Single used disposables prevent any risk of infection transmission. Post laser, there are small wounds which close over quickly, usually within 2 to 3 days. If you develop any discharge, pain, swelling or fever please notify your doctor.

8. If I have vaginal yeast infection, will this treatment make it worse?

No, it will not make is worse, but if you are prone to getting yeast infections, please let the doctor know and shee can discuss preventative medications with you.

9. Can I have it if i am on my period?

It is advisable not to have it during your period as the blood may interfere with the penetration of the laser into the vagina skin and make it less effective.

10. Can it irritate my cystitis?

This treatment has not been associated with any worsening of cystitis type symptoms such as increased urination frequency or burning sensation passing water.

11. I suffer from pelvic endometriosis. Can I still have this treatment?

In most cases yes. If you suffer from intense deep pelvic pain during intercourse then the gynecologist might advise against it.

12. I am on antibiotics can I still have treatment?

Yes.

13. I am having laser hair removal on my bikini line is it ok to have femilift after?

Yes.

14. I think I might have a STD, can I have Femilift?

No. You must have this evaluated completely before doing this treatment. The laser creates small wounds in the skin, and we do not want to risk exposing the open wounds to bacterial.

15. How far does the laser go?

The laser probe is inserted full length into the vagina up to the cervix about 6 - 8 cm deep. The laser light beam travels about 0.2 - 0.5 mm into the vaginal skin not very deep but deep enough to reach the level of the skin where the new collagen is formed.

16. Can you exercise straight after?

Most exercises can be continued but strenuous exercises should be avoided for 3 days.

17. How many treatments do I need for maximum results and what is the ideal gap between them?

We think that about 90% of patients will have a good response to 2 - 3 treatments. As time passes aging cause angoing progression of your issues, and maintenance treatments would be recommended. For maintenance, a single treatment every 6 - 12 24 months (depends on your personal needs) would be required.

18. Can you have a shower ater the treatment?

Yes. Please do not soak in a tub, pool or hot tub until day 3.

19. Will any form of contraception interfere - like pills or implant?

No.

20. Will this treatment help or prevent prolapse?

It may help with mild prolapse but is unlikely to prevent prolapse long-term.

21. Can I have this treatment if I had a hysterectomy?

Yes.

22. Can I have this treatment if I had previous vaginal repair surgery for prolapse?

In most instances yes. If there was any mesh used to repair the prolapsed, then the gynecologist may choose to advise against it.

23. I suffer from vaginal dryness. Will this treatment make it worse?

No. If anything it will help improve lubrication. Recent studies showed improvement in dryness caused by menopausal symptoms.

24. How long after giving birth can I undergo treatment?

After a vaginal birth, it would be advisable to wait 3 months to ensure that any scars from tears or episiotomy have had a chance to heal and the vaginal tone has recovered naturally.

25. Can I have the treatment while breast feeding?

Yes.

26. Are there any special instructions for after treatment?

Only one. Avoid penetrive intercourse for 3 days.

27. Can it hurt my clitoris?

No, the clitoral nevres are safe and are located much deeper then what the laser can penetrate into.

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