Patrick Bitter, Jr., MD, FAAD

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Importance of Pulsed Light-Based Skin Rejuvenation in the Anti-Aging Practice 18 TH Annual World Congress On Anti-Aging Medicine December 10, 2010 Las Vegas, Nevada Patrick Bitter Jr., MD, FAAD, FAAAA Los Gatos, CA Beverly Hills, CA Patrick Bitter, Jr., MD, FAAD bitterjrmd@aol.com Disclosures Equipment: None Speaker s Bureau: Sciton, Sanofi-Aventis, Edge Consultant: Scientific Advisory Board, Isagenix Stock Holder: None Foto Facial BBL Patrick Bitter Jr. MD 1

Objectives of Presentation Learn the multiple applications of pulsed light treatments and the benefit to the anti-aging practice Discuss what anti-aging practitioners should know about pulsed light therapy Learn how pulsed light therapy is being used to delay skin aging Appearance Medicine The practice of medicine that concerns the enhancement and improvement in the appearance of the patient using surgical or non-surgical therapies Aesthetic Medicine: What Our Patients Want Look Better Look Better Without Downtime Look Better Right Away Look Better Without Pain Look Better Without Surgery Look Natural Look Better without costing too much A Treatment that works Delay aging Foto Facial BBL Patrick Bitter Jr. MD 2

Facial Aging Intrinsic Extrinsic Anti-Aging Medicine: What Our Patients Want Feel Better Look Better Live Better Prevent Aging Prevent Disease Live Longer Improve sex life Improve a Chronic Disease Lose Weight Improve Body Appearance Gain an Advantage Be the best they can be Foto Facial BBL Patrick Bitter Jr. MD 3

What characterizes youth and vitality? What characterizes a youthful appearance? Foto Facial BBL Patrick Bitter Jr. MD 4

Young Skin is BRIGHT Skin A youthful face is a FULL Face Youthfulness is characterized by BRIGHT Skin and a FULL Face Total Aesthetic Wellness The key to optimal emotional, physical, mental and spiritual wellbeing is balancing six key areas in your life. Foto Facial BBL Patrick Bitter Jr. MD 5

Total Aesthetic Wellness Just like our hormone symphony is about optimizing the balance of all hormones, looking your is about balancing each of the key factors for wellness. Six Key Pieces Lifestyle -diet -exercise -sleep Skin care Regimen -sun protection -products -relationship Aesthetic Nutritional Supplements Treatments Avoid and eliminate toxins Hormone Optimization What I currently offer in my practice Nutritional Supplements Isagenix Skin care Products Osmosis Isadermix Hormone Optimization Optimal Health Labs Aesthetic treatments lifestyle Foto Facial BBL Patrick Bitter Jr. MD 6

Top Non-surgical Aesthetic Procedures* Skin Rejuvenation Face and Body (FotoFacial BBL) Non-invasive skin tightening (BBL) Combination laser treatments (MLP, ProFx, TRL) Botulinum Toxins (Botox, Dysport) Injectable Fillers (Juvederm, Restylane) Poly-L-Lactic Acid (Sculptra) Laser Hair Removal Non-surgical body contouring ProLipo (laser-assisted lipolysis) Intelligent Use of Skin Care Products *my opinion What is Broad Band Light? How Does Broad Band Light Work? Foto Facial BBL Patrick Bitter Jr. MD 7

Broad Band Light 420 515 560 590 640 695 ST Not Drawn to Scale BBLs The single most versatile and valuable technological tool bridging aesthetic medicine and anti-aging medicine Proper Technology Foto Facial BBL Patrick Bitter Jr. MD 8

Different Wavelengths for Different Indications Proper Technology FotoFacial BBL: Selective PhotoThermolysis Objective: Visible Improvement in all elements of aging skin non-invasively using Pulsed Optical Energy Foto Facial BBL Patrick Bitter Jr. MD 9

FotoFacial BBL Indications Photodamage Rosacea Erythema and Flushing Dyschromias Non-Facial Photodamage Non-Facial Erythema and Flushing Inflammatory Acne and Acne Scars Fine lines and wrinkle reduction Large pores Skin Health Maintenance Anti-Aging Skin Cancer Prevention Broad Band Light (BBL) Indications Skin Rejuvenation of Photo-aged skin Non-Facial Skin Rejuvenation Erythematous-telangiectatic Rosacea Inflammatory Rosacea Erythema Flushing Dyschromias Inflammatory Acne Hair Removal Broad Band Light (BBL) Newer Indications Post-laser Erythema Erythematous Scars Hypertrophic Scars Striae Post-sclerotherapy Hemosiderosis Non-invasive Skin Tightening Non-Ablative Wrinkle Reduction Correction of IPL-Complications Foto Facial BBL Patrick Bitter Jr. MD 10

Broad Band Light (BBL) Innovative Uses Skin Health Maintenance Delay Skin Aging Post-injection Purpura Skin Cancer Prevention? BBL Rejuvenation of Vascular Skin Conditions FotoFacial BBL for Rosacea untreated treated BBL face before and after five treatments Foto Facial BBL Patrick Bitter Jr. MD 11

FotoFacial BBL for Rosacea untreated treated BBL face before and after five treatments BBL Rejuvenation of Photo-aged Skin Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia FotoFacial BBL three treatments Foto Facial BBL Patrick Bitter Jr. MD 12

Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia Before and After 3 Treatments Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia Before and After 3 Treatments Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia Before and After 3 Treatments Foto Facial BBL Patrick Bitter Jr. MD 13

Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia Before and After 3 Treatments Photo-Rejuvenation with FotoFacial BBL and MLP Dyschromia Skin type IV untreated treated MLP of spots followed by BBL three weeks later before and after one treatment at four weeks FotoFacial BBL Photo-Rejuvenation Dyschromia Skin type IV untreated treated MLP of spots followed by BBL three weeks later before and after one treatment at four weeks Foto Facial BBL Patrick Bitter Jr. MD 14

FotoFacial BBL Photo-Rejuvenation Dyschromia Skin type IV untreated treated MLP of spots followed by BBL three weeks later before and after one treatment at four weeks BBL Rejuvenation of Pigmentation and Dyschromias including Melasma FotoFacial BBL Photo-Rejuvenation Dyschromia Skin type IV untreated treated BBL face before and after one treatment Foto Facial BBL Patrick Bitter Jr. MD 15

FotoFacial BBL for Rosacea untreated treated BBL face before and after five treatments FotoFacial BBL Photo-Rejuvenation Resistant Melasma Skin type IV untreated treated BBL face before and after one treatment FotoFacial BBL Photo-Rejuvenation Resistant Melasma Skin type IV untreated treated BBL face before and after one treatment Foto Facial BBL Patrick Bitter Jr. MD 16

IPL and Poly-L-Lactic Acid Two months post two vials at one session Adding volume for a more youthful face age 45 IPL and Poly-L-Lactic Acid 4 vials over 3 sessions Adding volume for a more youthful face Age 62 BBL Rejuvenation of Photo-aged Non-Facial Skin Foto Facial BBL Patrick Bitter Jr. MD 17

FotoBody BBL BBLTreatment of non-facial photoaged skin Rejuvenation of Non-Facial Skin with IPL Before After Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia Before and After 3 Treatments Foto Facial BBL Patrick Bitter Jr. MD 18

Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia BBL treated hand before and after five treatments FotoBody BBL BBLTreatment of non-facial photoaged skin After three treatments using BBL 515 14/10/15 FotoBody BBL BBLTreatment of non-facial photoaged skin After three treatments using BBL 515 14/10/15 Foto Facial BBL Patrick Bitter Jr. MD 19

Rejuvenation of Photo-aged Skin with Combination BBL and SkinTyte Rejuvenation of Photo-aged Skin with Combination BBL and SkinTightening Maximizing Results for laxity and wrinkles for non-ablative, no downtime treatment Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia Foto Facial BBL Patrick Bitter Jr. MD 20

Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia: FotoFacial BBL/SkinTyte Combo Treatment BBL and ST treated half of face before and after two treatment Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia: FotoFacial BBL/SkinTyte Combo Treatment untreated treated BBL and ST treated half of face before and after two treatment Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia BBL and ST treated half of face before and after two treatments Foto Facial BBL Patrick Bitter Jr. MD 21

Non-ablative Skin Tightening with BBL SkinTyte Goals of Skin Tightening Visible firming and smoothing of lax and wrinkled tissue Indications for Skin Tightening Areas most amenable to visible improvement: - Sub-mental neck - Lower face and jowls - Along mandible - Malar cheeks and lower lids - Posterior arms - Lower abdomen - Crepiness of cheeks and neck - Wrinkles of upper lip and chest Foto Facial BBL Patrick Bitter Jr. MD 22

Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia BBL and ST treated half of face before and after three treatments Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia BBL and ST treated half of face before and after two treatments Non-Invasive Photo-Rejuvenation Photo-damage/Dyschromia BBL and ST treated half of face before and after two treatments Foto Facial BBL Patrick Bitter Jr. MD 23

BEFORE / AFTER 1 tx courtesy of Gloria Lopez, MD Non-surgical, non-invasive skin tightening 70 2009 Sciton, Inc. All rights reserved. 2600-033-18 Rev. A B&A ST BEFORE / AFTER One month post 1 tx courtesy of Michael McCall, MD Parameters: 40 J, 5 s, 15 C, 2 s post-cooling 71 2009 Sciton, Inc. All rights reserved. 2600-033-06 Rev. B B&A ST BEFORE / AFTER 1 tx courtesy of Gloria Lopez, MD 72 2009 Sciton, Inc. All rights reserved. 2600-033-69 Rev. A B&A ST Foto Facial BBL Patrick Bitter Jr. MD 24