01Title

• Welcome, housekeeping, course structure: theory slides, then practical at the machine, then assessment and sign-off.

02Learning objectives

• Read the twelve quickly — they map to the sections that follow.
• Tell the group there is a knowledge check and a practical assessment at the end.

03What is CO₂ laser resurfacing?

• 10,600 nm is very strongly absorbed by water, and skin is mostly water — the energy is used up where it lands and vaporises a microscopic column (ablation).
• Step 2: the tissue around the column is heated but not removed (coagulation). This controlled injury is what starts the healing response and collagen remodelling.
• Step 3: a longer pulse gives heat more time to spread, so the heated zone gets wider. This comes back on the Duration slide.
• Depth comes from energy and duration, not wavelength.

04What is fractional resurfacing?

• Fractional does not treat every part of the surface — it treats small columns and leaves skin between them intact.
• The untreated skin re-surfaces the columns in days, which is why healing is faster than full-field.
• Depth and density are set on the machine — covered in the machine controls section.

05How does CO₂ affect the skin?

• Vaporises targeted tissue, creates controlled thermal injury, triggers wound healing and collagen remodelling.
• The surface heals in about a fortnight; collagen keeps remodelling for 3–6 months. Assess results then, not in the first weeks.
• Walk the "depends on" row — every item is something the practitioner either assesses or controls.

06Indications

• "Selected" matters — CO₂ may be used for these, not always.
• Pigmentation in particular needs care, especially in darker skin (next slides).
• The five-part check at the bottom comes back on the insurance and scope slide.

07Contraindications

• Left: the trainer's list. Right: specific examples from the training manual.
• Isotretinoin: impaired healing and scarring risk — 6–12 months is the manual's window.
• Caution cases (adjust, delay or get clearance): history of PIH, smokers, immunosuppression, recent peel or laser, photosensitising medication.
• If in doubt, don't treat — and document why.

08Fitzpatrick skin type

• The scale is about UV response (burns vs tans), not just how skin looks — ask the questions.
• Darker types have a higher risk of post-inflammatory hyperpigmentation and other pigment changes after ablative resurfacing.
• A tanned type II behaves like a type IV. V–VI means "carefully", not "never".

09Consultation

• Walk the form, not the slide — this list is the consultation form.
• Cold-sore history triggers antiviral cover (prescriber) — see client preparation.
• Tanning and recent sun change the risk (Fitzpatrick slide).

10Client expectations

• Most dissatisfaction comes from expectations, not technique.
• Script: "most clients see a clear improvement; it takes several sessions and a few months to show."

11Informed consent

• Show the actual consent form here.
• Consent is specific: a new area or a different treatment needs its own consent.
• No signed consent, no treatment.

12Patch testing

• Discrete area, e.g. behind the ear or along the jawline, with the planned settings.
• 24–48 h minimum comes from the training manual — confirm it matches AW3 / workplace policy.
• Record it exactly like a treatment.

13Pre-treatment checklist

• This is the practitioner's checklist on the day. Client preparation is next.

14Client preparation

• Prep is mostly about not arriving with reactive skin — tanned, peeled, freshly waxed or on actives.
• Numbing (clinic cream ~1 h before, or a nerve block by a clinician) is the clinic's call. Warning signs of a reaction to the numbing cream: dizziness, ringing ears, metallic taste, feeling unwell.
• Cold-sore history → prescriber arranges antiviral cover. Don't stop prescribed medicines without the prescriber.

15Laser safety

• Eyewear must be rated for CO₂ (10,600 nm) — eyewear for other lasers is not interchangeable.
• Smoke evacuation: the plume carries debris and viral particles — keep the evacuator within ~2 cm of the site (training manual).
• Metal corneal shields for periorbital work.

16Treatment room

• Do the room check at the machine during the practical.

17Infection control

• The skin is open for days after treatment — infection is one of the main complications.

18Treatment planning

• Same numbers on a different machine do not mean the same effect on the skin.

19CO₂ treatment parameters

• Left is the generic list from any CO₂ course; the middle column is what it is called on this machine.
• Ranges are machine limits, not recommendations.

20The treatment screen

• Point at the real screen while this is up — the layout matches.
• The top box is calculated: Point energy and Enveil come from the rows below.
• Select a row (it turns dark), then ▲ / ▼ to change it.
• Standby → Ready enables firing. Memory 1–5 + Save stores settings. Shape / preview is shown at the machine.
• Impulse mode (non-scanning single spot) is a separate branch, not used in these protocols.

21Point energy = power × duration

• The pulse is a block: height = power (W), width = duration (ms), area = point energy (mJ).
• Steps: 15 × 1.0 = 15 mJ (anchor) → 15 × 1.4 = 21 mJ (cheeks) → 18 × 1.5 = 27 mJ (scar).
• Duration is how long each pulse lasts; longer = more heat spreads.
• Interval is the gap between pulses — 1.0 ms in every preset. Range 1–6000 ms.

22Distance controls density

• Distance is the dot spacing. Enveil is the machine's density number for it.
• 2.5 mm → 10 % · 2.0 → 12 % · 1.0 → 25 % · 0.5 → 50 % · 0.2 → 100 % (dots overlap — full-field).
• 10–12 % for most treatments, 25 % is strong, 50 % maximum — only for a single small scar.
• Curiosity: the screen shows Enveil ≈ 25 ÷ distance, rounded down.

23Treatment technique

• Handpiece perpendicular to the skin, consistent contact.
• Times 1: place, fire, move — avoid overlapping squares. Times > 1: keep moving.
• Demonstrate at the machine.

24Starting presets by area

• Each click changes the preset; rows that changed turn orange.
• 1 · Superficial, forehead — matches the photographed screen. 2 · cheeks — longer duration. 3 · stronger — longer and closer.
• 4 · painting — Random × 20, keep the handpiece moving. 5 · mild rejuvenation, skin type III — Random × 12. 6 · scar — higher power, 27 mJ.
• Pass = the operator's passes over the area (1 in every preset); not a screen field.
• Starting points only — adjust to skin type and response.

25Expected immediate response

• Intensity-dependent. Pinpoint bleeding is normal with deeper settings.

26When the response is not expected

• Severe pain is never "part of the process".
• Grey or white areas and large blisters suggest too much heat — stop.

27Aftercare: day 1–2

• Cool packs always wrapped. Bland healing ointment with clean hands. Sleep with the head raised.
• Swelling can peak on day 1–2, especially around the eyes. Bronzing is micro-crusts, not a burn.

28Aftercare: day 3–7

• Peeling must happen on its own — picking causes scarring and pigment problems.
• Make-up only once fully healed (usually after day 7).

29Sun protection

• SPF goes on once the surface has closed (typically day 5–7). Before that: avoid sun, hat, shade.
• The training manual advises strict protection for at least 8 weeks — new skin pigments easily.

30When to contact the clinic

• Give a printed aftercare sheet — verbal aftercare is forgotten by the car park.
• NHS 111 when the clinic is closed.

31Treatment intervals

• Source: training manual — 30–45 days for general resurfacing, 45 days for scars; acne scarring typically 3–5 sessions (say this verbally, never as a promise).
• Confirm these match AW3 protocol for this machine before teaching them as fixed numbers.

32Possible complications

• PIH is most common in darker skin and usually appears 2–4 weeks after treatment.
• Hypopigmentation is rare but can be permanent — more likely with aggressive settings.
• Redness beyond 2 weeks with hardening can signal scarring — refer.

33Managing an adverse reaction

• Walk the nine steps in order. Show the incident form.

34Clinical photography

• Same room, same light, same distance every time — otherwise before/after comparisons mean nothing.

35Record keeping

• Record every parameter from the screen, including Times and scan mode.
• Records are the practitioner's protection as much as the client's.

36Professional responsibilities

37Insurance and scope

• Ask the insurer in writing, naming the treatment and the machine.

38Practical assessment

• Explain how the practical will be assessed before starting it.

39Knowledge check — answers

• 1 · About 10,600 nm.
• 2 · Treating microscopic columns and leaving the skin between them untreated, which speeds healing.
• 3 · It predicts the risk of pigment change (PIH) and guides how conservative the settings must be.
• 4 · e.g. medication, allergies, cold-sore history, scarring/keloid history, recent sun or tanning, previous laser, current skincare, expectations.
• 5 · Informed, voluntary, specific to the treatment, obtained before treatment, documented.
• 6 · e.g. prolonged redness, infection, burns, PIH, hypopigmentation, scarring, cold-sore reactivation.
• 7 · Power, duration, spot and density behave differently between devices — the same numbers do not give the same effect.
• 8 · Eyewear rated for 10,600 nm for everyone in the room; eye shields near the eyes; gloves/PPE per infection control; smoke evacuation.
• 9 · Picking, heat and sweating, sun, make-up before healing, actives (retinoids, acids).
• 10 · Stop, make safe, follow the incident procedure, first aid within competence, seek help, inform, document.

40Practical scenario — model answer

• No — postpone until the tan has faded (recent tan = higher PIH risk).
• Ask about medication, previous treatments, skin type before the tan, healing history.
• Cold sores: prescriber arranges antiviral cover before treatment.
• Expectations: improvement, not removal; several sessions; results over months.
• Patch test; conservative settings; document the consultation, advice given and consent.

41Key takeaways

• Walk the chain left to right — it is the whole course in one line.

42Questions and sign-off

• Take questions, then move to the machine.
• Practical checklist: CO₂-rated eyewear for everyone, smoke evacuation, Standby → Ready, save the anchor preset to slot 1, patch-test demo, supervised firing.