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Performing the Different Types of BBL (And What You Should Know About Them)

May 2024

Aesthetic devices are tricky to figure out for a lot of practices. There are so many viable options on the market that figuring out which one you should invest in often comes down to a host of different business considerations.

Broadband Light, or BBL, is one that practices often find themselves landing on because of its ability to treat a vast array of concerns with a single machine. Whether you are a brand new aesthetic practice or a seasoned vet, there is typically always some reason why adding a BBL machine to your lineup could be beneficial.

Unfortunately, BBL’s biggest strength – its versatility – is also its biggest point of frustration for its users. We have seen plenty of highly capable medical aesthetic practices struggle to figure out why their BBL results simply aren’t adding up to what they see achieved in other practices. There are also many clinics that get great results but aren’t able to use the device to its full capacity. After all, BBL was originally used to provide general correction to the face, but now, there are other modalities like Forever Young BBL, a protocol developed by Dr. Patrick Bitter, and BBL HERO that convolute the best practices and make things even harder to perfect and, frankly, understand. We’ve provided countless offices with practical in-person training on how to operate the BBL device, and we’ve even developed an entire virtual training program that covers every aspect of BBL implementation, from marketing to hands-on technique. But, understanding the differences in the types of BBL treatment – specifically between the traditional corrective, Forever Young, and HERO – still pose some of the biggest hardships to practices, so we’ve decided to break down some of the key approaches and techniques for each type. Here’s the basic rundown: BBL therapy uses high-intensity light to induce regenerative changes in the skin. This particular approach is particularly effective for general tonal correction, addressing issues such as uneven pigmentation, light scarring, and general skin dullness. Many people already know this much, though, so here is some more advanced information for you to consider.

You Should Tailor Your Treatment to Each Skin Type

Your first step prior to any BBL treatment should always be to assess your patient’s Fitzpatrick Skin Type. This classification helps predict how the skin reacts to UV light, which is critical in setting the energy levels of the BBL device. 

As a general rule of thumb, Fitzpatrick Types I and II (lighter skin) can tolerate  higher energy levels. Types V and VI (darker skin) require more conservative settings and need careful handling to avoid hyperpigmentation, burns, and blisters. While skin color plays a part in the Fitzpatrick scale, it is not safe to determine settings based on the skin alone. For example, Asian skin generally presents lighter. This is due to the fact that Asian cultures tend to prioritize skin protection although they still have a strong ability to tan. Avoiding sun exposure keeps the melanin deep within the skin instead of bringing it to the surface. Considerations like eye color and natural hair color can give more accurate indicators of the most appropriate Fitz type to select. . It is critical that you tailor the treatment specifically to how your patient’s skin is reacting to treatment. We love to ask the question, “When you were a teenager, trying to get a tan, how quickly did you burn?”  This question is great because it does not reflect on their skin practices now which may affect the quality of the responses you receive. Yet, teenagers rarely wear sunscreen and find themselves in high sun exposure often in the summers. This question causes the client to stop and think about the answer. If they developed a sunburn within an hour, they would typically fall into Fitz I or II. Fitz III’s have to think for a minute, and usually respond with something along the lines of: “Oh, I don’t know, maybe a few hours, but only at the beginning of summer.” Around Fitz IV, patients state that they did not tend to burn. This question gives us a great place to start when choosing the safe start settings, and then we are watching how the skin responds to see if we need to adjust the fluence, pulse-width or temperature throughout the treatment.

It’s important to note, if a client falls between two Fitz types, always assume they are a higher Fitz type. This will give you safer start settings that can then be adjusted specifically for the client  as you see how their skin responds to the treatment, to ensure we are achieving clinical endpoints.

Corrective BBL

Corrective BBL alone is simply correcting only the reds and the browns in the skin. A corrective treatment may be used when combining with another modality such as HALO or Moxi. You may choose to do corrective only in this case due to the topical numbing cream. To avoid decreased efficacy of the numbing, you will want to quickly and efficiently complete the BBL to maintain as much numbing as possible for the more intensive fractional device.

Forever Young BBL

Forever Young BBL steps beyond the traditional concept of corrective broadband light treatment. While BBL technology provides a wide range of applications, FYBBL — as you may or may not know — is a specialized protocol developed from a Stanford study that uses BBL to directly combat the visible signs of aging. As you begin FYBBL, don’t neglect the importance of strategic passes along the skin. There are three intentional passes you should be making:
  1. Base Passes: Prepares the skin by heating the upper layers, making it more receptive to subsequent treatment. This step requires two total passes throughout the entire treatable area. The entire point of this treatment is to get a base understanding of how the patient’s skin will react to the treatment.
  2. Correction Pass: Targets specific skin concerns, such as pigmentation or red spots, by adjusting the wavelength and intensity of the light.
  3. Skin Tightening Pass: Focuses on improving skin elasticity and reducing the appearance of fine lines and wrinkles. (You will need access to SkinTyte in order to do this pass, but you could also use HERO, which is becoming a much more common way to conduct the skin tightening phase.)

Forever Young BBL Is Performed in Three Steps

The Forever Young process consists of three meticulously designed steps (similar to what we see in corrective treatment), the first of which is skin preparation and collagen stimulation, where gentle passes of light energy at a lower setting are applied to the skin. This controlled energy warmly stimulates the deeper layers of the skin, triggering the natural production of collagen. This entire step of the treatment should only take about five minutes. In this step, it is best to take a conservative approach to your settings — find the Fitzpatrick scale number that best fits and feel free to use the settings that the machine automatically gives you. When you feel comfortable with the patient and with the setting of the device, then you can adjust the settings to be more aggressive for the best possible results. (Another pro-tip: when you feel comfortable with the mechanics of your device, set it to fire at one-second pulses so you can avoid using the foot pedal every time you want a pulse.) 
Video of first step, taken from “Forever Young” video

The second step is targeted correction. During this stage, the energy output is increased for a more focused treatment, which means this is where you will notice some of your patients experiencing discomfort. You should always pay attention to your patient’s expressions and mannerisms — if you see clenching, breath holding, or other signs of struggle, make sure to open up a dialogue about the pain with them (and make adjustments as necessary).

You can always reduce the rate of the light pulses or bring energy levels down to reduce pain. In most cases, we recommend shooting for a pain level of about 4 to 5 out of 10 for treatment, which is aggressive enough to provide powerful results without causing too much discomfort. 

The light now precisely targets specific areas of concern, such as hyperpigmentation (sunspots, age spots), broken blood vessels, and uneven texture. The light energy breaks down unwanted pigment and diminishes the appearance of redness, two factors that cause a face to appear aged.

Remember, if the changes are not happening on the table, it is likely that the result is going to be underwhelming for the patients. Here are a couple of indicators of endpoints:

  • Browns in the skin should get darker and erythema should be noted around each lesion. 
  • Reds in the skin should darken and the heat needs to hold.

Video of second step, taken from “Forever Young” video

The third and final stage is skin tightening, and it employs unique filters that are designed to further stimulate collagen production and trigger the natural healing response. This concentrated light energy creates additional warmth within the skin, enhancing firmness and providing a subtle lifting effect. 

Your goal is to generate heat throughout the skin layers which can cause some stinging, but there should not be pain. Allow the patients to tell you what they are experiencing so you can adjust accordingly. They should be able to tell you as their skin goes from cool, to warm, to hot so that you can release light into the skin at a rapid pace.

(If you are using a thermometer, you will want the skin to reach between 38 and 42 degrees celsius to achieve the most effective conditions.)

The trick in this step is to keep moving your device quickly along the face, getting each section of the skin to its ideal heating point three times, allowing the “off” zones to cool. This means you will deliver about three passes on each zone. 

Video of third step,  taken from “Forever Young” video

HERO

Understanding the mechanics of your device is important for any treatment or modality, but for HERO specifically, it is incredibly important to understand the definitions of these five concepts, as well as their relationship to one another:
  • Wave Length — How deep the energy is applied to the skin. The most common choices are 590, 560, 515. Remember, the deeper the wave length, the safer the setting.
  • Fluence — The amount of energy being applied to the skin, measured in Joules.
  • Pulse Width — How fast the energy is applied to the skin, measured in milliseconds.
  • Speed —The number of pulses delivered per second. (Newer providers may choose to deliver one or two pulses per second, while experienced providers may prefer to deliver up to three pulses per second.)
  • Overlap  10% overlap between pulses is the goal. This amount allows for consistent treatment zones, while more than 10% increases the risk of branding or burning and less than 10% increases the risk for untreated tissue and inconsistent results.
When you understand these concepts, becoming proficient or advanced in BBL HERO treatment becomes much easier. 

HERO Requires Three Slightly Different Steps

In both the corrective and Forever Young versions of BBL, the first step is usually one or two passes through the skin to increase the temperature to prepare for the more intensive steps. But, when it comes to HERO, this first round of passes is really determined by the patient’s complexion. When treating a patient without rosacea, pigment lesions, or other factors in their complexion that would generate additional energy, you can do four passes in the first step and not worry about overtreating or developing blistering or bruising.  When treating patients with rosacea, pigmented lesions, or other conditions that increase skin coloration (and consequently heat generation), you might consider performing two passes in the initial step, following a method akin to the Forever Young protocol.  The second step is the corrective phase of the treatment, where the focus is to specifically address all pigment and vascular irregularities present in the skin.  The third step involves additional HERO passes which utilize lower energy delivered more rapidly at higher temperatures. This final stage is designed to maximize the penetration of light energy into the tissue. However, if clinical endpoints are achieved during the second step, and further energy application risks complications, the treatment should be concluded before this step.  A successful outcome in most cases is indicated by darkened brown lesions with noticeable erythema and intensified red areas that retain heat, ultimately resulting in a pleasing aesthetic improvement.

Want More Education?

Everything covered in this piece was taken from a small portion of the total amount of education we can provide on BBL. If you want to know more about BBL — such as setting up a treatment room, working through a consultation, proper end points and results goals, or how to market the treatment and increase your revenue, check out our e-course on BBL Photo Rejuvenation We also have an amazing podcast episode further explaining the differences between the types of BBL. You can listen to Episode #24 – Understanding BBL, FYBBL, & HERO here If you are interested in learning more about the other types of education you can get access to, head over to our  Online E-course catalog or virtual training. There, you can find dozens of helpful resources tailored specifically to medical aesthetic practices looking to level up their services, marketing, or operations. Whatever path you choose, we are excited to be here to help guide you through the process.