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  • Misaki - Guide to Sensitive Areas**Update 4 July 2011**
    Will eventually rewrite this review using long-term results. Using too few pulses will lead to no reduction in hair growth, or at best thinner hairs, because insufficient heat was absorbed to destroy all hair-producing cells, even if it was enough to weaken the hair root allowing the hair to fall out. Growth might be slow, but eventually the hair will grow back.

    To prevent this from happening, it is essential to use enough pulses to completely remove the hair follicle on the first try, since later passes in the months following will both consume a large amount of time, and will have lower chances of success if the hair has become thinner. This means knowing how many pulses are enough to simply make the hair fall out, and then exceeding that number to ensure the follicle is completely destroyed. To gather this data, the original suggestion of epilating prior to using TRIA should not be followed, since the best way to check if TRIA is working is to use tweezers, or even your fingers to check if the hair can be easily removed several seconds after finishing the series of pulses.

    By far the most significant factors in applying enough heat to the follicle are wetting the skin, which both provides cooling from evaporation and also moderates the temperature increase of the outer skin surface preventing burns; cooling with ice, beforehand and possibly between TRIA pulses; and applying all pulses to a specific hair follicle in rapid succession, instead of moving away from the area and later returning multiple times to overlap coverage. Heat dissipates very quickly from a hair to the surrounding area, but the follicle only needs to be at a high enough temperature for a few moments. Also, work in patches since this method is very slow and the lack of progress can be discouraging without a visible contrast between completed areas.

      - The relatively thick hairs found in particular areas can be removed with no resistance with as little as 1~2 full-power pulses, but to prevent regrowth this number needs to be increased. I am currently testing having used 3~4 pulses in rapid succession, with both ice (which cools the follicle as well) and wetting the skin (which mainly prevents burns).
      - For legs, applying pulses in overlapping lines (moving about half the diameter of treatment window after each pulse, so each follicle receiving 2~3 pulses during a pass) lead to significant reduction of growth for several months, but many (40~70%) regrew at a similar or thinner width. A thinner hair just means more pulses are needed to remove it again, if it can be removed at all. Currently testing 4~6 pulses in rapid succession with ice beforehand and wetting the skin, which seems to be enough to remove most hairs in the correct growth phase (thinner hairs that aren't growing and don't hurt when lasered are just pulled out after several pulses to avoid confusion and wasting pulses).
      - For arms, while hairs are smaller than on legs they are comparable in size to the thinner hairs that result from insufficient pulses on legs. While I have tried to do arms several times, ranging from several pulses on power 4 (out of 5) with cooling to a full-power pulse with no cooling to 2 pulses per hair without cooling, this significantly underestimated the number of pulses necessary for hairs of this size. Now have several test patches, which required as many as 6~8 pulses (with cooling prior and once during) for the targeted hairs to be easily removed with no resistance.
      - Armpits/underarms: Several attempts for the entire areas. The hairs might have reduced in size, not sure since nothing to compare them to, but the technique used simply did not apply enough heat, and overlapping coverage just caused pain because there was too much time to dissipate heat between passes. The method of testing ease of removal seems to be the most reliable way to know how many pulses are needed, but currently for me other areas have priority.

    It is easy to vastly underestimate how much time may be needed to permanently remove hairs using the TRIA! Using just 1~2 pulses at full power may take a moderate amount of time comparable to say epilating, but this will be completely ineffective at permanently removing hairs, much less when judging based off the smaller amount of time to cover an area at a lower power setting. Test the effectiveness by pulling out a representative hair after using TRIA on it, or risk having to do the same area again (having fewer hairs in the 1cm window does not mean it goes faster!) using even more pulses per hair a few months later when the hairs in that area regrow!

    Hairs using a smaller number of pulses have taken significantly longer to regrow than from epilation (2 months as opposed to 3 weeks) and are thinner than before, but the area still has to be redone. If this regrowth can be prevented by increasing the number of pulses, this review will be updated and condensed to reflect that result.

    **end update**
    Original review:

    First and foremost: some pain is necessary, but most pain is unnecessary!

    Whether or not the TRIA laser is effective depends on several factors—
     ‣ The colour of the skin and hair, but also...
     ‣ Depth of the hair follicle from the skin surface.
     ‣ Size of the follicle.
     ‣ Width of the hair at the surface.
     ‣ Number of hairs within the area of the treatment head (hair density).

    If enough laser light is delivered to the hair follicle within a small enough amount of time, it will heat up to the point that the hair follicle is destroyed. The two main reasons that this temperature is not reached are the sections of hairs at the surface of the skin heating to the point of causing localized damage, or a general rise in temperature of the entire area of skin being treated to the point that damage results.

    The second effect can be mitigated by cooling the skin and continuing to direct laser pulses towards the follicle; but the first, of damage at the surface around hairs, can only be addressed by removing the hairs to prevent them from absorbing laser light at the skin's surface.

    According to the instructions epilation should be avoided for 4~6 weeks prior to the first use of TRIA laser. This may be fine for those with the most ideal skin tones, since most of the laser light can reach the follicle and hairs that are slightly visible after shaving help guide where to use the laser. Those who do not have ideal skin tones should consider the following on whether to epilate prior to TRIA laser use:
     ‣ Is the area of skin being treated darker than other areas of your body?
     ‣ Do the hairs come straight out, or are they slanted making the roots closer to the skin surface?
     ‣ How thick are the hairs at this location?
     ‣ How dense is the hair growth?

    All of these combined, on if you should epilate can be answered with one simple result from using the TRIA laser: It hurts!! And what's more, even if you withstand a full treatment of the area, it will have virtually no effect since not enough light is reaching the follicles despite a similar intensity working perfectly fine to remove hair on other areas of your body. This is what tells you of the need to epilate that area for TRIA to work.

    My own experience:

    Tried TRIA on lowest setting and it hurt so much I waited for a satin smooth res-q pain relief product to arrive.

    After an hour with a very generous coat of 4% lidocaine product applied, the area felt somewhat numb and the pain was almost bearable for a moderate power setting with the TRIA laser. However, despite the overall temperature of the area of skin feeling very warm and pain relief cream to the point that a tiny amount seeped inside the treatment head to the other side of the transparent window forming a small, clear yellow spot, the pain was still intense and despite using the entire battery charge with a power setting of 3~4 and repeating areas as dictated by the instructions, there was no noticeable reduction in hair growth except at the very edges of the area where hairs grew slanted with the roots close to the skin's surface.

    What did happen, was it seemed oil glands opening on to the hair shafts had been damaged by the intense heat flux, causing a crusty residue around the hairs and other signs of damage to the skin immediately surrounding each hair! And yet a week later, those same hairs had seen no reduction in growth rate.

    Next: using cold water to cool the skin, without the pain relief product, to try to focus the effect of TRIA laser on the roots of the follicles. Another full battery charge later, surprisingly with the same amount or less pain due to the numbing action of cold on surrounding nerves, there was again no noticeable reduction of hair in that area.

    Finally resolving to try epilation again, which has problems in similar situations of relatively thick hairs and dense growth except with the added complication of skin tautness being needed to prevent additional (unnecessary) pain. It may even be necessary to use tweezers, which may take several hours but as you'll see it's worth it...

    The next attempt was two days after epilation. It still huuurt, even with absolutely no visible hair growth, even while using ice to numb the entire area! Then again another two days after that. The result as seen several weeks later...
     ‣ 95% reduction of hairs rate on areas of 2~3 pulses on maximum power average coverage.
     ‣ 60% reduction of hairs (uneven) on areas of 1.5~2 pulses on maximum power, due to bending to reduce the amount of pulses needed to cover the area, instead of trying to stretch the skin to bring roots of the follicles closer to the surface of the skin.

    On a different area with similar hair density, overlapping coverage of 2~3 pulses on cooled skin, one day after epilation, has lead to approximately 90% reduction of hairs at that area four weeks after a single session of TRIA laser, despite that the skin was actually slightly too dark to register as green on the skin sensor compared to skin tone of the surrounding areas. An agonizing session a week beforehand had lead to practically zero reduction of growth and even a slight burn due to over-application of laser light >.< Even when using ice to cool! A nearby region with slightly less dark skin (registering green on sensor) with slanting hairs and follicles close to the surface and equivalent density seemed to not have resulted in significant reduction prior to epilation, but a month afterwards that particular area is down 60~80% from normal (patchy) despite not having gone over that area a second time, but this unexpected result was due to the direction of hair growth allowing much more of the light to reach the hair roots instead of just being absorbed at the surface.

    So as you can see, if you are accustomed to epilating before making the choice to invest in the TRIA laser, don't hesitate to do so one last time several days before using the TRIA on an area with relatively small follicles such as the leg, or the day before or even the day of for areas with somewhat larger hairs like the delicate zone. You will probably not have a reason to do so later on as identifying single hairs will become the focus instead of broad swaths of laser pulse application.

    Other things to keep in mind:
     ‣ While using ice to cool the entire area does reduce pain, it also increases the number of pulses that must be applied per unit area.
     ‣ A momentary touch from ice or another cold object can cool the skin surface enough to keep it from being damaged for those with darker skin tones, while not propagating deeper within the skin before the destruction of the hair follicles can occur from repeated laser pulses.
     ‣ Just like with electrolysis, when the follicle is destroyed the resistance of the hair to being pulled out weakens drastically. If a hair doesn't do this when you apply the usual number of pulses, try tweezing it out and you'll probably see the hair narrowing as it approached the follicle and a pale dot at its end, which didn't absorb sufficient laser light to die and means the hair was in the wrong growth phase.
     ‣ Aim for the root of the follicle! When cleaning up isolated hairs on your legs this depends on the sub-surface hair length for slanted hairs. May help to not shave for several days so you can see which hairs are still growing.

    **First Update, 22 May 2011**: minor regrowth in a few areas, though I still haven't finished legs. 3~5 full-power pulses on a single hair takes a while if you're not dedicated, even if it is mostly permanent. If it's hairs in the same place that appear instead of vellus hairs converting due to hormones, it's probably because part of the follicle didn't receive enough heat. Be generous and give an extra laser pulse more than what's necessary for the hair to simply fall out, to make sure enough heat reaches all of the epithelial cells of the hair matrix. Otherwise the tiny hairs that result could be impossible to laser away, though other methods might work. If you are trying to completely remove even the smaller hairs, be sure to appropriately increase the number of pulses according to size of the hairs being treated as a smaller hair root both absorbs less heat and dissipates it more quickly between pulses. However, if you have experienced pale dots on skin from loss of melanin, you might want to just accept that small hairs might remain where larger ones were. I checked one tiny hair stub on my leg that had not fallen out, and attached to its base was a tiny new hair much smaller than the original, due to the hair production cells which did not receive enough heat when the area was treated.
  • zattack "-Z" - Improving on an already great bookNo errata so far, if you are waiting for errata, you can keep waiting. The authors gave me and about 3000 other students a chance to edit the 2013 edition for a couple months before its release in Jan 2013. I can tell you that the editing box was riddled with comments and suggestions that they took to heart. The comments and changes resulted in what I believe to be the best first aid yet, a first aid that conveys the information more concisely without the extra book of errata that accompanies the 2012 FA.

    Other notes:

    Addition of more information to supplement such as a drug tox chart and other things that are really high yield.

    The embryo section was split into organ systems

    I strongly urge you to buy this book if you are studying for step 1. I believe it an essential part for those few months we have to study.

    Im going to get back to it. Good luck everyone!