Laser Rosacea Treatment

Long-pulsed Nd:YAG laser (VersaPulse®)

This laser system is also for vascular lesions and has proved very effective in removing such complaints as facial flushing, redness, broken capillaries, telangiectasia, pronounced (Teel-ann-ject-AZE-yah) which are purple or blue veins on the face, and hemangiomas which are sacks of red, purple or blue blood vessels resembling a blister, also known as strawberry hemangiomas and more.

Long term results are unknown.

Approximate Cost: dependant upon area and practice

Eximer laser (including XTRAC™)

This system is the first FDA approved lasing system beneficial for those who suffer from vitiligo and psoriasis. Sessions may be from 3 to 30 depending upon your case.

Long term results are unknown.

Approximate Cost: dependant upon area and practice

Long-pulsed Alexandrite Laser Apogee 9300®

This laser is specifically for hair removal of the face, neck and other areas. You may need up to 15, averaging at 10 treatments before permanent results are seen. However, permanency has not been reached for leg and the back areas.

Approximate Cost: dependant upon area and practice

Not everyone is a candidate for laser resurfacing. If you are prone to keloids, hyper or hypo pigmentation or do not react well to burns or excessive scarring due to minor cuts and abrasions, laser resurfacing is not such a good idea. The laser is a type of burn as it literally evaporates the top layers of skin to reveal younger-looking, fresh skin beneath. If you scar badly when you are burned, the results of laser resurfacing could be disastrous. Also, if you have ethnicity (i.e. Greek, Italian or African-American, etc.) in your biological family, you may be prone to hyper or hypopigmentation resulting from the procedure. An "ideal" patient would be of white European descent with elastic, non-oily skin.

For some ethnic patients, The Erbium, pulsed dye, Depilase YAGLASE and NLite laser may be a safer choice although every case is individual and only a qualified surgeon who is very skilled with a LASER can make this diagnosis.

Communication is crucial in reaching one's goals. You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are. Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo a cosmetic procedure. This is an operation which requires patience and stability in dealing with the healing period. There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure.

First and foremost, only choose a surgeon specifically trained in laser resurfacing and who is well-educated on the subject. Not all cosmetic surgeons know how to perform laser surgery. There are techniques to be followed and levels of experience differ with each surgeon.

At your initial consultation; you will meet with the surgeon and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take. This is very important. Your skin will be examined and the elasticity will be determined. You will discuss your complaints and concerns and discuss the various techniques and lasers available to you.

You need to disclose your full medical history and discuss your realistic expectations. Make sure you give your surgeon a full disclosure. This is very important, in determining which procedure is best for you. The surgeon should discuss in detail the procedure and its risks and complications and what to expect during the procedure. You will also discuss the available anesthesia that will be used for your procedure. Most Laser Resurfacing procedures are performed under light sleep sedation or general sedation although some surgeons may use a local or regional only - some even topical anesthetics.

You need to discuss what areas should be treated as sometimes only around the eyes, lips and perhaps the forehead will be resurfaced.

You should be given a pre-operative information packet that explains everything you should do and know before your surgery date. The packet should include a list of all the medications you should not take starting usually at 2 weeks before your surgery. These medications will include, but are not limited to, aspirin containing products, stimulants, seratonin supplements, etc. Also, if your surgeon advised that you may take Arnica montana, Bromelain, Vitamin K, etc. for swelling and bruising you should either have this in your packet or begin shopping for your necessities.

If you have a history of cold sores, herpes or other viral infections it’s very important to disclose this to your surgeon! After laser treatments, chemical peels and dermabrasion - viral anomalies may spread and severely disfigure the treatment area. You will be placed on anti-viral medications beforehand and continue during the healing phase. Bacterial infections are also a severe risk and even water-borne or plant-borne bacterial infections can severely scar your treatment area.

It is quite possible that you will have "blood work" performed. This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count and check for disease or disorders beforehand. If you are a female they may take an extra vial for a pregnancy test. Some surgeons ask that you have physical. This can be yet another out of pocket expense so ask at your consultation what will be needed when you are quoted a price.

The next step is the pre-operative appointment which addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure. Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead. You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs. Many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes. Remember, always ask your doctor before taking any product.

Laser Resurfacing can last from 30 minutes to more than an hour.

First, you will have monitoring "pads" attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation. When you are brought to the operating room, electrodes will be "plugged" into these pads which are connected to the monitoring equipment.

Once you are on the operating room table, you will then be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date. If you had been given an oral sedative or valium prior you will have less anxiety. They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular "doorway" for anesthesia, antibiotics, and other medications. If you haven't been given a sedative, it is more stressful for some patients. If you feel that you may experience anxiety inquire beforehand regarding an oral sedative. Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time. It's the initial placement of the IV that may sting a bit. Some people get their IV placed in the crook of the elbow, some the hand - it all depends upon your veins though. So if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet. After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein. This is called a "catheter". The catheter is taped to your skin so it is not accidentally knocked or pulled out and is ready to be used as a sort of entryway for anything the surgical team deems necessary for your body. This is usually done before you get into the actual O.R. - by a nurse - and you have a saline bag hooked up to you. The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively.

If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of it with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body. The effects of the anesthesia are felt soon after injection or opening the stopper - a few seconds in fact. It may feel similar to a sensation of "heat" entering your arm or hand at the catheter site. It then feels as though it is creeping up your arm - then it "jumps" from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized. The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin.

Your face is then scrubbed with betadine to remove bacteria such as Staph. The surgeon then passes the laser over the area to be treated. This could take anywhere from a few minutes to an hour and a half for very deep facial or body resurfacing. Some patients need 1 or 2 very either light or very deep passes. Some surgeons adhere to utilizing several light passes only. Although, with some lasers the skin cannot be passed over the treatment area again. Several light passes result in a blended area where the laser did not pass rather than leaving a demarcation. This way there is no tell-tale obvious line. The laser literally evaporates the targeted areas of skin. It is almost magical as the targeted, damaged skin disappears leaving only a faint trace of "smoke and steam" and revealing undamaged, pink skin as a result.

If you have specific complaints such as lines and wrinkles of the forehead or crow's feet and lip lines, the surgeon will concentrate on these areas a little more for deeper penetration. Some surgeons may limit the laser's penetration to the epidermis (the uppermost areas of your skin) for the very lightest and medium of peels. Although when the damage is anchored deeper the laser can be set to penetrate the upper layers of the reticular dermis. The reticular dermis is the deeper layer of the dermis formed of interlacing fasciculi of white fibrous tissue.

After the skin resurfacing is complete, your surgeon will cover your face with either a thin film of Bacitracin or antibiotic burn cream like, Silvadine or even BurnJel by Water-Jel Technologies. BurnJel can only be used for light peels. Some surgeons use a second synthetic breathable skin to protect the newly surfaced tissue during its healing process. There are several experimental coverings that are undergoing testing. Some will even provide you with or suggest that you get a hydrogel-type masks or sheeting.

Some bandages consists of several layers; the main layers consisting of the purified "crab shells" (chitosan) as well as a synthetic barrier that whisks away moisture and fluids from a weeping, healing wound. An outer layer of cotton gauze absorbs the fluids. The gauze pads can be changed but the synthetic skin and chitosan covering stays to protect the wound. The chitosan are actually absorbed harmlessly into the body and excreted. Miraculously, the crab shells have a superior antibacterial property unheard of in any relative substance. Reportedly, no known fungus or germ can adhere to its surface. When the bandage is removed - perfect, "flawless" skin appears.

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released. This is dependent upon the individual but may take up to two hours. Your face may feel tight and quite tender as the anesthesia wears off. You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia. You may also experience "rigors" or shivering. This may feel uncontrollable and is usually from the medications - more than likely the epinephrine which is a vasoconstrictor. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable.

Some patients feel nothing different although if you have had general anesthetisia you may feel a little sick - hopefully your surgeon will give you something to lessen this. Your prescribed medication should alleviate this pain and discomfort. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.

You may be groggy from the anesthetic and or oral medications and probably won't remember much of the first day or two if you were sedated. You will have to take it easy and sleep on two pillows to keep your head elevated for 7-14 days - or however long your surgeon suggests. When you wake up you will notice that your face will look even more swollen in the first 3 days. But, as the days go on the swelling will dissipate. There may be bruising, but this will go away, as well. So make a mental note of this or you may be shocked into a depression. Bruising and swelling are a normal occurrence in most invasive procedures.

There will be redness and slight discomfort post-operatively. Your surgeon will have instructed you on the proper care of your treatment area as well as prescribed you the necessary antibiotics and pain medications to help alleviate your discomfort. Take your temperature on time and regularly. An elevated temperature could mean an infection. Take those antibiotics ON TIME. And don't forget if you are taking birth control that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well. The swelling can be alleviated with ice packs. You may be instructed to apply ice, gel masks and vinegar soaks on your treatment area for the first 48 hours. According to Yale Medical University regarding a facial burn from either Laser or any heat source.

Your healing time totally depends upon the depth of your treatment. You can expect to be down for at least 1-2 weeks. Your skin will feel like a major sunburn. It may weep and need dressing changes and additional ointments which will be supplied by your doctor directly or by prescription. You will wear these bandages for about 5 to 7 days. You will more than likely have them removed by your doctor on day 5 but this could be longer if the penetration was pretty deep. After your bandages are removed your doctor will go over with you the proper care for your treatment area such as cleansing and applying ointment. You will notice crusty formations; DO NOT PICK AT THEM OR PULL THEM OFF! You will scar as a result - probably more than before your treatment. But, don't worry, they usually subside by day 10.

You may be given a bovine mucopolysaccharide ointment or cream, this is a cow-derived cartilage extract that has the anti-inflammatory properties of 1-2% hydrocortisone. It accelerates epidermal healing and stimulates the production of prostaglandins and interleukins. The ointment and cream act like a steroid application without the risk of steroid induced atrophy or telangiectasia formation. The product is CX-10 Ointment and CX-5 Correction Cream, manufactured by Donell Inc. in NYC.

You will have to use sun block faithfully! Your skin is very susceptible to damage by UVA/UVB radiation (the sun). This includes artificial sunlight like tanning beds as well as simply driving to the store or around town all day in your car. Believe it or not you do get sun exposure when you drive around. You should not use using AHA's, Vitamin A (Retin A) or exfoliants. Your skin is very fragile in its healing stage - which could last for months.

You may be pink for up to 5 months or more, depending on your skin's ability to "bounce back". You must take care of your skin in order to keep it looking vibrant and fresh. Although, no procedure can keep your skin from aging - it can give you a young, relaxed appearance and buy you some time.

At about 2 weeks or as soon as there is no weeping and no crusting (but please ask your doctor first) you can safely wear cosmetics to cover the redness. There are special cosmetics one can buy to offset the redness or you can experiment on your own with what you have.

Ascertain that your surgeon discusses all of the risks and complications with you at your consultation. There could be allergic reactions to the anesthetic. Just make sure that you disclose your medical history and this is very important - your nationality. If you are susceptible to Keloid scarring or have active skin infections or afflictions such as herpes outbreaks, you may not be a good candidate for Laser Resurfacing.

If your skin is olive, black, brown and even yellow-toned - take care in your choice of resurfacing measures. Even Dermabrasion and chemical peels can cause noticeable damage to ethnic skins. You should request a "spot test" if you or your doctor are uncertain. You can never be too careful.

There is also the risk of bullae (blisters), infection, thicker scar tissue of the treatment area and hypopigmentation as well as hyperpigmentation, as said before. You must also be very careful if you have taken Accutane within the past year and a half (12-18 months). Accutane causes dermal thickening and can cause increased scarring.

Using Light Rather Than Lasers

For those of you who have not the time to recover from nor the epidermal capacity to withstand lasers - High Intensity Pulsed Light Therapy may be for you. This promising new procedure is also known as Intense Pulsed Light Therapy, computer controlled light therapy, Light Laser, MultiLight, Photo Laser or by various trade and service marks, FotoFacial™, PhotoFacial™, PhotoDerm™, EpiLight™, MultiLight™, PlasmaLight, etc

It is phenomenal new mini-procedure capable of diminishing or fully ridding one of age/liver spots, fine wrinkles, facial flushing, redness, broken capillaries, telangiectasia (Teel-ann-ject-AZE-yah) which are purple or blue veins on the face, hemangiomas (sacks of red, purple or blue blood vessels resembling a blister, also known as strawberry hemangiomas), freckles, minor sun damage, port wine stains, tattoos, varicose veins, spider veins, flat birth marks, hypo-pigmentation and even hair removal. There is also one unique benefit - no downtime.

Intense Pulsed Light Therapy gives you the benefits of a medium depth laser or chemical peel or other type of resurfacing/rejuvenation procedure without the blisters, burns and long recovery time. Not only that, it is the only proven therapy to help with redness (rosacea, flushing, etc)! And to boot, many patients report a reduction in pore size, smoother skin, and less wrinkles.

This new therapy was pioneered by Dr. Patrick Bitter Jr. and is based on emitting high intensity pulses of light (not lasers) to penetrate the skin and rid you of various complaints. There are different machines for different levels or types of penetration. It is also known as IPL Photorejuvenatio,n PhotoDerm™ as the PhotoDerm VL (vascular lesions) {VascuLight/MultiLight}, PhotoDerm PL (pigmented lesions) or PhotoDerm HR (hair removal). PhotoDerm and PhotoFacial™ .

Photoderm®VL ?

PhotoDerm®VL is a non-invasive medical technology that uses light therapy to eliminate varicose veins, spider veins on the legs and face, as well as other vascular conditions.

You may experience some side effects which generally last only a short time. This may include slight reddening of the skin or local swelling which goes away within a few days. In rare instances there may me transitory blistering or burning. Longer lasting side effects may include temporary changes in skin color which last up to several months.

Laser skin resurfacing utilizes a laser that emits pulses of light and energy onto the skin's surface. The high energy of the laser allows for quick removal of troubled spots and minimizes the heat that is absorbed into the skin (making it safer for surrounding facial tissues). The precision of the laser allows the surgeon to accurately remove unwanted lines, spots, and layers of skin on the face. On the initial pass, the laser evaporates the top layer of skin. On subsequent passes, the underlying skin becomes tightened and smoothed. Laser skin resurfacing can be highly targeted and be performed on specific parts of the face (including the forehead) and around the eyes and/or the mouth. This approach, however, increases the chance of uneven facial coloration. It is typically performed in the surgeon's office and requires a local anesthesia and mild sedative. The procedure lasts between 30 minutes and an hour.

The skin is usually very dry following the procedure. It is, therefore, important to apply lotion or ointment to soothe and moisturize the treated areas. The treated areas should be kept well moisturized for 5 days after the procedure. An ice pack can help minimize the small amount of swelling that occurs. Also, the surgeon can prescribe medication to help any potential discomfort. It is very important for patients to remain out of the sun for 5 days following the procedure because the treated area is similar to a baby's new skin. After a week, makeup can be applied to cover up the light pinkish tone of the treated area. Most of the visible effects of the procedure are unnoticeable after 14 days.

PhotoFacial - Dr. Bitter

This procedure is not recommended for patients with connective tissue disease or auto immune disorders. It cannot be done during pregnancy, nor can it be done on recently sun-tanned skin or in those who may receive excess sun exposure for a few weeks following treatment. It cannot be used on patients taking Accutane or for six months after stopping Accutane. The procedure is not usually done on patients with active acne cysts and large pustules. The same is true for highly active rosacea. Most photosensitive medications such as antibiotics, anti anxiety, sulfa drugs, birth control pills and anti-hypertensive medications are not a contraindication. Care must be taken in patients who get fever blister attacks on the face. An anti-herpes medication can be taken thus avoiding the problem.

Most side effects are mild and of short duration. These can consist of short-term discomfort during the actual treatment. There is usually additional redness immediately following treatment, lasting less than 24 hours in most people, on rare occasions it may last up to three days. Mild blistering and bruising is possible but in our experience occur in less than 1% and usually clear very quickly. Post treatment pigmentation has been noted on occasion. Another possiibility is a decrease in pigmentation of the skin after treatments. This also clears in time as well. Scarring or an infection of the skin after treatment can also occur. Swelling of the face for 3-5 days occasionally occurs and is most common in severely sun-damaged skin due to reduced quality of connective tissue around the blood vessels.

There are a few risks associated with Photoderm. These include permanent pigmentation change, scarring, and poor response to treatment. It should be noted that laser skin resurfacing is less effective for darker skinned individuals. The procedure can discolor or lighten certain areas, causing mild differences in coloration between the treated areas of the face or hands. The healing process lasts anywhere from 5 to 10 days. If you smoke, plan to quit both two weeks prior to and following the surgery. This insures that healing occurs at the appropriate rate. In order to maximize the success of surgery and minimize the risk of postoperative complication, always follow your surgeon's specific instructions.

PhotoDerm VL (vascular lesions)

With this machine, the light pulses are directed at the spider and varicose veins as well as vascular birth marks. The tissue targeted is the hemoglobin in the blood. Hemoglobin is an iron-containing respiratory pigment of red blood cells that functions primarily in the transport of oxygen from the lungs to the tissues of the body.

A highly advanced computer regulates the light pulse to a specific wavelength range, which in turn heats the visible, targeted blood vessel(s).Thereby damaging or otherwise destroying the targeted lesion while sparing the surrounding healthy or "normal" tissue. The penetration depth and degree of heat is highly controlled so that most complications contributed to these specific factors are not an issue with Pulsed Light Therapy.

PhotoDerm PL (pigmented lesions)

With this machine, the light pulses are directed at the age spots, freckles, flat pigmented birthmarks and other types of discolorations. The area targeted is the melanin or darker spots on the skin. The melanin is then heated and damaged or destroyed - thereby ridding you of the unwanted hyper-pigmentations.

According to a lecture by Dr. Robert A. Weiss, the assistant professor of dermatology at the University of John Hopkins School of Medicine in Baltimore, Maryland on intense pulsed light treatments: It is quite possible to actually shrink sebaceous glands (oil glands), pore size, with repeated treatments. Although at this time it is unknown just how many treatments this result would require. Also hyper and hypopigmentation is possible.

If you are prone to keloids, hyper or hypo pigmentation, are dark-skinned, darkly tanned or do not react well to burns you may not be a candidate for High Pulsed Light Therapy. Also, if you have ethnicity (like Greek, Italian or African American, etc.) in your biological family, you may be prone to hyper or hypo pigmentation resulting from the procedure. An "ideal" patient would be of white European descent with elastic, non-oily skin. Although many other types of skin are treated successfully, only a qualified doctor or dermatologist can determine if you are eligible for treatment.

If you have lesions such as age/liver spots, broken capillaries, telangiectasia (purple or blue veins on the face), hemangiomas (sacs of red, purple or blue blood vessels resembling a blister, aka strawberry hemangiomas), freckles, port wine stains, tattoos, varicose veins, spider veins, flat birth marks or hypo-pigmentation you may be a candidate for HI Light Pulsed Light Therapy. HI Pulsed Light Therapy can even remove fine wrinkles, facial flushing, rosacea, redness, minor sun damage, and even hair removal.

If you are an insulin-dependent diabetic, you can not be treated. Insulin-dependent diabetics run the risk of wound-healing and infection problems. Although diabetics who take prescription oral-medication, to be treated, you must provide a letter from your primary care physician, written on his medical office stationary stating that you are, indeed, approved for HI Pulsed Light Therapy.

Also, you should discontinue the use of any blood thinners such as Coumadin®, Heparin®, aspirin or other types of anti-platelet or anti-coagulant herbal remedies including and not limited to...

Garlic, Ginger, Cayenne, Papaya and Bilberry Tablets/Supplements, have anti-platelet properties and may inhibit vital clot formation. These medications are normally taken to remedy edema (fluid retention).

We continually update this site to keep you informed of the latest scientific findings about rosacea.

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