QUESTION
I've enjoyed your website immensely and wonder if you could
shed some light on a question I have. I've been diagnosed
with rosacea, and it's progressed greatly. I have a general
redness, but few broken blood vessels. Can you tell me
which laser is preferential for treatment; the scleroplus
or photoderm?
Also sir, if you could recommend someone in the Boston area
or New Hampshire area it would be greatly appreciated.
Thank you for your time,
Regards,
Laura C.
ANSWER
Thank you for your inquiry Laura. A few years ago there were
some physicians reporting problems with the early versions
of the Photoderm. But more recently these have been resolved
by software and treatment parameter refinements. Newer
versions of the Photoderm, including the Quantum series,
have enhanced features for safety and comfort and produce
consistent reliable results.
The biggest advance in the laser or pulsed light treatment
of Rosacea including redness flushing and visible broken
veins (telangectasias) is the FotoFacial™ technique
developed by Dr. Patrick Bitter Jr. MD. I have trained with
Dr. Bitter Jr. in this method and now offer it in my practice
as the preferred method for treating these problems in most
patients. (See information on FotoFacial™ under
Services on this website.)
The long pulsed dye lasers such as Sclero Plus (and others)
have an excellent safety record. Scarring and permanent pigmentary
changes are rare (a fraction of one percent). And they are
very effective with just two or so treatments. That is why
I use and recommend the Sclero Plus laser. The downside is
the purpura discoloration that lasts for two weeks after
a treatment. But it does go away and the results are very
good. It takes away the deep redness as well as the broken
vessels (telangectasias).
Another alternative is using the lower power KTP lasers
just to treat the specific telangectasias. Very little side
effects occur and it is also very safe. But the improvement
is not as dramatic.
Also choose a good home care regimen. For Rosacea, lactic
acid products such as Lac-Hydrin may be more beneficial than
glycolic acid products. And you should stay away from tretinoin
(Retin-A or Renova) that can make the redness worse.
Back to top
QUESTION
I saw your web site on the internet and I'd like some info
on your procedure for plantar warts using the flashlamp
pulse dye laser. I have numerous plantar warts on my feet
and a couple of them are quite large and Ive probably waited
too long to do something about it. How does the laser compare
with surgery for removing the warts and do you do the surgery
also? Are some warts better removed with surgery or will
the laser treat them just as well with less complications
(like pain). Can you give me any rough idea on the cost
involved with the laser? I have medical insurance through
Providence Good Health plan here where I work in Newberg,
Oregon, but I don't know if they will cover the laser.
Ive already seen my GP and he is referring me to a podiatrist
who will probably suggest surgery, but I want to know all
the options.
ANSWER
Laser treatment is certainly superior to surgical excision
for treating that have failed the more common and simple
treatments. The advantages are: speed of treatment, lack
of pain, lack of scarring, and a high success rate.
For fairly thin plantar warts I simply use the pulsed dye
laser at the yellow wavelength of 595 mm. This eliminates
the capillary blood vessels which feed the wart from beneath.
Deprived of its nourishment, the wart starves and falls off.
This treatment-from-beneath is fundamentally different than
most common wart treatments which work form the top down.
It typically takes one to four treatments to eliminate the
warts (average is 2.5).
If the plantar wart is very thick and hard, I treat first
with the erbium laser to remove the bulk of it. This relieves
symptoms immediately as it no longer feels like you are walking
on a stone. This is followed by the pulsed dye laser treatment
in the same treatment session. It is fairly quick and patients
are quite pleased with the results. Pulsed dye lasers have
and excellent safety record and a very low incidence of scarring.
This is important on the bottoms of your feet.
Back to top
QUESTION
Having fair skin and living in the tropics for 2 decades,
what are my options for working with the skin damage I
have accumulated? I have recently been to another doctor
for some treatment on precancerous spots. Is laser treatment
an option for this condition? Also what kind of expense
is involved for eye lid laser, and facial surgery? What
is the time frame for recovery?
ANSWER
Yes, laser skin resurfacing can be very beneficial for this
type of skin damage. When actinic keratoses and other precancerous
lesions start appearing and need removal often there are
many more forming which will continue to appear over the
years. Skin resurfacing with laser removes the whole "crop" in
one treatment. The epidermis is renewed from non sun-damaged
cells within just 4 days after the resurfacing.
It also removes all of the other sun damage spots such as
lentigo (age spots) and removes the wrinkles and firms slackened
skin at the same time. The results are quite remarkable.
Healing is rapid with the erbium laser procedures. Most
people are back to work, sports, and full activity after
one week. Costs start at $4200 for the eye areas and eyelids.
More for larger regions or full face. May I invite you for
a consultation with me so I can answer your questions and
show you some examples of my work and what you might expect.
Call Sandy at 330-6160 for an appointment.
Back to top
QUESTION
Regarding hair removal, on the upper lip and chin: the PhotoDerm
apparently takes only one treatment, while the Gentle Laser
takes 3-6. Why the difference?
You mention that the Pulsed Dye laser and the Alexandrite
laser are safer than the PhotoDerm. What are the risks of
each? I am not sure what "safer" means.
ANSWER
Any of the several lasers (including the Gentle Laser) and
the photoderm/epilight devices can all produce a short
term hair loss in one treatment. But much of the hair will
re-grow in 6 or so weeks.
Permanent hair reduction (defined as 75% or more hair reduction
lasting at least a year) requires three to six treatments
spaced at 6 to 8 week intervals. Most people are not satisfied
with just the short term effect. No system has a better record
of long term or permanent hair reduction than the gentle
laser system. (Though other centers may make other claims!)
There has never been one case of scarring reported from
the Gentle Laser alexandrite system when used properly. In
1998 a study was published in the Journal of the American
Academy of Dermatology reporting over 20% incidence of scarring
using the Photoderm device. That is not acceptable and this
is why I do not feel it is sufficiently safe.
The Pulsed Dye laser has a long history of safety (lack
of serious adverse results such as scarring and permanent
pigmentary changes). This is why it is used even in infants
and children for birthmarks.
I would be happy to provide documentation of the safety
and efficacy of all of the laser technologies that I have
selected for Aesthetics MD. I believe they are
the very best available today.
Back to top
QUESTION
What is approximate cost for spider vein treatment? How many
sessions? Cost for hair removal? Another laser in Bend
requires one treatment, rather than 3-6 -- why the difference?
ANSWER
Facial spider veins clear in one treatment in some patients.
Usually they clear 75% with the first treatment and a second
is given about 4 to 6 weeks later. It is safer to do it
this way.
Leg veins usually require more work. Some patients have
the majority of the small spider veins clear after one treatment.
But full clearing often requires about three treatments.
I use the Sclero Plus pulsed dye laser which is the most
effective and safe method available today. Deeper blue veins
often respond better to my alexandrite laser, so I use them
both as needed. The cost depends on which laser is used and
how extensive the veins are. The prices begin at $185. Aesthetics MD is the only complete and dedicated specialty
center for laser treatment in Central Oregon. (The Photoderm
is not really a laser. I do not recommend it as many laser
physicians have had serious problems with it.)
Back to top
QUESTION
Once laser skin resurfacing is accomplished, what skin care
is required after (long term) and can this procedure or
any other be done after laser resurfacing. Is there "enough" skin
left? How long are results expected to last and what activities
would be detrimental? Would being in the sun and salt water
(with sunscreen) be feasible?
ANSWER
Laser resurfacing removes the damaged epidermis and some
of the damaged and wrinkled upper dermis is sculpted smooth.
But the epidermis regenerates completely from undamaged
cells. And new collagen synthesis in the dermis restores
the dermis to a composition, thickness and resiliency that
is more like youthful skin. So even though some tissue
is being removed, it does not end up being thinner in the
end.
Since the skin will be renewed it is like a baby's skin.
You will need to protect it from excessive sun exposure and
use a good moisturizer until it is used to being out in the
world again. This does not mean that you cannot be out in
the sun and doing water sports, skiing, etc. But good sun
protection is important. I help my patients select a skin
care regimen that will protect their skin for the years to
come after laser skin resurfacing. Using products with alpha-hydroxy
acids (AHAs) and tretinoin or Kinerase can help keep laser
renewed skin healthy and smooth in the years ahead.
Back to top
QUESTION
I would like to come in next spring for facial resurfacing,
wrinkle removal from my neck (I have "turtle rings"),
and significant hair removal.
I am brown-skinned (Janet Jackson-like), but with a fair
undertone. "Fair" means that my skin turns red
when it gets irritated, and I do sunburn (about two times
a year).
Will this affect my treatment? If so, how?
ANSWER
Yes you can undertake laser treatments for the conditions
you mentioned and can anticipate the same success as others
achieve. Of course there is individual variation. It would
be helpful if you could send digital photos of your areas
of concern. Then we could discuss what approaches may be
best for you.
With regard to your skin type: The fact that you can sunburn
at times would put you between three and four (on a scale
of six) for skin type. Darker skin types will still have
good results, but the treatment needs to be made more gently
with laser. You can expect that there will likely be some
temporary darkening of the skin during the healing process.
But this goes away, usually by three months and almost always
by six months. Using medicated creams before and after laser
can help reduce this and help it to clear more quickly.
Back to top
QUESTION
I am inquiring into what is included, recommended, required
in conjunction with the laser skin resurfacing procedure.
I have already been in for a consultation would like more
details.
ANSWER
All pre-op and post-op visits are included in the basic fee
for laser skin resurfacing. And if any touchup treatment
is needed within a year afterward that is also provided
at no extra charge. (This happens in about one in twenty
cases when we think more improvement is possible.) Some
patients need adjunctive procedures such as Botox or scar
revisions. But this is decided on an individual basis.
When needed there is a separate charge for those procedures.
I prefer to have patients on a skin priming regimen for
a few weeks before laser resurfacing. This helps the skin
to heal better and faster. When needed these products may
be provided in a kit which includes the products for skin
care after resurfacing. There may be a few prescriptions
given to help with the healing process as well.
I would be happy to meet with you again to discuss your
specific plans. Or you may talk to either Susan or Johane
in my office. And the consultation fee paid previously is
of course 100% applied towards any services you receive.
Back to top
QUESTION
Can you tell me about SoftLight Laser Resurfacing. Also,
if you perform Botox treatments for a few years, can the
results last longer than six months? (And is botox effective
in conjunction with laser resurfacing?) Thank you very
much.
ANSWER
Thank you for your inquiry. Softlight laser resurfacing is
a technology for stimulating improvement in fine wrinkles
and skin texture by activating new collagen production
without removing tissue from the surface of the skin (ablation).
So it does not remove epidermal sun damage such as pigment
or precancerous lesions. No surface wound is produced so
there is no significant "down time" for healing. But it
is a good alternative for those with only fine wrinkles
who do not want to undergo the healing time for ablative
laser resurfacing. Some other lasers have also been shown
to produce this effect including the long pulse dye laser
and the Nd:YAG lasers. I am currently doing research on
the Alexandrite laser for this same purpose. It is an exciting
area of research in skin lasers today.
Botox often lasts longer than the initial four months with
repeated treatments. This is thought to be due in part to
the weakening or atrophy of the involved muscles. It seems
best to retreat with Botox when about half of the original
function of the muscles has returned. This is for frown lines,
crows feet (or smile lines) and brow furrows. Repeat treatments
may last six or eight or more months. The results vary with
the individual. Botox is often a very valuable adjunct to
laser skin resurfacing. Since new collagen is formed for
at least six months after laser resurfacing, it is good to
have troublesome dynamic wrinkles relaxed for several months
after resurfacing. The overall improvement is enhanced by
this.
Back to top
QUESTION
I had laser resurfacing 18 months ago. It did improve some
of my problems (acne scarring reduced, etc.) but the doctor
used erbium on some areas and some areas C02. I healed
okay, although my skin is still on the "red" side
where I used to have yellow undertones. Is it possible
to further reduce the scars if I were to have another C02
treatment? The scars are not that deep, but he only did
one pass with the C02, and I think I should have had more.
Could improvement be gained with an additional treatment.
Are there more risks if you've already had the surgery
once?
ANSWER
A second treatment has often been shown to improve results
significantly, especially when the initial treatment was
too light to achieve maximum improvement. I use the dual-Erbium
contour laser which can deliver very deep and very precise
treatments - as deep as CO2 lasers, but with less thermal
injury. For acne scar treatment we are using total depth
of resurfacing up to 600 to 700 microns. This is significantly
deeper than was done just a couple of years ago by any
laser. The healing is still excellent and is not prolonged.
But the improvement in acne scars is much better. The Erbium
also has the advantages of lower risk of adverse scarring
or pigmentary changes. And the redness resolves more quickly.
So if you are not satisfied with the degree of improvement
I would say that probably you could achieve significantly
more.
Back to top
QUESTION
Can one do laser surgery after taking accutane? If so, how
long do I have to wait after I end my treatment?
ANSWER
This is a very good question. The resurfacing laser procedure
involves healing to renew skin elements. Healing comes
from cells in the sebaceous glands within the skin. Since
Accutane inhibits the sebaceous glands, it can also impair
healing. So it is best to wait until these glands have
recovered before having laser resurfacing. Six months is
the minimum. Some physicians wait one year or even two
after Accutane treatment. Usually if the skin has returned
to its original level of "oiliness" then it is safe to
do laser resurfacing. But never less than six months.
Back to top
QUESTION
I am 53 years old and have extensive spider veins on my legs.
I would like to know approximate costs, and time of treatment
and recovery. I am a mail carrier and spend 3-4 hours a
day standing and 3-4 hours driving each day.
ANSWER
I prefer to use the Sclero-Plus pulsed dye laser to treat
spider veins on the legs. There are two reasons: First,
it is very effective. The typical patient has about 75%
clearing of treated veins in just one session. A second
treatment often finishes the job nicely. Second, this laser
is very safe. It is even used on infants and the chance
of scarring is extremely rare. The disadvantage of using
this laser is that it causes temporary darkening (purpura)
which can take several weeks to clear. So I recommend it
for the fall or winter when you are not out in shorts or
short skirts. There are other laser and light systems for
treating leg veins, but I have not found them to be as
effective.
Usually all veins can be treated in one session. It is not
at all painful and does not take a long time. Costs of treatment
depend upon how many are treated - how many laser pulses
are needed to cover them. $275 is the minimum charge. For
very many veins requiring several hundred pulses the fees
may run $475 or $575. Second treatments are usually less
as fewer veins remain. Call Sandy at my office if you would
like to visit us in Bend. We could do your consultation and,
if you choose, your treatment in the same session.
Back to top
QUESTION
Can you please explain the difference between the Photoderm
VL and the KTP laser? I have dilated capillaries on the
face and neck and unfortunately, there are no physicians
in the Portland area which offer the KTP. Is the photoderm
a viable option for me? Can I expect similar results?
ANSWER
This is a very good question. The KTP laser will clear the
most conspicuous vessels very quickly. In fact many will
disappear instantaneously with treatment. Overall clearance
is about 60% or more with each treatment. But each vessel
must be individually traced with the laser. So perhaps
a few dozen up to two hundred vessels can be treated in
one session.
When there are thousands of vessels to be treated, as when
a whole region has abnormal redness from enlarged vessels,
then it is not practical to try to clear them all with the
KTP laser. Though the worse ones could certainly be targeted.
The Photoderm VL when used in an advanced treatment protocol
such as the FotoFacial™ can treat all of the abnormal vessels,
no matter how numerous and tiny they may be. And it will
simultaneously clear abnormal pigment and improve skin quality
and texture. But a full series of five treatments is needed.
One or two treatments may not show any much immediate improvement.
Yet in the end the results are very gratifying. I find this
to be the best treatment when there is a lot of background
redness from enlarged vessels such as is seen in rosacea
patients or sun induced redness. The KTP laser can then be
used as a supplement to clear the larger vessels more quickly.
Back to top
QUESTION
Do I need to have any AHA peels or facial treatments since
having my laser skin resurfaced? Will it help keep it great
looking?
ANSWER
There are certainly some skin care agents that will help
to maintain your skin in optimal condition protecting and
enhancing the results of laser resurfacing. We would be
happy to review your regimen whenever you like. Peels have
been used in the past for maintenance regimens but now
I am seeing much better results from maintenance FotoFacial
treatments for most of my patients. They extend and complement
the changes from resurfacing and reverse sun damage and
pigment accumulations. Maintenance regimens for those who
have had laser resurfacing (or completed the initial series
of FotoFacial treatments) are available at reduced cost
for our established patients. These are done either annually
or every six months. There is additional information on
the FotoFacial™ on this web
site.
Back to top
|
