Posts Tagged ‘rosacea’
Photofacial is one of the most popular treatments for skin rejuvenation and with good reason. Photofacial can treat a variety of skin conditions including skin discolorations and redness, but with all the different light devices and treatment names being used there is a lot of confusion about this versatile treatment.
What can be treated with IPL.
Photofacial uses Intense Pulsed Light (IPL), which is well absorbed by chromophores that have color such as melanin and hemoglobin (think red and brown). It works best for brown spots and vascular skin conditions. IPL treatments can help stimulate collagen production, can kill acne causing bacteria and some IPL devices can also be used for hair removal.
The most common conditions treated with IPL include:
- Broken capillaries
- Flushing/ Facial redness
- Sun damage/Age spots
- Brown Spots
What is in a name?
Photofacial is a photo rejuvenation treatment that uses Intense Pulsed Light (IPL) technology. Photofacial is known by many different names with a variety of spellings including: PhotoFacial, Fotofacial, FotoFacial RF, Photo-Rejuvenation, Photoderm, BBL or simply IPL. These are essentially all the same thing, however some names may be trademarked, associated with a specific device or a developed treatment protocol. Dr. Patrick Bitter, Sr. developed the procedure PotoFacialSM in 1988 and Dr. Bitter Jr., is the developer of the FotoFacial™ and PhotoFacial™. BBL is Sciton’s trademarked name for their IPL machine, which is said to be the most powerful IPL device. You do not need to be overly concerned with the name being used to describe an IPL treatment, instead focus more on the device being used and the experience of the technician performing the treatment.
What device should be used for a Photofacial?
Photofacial is a treatment and the devices used is Intense Pulsed Light (IPL). Some people will use an LED device and call it a Photofacial, however this is not a true Photofacial. LED devices are commonly use in spas, they have lower energy and do not produce intense light.
Due to the increasing popularity of Laser and IPL treatments and the growing industry there has been an explosion of new devices on the market. Many of the new devices are less effective. As Laser Technicians we look for a device that gives us more precise control. IPL treatment settings do not work by simply turning a dial up or down. We control things such as the pulses, pulse duration, the amount of joules used and cut off filters. Devices that use a larger selection of cut-off filters are more effective because they allow for treatment of vascular and pigment lesions at different depths. In the authors opinion the best IPL devises are Scitons BBL and the Lumenis One/M22.
How many treatments are needed?
The first treatment will generally provide significant correction, however for best results a series of treatments are recommended. The exact number of treatments will vary depending on the condition being treated, the desired patient results, how the skin responds and how compliant you are with pre and post skin care. A very generic protocol would be a series of 5 treatments scheduled 3 weeks apart, however it is better to work on a plan that is designed specifically for your skin and your lifestyle.
What to expect after a Photofacial (IPL/ BBL).
There generally isn’t any down time with Photofacial, however if you have a lot of sun damage you may not look great for a week or two. Immediately after your treatment your skin will be a little pink and slightly warm. It is normal for it to feel like a mild sunburn, windburn or razor burn, but if you experience an excessive or lingering heat you should communicate this to your technician.
If you have brown spots they will darken up and gradually flake off over the next two weeks. Freckles tend to look darker, skin with a lot of discoloration may look “peppered” before it flakes off. If you have treated non-facial skin such as neck, chest, hands or arms it may take three weeks and some spots may take even longer. You may be able to speed up the process with a microdermabrasion 7-10 days after your treatment. Swelling and redness may also occur, you can apply cold packs to help with swelling and some people find an over the counter antihistamine helpful.
It may feel hot. If the skin does not cool down quickly after treatment it is very important that you go home and apply cold cloths until it is no longer hot. Take a large, clean bowl fill it with ice, add water and put clean washcloth in the bowl. Ring out excess water and apply cold cloth to treated area. When the cloth is no longer cold, trade it out for a cold one. Continue to do this until the area is no longer hot (this could take hours).
How can I improve the results of my Photofacial treatment?
The most important thing you can do is follow all pre and post care instructions, this includes not tanning, avoiding heat immediately post treatment and using the recommended topical skin care. If you are treating skin discolorations you will most likely need a skin care regimen that includes tretinoin and 4% hydroquinone. If you are treating rosacea you will need a topical vitamin-C. Everyone will need an approved sun protection with Zinc Oxide, the SPF should be over 30.
IPL treatments can be combined with other technologies for enhanced results. I will often use a vascular laser in my treatments for treating broken blood vessels or add Radiofrequency (RF) for skin tightening. Other possabilities include blue light for acne, laser resurfacing and laser hair removal. A microdermabrasion may be done prior to treatment to cause vaso diolation which can enhance results of an IPL treatment for those with facial reddness.
If you really want to increase your results you may want to do a PhotoDynamic Therapy (PDT) treatment. PhotoDynamic Therapy uses Levulan (aminolevulinic acid) also known as ALA to photosensitize the skin prior to a photofacial Adding Levulan results in a higher level of correction of freckles, sunspots, skin discolorations, broken blood vessels and redness. You will also have the added benefit of an aggressive acne treatment and treating Actinic keratosis (AK’s).
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Rosacea is primarily a facial vascular disorder in which blood vessels are functionally and structurally abnormal. Currently rosacea can’t be cured, however it can be effectively treated and controlled. Rosacea is a progressive skin disorder, that should be treated when symptoms first begin. Treatment should be aimed at treating the underlying vascular issues associated with rosacea. Vascular Lasers and IPL treatments are extremely effective at treating existing redness and broken blood vessels. In addition to avoiding rosacea triggers, topical products can be used to prevent flushing and further damage that can accelerate the progression of the disorder.
Laser and IPL Therapy
Both Laser and IPL therapy are very effective at treating telangiectasia (broken blood vessels), generalized redness and flushing. IPL therapy can also be enhanced with Levulan to get the added benefit of treating acne, rosacea papules and pustuals.
Lasers that are absorbed well by hemoglobin are used to treat vascular concerns. The laser energy is absorbed by the blood vessel and creates heat within the vessel which damages the vessel wall and permenatly closes that vessel. The treated vessels are then absorbed by the body. Although there isn’t a cure for rosacea, studies show that laser treatment can permantly remove damaged facial blood vessels and with repeated treatment blood vessels will not always be created to replace the old vessel. Facial blood vessels treated with lasers are sometimes replaced with connective tissue. This is good news, because this will permently reduce the number of blood vessels in the face, near to the level of vessels found in healthy skin.
Lasers have a single wavelength that work at a very specific depth. So any idividual laser has it’s limitations. KTP 532 nm and Pulsed Dye: 577 -585nm lasers are well absorbed by hemoglobin and are very effective at treating superfical blood vessels in the face, while Nd:YAG 1064nm lasers are also well absorbed by hemoglobin, they are effective at treating vessels that are located deeper in the skin.
Intese Pulsed Light (IPL)
IPL skin treatments are known by many names including Fotofacial, Photofacial, Photoderm and Photo rejuvenation. Intense Pulsed Light (IPL) differs from lasers because IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range, while lasers have a single wavelength. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once. IPL uses special cut-off filters that can be selected to target chromophors in a certain range within the skin. When treating rosacea or any vascular concern, the intended target is hemoglobin. The advantage IPL treatments have over laser treatments is that IPL can target vessels at different depths.
Combined Laser and IPL Therapy
Best results are achieved when you combine IPL and Laser treatments. IPL and Laser treatments can be done independently, however combining technologies at the same treatment time will provide a better result. This type of treatment is fairly aggressive and should only be done by someone that is very experienced in combining these technologies.
Oral and Topical Products
Topical Metronidazole Gel
Metronidazole is topical agent used to treat rosacea, available only by prescription. The primary action of Metronidazole is anti-inflamatory. Metronidazole is effective at reducing papules and pustules and has a fairly minimal effect at reducing inflammation. Unfortunately, it isn’t effective for treating broken blood vessels or flushing.
Antibiotics have long been used to treat rosacea, however they work primarily through their anti-inflammatory properties rather than antibacterial. Antibiotics are effective at reducing papules, pustules, and inflammation. The limitation with antibiotics is that they are not effective at treating telangiectasia or flushing.
Antihistamines are effective at reducing facial inflammation, swelling and burning associated with rosacea. Histamine contributes to swelling, itching and burning. Histamine has also been shown to play a role in inflammation and redness.
Sunblock with Zinc Oxide
UV rays can penetrate the skin and activate sensory nerves that release potent vasodilators, as well as creating heat in the skin causing facial flushing. Zinc oxide reflects both UVA and UVB rays, blocking out heat from the sun. Topical zinc oxide also has significant healing properties when applied to damaged skin and has been shown to decrease inflammation in both the epidermis and dermis.
Dimethicone is a silicone based ingredient with moisturizing ability. Dimethicone is also a protective ingredient that has been shown to reduce flushing caused by skin irritants.
Free radicals have been shown to cause structural damage to vascular walls and many free radicals are potent blood vessel dilators. Dietary and topical antioxidants help to block the damaging effects of free radicals.
Studies show that vitamin C can protect blood vessel walls from free radical damage and reverse existing vascular damage. People with rosacea should get plenty of vitamin-C in their diet, and may want to consider a vitamin-C supplement. In addition to being a great antioxidant, topical vitamin-C has anti-inflammatory qualities.
*This post is intended for informational purposes only.
Rosacea is a vascular disorder that affects facial skin and eyes, causing facial redness, inflammation, broken blood vessels and red bumps known as inflammatory papules. Rosacea is a progressive disorder beginning with mild symptoms, and if left untreated can become severe. Rosacea treatment should begin as soon as possible to slow the progression, with an emphasis on treating the underlying vascular disorder. With continued treatment and avoidance of rosacea triggers, suffers can control their symptoms and slow or prevent further progression.
This post is intended for informational purposes only. Only a Doctor can diagnose rosacea, if you suspect you have rosacea you should consult with a physician, as facial flushing can be a sign of other systemic disorders. If you do have rosacea it is a good idea to begin a rosacea diary to track your specific triggers. Begin treatment as soon as possible to control your rosacea and do your best to avoid triggers.
Rosacea Stages: The progressing of symptoms
Pre-rosacea is characterized by frequent, temporary bouts of flushing and blushing. Facial redness disappears immediately after the trigger is over.
Mild rosacea is characterized by flushing and redness that lasts for an abnormally long time after trigger is over (half hour or more). Broken blood vessels (telangiectasia) may be present and skin may be sensitive to products.
Moderate rosacea is characterized by facial redness that last days or even weeks. The nose and cheeks may have a semi-permanent redness, causing a sunburned appearance. Swelling, burning, broken blood vessels, and inflammatory papules may be present. Some people may experience eye symptoms such as irritation, dryness, crusting, sensitivity to light, swelling of the eyelids, and a feeling of a foreign body in the eye.
Severe rosacea is characterized by severe flushing, inflammation, burning and swelling. Inflammatory papuals, pustules and nodules may develop. Rosacea that progresses to this point can be painful. In some cases rhinophyma may develop, this is a bulbous enlargement of the nose.
Function and Structure of normal blood vessels in facial skin
Blood vessels deliver oxygen and nutrients to the skin, as well as remove waste generated from skin cells. It is important to understand that blood vessels help regulate internal body temperature. When the body internal tempeture is high, blood flow will increase through the vessel to release heat from at the skins surface.
Vessels are made up of several layers, each of which serves a specific purpose. When discussing rosacea, we are most concerned with the middle layer which is composed of vascular smooth muscle cells, and the inner layer which is composed of endothelial cells.
The smooth cells, or the muscular layer of blood vessels serve to control blood flow through dilation and constriction. When the muscular layer contracts the blood vessel will become more narrow and decrease blood flow through the facial skin. The constriction of these vessels will cause the skin to be less red. When the muscle relaxes, the blood vessel dilates or becomes wider which will increase blood flow through the skin. The dilation of facial blood vessels will cause the skin to be more red.
The endothelial cells line the inside wall of blood vessels and release potent dilator substances. When these dilators are released they diffuse to the smooth muscles cells and cause the vascular muscle to relax or dilate. When the vessel dilates, blood flow to the skin increases causing flushing and redness.
Function and Structure of Rosacea Blood Vessels
Rosacea is primarily a facial vascular disorder in which blood vessels are functionally and structurally abnormal.
With rosacea there are functional changes that take place in vessels. The blood vessels in facial skin become hyper-responsive to internal and external stimuli. Vessels may dilate to a substance that normal blood vessels would not respond to. They may also dilate or open more widely than normal blood vessels, and stay open for an abnormally long time.
The structural changes of facial blood vessels, lead to the progression of rosacea.
- Blood vessels may become permantly dilated, this is known as telangiectasia or broken blood vessels
- The muscular layer of the vessels may be thin and damaged.
- The (endothelial cells) inner layer of vessels may be damaged and dysfunctional
- There may be an abnormal growth of new vessels
- Blood vessels may be closer to the surface of the skin
- Vessels may fuse together forming abnormally large vessels that can carry large vollumes of blood to the surface of the skin
Heat will cause blood vessels to dilate, allowing more blood to flow to the surface of the skin and causing facial flushing. Heat from both external and internal factors will cause facial flushing. In rosacea skin this reaction is exaggerated.
Although cold temperatures initially cause blood vessels to constrict, over an extended time the skin cells can become deprived from oxygen and nutrients, which can trigger the release of potent dilators. Flushing caused by cold temperatures are influenced by the how cold and for how long skin is exposed to the cold factor. For example cool air will cause less constriction than cold air and would not deprive skin of oxygen and nutrients in the same way cold air does. Cool air will not cause flushing, but cold air may.
Facial nerves play a major role in rosacea flushing. Many medical experts believe that rosacea is a neuro-vascular disorder, meaning that the facial nerves release dilators onto blood vessels which intern causes flushing.
Sympathetic nerves help regulate thermoregulatory flushing, this type of flushing helps reduce internal body temperature and serves to protect the brain from heat. If the internal body temperature is to high, the brain activates sympathetic nerves, which release neurotransmitter substances on to blood vessels, telling them to dilate and causing flushing.
Consumeing hot beverages and food, as well as exercise can activate sympathetic nerves. Even emotional stress, anger and embarrassment can trigger these nerves.
Parasympathetic nerves are partially responsible for flushing caused by certain foods, crying, facial movement, and even facial pain. It is important to note that even mild foods can cause flushing, and each person may find they respond to different triggers.
Sensory nerves release potent vascular dilators and are responsible for flushing caused by skin irritations, and environmental factors such as wind, heat and sun.
can penetrate the skin and activate sensory nerves, as well as creating heat in the skin causing facial flushing.
Clinical studies suggest that blood vessels are often the first structure encountered by free radicals and can be the hardest hit. Causing structural damage including weakening the vascular walls. In addition to the vascular damage, many free radicals are potent blood vessel dilators.
[ Read more about Free Radicals and Antioxidants]