Interview with Dr Jerry Darm, MD

Doctor photo

Dr Jerry Darm, MD
President & Owner of Aesthetic Medicine. He has practiced aesthetic medicine for the past eight years with over 10,000 laser procedures performed. Previously, Dr. Darm was a board certified Emergency Medicine physician with over 20 years of experience. He graduated from Stanford University with a Bachelor of Science in Biology and a minor in Psychology. His medical training was obtained at OHSU where he did his Residency Training in Pathology. He was previously Board Certified in Bariatrics (Weight Loss) medicine. He continues his busy practice in both Weight Loss and Aesthetic Medicine.

Aesthetic Medicine
9735 SW Shady Lane
Tigard, OR 97223
Tel 503-697-9777
Fax 503-597-3708
info@drdarm.com

Questions and answers 20 October 2006

Could you please explain the difference between the AL and the 1064 YAG.

The AL (Aesthera Laser) is an IPL (intense pulsed light device) with an extended spectrum from 400 to 1200nm—An IPL is literally a white light generator with very high intensity—Most IPL devices have cutoff filters which can vary from 515 to 745—Thus the &qout;flash" from a standard IPL device would contain all the wavelengths between 590 to 1200 if a 590 cutoff filter were being used—This confers an advantage when higher fluences (power levels) are being used in that you can treat darker skinned individuals—The darker the skin the higher the cutoff filter—Historically it has been thought by many including me that the higher cutoff filters allow the light to penetrate deeper but after much reflection and thousands of treatment sessions I'm not so sure—Most of my patients that you see on my website (drdarm.com) were treated with the 515 filter—Perhaps there is a study that shows the depth of penetration using different cutoff filters but I have not seen it—However I would love to learn more if anyone has additional information—The AL does not utilize any cutoff filters but nonetheless is approved for skin types I-V--

All of this said excellent results can be obtained for the average rosacea sufferer with the IPL treatments---The Lum One, Photoderm and many other IPL devices are available for treatments—As IPL's have progressed they have become more efficient with less energy—The AL is the next step in this progression—Other devices have altered how the beam is generated but the AL alters the target tissue with a vacuum suction tip that also delivers the intense pulsed light—By sucking up the skin into the bell the target tissue is spread out and becomes more vulnerable and can therefore be successfully treated with less energy—That is why the AL is much more comfortable and presumably safer--Also the intense light does not need to penetrate as deeply to reach the target tissue—The AL can be used to treat not only Rosacea but also Acne and is used to remove unwanted hair—By extending the wavelengths out to 400 thru 1200 the AL takes advantage of the lower light spectrum in the 400 range which is known to kill bacteria in acne patients—At 417nm, light creates protoporphirin #9 ( PP9 ) inside the acidic plugged infected sebaceous glands which are responsible for acne—The PP9 kills the proprionobacterium responsible for the inflammatory aspects of acne--For most applications the AL is truly painless—However after a treatment with our 1064 Laser (the Genesis) there can be a small amount of discomfort so we continue to use the Lasercaine. The risk is presumably less with the AL since less energy is used but only time will tell—

We continue to use the 1064 Genesis for our Rosacea patients because of our positive experience in the past with patients who have flushing and pain with flushing—The 1064 penetrates deeper and that is presumably why it is more effective in treating the deep blood vessels responsible for flushing—During the past several years we have noted that those patients with the deep flushing syndromes have required treatments more often in order to maintain a reasonable remission—Many of those patients have reported improvements after having minimal results with IPL treatments—In addition the 3mm Genesis head is fabulous for treating the superficial spider veins and even the enlarged nasal veins that can occur—Parenthetically the AL does not appear to do a very good job thus far with the superficial spider veins which is another reason to continue using the combination—The combination of Genesis and AL will continue to be our protocol—Thus far the existing patients have told us that they are getting better results with the new protocol with less discomfort—We are also using the AL for acne treatments and finding that it is far superior to any system that we have used yet—This may be due to the vacuum and the 400nm wavelength included in the IPL or a combination of the two—In any case the very difficult teenage cases are clearing much more rapidly and backs and chests are also clearing quickly—In addition the sun damage even in Asian patients seems to respond and with a greater margin of safety than when using the older IPL's—One interesting note is that Poikiloderma of Cevette ( the redness of the neck ) sometimes seen in rosacea patients responds quite a bit more effectively than with any other treatment that we have seen—Another is that there has been some success with treating melasma--

Do you feel the AL will work better than the standard IPL/1064 procedure?

I think that the combination of AL plus 1064 Genesis will work better than the older IPL/Genesis combination—I also believe that the AL by itself will work better for most applications than the older IPL's—At this time I do not believe that the AL by itself will be better than the old combination of IPL/Genesis or the new combination AL/Genesis

How long have you been using the AL?

3-4 months

Do you use the AL in conjunction with your Genesis laser?

Yes, see above—The AL has replaced the old IPL in all of our protocols

Do you use the AL in place of the Quantum IPL?

Yes, We were actually using an older Photoderm which has now fallen into disuse—The newer device is faster, safer, virtually painless and more effective than our old IPL

Is the success rate with the AL better than previous ones?

Yes—While I have not used the Lum One and cannot therefore make a comparison, the AL runs circles around our older IPL

Do you feel the AL is safer than previous ones?

Yes—Thus far the AL has lived up to it's advertising in terms of safety—Like all these devices there is a definite learning curve and optimal settings for different applications—Occasionally if the skin is too loose in an area it can be sucked up into the bell and comes too close to the flashlamp—This can cause a superficial dark crusting on the skin which goes away quickly in a matter of days—Also the suction can rarely create a small bruised area—Otherwise so far so good—Like all other IPL's you should avoid tanning prior to treatment—With our protocol you can experience redness lasting several days post-treatment

What is the technology behind the AL being able to "pull up the target area"?

simple suction pulls the skin up into the treatment chamber

Has the AL lived up to its advertising?

Thus far the device has lived up to its advertising in terms of efficacy and safety—That said I'm sure that our skill and knowledge of the capabilities of this device will increase dramatically over the next year

Will the AL help deep flushers? How does it improve treatments for severe flushing?

Whether this device will be able to treat flushing all by itself we may never know because our protocol includes the genesis which is very specific for flushing—In the past our IPL treatments could achieve some success with flushing if we preflushed before treating—Theoretically the AL might be able to treat flushing all by itself by bringing the target closer to the light—However at this time I cannot say for sure—

Will the AL help with general redness?

Yes the AL can help with generalized redness—In fact it is the most effective device we have found to treat the redness of the neck often associated with Rosacea

Is the AL safe for Rosacea skin?

Yes the AL is safe for Rosacea skin—However the post treatment redness may last several days longer on occasion—One theoretical concern is the development of new telangiectasias from the suction—While we have not seen that it remains a concern—Nonetheless telangs are easily treated in our center—

Does the AL have an effect on acne/large pores/sebum etc?

This device may be the most incredible treatment for acne that we have seen—It was just approved by the FDA for acne—In our hands thus far it cleans up acne much more effectively and much more quickly than the Nlite—We have seen 50-100% improvement after the first treatment so far—The 400nm wavelength kills the bacteria, the suction pulls the sebum out of the pores and the IPL seems to reduce the inflammation—Unfortunately retreatment at frequent intervals is necessary for teenagers every one to three months—Adults may achieve a remission lasting up to two years after a series of treatments—We continue to use the Nlite in our protocol to reduce pore size and for scarring and for deep scarring we add the vasculite ( 1064 ) for a third pass—

Do you have any before and after pictures you can share?

Unfortunately we have not had enough time for any significant before and after pictures—The pictures on my website took many years to collect—

For some of us the nose is the worst. Seems like the vacuum process would not work well on that area. Can you use this on and around the nose, or do you use something else, or some combo of devices?

we will always use the Genesis 3mm for visible veins around the nose—The AL has a very small head which can be used on the nose and can still obtain suction— Based on our experience thus far I do not believe that the AL can do a good job with the nasal veins or with spider veins in general but it is adequate for redness, papules or pustules on the nose—In addition we would always “paint” the nose with the 5mm Genesis head to get optimal results—

Do you think the AL machine will produce results if I have tried others and had no success?

I cannot tell yet if the AL alone will produce results in patients who have not had success—Obviously it always depends on the underlying symptoms, number of previous treatments, experience of the operator etc etc—I can say that the patients who seem the most frustrated are those who have flushing with or without pain—Many of these patients have come to us from around the world over the last several years having had 20 or more treatments with little or no success—By preflushing and treating with the combination of IPL and genesis we have seen improvement in many of these patients—Unfortunately they should be treated every 3-6 months with maintainence treatments to keep the flushing under control—It is possible that the Al may be able to treat flushing all by itself but we just don't know and may never know because of the nature of our protocol—For flushing patients we always add the genesis because of it's proven track record with our these patients—

What is the downtime of the AL compared to other procedures?

1-2 days of redness for rosacea patients--

It says no pain but is this actually true?

The device is much less painful than the old IPL's—Most hair removal and sundamage experience no pain whatsoever—However after a one hour genesis treatment some patients are more sensitive so we still use the lasercaine which pretty much eliminates any discomfort—

Is the AL machine easier for less trained doctors?

Hard Question—There are fewer settings on this machine—However IPL's are very hard in general—The difference between no result / good results / and burning is very narrow—I would therefore have to say that with any IPL that user experience is crucial—

Does the AL machine reduce the number of treatments needed?

Probably but not sure yet—

Are there any medications that you are aware of that should or should not be taken before or after treatment? By the term "treatment", I mean laser/IPL from the machines that you use, in general.

You should avoid Retin A, Accutane, tanning and tanning solutions prior treatment—There are many drugs that can improve Rosacea symptoms but that is an entirely different discussion—

Do you recommend that a patient do anything in particular leading up to treatment?

The bigger the target the better the treatment—Therefore discontinuing certain meds before treatment can enhance results—

What do you recommend post treatment - topicals, medications, general.

We use a one time application of betamethasone to calm post treatment inflammation—Additional meds might include clonidine or inderal—

Thank you for this opportunity to respond to your questions—If you have any additional questions please do not hesitate to ask—Thanx J Darm


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