Interview with Dr Peter Crouch (2012)

Doctor photo

Dr Peter Crouch MB.BS.(T)GP. Section 12 Approved
General Practitioner & Forensic Medical Examiner (Principal Police Surgeon for Wiltshire)
Medical Director: The Great Western Laser Unit
Clinical Director: The Burghley Park Clinic
Office   +44    (0)1793 709580
Fax       +44    (0)1793 709581


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



Questions and Answers January 2012


rhesa ardiansyah

i have v beam laser for ten days ago...i have purpuric in my face...i seem fading away but in the 8 th days until now , not seem fading away..it look like the same...what should i do?thx anyway...its normal?


Dear rhesa ardiansyah

Thank you for your question. In my experience this can be quite normal with the purpura (bruising) created by purpuric(bruising) pulsed dye laser treatment. In my experience it varies widely how long the purpura lasts (this depends upon the individual and the location of the treatment and how much treatment is done i.e. how big an area is treated and where the treated area is (some areas clear quicker than others). In my experience the bruising can normally last up to 4-6 weeks in some cases (everyone is different). So it is early days for you and your treating clinician will be able to advise/reassure you. Sometimes, after Purpuric PDL treatment, patients are left with a “bronzed look” for a while after the bruise fades which is thought to be due to the iron containing breakdown products of the haemoglobin in the blood which has been coagulated(clotted) by the laser pulse as it is absorbed. This is not always unwelcome (some patients like it as it leaves them looking slightly suntanned) but if it becomes persistent and wont go, then Intense Pulsed Light (IPL) if suitable for the patient (again, the treating clinician can advise), may help to lessen or remove the brown appearance of any haemosiderin staining. I hope that helps, as always.


Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



freeme3

mild rosacea, treat with lasers?

Hi Dr. Crouch. I just was diagnosed with rosacea and it is mild. I have a lot of burning annd redness that comes and goes at it pleases. My nose also flushes for no reason. I'm trying to be proactive and want to treat my skin before it gets worse. Do you recommend doing. Laser treatments on mild rosacea? Could that keep it at bay? I have flushing and burning.

Thank you,
pam


Dear Pam,

Thank you for your question. Although it is difficult/not possible to advise without having met you or without access to medical history or the opportunity to examine you etc. In general terms, there are lots of potential options including trying to tackle the flushing and the redness. If you haven’t already, I would recommend that you read the leaflet “PART 1: HEAT REGULATION AND THE WARM ROOM FLUSH PHENOMENON” guidance by Colin Dahl, Chief Scientist from Australian Sciences. Click here for the link to this document. Medication may also be an option worth considering (you could ask your treating clinician about this or see a dermatologist with an interest in treating flushing associated with rosacea. Intense Pulsed Light (IPL), in my experience, can be helpful, even in the early stages for treating redness and pustules/papules (provided, of course, that it is suitable for the patient – your treating clinician should be able to advise/refer you to someone with experience of treating patients with rosacea with IPL/Lasers). The burning sensation may go as the redness and pustules recede but it would also be good to exclude any other rare but similar underlying cases (I’m sure that your clinician will have considered/excluded these). I hope that this answer helps you.


Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.

Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



Marcella

2 months post V Beam

I had the bruising pretty severely and now I am left with brown spots across the cheek bones on both sides of face. I would like to know if Dr Crouch thinks another light v beam or ipl would be appropriate to remove these pigment spots? or any other suggestions ?
thanks
M


Dear Marcella,

Thank you for your question (which is similar to rhesa’s question above). Sometimes, after Purpuric PDL treatment, patients are left with a “bronzed look” for a while after the bruise fades which is thought to be due to the iron containing breakdown products of the haemoglobin in the blood which has been coagulated(clotted) by the laser pulse as it is absorbed. This is not always unwelcome (some patients like it as it leaves them looking slightly suntanned) but if it becomes persistent and wont go, then Intense Pulsed Light (IPL) if suitable for the patient (again, the treating clinician can advise), may help to lessen or remove the brown appearance of any haemosiderin staining. I hope that the answer helps.

Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.

Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



Quench

Lyra laser for rosacea

I manage to keep my rosacea under control except for one patch on my cheek. It's about 3cm diameter, angry red and sometimes (like now) has pustules. I decided to try the laser route and recently had an IPL treatment combined with Lyra laser targetting this stubborn redness.
That was exactly a week ago. The patch now looks worse than ever - the pustules have expanded in size, the area is dry and a bit crusty and very red. Worst of all, it caused a fair bit of swelling - I looked like I had a black eye. The swelling has gone down a bit but has not gone completely - my face still looks lop-sided. Is it normal for swelling to last this long? And is Lyra suitable for treating rosacea with pustules?

Thank you for any advice.

Female, age 42. Using Zia Fresh Cleansing Gel, emu oil and ZZ cream.


Dear Quench,

Generally, provided it is suitable for the patient, I generally use Intense Pulsed Light (IPL) in my practice for pustular rosacea and I generally don’t like to combine more than one treatment modality (type) on the same patch of skin at the one treatment because I generally find that it can be tricky to work out what caused what if any problems were to arise. I also find that the energy level calculations can be complex – for example, simply halving the energy level of two treatments delivered one immediately after the other often doesn’t create the same effects. You might want to talk this through with your treating clinician who may have more experience of combining treatments in this way. In my experience, swelling from Nd:YAG (Lyra) or IPL (Lumenis One) would be an uncommon (almost unheard of) outcome of treatment for rosacea using our clinic protocols but it might be that your treating clinician has more experience with combining treatments and it would be good to discuss it with them. I hope that this helps.


Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



m-lou

Early stage rhinophyma

I'm a 48 year old female diagnosed with mild Rosacea earlier this year. About 3 years ago I noticed a lumpy area on my nose which gradually spread. At the same time tip of my nose became more prominent and weird looking. When I initially went to see a private derm she was not entirely convinced it was Rosacea as I had no history of it and not really suffered with pustules etc though It was prone to getting hot, red and more inflamed undercertain conditions. She did a biopsy on my nose to rule out anything sinister. Where the swelling spreads I'm left with what feels like a hard compressed lump and little hairs The biopsy confimed mild Rosacea and I was then put on Isotretinoin, 4 months on that and no result but lots of side effects it was promptly stopped. I was told at this point we can't do anything more for you your next option is private laser treatment. I am very self consious of the rapidly changing appearance of my nose. You can clearly see the enlarged subaceous glands Everyday it feels like its grown a little bit more and the realisation its only getting worse is scary and depressing. Everything I've read tells me the earlier I can treatment the better. Yesterday I visited the derm department for another matter, I mentioned my situation to the nurse who went and asked my derm who I should contact re laser treatment she advised these people www.sknclinics.co.uk but having looked at their site I dont think they treat Rhinophyma. What I need to know is who do I go to now. Do i need to see a plastic surgeon privately, I don't want to waste to much money finding the right person as I'm going to need it to pay for the treatment. Any advice would be greatly appreciated
as I feel pretty desperate
Thank you

m-lou

Early stage rhinophyma

Re my earlier post. I forget to say I am in Derby East midlands uk. Though I am willing to travel for the right specialist

M-lou


Dear m-lou,

It sounds like you have been competently investigated and treated to date and the approaches so far have been very rational but you couldn’t tolerate the isotretinoin and it was sensibly discontinued. I could recommend that you look up Mr Max Murison (http://www.bmihealthcare.co.uk/consultant/consultantdetails?p_name=Maxwell-Murison&p_id=41081 ) who has experience treating rhinophyma with the carbon dioxide laser. This is in no way to suggest that skinclinics may not also have access to an expert in the same field but that’s where I would normally direct patients who present to me with rhinophyma if they couldn’t tolerate medication as the first line of treatment. I’m sure that Max receives referrals from much further afield. I am always flattered by how far patients are often prepared to travel. We have patients currently treated who travel from Norway, Ireland, the USA and Canada, New Zealand and China. I think that it would be well worth the travel to see Mr Murison from the East Midlands.


I hope that this helps,

Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



ndkrn

How long after having non purpuric v beam treatment, can you expect swelling and lumpiness in cheek area? What is the lumpiness from?


Dear ndkrn,

Thank you for your question. I have to assume that you are asking about the settling down of the immediate post treatment oedema (tissue swelling due to tissue fluid gathering around the treated area). This is usually more or less absent in my experience with non-purpuric treatments. Having said that, any prolonged “lumpiness” or texture change in the treated skin would be unusual in my experience even with purpuric treatments more than say 1-2 days post treatment and certainly by 5-7 days post treatment (especially with non-purpuric settings) I would have expected any oedema to have settled but your treating clinician should be able to answer any queries you have and reassure you about what they would normally expect using their protocols and device. I hope that this helps.


Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.

Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



roryf

Hi Dr Crouch

I have had 2 IPL treatments with an Alma Harmony machine - one at 13 joules and one at 15 joules at 4-week intervals. I have redness on cheeks and nose, but no p and ps. I have been diagnosed with a combination of seb derm and rosacea. My derm has recently prescribed efracea (European oracea) in the hope that this will help my skin.

When should somebody start seeing results from IPL? Is it worth carrying out the full 5 treatments? I stopped because I felt I couldn't justify the cost after having 2 treatments with no obvious improvement. Was this foolish?

Many thanks for all of your efforts.


Dear Roryf,

Thank you for your question. In my experience, it can take 2-3 treatments to safely reach effective treatment fluencies (power). If however there are no results seen after 2-3 treatments then you may need to consider that the gamble that every patient plays i.e. that the treatment will be a success, will increase if there are no results seen despite a moderate increase in fluence when the desired treatment endpoint (outcome) has not been achieved. I don’t think it is foolish to have stopped – it was quite understandable and rational to have done so. The question though now is whether to carry on a little further to see if you get a breakthrough (this can sometimes happen with a modest increase in fluence/change of parameters between treatments) or whether you look to switch horses and try something different e.g. medication (or try both provided your treating clinician(s) are happy to do so). Some medication treatments are not advisable to take at the same time as laser/IPL but your treating clinician(s) will be able to advise.


I hope that this helps,

Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



rcb67

In advance thank you for your time and response.
my cheeks flush heavily from emotions, exercise, food, the sun, and alcohol. i have flushed at times since i was a teenager. now i am 28 and i flush more than ever and longer than ever. i now also have broken capillaries and some hyper-pigmentation on my upper cheek bones. Aside from the adjusting of my diet, cutting exercise, and limiting sun exposure, should i do a lazer, and if so what kind etc? will lazer make me more photo sensitive? will it block flushing? what can i expect realistically?
thank you

Dear rcb67,

Thank you for your questions. It is difficult/impossible to advise without having met you or knowing your medical history/examined your skin or knowing your skin type/ medication etc however talking in purely general terms and with the caveat that not all skin types can safely/appropriately be treated with Laser/IPL, I would recommend that the underlying cause of the flushing/redness may need to be investigated to rule out any uncommon but significant conditions. A dermatologist should be able to do that for you. If your skin can tolerate Laser/IPL, then given the broken capillaries and pigmentation then IPL may help but a word of caution. If you have hyperpigmentation of your skin and this is somehow related to or made worse by light exposure, IPL may be contraindicated as hyperpigmentation can be a side effect of treatment. If, by hyperpigmentation, you mean, uneven pigment often seen post heavy sun-exposure, then IPL may help to even this up. Your treating clinician will be able to properly assess your skin and condition and advise. IPL may also be able to help address the appearance of broken capillaries.

Turning to the flushing. The Nd:YAG laser is not FDA approved for treatment for flushing – it IS FDA approved for “photojevuvenation” and for thread vein/ prominent broken vessel treatment and that is what most patients would like to receive anyway. What we discovered is that patients who flush and who receive an Nd:YAG treatment for photorejuvenation, often seem to experience random bouts of flushing for 2-4 weeks post-treatment but that this seems to settle by 6 weeks post-treatment and often the settled flushing appears to be less than they experienced before treatment. When patients have flushing and redness and wish to try to tackle both issues, I recommend alternating between Nd:YAG and IPL so as to try to make progress on both fronts as treatment progresses. Whilst there is always a risk that IPL/Laser could increase photosensitivity, this is uncommon in my experience. As for blocking flushing, I think that some degree of flushing probably serves a good purpose and blocking flushing would be an unrealistic (and probably undesirable) treatment outcome. I think that reducing the impact of excessive flushing to bring it more into the normal range is a good treatment outcome to aim for. Does IPL reduce flushing – in my experience, whilst IPL can be more successful with reducing redness, I would not normally recommend IPL alone to tackle flushing. Your treating clinician should be able to discuss this with you.


I hope that this helps,

Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



lucy_nic87

Hi Dr Crouch - thankyou for again answering our questions. I have had mild transient flushing on and off for 5 years but it has never been a real problem. The last couple of months, after starting a new job around lots of artificial lights my skin has gone crazy. I have flushing and burning and my nose in particular flushes bright red every evening and is a bit swollen in the morning, although the redness has subsided by then. Am i likely to benefit from laser treatment? I had started on a low course of roaccutane for persistant acne and am aware i cant be doing both, but right now the flushing if more troublesome so i would be willing to stop roaccutane in view of laser therapy. what do you think? (i was flushing before beginning roaccutane so i do not attribute it to that). thanks so much!

lucy_nic87

Hi Dr Crouch - im sorry i forgot to ask previously, ive read about hair removal as a side effect of ipl. if this is a wanted side effect can it be permanent following a series of ipl treatment for rosacea? or are settings different for hair removal? thanks again!


Dear lucy_nic87,

Thank you for your question. You may benefit from laser/IPL treatments but would need to be off of the roaccutane for some time in order to safely start laser/IPL (assuming that both were appropriate). Depending upon your skin type and that of your ancestors, you may need to take the precaution of having a test patch but your treating clinician can helpfully advise you.

In terms of hair removal as a side effect, IPL can remove/reduce/increase hair growth post treatment. IPL was (and still is) licensed and effectively used for hair removal in skin types that can tolerate IPL and where there is a good contract between hair and skin colour, however more specific lasers are often considered to offer more effective treatments with a lower risk of side effects in certain skin types. We generally warn patients that this is a known side effect of treatment (sometime this is welcomed by patients if hair in the treated area is unwanted). Is it permanent – although it can reduce hair permanently, generally I would suggest that even laser hair removal in suitable skin types with a good skin/hair contract may offer up to 80% reduction in 80% of cases in order to adjust treatment outcome expectations appropriately. In a few, rare cases, it has been observed that IPL has increased hair growth in treated areas (presumably because of stimulation of the hair growth mechanism by levels of heat energy insufficient to adversely affect i.e. kill hair growth). You can imagine how that could come as a “less than welcome, nasty surprise” to someone not expecting that as a rare but potential outcome. Hair loss is generally more of an issue for men than for women as the area that is commonly affected with rosacea can extend into the beard line. If as you say you are not worried about permanent hair loss in the area treated, provided you don’t get the rare “paradoxical hair growth” then provided that you realise that it may not reduce hair or that any hair reduction may not be permanent, it can only be better than your expectations and that’s how I prefer to combine realistic expectations with rational treatment goals with patients.


I hope that this helps,

Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



roasceaclearwannabe

Rosacea Treatment

Hello Dr Crouch,

Thanks in advance for taking the time to read and reply to my question.

I have suffered from Roscaea since I was approximately 12/13 years old (I am now 23), the symptoms consist of permanent redness to both of my cheeks and ears however all of these areas flush heavily when reacting to the trigger factors – extreme in temperatures, anxiety, stressful situations, exercise and exposure to windy environments. I also find that when I get embarrassed and all other situations where a ‘normal’ person would go slightly red I flush heavily due to my Rosacea.

I currently do not have any visible broken blood vessels however I find the flushing very painful and the redness does bother me slightly.

Is it possible that light or laser treatment could help treat my condition? If it is possible, is there a high chance that the treatment could prevent extreme flushing in situations where a ‘normal’ person may just go a little red or pink to the cheeks e.g. embarrassing situations.

Once again thanks for your help.


roasceaclearwannabe

Hello Dr Crouch,

Once again thanks for taking the time to read and reply to these questions, your views and experience are priceless.

I forgot to ask in my earlier post - IPL is also advertised as a treatment for hair removal, if I were to have IPL treatment for my rosacea, which currently affects my cheeks, would I no longer be able to grow facial hair in this area or is the IPL set at a different setting for Rosacea IPL treatments?

Sorry if it sounds like a silly question!

Thanks again



Dear Rosaceaclearwannabe,

Thank you for your question. It is possible, yes, but you probably won’t know until you try – initially cautiously with one or two sessions and with reasonably long intervals between so that you can properly assess the effects of each. It would be sensible to have had other underlying causes excluded before treatment – it is difficult to comment without knowing if you have seen your GP/any specialists before or had any previous treatments for the flushing or if you are currently treated.

In terms of the embarrassing situations, have you considered seeing the psychology team perhaps with a view to them assessing you and recommending Cognitive Behavioural Therapy perhaps? This can often help with any anticipatory flushing and also help address the emotional impact of having had a troublesome painful condition for some time. They might also be able to discuss any inclination you might have for avoiding socially embarrassing situations and offer strategies for coping with them, should they arise. In terms of avoiding the flushing being too troublesome when it does occur, I would also echo my answer to a previous question about flushing i.e. if you haven’t already, I would recommend that you read the leaflet “PART 1: HEAT REGULATION AND THE WARM ROOM FLUSH PHENOMENON” guidance by Colin Dahl, Chief Scientist from Australian Sciences. Click here for the link to this document.


In terms of risk of hair loss with IPL – this is not a silly question at all and thanks for asking the question. The truthful answer is that hair loss is a possibility and we warn patients about this giving them the option to avoid treating especially conspicuous hair bearing areas e.g. the beard area in men. I have often been told by men not to worry about treating the upper lip because they wont mind if IPL removes their ability to grow a moustache or just have the appearance of “Five O’Clock Shadow”. In my experience, (and this is where I trust my gut instinct), patients who have been treated elsewhere and who have lost hair on their upper lip (fully aware in most cases that this was a possibility – a distinct possibility that it might be permanent in fewer cases as the consent process sometimes made light of it) often REALLY DID mind retrospectively. For this reason, I generally wont treat the upper lip with IPL on men (apart from anything else it is often especially painful because of the energy absorbtion by the hair present in that area. To directly answer your question, turning now to the beard area, it is not definite that you would get permanent hair removal following an IPL treatment, but the reality is that you could do. Sometimes patients wait to see how their redness responds to the IPL in the beard area before venturing there with treatment lest the redness is non-responsive to treatment (but their hair is!). If the beard area provides useful camouflage for mild redness due to rosacea, removing hair as an unwanted side effect and then finding that the redness is non-responsive to treatment could leave the patient’s redness more prominent because the natural camouflage has been removed by enthusiastic over extension of the treatment area.


I hope that this helps,

Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



jlb2010

Questions Regarding IPL and PDL

Hi Dr. Crouch. Thank you for taking the time to do this session. I have some questions on your IPL process, as I have had several light and laser treatments that have shown minimal improvement. I lead a very miserable life, with severe flushing, depression and seclusion as a result of this disease and I would greatly appreciate any advice that you can provide.

I have had severe flushing Rosacea for 2 years. When I initially was diagnosed, I had a purpuric VBeam treatment that really was too aggressive. It took 6 months to heal - I believe my flushing was made worse and I was left with hyperpigmentation that took 6 months to heal. After the hyperpigmentation was gone. I then undertook IPL treatments with another leading practitioner using his triple pulse triple pass technique. I had 10 of these treatments (he used very minor settings at first progressing to standard settings toward the 10th treatment) and had minor improvement in both redness and flushing. I notice that the two of you have some differences in the way you conduct your triple pulse triple pass technique, and I would like to understand if these could have significant impact on the effectiveness of the treatments, or if they are minor differences. Can you please comment on the benefits of your methods:

- Why do you start with the shallow filters first and then progress to the deeper filters. My practitioner starts with the deeper filters and then progresses in the final pass to the more shallow filters.

- I also noticed that you prescribe Clarithromycin following your treatments. That is not a commonly prescribed drug here in the US. Do you still use that as a mechanism to stop angiogenesis between treatments - or is Oracea/Docycycline just as effective?

- I also noticed that you change the orientation of the "head" of the IPL between passes. What is the benefit of this?

- My treatments were spaced 2 weeks apart, instead of the 3-4 weeks that you use.

- What percentage of your patients require greater than 10 sessions to see acceptable results? What percentage of your patients simply do not improve from IPL?

After I had the 10 IPL's done and didn't see much improvement, I had 2 PDL treatments done again. Once again, my skin simply cannot handle PDL or Vbeam - it is too sensitive.

On a separate note, are there laser/light treatments that are better for countering major flushing triggers such as high stress, high anxiety, extreme temp, etc.? We found that IPL makes a difference for minor flushing triggers, but not the major ones.

Thanks again for your time.



Dear jlb2010,

Thank you for your question. The filters selected will vary depending upon the patient but, for the sake of illustration, let’s assume that the most commonly used filters/ fluencies (energy settings) are being chosen because there are no special factors in play.

I start with the 590 filter because, of the three, this is likely to provide clearance of the more superficial redness. It is important to remember that the filter is a low pass cut off filter and that as the numbers increase, a narrower band of wavelengths is being let through. A 590nm filter lets through every wavelength from 590nm up to 1200nm which is the upper level of wavelength produced by the Lumenis One IPL handpiece. A 615nm filter by comparison blocks wavelengths not only below 590 (as the 590nm filter did) but also those between 590nm and 615nm, allowing wavelengths from 615-1200nm to pass through. The same logic can be applied to the 695nm filter which lets through an even more narrow band of wavelengths (695-1200nm).

The reason I start with the lower filter number is that, any decision to move onto the next phase of treatment i.e. the second or third pass respectively, is based in large part on how the skin is tolerating the previous pass. By starting with the filter with the widest spectrum of wavelengths but at lower fluence (remember as I change the filters to narrow the wavelengths I also increase the energy between passes normally by 2 J each time) I am prepared to suspend the treatment after pass one or two if the skin is showing signs of not tolerating the previous pass.

The reason for increasing the fluence (power) as the spectrum narrows on subsequent passes is that we are hoping to successively target deeper vessels on passes 2 and 3 and for that you need slightly higher relative fluencies to drive the narrower spectrum deeper. That the spectrum is narrowing with each pass is reassuring because the skin has already been treated by one (or two) previous passes. I feel that it is logical to be cautious with just previously treated skin when applying more energy in a subsequent pass.

What I find helps to illustrate the order best is this – consider what would happen if you reversed the order of the filters and increased the fluence? You would risk exposing already treated skin to a widening spectrum of increasing energy on every subsequent pass and I prefer to stay on the side of caution. In short, I believe it may be safer to do it this way. Our Lumenis One machine has delivered over 25,000 treatment shots and I can recall only one minor blister in the early days with the new machine. The tiny blister healed very quickly with no significant consequence for the patient who is still coming for treatment and was actually very pleased with the clearance beneath the tiny area of overlap (which was what almost certainly caused the issue). As I know all clinicians do, I have worked hard over the years to always try to provide safe but effective treatments but this is a tricky area and experience has taught me to stick to well trodden pathways and closely adhere to principles and to trust clinical instinct. We don’t offer to prescribe Clarithromycin as standard any more as an angiogenesis inhibitor (we found that it wasn’t necessary in virtually all cases but it is still an option for those who get good clearance with IPL) only to find that the blood vessels regrow very quickly again after treatment. I have found that being less aggressive and trusting to longer intervals between treatments can often provide the best and most sustained clearance with IPL. As a rule, I don’t treat again any earlier than 6 weeks and the normal interval between closely spaced treatments at my clinic is c 12 weeks apart. We change the orientation of the treatment head between passes wherever possible in order to reduce the likelihood of “barcoding” – the appearance of multiple parallel lines of redness or pigmentation in the treatment area that could arise with multiple passes using identical treatment head alignment (hope that makes sense). I would estimate that <1-2% of the patients need more than 10 sessions to achieve acceptable results – most see results after 2-3 sessions and we tend to reach stable treatment settings at the 3rd or 4th treatment session. I would estimate that less than 5% of patients don’t respond at all.

It sounds like your skin is not Pulsed Dye Laser tolerant and I would suggest that for you, it is best avoided in future given your history.

I would agree with the suggestion that IPL can address minor flushing issues but I have found that the patients we have treated with both the Nd:YAG and the IPL greatly favour the Nd:YAG over IPL for flushing. The reverse can be said for the treatment of symptoms of redness and especially papules and pustules in which case, provide the treatment is suitable for the patient, I really don’t think that you can match the positive and often dramatic impact of sensibly delivered Intense Pulsed Light for inflammatory rosacea with papules and pustules.

I hope that this helps,

Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.

Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



jstev4506

Hi Dr. Crouch,
I am a 27 year old male who was first diagnosed with mild rosacea about 7 months ago. At this time is is concentrated to my upper cheek bone on both sides of my face. The right side is the trouble spot; The blood vessels are very noticeable and lately it seems like everything causes it to flare (constantly red). I had a consult with a medical esthetician for IPL and have an appointment scheduled in a couple weeks. I'm just wondering what I can expect in terms of results (in your opinion)? Will the IPL destroy all the problem blood vessels in the area or will they return in time? Is the IPL the most appropriate laser for my condition? And if so, what is the approximate timeframe on that? What kinds of questions should I ask the esthetician before/afterwards? How long can I expect to have bruising?
Thank you in advance for your time and I look forward to your reply.

Dear Jstev4506,

I think that you might hope for some improvement after 2-3 treatments but it would be rather optimistic to expect the IPL to destroy all of the problem vessels. The best you should prepare yourself to hope for is a reduction after 2-3 treatments that improves your self esteem and confidence and that leaves you feeling happier about your appearance. The issue, as you have correctly alluded to is that, once treated, new vessels (not the same ones - a popular misconception it seems) can grow back over time and rosacea tends to be a progressive condition (not always). You may want to consider how aggressively you want treatments to be because it may be that more aggressive treatments provide good initial clearance but become the unwitting victim of more new vessel re-growth. In my experience, some of the best work I have done over the years has involved recommending to the patient that being a bit more conservative with treatment settings and spacing treatments out a little further, can often provide the best long term outcomes and at a frequency and cost to the patient that is both acceptable and sustainable in the long term. The approach I adopt is to consider what I would be recommending to a close friend or relative especially if I were paying for the treatment. Finally, small point, I almost hesitate to sound picky by mentioning it, Intense Pulsed Light (IPL) is just what it says on the tin – very bright light of multiple wavelengths delivered in pulses. Laser is quite different – also very bright but normally a single wavelength. They can both effectively target blood vessels. I think that IPL sounds like a good option for you but your treating clinician will be best placed to advise you as they will have had the opportunity to meet you, take a history and examine you etc. I don’t find that IPL treatments delivered by our clinic tend to bruise but your treating clinician should be able to advise you about what they would expect using their machine and protocols. I hope that this helps and good luck with the treatment in a few weeks.

I hope that this helps,

Kind regards,

Dr Peter Crouch, Laser Clinician, The Burghley Park Clinic, Swindon.

Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



Melissa W

Hi Dr Crouch, I hope all is well with you and your family. Thank you for taking the time and energy to do another Q and A with us. Your thoughtfulness is much appreciated by the RF.
Are there any new or exciting treatments on the horizon for rosacea? Anything that has potential that might be coming up in the near (or distant) future?

Thanks again Dr Crouch.
Kind regards,
Melissa


Dear Melissa,

Thank you for your kind wishes – all well here thank you, everyone is fine. Preparing to write these answers between Christmas and the New Year, I always feel optimistic about what a new year will bring but alas, with the downturn in the economy, with Research and Development output seemingly at a bit of a low point in terms of new devices, I haven’t got anything really to suggest in terms of lasers and IPL. There doesn’t seem to be anything particularly attention grabbing at present in terms of new kit or protocols. When Lumenis released the Lumenis One platform, it felt like a Rolls Royce of a machine with nice design and good cooling. We have been taking very good care of ours (not exactly parking it our front and polishing it every weekend, but I’m sure you get the analogy). I’m relieved to say that nearly 30,000 treatment shots later, it is still performing well as is our Pulsed Dye Laser(NLite) and Nd:YAG (Gemini) and I generally use each of them several times every day we operate the clinic and having the ability to be able to offer IPL/PDL and Nd:YAG is a real luxury. My practice now almost exclusively centres around treating Rosacea with IPL and Lasers. There may be some advances in terms of medication and topical products but the Laser/IPL device side is fairly consistent. What this does positively afford, however, is the opportunity to consolidate and concentrate on increasing the numbers of patients using the existing devices and protocols and with this comes larger numbers of patients receiving similar treatment parameters for similar presentations of the same condition and this builds experience and confidence. My Professor of Medicine at Medical School always urged us to pick a specialty we were interested in and suggested that the best way to proceed building a career was to keep focussed on a few (or one) condition(s) and see lots of patients and deliver lots of treatments and “get good in a narrow field of expertise”. Each time a new device comes along, it takes time to develop new experience and get used to the treatment parameters and develop new protocols based on your experience and the experience of others etc. Perhaps it’s not such a bad thing that the industry has calmed down for a while in terms of putting out new devices. It would have been if we didn’t have access to some excellent machines but until something stunning comes along, I think I, like many others, will stick with the current, well understood, fully road-tested and battle hardened kit. Thank you once again for the question.


Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



Souris24

Hi Dr Crouch,

Thank you very much for again taking the time to answer our questions.

A derm I saw strongly invited me do have IPL done for my flushing but when I asked him about the risks, he answered that there were none. I asked a second one, who gave me the same answer. I, of course, know that there are risks and i would like to know if there is a type of skin which is more vulnerable to lazer treatment and in which case you would avoid doing lazer treatments. I am very scared of having it done as my skin is very thin and sensitive. I fear excessive swelling and fat loss . I mainly flush with going from cold to hot temp., emotional stress, eating, heat and have a few P&P's. I've had quite some sunburnts during my teenage years.

Thanks again for your help.
With my kind regards.


Dear Souris24,

The last thing I would wish to do is contradict advice given by not one but two professionals particularly as I haven’t met you am not in a position to assess your skin type/ take a history etc.

I’m not sure that “no risk” would ever be advice given by our clinic (and the consent form would certainly make that clear) however and you would have to ask them, I’m guessing that what they probably meant to convey was that, based on their experience and their assessment of you and the treatment settings they were proposing to use, they thought that the possibility risk was so low as to be virtually “none”. I don’t know that I could make that leap of faith in terms of expressing tiny as none but there you go. Some skin types are more at risk of IPL (e.g. pigmented, steroid ravaged, thinner, older skin with patients currently or recently taking certain medication e.g. roaccutane).

Your skin does sound sensitive and you say you were prone to sunburn. I would be cautious with your skin and if you needed IPL/Laser, I would probably start down the Nd:YAG route as you mention that your primary issue was with flushing. The settings we use for the Nd:YAG are conservative and we have had no problems with the protocol – it is very popular with the patients.

If you had any basal redness and needed IPL (which you may be less tolerant of) I would generally advocate doing a test patch and using conservative settings with IPL to start with and then increasing fluence (power) gradually only after checking how your skin reacted the previous time. Treatments should ideally be spaced out to enable full recovery between treatments. Over time your skin might adapt to well to the light based treatments. You may have a light treatable condition but light intolerant skin in which case I would normally let the patient know as early in the process as this became evident so that they could stop / change tack.


I hope that this helps,

Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



freeme3

Help for burning

Hello Dr. Crouch,

I have very sensitive skin which is dry and my face burns a lot (but does not always turn red). I have some mild redness on my cheek that seems to be always there but it is barely recognizable. Is there a laser that you would recommend for the burning or could it possibly make it worse?

Also, I am having a difficult time finding a doctor who does laser in my area despite the fact that I live in a city that has great hospitals. It seems like most office have physician assistants who do the lasers. Would it be best for a doctor to do the treatment?

I appreciate your time and help!


Dear Freeme3,

Thank you for your question. A burning sensation can be distracting and uncomfortable and needs to be addressed carefully. It can accompany several conditions – not always just rosacea. This needs careful diagnosis and may involve several treatments combined. I try to be honest with all patients and if asked if any treatment could make things worse (the truthful answer is – it could) but the skill of the practitioner is to make as accurate a diagnosis as possible given the information available and the outcome of any evaluation and to recommend treatments that may help with an informed appraisal of the possible outcomes. You are depending upon the skills, knowledge and experience of the practitioner. In our clinic, I would see all new patients and prescribe and personally deliver the test patches and IPL treatments. We were very lucky in our clinic a few years ago to have the services of a highly experienced, fully trained laser nurse practitioner who worked within expert treatment protocols written by and supervised by myself and patients who were well established on treatments could opt to see Christine for treatments and these were always delivered professionally and within the parameters which I had previously prescribed. Had there been any deviation from the response, the arrangement would have been that I would have seen the patient again and adjusted the prescription based on a re-evaluation. There are two components here; a) the clinician who evaluates and diagnoses and who formulates a prescription and provides clinical supervision and b) the clinician/technician/assistant who delivers the treatments using their skills, knowledge and experience of treating the condition. They may be one and the same person (but not necessarily). I would always establish this (tactfully) before agreeing to treatment as it could be awkward or embarrassing on the day of treatment if you turn up and find that someone you have never met before is planning to do the treatment. No one should mind being politely asked how much experience they have with treating your condition with the equipment it is proposed to use and are they following a prescription and expert treatment protocols adopted by the clinician who has met you, evaluated you and who is supervising your treatments.

I hope that this is helpful – I would suggest that you discuss this with the clinician who assesses you. I have had the privilege of working with some fantastic laser assistants (in our case they were all qualified nurses) – ones that I would have no reservations treating myself (or a close friend or relative) and I found that reassuring patients that this would be the standard I would always use was reassuring.


Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



Claude

Hello Dr Crouch

Thank you again for answering our questions.

I was just curious to know what advise you give for sun protection to your patients that had IPL or PDL treatments? I'v had PDL treatments last fall and I'm going on vacation on a cruise next month. I don't want to ruin the results I got with my treatments. Is our skin more sensitive to the sun after we had this kind of treatments? Some say yes, some say no...

Thanks again!
Claude


Dear Claude,

Thank you for your question. I give patients general sun smart advice but following IPL treatments (or purpuric PDL) I recommend sun avoidance (preferably hat and stay out of prolonged direct high intensity sunlight) plus very high sun factor for several days post treatment and to be very cautious up to 4 weeks post treatment. IPL can remove pigment (and therefore reduce the skins natural sun protection) so we tend not to do IPL when patients are very sun tanned (it would be less effective and risk increasing or damaging their natural pigment) and we can’t IPL patients who turn up at the clinic looking sun-burned. This occasionally happens when there is an unexpected bright few days before a treatment and someone has forgotten their sun block or has inadvertently stayed too long in the sun. I try to be sympathetic but it can be disappointing to be told that we can’t treat on the day (or have to turn the energy down to take account of mild sun exposure).

Your cruise is unlikely to ruin the treatment – enjoy the cruise and have fun, just be careful and be smart in the sun.


Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



RudolfRedFace

Hi, Dr. Crouch.

I've not been concretely been diagnosed with rosacea, however I clearly have symptoms that would point to it being that. I'm going to have laser treatment next month, and I'm curious to if that does help, is that evidence that I have rosacea, and if not, how will the doctor determine if I actually have rosacea? She has looked at all my symptoms but have not yet diagnosed me. It's frustrating to not get an actual diagnosis because I've had the symptoms for so long, what would you suggest do next to find out if it is rosacea? I'm 20 years old and there for my doctors have doubts, because apparently it's very, very rare to get at my age? Also; I have relatively mild redness and my doctor has said that laser treatment would take away the redness by 50% at best, is that true in all cases?

Thanks in advance!


Dear RudolfRedFace,

Thank you for your question, the response to laser treatment may give clues to support/refute the diagnosis but is highly unlikely to be diagnostic as such. You may have a laser/IPL resistant condition or laser/IPL intolerant skin and the clinician will be able to advise you once they get going with starting treatments. I would respect a clinician who can be honest about not knowing for sure as the diagnosis can be difficult especially with mild cases presenting earlier that the majority. You may have a similar condition e.g. seb derm or KPRF or a mixture of rosacea/seb derm. Your clinician is the best person to advise and I would look to trust the judgement of someone with the skills, knowledge and experience that has been able to see you and evaluate you properly and then see how you respond to cautious treatment. It is always best to be conservative with predicted treatment outcomes – that way this doesn’t raise expectations unrealistically.


I hope that this helps,

Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



MrBenn

Hi Dr Crouch,

Would you recommend YAG laser for dealing with flushing after eating? This has become a persistent trigger for me. I am currently taking propranalol which does not seem to be helping with this aspect.

Any help much appreciated, thanks for your time.


Dear MrBenn,

Thank you for your question. Nd:YAG isn’t FDA approved for treatment of flushing and the effects we have observed have not been specifically linked to flushing after eating although some have reported an improvement in this symptom as part of an overall reduction in a range of triggers including flushing after eating. There may be other causes that should be excluded and treatments that would be equally/more effective. Presumably someone is prescribing you the propranalol and has excluded other causes. It is difficult to suggest anything without being able to evaluate/take a history/examine you etc. I would suggest that you discuss this aspect with a laser clinician that can see and examine you.


I hope that this helps,

Kind regards,

Dr Peter Crouch,

Laser Clinician, The Burghley Park Clinic, Swindon, UK. January 2012


Disclaimer

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.