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2009-Q&A-Interview with Dr Crouch

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  • 2009-Q&A-Interview with Dr Crouch

    Dr Crouch has once again kindly offered to do another question and answer session.

    So for the next three weeks this thread will be open to anyone with questions concerning the treatment of rosacea with lasers, IPL, etc.

    If you haven't read the previous Q& A by Dr Crouch I would suggest you have a look here. You might also want to have a look at Dr Crouch's Triple C website

  • #2
    hi dr crouch, I had a bad experience with ipl in 2007,I received 6 treatments,At the time i didn't now wiser and got sun burnt badly after two sessions of ipl,Ive developed a very rough skin texture as a result,Currently I'm trying higher filters on the lumenis one to produce more collagen and try to smoothen my skin,My texture is very keritosis pilaris like,How do u go about treating rough texture?Have u ever seen ipl mishaps which give a huge texture change?Does it come down to a chemical reaction?
    Is producing collagen the key?Is the 695 filter capable off doing this?
    Thank you very much,Matt


    • #3
      Dr Crouch

      Many thanks for helping us out with another Q&A. Has there been any new developments in the use of lasers for rosacea over the last year or so? any new products that are in the pipeline?


      • #4
        Hi Dr Crouch,

        Thanks so much for taking the time to help the RF with another Q and A.

        Is there any laser/IPL or any other treatment you would recommend for the enlarged pores that seem to be associated with ongoing rosacea? I used to have invisible looking pores and now I definitely notice them on my cheeks. Though I know these can change as we get older I am guessing this has to do with my rosacea since it seemed to happen overnight.

        Thanks very much and I hope all is going well with you and your family.

        Best wishes,


        • #5
          Hi Dr. Crouch,

          Do you prefer IPL or V-Beam to help rosaceans, and why, please?

          Thank you for your time.

          • 58 yr old woman
          • Rosacea at 48, debilitating at 52
          • Clonidine 100mgc ev. 8 hrs;
          • Remeron 15mg nightly;
          • Zebeta=Bisoprolol=Beta blocker 5mg nightly;
          • Brimonidine worked well initially, then MASSIVE rebound flushing and damage;
          • Countless IPL with Lumenis One;
          • Now purpuric V Beam with Candela Perfecta; more clearance, less downtime than IPL;
          • Botox (with mesotherapy needles), good not great results;
          • Monthly Kenalog injection to blunt debilitating flushing.


          • #6
            In the last year or so we have been seeing more reports of side effects that people have associated with laser/IPL (such as fat loss). Could you perhaps shed any light on this issue-studies, anectodal reports, etc.


            • #7
              If you were new to an area and looking for some one to treat your rosacea with laser/IPL how would you go about choosing (would you want them to be medically qualified, etc,etc)? What questions would you ask when you had your initial visit?


              • #8
                Hi Dr. Crouch,

                Thank you for another Q &A session. Your feedback and information is always helpful and appreciated!

                I wanted to ask you a few questions regarding Accutane.

                For reference, I was on low dose Accutane two years ago. It worked great within a month on it (super clear and soft skin) and for eight months off. Then out of nowhere, I experienced bad acid reflux and found out I had a gluten sensitivity - my face went mad!! Prior to Accutane, I had mild acne (but persistent) and I have mild-moderate Rosacea. I can take another course, but have been getting IPL for now and it's helped a lot. So, mainly my questions are for those curious about Accutane or for general information.

                1) What is your opinion for treating Rosacea, those with papules/pustules/acne with low dose Accutane (ie. if other antibiotics have failed)?
                2) Would you recommend low dose Accutane for persistent flushing only, without papules/pustules/acne? *Most of us here feel type I Rosacea is better treated with lasers and not Accutane, however, your input is appreciated for those curious.*
                3) What treatment length do you normally recommend for Accutane?
                4) Have you ever performed laser on someone who is on very low dose Accutane? Personally, I wouldn't have laser done while on Accutane, however, there are a few folks on very low dose (ie. 5mg two/three times a week) that have had laser done. What are your thoughts.

                My question personal questions are :

                1) I have a few stubborn veins outside my nose and above my lip area that IPL hasn't been able to blanche or clear. My nose and cheeks are lighter pink, but if there is a better treatment that can help more my ears are listening.... One Derm. suggested Vbeam, Diode laser or schlerotherapy and another said VersaPulse laser (he doesn't have Vbeam - just IPL and VersaPulse)? Please tell me about these treatments and which is best. I did have two Vbeam treatments last year before my skin went haywire (acid reflux and gluten allergy) so I couldn't really see the effects since my skin went bad. Nervous to try to get the stubborn veins now as I don't want to undo the "good" that has been done with the IPL treatments.

                2) I still get papules or that sandpapery feeling (likely small comedones) on my jawline. I'm on Oracea - it helps a little. I hear jawline breakouts are often hormonal (I'm a gal) and can also be part Rosacea. Sometimes too, I notice a "pinching sensation" and then a papule is born! For reference, IPL treatments has diminished this sensation quite a bit as it did the papules - maybe I had some "extra" aggressive mites in my skin? Anyway, what other recommendations do you have in keeping this area clearer? I'm allergic to sulfa/sulfur and birth control pills aren't an option, unfortunately. Also, any input regarding mites and their correlation with Rosacea and papules? Feel free to share your thoughts - this topic surfaces a lot.

                Many thanks foryour input and expertise!!

                Last edited by Yvette; 3 August 2009, 08:19 PM.


                • #9
                  Hi Dr. Crouch, thank you for taking the time to again answer our questions.

                  My question concerns post vbeam hyperpigmentation. I had purpuric vbeam 8 weeks ago and when the bruising faded I was left with hyperpigmentation. I have read that this can be a side effect of vbeam and can persist for months. Is there anything I can do to speed up the lightening? (especially since many of the lightening agents are aggressive and would irritate my skin). Will this hyperpigmentation improve on its own in time? Would a different type of laser or IPL help speed this up?

                  thanks so much.


                  • #10
                    Sorry Dr Crouch I have another question!

                    What do you think of the use of botox for the treatment of flushing?


                    • #11
                      Dr. Crouch,

                      Thank you so much for taking the time to share your expertise.

                      I have had YAG and two IPL treatments within a year's time. I now have noticble permanent discolored indentations (scarring) on my cheeks and chin, yet I am unable to determine which of the two procedures caused this as I noticed it much later after the treatments. Would you know which of these procedures most likely caused this? And are there any laser treatments that you would recommend to resolve this, as well as to address the permanent redness/large broken blood vessels still on my cheeks and chin.?

                      Although I would love to have you provide any future treatmeants, unfortunately I am unable to travel from the US to your clinic. Can you recommend several colleagues in the US who have your expertise/knowledge with laser surgery for rosacea patients?

                      Lastly, for some reason, I have now become sensitive to every mild cleanser. I was able to use Cetaphil until four months ago, but it now aggravates my skin. I have tried everything - Cetaphil, Eucerin, Toleraine, Cereve, Aveeno, Aquanil, Olay, etc. to name just a few. What have you recommended for patients who seem to be unable to tolerate anything?

                      Thank you again,


                      • #12
                        Hi Dr Crouch
                        Thank you for your time.
                        I started six months ago with flushing, burning and tingling sensations. This has progressed to intermittent flushing and sensations leaving permanent red mottled cheeks and the start of p&p. My GP has diagnosed rosacea but offered no treatment.
                        My question to you is, what other treatments apart from light/laser would you recommend?
                        In your opinion what do you believe is the course of rosacea (SIBO,dermodex,genetic)?
                        Which would be cheaper, a private referal from my GP to The Great Western Laser Unit or a private appointment at the Burghley Park clinic?
                        Kind regards


                        • #13
                          Hello Dr. Crouch,

                          My main problem are pustules (not even papules, I don't get those). Did you treat such cases and did IPL work for them? Also, do you think RLT would work?

                          I am tired of taking Accutane and antibiotics because they just work while I take them, the symptoms get back in a few weeks after I stop them.

                          Thank you!



                          • #14
                            Hey Dr Crouch

                            Thanks for doing this.

                            i) It seems to me a lot of people are excessively anxious about flushing in the days post IPL/ laser (concerns about angiogenesis and whatnot). What are your thoughts on this and what do you currently advise your patients?

                            ii) Some visiting your clinic may have to negotiate Swindon's Magic Roundabout. As a local, how do you suggest they proceed?



                            • #15

                              Hello Dr. Couch,

                              Thank you for taking the time for some Q&A:

                              I recently had 3 V-beam treatments each 2 weeks apart. My dermatologist assured me that this frequency of treatment is recommended since the blood vessels are weaker. My settings were as follows:

                              1. 7mm, 6ms, 9 j/cm^2 - moderate swelling, 75% improvement

                              2. 7mm, 6ms, 9 j/cm^2 - mild swelling, 85% improvement

                              3. 7mm, 6ms, 10 j/cm^2 - severe swelling, more splotchy and 3 bruises

                              Do you think I was overtreated?