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2010 Q and A Interview with Dr Crouch

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  • 2010 Q and 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
    Dear Dr Crouch. I had an V-beam treatment around 3 months ago. The treatment was not particulary aggressive and not purpuric (I think it was 8,5 joule in strength). Both my nose, left and right side was treated and the right side was treated a little more than the left side since the right side was my worst side prior to the procedure. What happened was that both sides reacted with swelling, the left side had minor swelling and the right side had a pretty intense swelling with burning and pain. The swelling on my left side subsided pretty fast and has never returned. The problem is my right side, the intense swelling lasted five days and then it subsided a lot, BUT the problems is that it returns when I flush. The more intense I flush the more intense the swelling, in addition the area has been very sore to the touch and generally not very good.

    My questions is as follows:
    Prior to V-beam I did NOT swell when flushing, now I swell pretty much on my right side when I flush (not the left). It also seems the more I flush the more I swell. The area also becomes a little sore and painful to touch.

    1) Have you seen this kind of reaction before, and do you think it will resolve over time?

    2) Why do you think this is happening, is it my lymph system or blood vessels that creates the swelling?

    3) Do you have any suggestions on how to deal with it?


    • #3
      hey Dr crouch,

      Do you ever surpass 26J's with the 590?

      And have u ever taken the 640filter or the 695 filter up to and passed 30J's

      Ive just recently had a pass with the 590 at 26J's and the 640 at 28J's(lumenis one)A little bit of crusting in the skin but overall it went well,Its my eighth treatment with that laser all spaced 5-6 weeks apart,We started off low and slowly raised the energies(being careful suffered damage before With a dodgy old ipl and fat loss with a very aggressive pdl(different people)every things gone great and ive improved alot so just wondering with all your experance what is the cut off level in your mindset with lumenis one ipl??

      Thank you for your time,

      Regards Matt.


      • #4
        Dear Dr Crouch,

        I would very much like your opinion and advice. I am 27 years old, living in London. I believe I have had mild-ish rosacea since my teens, with permanent background redness of the skin (which I was previously able to cover with foundation). At the age of 22, I experienced a short episode of 'hot flushes' where my skin would 'burn' and feel very hot, and look extremely red. I had no other After a few weeks I didn't suffer any hot flushes for several months, except for the occasional one when I was in a very hot environment.

        I have recently had my first baby and in the latter part of my pregnancy experienced 3 weeks of very severe facial flushing, which was more excessive on one cheek. This time, my cheeks not only felt very hot but stung when I had a hot flush. The redness was really extreme, practically plum coloured. I also noted the skin seemed shiny and swollen and it hurt to smile. The skin also went very dry.

        The hot flushes have since stopped although I have been left extremely depressed by this as the background redness has increased and I have been left with a redder patch on one cheek. I also have a redder nose with visible blood vessels on the sides of my nose.

        At the age of 20 I had one IPL treatment for the sides of my nose (as I had a visible vein on one side - pretty minor in comparison to what's happened recently). Although I think it improved the vein, I'm sure it increased the background redness of the sides of my nose, and I now have visibly enlarged pores there too.

        I now feel depressed that IPL will not work for me and there is no way out and no way to improve my appearance. I am concerned about IPL resistant skin and stories about fat loss from IPL.

        I am currently being treated for severe depression due to this condition but various medics have told me that they think my face is a hormonal thing - not rosacea 'because I do not have obvious telangiectasia' - and should be left to settle after the pregnancy before referral to a dermotologist (they don't want to refer me when I am depressed). The thing is, the depression is absolutely secondary to the rosacea and I feel the argument that this is not rosacea is poor because I am displaying all the symptoms of it. I know that very visible veins in the cheeks do not necessarily come until later.

        My 68 year old mother also has rosacea and a red face (with visible veins) but she is not at all bothered by this - I wish I wasn't either.

        Is there any hope that this can be improved? I want desperately to be able to enjoy my new baby and my wonderful husband but I feel so low about what has happened to me.

        Kind regards


        • #5
          Background redness and flushing

          Dear Dr Crouch,

          I developed very uncomfortable rosacea symptoms in April 2007 after having 'Microdermabrasion' to treat mild acne. The procedure was stopped early as my face went very red and sore. Ever since that day I flush very easily and have to moisturise thoroughly to help calm my skin down. I also have a lot of background redness mainly on the cheeks and nose, very tiny broken blood vessels and tiny rosacea spots develop after a bad flush leaving me with inflammation.

          I have managed to keep the spots and some inflammation under control by taking a small dose of Isotretinoin weekly but I still have this reactive background redness which soon enough turns into a flush and lasts a long time!

          I am being treated by Dr Neil Walker with pulsed dye laser to help get rid of the background redness and reduce flushing. I am having my fourth and final non bruising treatment this Friday however I have only noticed a mild improvement, I don't think it penetrates deep enough and four treatments cost over £2,000!

          Is there any other laser I can try which will have more noticeable effects? My skin is very transparent so I don't know why the improvements aren't more drastic?
          I used to have very white pale skin and I would really like it back.

          Thanks for you time,

          Last edited by katieee; 3 March 2010, 11:34 AM.


          • #6
            First IPL for rosacea w/paps and pustules

            Hi Dr. Crouch,
            Thank you so much for your help! I had my first IPL treatment for my rosacea. My cheeks and forehead were VERY red after teh treatment, adn now, 2 weeks later, I have some red scaley spots on my cheeks and forehead still. Any idea what might have caused this? Do you think they will go away? My rosacea seems to be more prevalent now than before my IPL treatments. I definitely have rosacea, and the machine was a luimens. Thanks!


            • #7
              Hi Dr. Crouch:

              I am having IPL treatments done. The 1st one the doctor used eye protectors but on the 2nd one he said it was not necessary that all i had to do was close my eyes. This way he could get close to the area under my eyes. Do you think the patient should always use eye protectors ? I have dry eyes so I thought maybe this way the dr. gets close under my eyes to help with the dryness.

              Thank you Dr. Crouch.

              using elidel at night, taking atelenol, had 2 vbeam laser treatments, 46 year old female


              • #8
                Hi Dr Crouch, Do you think that the IPL brand really cares? I mean machines with same power but different brand. if you think so, what brands are the best? I ask taht because I'm thinking take IPL sessions from a IPL machines that is not a Lumenis or Vasculight.

                Thank you in advance.


                • #9
                  Dr. Crouch,

                  Thanks for taking the time to answer our questions. I have noticed in your prior interviews that you are not a huge fan of Veinwave. Two quick questions. First: My prominent nose veins are a far bigger aggravation to me than my mild rosacea. I believe you like the Gemini over veinwave even in a case like mine, but would you say Veinwave is at least worth a try in such cases? Second: Would you venture a general percentage or any hint of the likelihood of Veinwave treatments making the veins worse than they already are, from your experience? An ineffective treatment won't hurt me too much. But I'd like to get a feel for the chances of making my nose even worse. Thank you!



                  • #10
                    Hi Dr Crouch,
                    Thank you for allowing us this opportunity once again.

                    My question is rather frivolous I am afraid. I have a couple of small hyperpigmented spots on my cheeks that have appeared in the last year and a half and surprisingly they really bother me. Compared to the burning of rosacea though they are nothing but nonetheless if I could make them disappear that would be lovely. My derm says they are freckles that occur with exposure to the sun even though I always wear sunblock (and reapply as necessary) while outside. I am very fair in coloring and while outside for any length of time apply a sunblock of zinc oxide and titanium dioxide of 60 spf.

                    Is there any laser/IPL procedure or any other treatment that you know of that could get rid of these hyperpigmented spots without aggravating my rosacea? My skin is ultrasensitive so I think topicals like hydroquinone, azelaic acid, niacinamide, and retinoids are out but am wondering if there is any treatment you would recommend even if it is one of these topicals since I have not yet tried anything to take care of this issue.

                    Thank you again and I hope all is well with you and your family.

                    Best wishes,


                    • #11
                      Hi Dr Crouch,

                      Thank you so much for once again agreeing to answer our questions.
                      In your opinion is it possible for IPL treatment, that has always been well tolerated in the past, to suddenly cause adverse effects?
                      I've had 15 or so IPL treatments over the past 7 years and have always had great success. Unfortunately I recently had two treatments (same Doctor, same settings) and they have caused extreme dryness all over my face and a huge flare of pustules and oily skin on my nose. I am pretty certain that it was the IPL that caused this because it happened after both treatments, but once again I should stress that IPL has never caused me any problems in the past.

                      My second question links to the first and concerns the relationship between Seb Derm, IPL and the N-Lite laser. I understand that IPL can flare Seb Derm (maybe this is what has happened to me) and I was just wondering if we had any idea why exactly IPL causes Seb Derm symptoms to worsen? I understand that you advocate the use of N-Lite to try and counter these effects, and was once again wondering if you know why N-Lite specifically helps in the treatment of Seb Derm.

                      Obviously I understand that it is difficult for you to recommend a particular treatment without viewing my skin personally (I believe I am currently on your waiting list for a consultation anyway), but do you think N-Lite would be beneficial for somebody that has very large pores, pustules, and severe oiliness (all on the nose)? I'm hoping that I can eventually turn to N-Lite to help undo some of the damage recently caused by IPL.

                      Once again thank you for all that you do to try and help fellow sufferers of Rosacea.

                      Kind regards,



                      • #12
                        Hello Dr Crouch,

                        Over time, I have read a fair bit about IPL (and also spoken to some practitioners too), with the thought that it might be an effective treatment for my rosacea. However, it sometimes seems that, as time goes on, more problems seem to be reported as being associated with IPL treatment. Do you think this is a reasonable assessment – would you say there are increasing reservations held amongst practitioners about IPL? And if so, is there a feeling that enthusiasm for IPL as a ‘relatively new’ (?) treatment has meant that it has perhaps not been used selectively enough?

                        Also, I understand that there are limits as to how close you can get to the eyes when carrying out any kind of laser/light treatment. Can you give any idea, for someone who has thread veins which veer up towards, nearby and over the eye socket, how far is ‘far enough’ away?

                        I seem to have largely ‘managed’ the rosacea so far, with the spots, veins and blotches wreaking havoc on my face occasionally, rather than most or all of the time; however, I feel that recently the symptoms have started to ‘accelerate’ and so I want to try and head things off at the pass before things worsen considerably. Are you able to say how long, approximately, is the waiting list for an appointment at your clinic; and do you have any update on the new methods getting in contact with you (recently announced elsewhere on these boards)? Apologies if this isn't the right place for this question, but I’m having difficulty getting in touch thus far.

                        Many thanks in advance, and best regards.


                        • #13
                          Dr. Crouch,

                          if you're dealing with severe vascular rosacea accompanied by debilitating flushing, do you prefer to treat it with IPL or V Beam? Which have you gotten better results with?

                          I've had both, and am seeing that V Beam seems to rupture more blood vessels while putting less heat into the skin and causing less post treatment flushing.

                          Would love to get your opinion on this. Thank you for taking the time to answer our questions.
                          • 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.


                          • #14
                            Dear Dr. Crouch,

                            1. I have a friend who has mild rosacea, one or 2 bumps appear on and off. She had Vbeam about 3 years ago and it helped to keep the redness/flushing away. Her cheecks have started to flush and get red more often again. She is wondering which is better for this Vbeam or IPL? The Vbeam helped her 3 years ago, she had 3 Vbeam treatments. Also, she is Latin, tan color skin.

                            2. I flush badly on my ears even when my face is not flushing. I've had 3 IPL treatments and they seem to be helping my face but my derm says he can not treat the ears. Do you have any recommendations for the ears?

                            Thank you so much for your help and taking time to answer our questions.


                            using elidel at night, taking atelenol, had 2 vbeam laser treatments, 46 year old female


                            • #15
                              V-Beam Results

                              Dr. Crouch: Thank you so much for doing this.

                              I have had rosacea for 15 years. When first diagnosed I was put on MetroGel. . .after some time I did very well on that - got an occasional bump but the MetroGel took care of it. I was almost symptom free for 14 years until a year ago. I tried a new mineral make-up and it caused a flare-up and it was like nothing I'd ever had before. . .not so much bumps, but rather getting more and more red and then the flushing began and the burning pain and I would swell up every day. It would ease some for part of the day and start all over. I went to dermatologist after dermatologist but all they could offer were creams - I finally found a Dermatologist who did V-Beam. She diagnosed me with Eczema on top of the rosacea and put me on Elidel which cleared up the Eczema quickly. My dermatologist kept me on Elidel and said I needed 3-4 V-Beam treatments. I have completed those and my last V-Beam was two weeks ago. After each V-Beam I would flush some and had some minor burning . . .the swelling would go down in about five days.
                              I haven't had a flush or a burn in 7 days.

                              My Question: What have you been seeing as the amount of time V-Beam (after 4 treatments) will keep me from flushing before I need to get a couple more treatments? I ask because I need to start putting some money aside to pay for these treatments.
                              Have been actually gone a year without the flushing and burning?

                              Thank you. Darcy