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2008 Q&A - Interview with Dr Nick Soldo

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  • #16

    I have a few more questions. In your interview, you stated you have your rosacea patients go on an alkaline diet. Many people recomment a high protein diet similar to Atkins which I think is an acidic diet. I know that I personally flush extermely when I eat protein esp. animal protein. Would you please expand on the alkaline theory and perhaps post the diet you put your patients on?
    Thanks so much,


    • #17
      alkaline diet

      Yes it would be very interesting to hear your theory regarding the alkaline diet. I have read online about the advantages of this and that it claims if you stick with eating foods that are only alkaine, and drinking green tea, it "cures" rosacea. Do you think the main cause of rosacea is food diet?


      • #18
        Dr Soldo,

        1. I have been treated by numerous triple pass lumenis treatment based on your protocol with beard loss. its been 6 months and my hair growth is still stunted. is this permanent, if not how long before my beard grows back based on yr experience?

        2. Is cleansing once or twice better for rosacea?

        3. How can you get papules when one doesn't flush in that area?

        4. Can one be immune to anti-inflammatory effect of doxycycline even if he might be immune to the anti-bacterial effect?


        • #19
          Dr. Soldo

          1. Can you compare the redness of Rosacea, to the redness of Keratosis Pilaris Rubra Faceii from a laser treatment point of view?
          2. What is your view on micro ETS surgery, worth the risk to stop flushing/blushing?
          3. Which laser do you feel would treat just permanent redness the best, and what power settings do you think would be appropriate?


          Last edited by justakid; 6 May 2008, 12:23 PM.


          • #20

            Dr. Soldo,

            My question involves treating Rosacea with IPL when there is an overlapping skin condition such as seb derm or eczema. In your experience how frequently does IPL aggravate these overlapping skin conditions and what is your recommendation for these patients.

            Thank you for your time.
            "Get busy living or get busy dying."


            • #21
              Originally posted by markjack View Post
              Hi Dr Soldo,

              There is things going around at the moment about IPL and fat loss and skin indentations? Have you ever encountered this before? Is this down to a inexperienced technician or is it a case by case basis and this potentially might happen to anyone?


              hello Dr Soldo

              Just to carry on from mark's question. A lot of literature states that IPL will not harm skin, yet after having a disasterous lumenis 1 session, not only was my rosacea worse but i was left with numerous small open pores where I had had the treatment. Is this common?

              Last edited by spuggylegs; 6 May 2008, 06:12 PM.


              • #22
                rosacea Q's

                Hi sorry if this is a silly question but what makes a person unresponsive to IPL/Laser treatments?

                Are their bad side affects i.e burns,scarring, or making the rosacea worse?

                Can IPL/Laser treatments work for everyone, if not what are the alternatives for controlling flushing/blushing?

                Would IPL/Laser be your next stage in treating rosacea after no success with antibiotics?

                Thanks for your time


                • #23
                  Dr. Soldo

                  Hi may i ask what is your opinion on having an anti yeast diet?

                  Do you have a diet of this in practice and if so could you post it please.

                  How do you go about getting tests done to see if rosacea is caused by hormones; harsh; topicals; vascular already in origin or fungus- resulting in vascular problems.

                  I am asking because I have had a fungal infection on my big toes which i still have dispite painting lacquer treatment on since 2006. I then had a bad and (unexplained) constant sore throat red and raw from new years day 2007 everyday to september 2007 ( i took anti histamines) at this stage i had bouts of thrush and then i got the ear infection in september 2007 which cleared up in January 2008. After that i was diagnosed with rosacea.

                  Do you think this rosacea has resulted in too much yeast/fungus in my body?

                  How can this be treated other than diet - ie IPL/Laser?

                  Many thanks i am sorry to bombard you with questions


                  • #24
                    Dear Dr Soldo,

                    I have a skin condition in which 'pore plugs', which looks like dry bits of skin on the pores and feels like sandpaper to the touch, cover my t-zone area, especially the nose. In order to get rid of them I have to exfoliate every day - I have tried all types of moisturisers and these haven't been able to get rid of them. Using a cleanser makes my skin very dry and my skin produces even more oil than it already produces. Therefore, I just use a moisturiser and exfoliator. Also, I have rosacea symptoms - redness and flushing.

                    1) Have you ever heard of this skin condition before?
                    2) Would it be possible that my skin is simply trying to heal itself and by exfoliating the dry bits of skin on the pores, I am not letting it heal? However, the longest time I have left these dry bits of skin on my pores is about 1-2 weeks and they still hadn't exfoliated naturally.

                    Any help would be much appreciated.

                    Last edited by adam_h; 8 May 2008, 08:30 PM.


                    • #25
                      On behalf of Emilyamcfan:

                      Is it safe to receive either of these two treatments when you have a slight (but persistent) case of facial edema? Could it possibly cause the condition to worsen, and if so, would it eventually return to normal?


                      • #26
                        From Shamrock

                        I want to ask the doctor a question-dr. do you think think this settings and passes are to high and could cause fat loss in face.-its a lumenis by vasalight not lumenis one-i pass at 560-1 pass at 590-1 pass at 695- and last pass at 755--one of the older photoderm machines 1998 but was upgraded.

                        question number 2=if there was fat loss do you recamind still doing photoderm treatments?-its been 3 years since last one.--not worrying about flushing -i have other methods for that-what settings for redness- and some pand ps--thanks jerry

                        ==your doing quite the job here on this forum melissawohl-takes a special person-thanks for helping


                        • #27
                          Hi there.

                          My question concerns blood vessel regrowth and age. I've heard that cell activity slows down as part of the ageing process. In your time as a laser specialist have you found that older patients have a longer gap between top up treatments compared to those who are considerably younger?.

                          Many thanks for your time.


                          • #28
                            hi Dr soldo

                            i recently had 8 IPL's with the vasculigt with no problems, i then went on to have 2 treatments with the quantum both times i reacted with swelling,the swellin subsided but left the bottom halfs of my face somewhat enlarged, like two sort of bulges(they feel jelly like) at the bottom towards the back of my face it also thickens wen i eat,its been over a year question is have u ever heard of ipl causing problems with the lymphatic system,or the other systems other than vascular,wat happened?

                            im 22 have red hair and pale lightly freckled skin

                            any help would be gratefully appreciated...thanx sam

                            p.s i also know of one other case who have experienced this with the quantum
                            Last edited by downtown; 12 May 2008, 06:27 PM.


                            • #29
                              OK guys,
                              I am closing this thread so we can put it together and send it to Dr. Soldo.
                              Thanks everyone for participating.

                              You can find the answers to the Q and A at this link

                              Last edited by Melissa W; 10 January 2009, 01:19 AM.


                              • #30
                                Intro from Nicholas Soldo, M.D.

                                First and foremost I want to thank all of you for the invitation to participate in this Q and A. I greatly appreciate the interest you have all demonstrated. My answers are only my opinions, but are derived from nine years of experience with IPL, especially treating rosacea patients. During that time I have done 100% of all the treatments performed in my office, and have used a variety of IPL’s and lasers. I also stay current with medical journals and medical meetings that relate to rosacea.
                                There is no specific agenda in my participation or my answers other than to offer some modicum of pertinent information. I am a fallible human like everyone else and do not profess to have any answers other than what works for me and my patients.
                                Everyday that I am in my office, I see patients with rosacea, many having been referred by local dermatologists who appreciate the interest, care and usual good results we extend to their patients.
                                I hope you all can glean something from this to hopefully be of help to you. You all have my best wishes.

                                This information does not constitute medical advice. Any individual who believes they are suffering from any medical condition, including, but not limited to rosacea, should seek treatment from a licensed medical physician who is qualified to diagnose and treat the particular condition. Nicholas Soldo, M. D.

                                Hi I have viewed the video a zillion time and wish to heavens that my derm would too. I feel that he knows zilch about rosacea and less about what is going on in his treatment rooms, which are staffed by “operators” at the best.
                                Here is my question. Thanks so much for offering your time and compassion for those of us struggling for normal lives. In your protocol, how many milliseconds for each pulse? Is the delay between each pulse 20 ms. I understand the filters (640, 590, 560) the joules 20 but I am not sure about the reference to 3-20 ms. In your experience and expertise, have you had any patients who were not helped by the IPL treatments and were more successful with the pulsed dye lasers. If so, which one or ones.
                                Sincerest thanks

                                There are no set numbers for any IPL settings. My Lumenis One has guidelines, but they are just that. Longer pulses are usually required for darker skin, and shorter pulses for lighter skin.
                                Also the delay between pulses are treated somewhat the same, in that you have longer delays for larger vessels and darker skin, and shorter delays for smaller vessels and lighter skin.
                                I often use very short delays when treating fine superficial veins in lighter skin patients.
                                The filters indicate the depth of penetration, and again, deeper filters are desirable for darker skin. Fluence is power and it’s measured in Joules.
                                All of these parameters, like duration of pulse, relaxation time between pulses, etc, are variable and depend on skin color, depth of vessels, etc. They are all related to and determined by the individual skin.
                                Lumenis One is the only machine where you can vary each of these settings, so you can get the absolute optimum results.
                                Bottom line is that not only should every patient be evaluated prior to choosing the settings, but also every treatment on the same patient could use different settings, depending on their progress and skin condition at the time of treatment.
                                If patients adhere to established guidelines and enough IPL’s are performed, all patients will improve, albeit to varying degrees.
                                Pulsed dye lasers are invaluable for such things as birthmarks (port wine stains), red scars etc, but in my opinion they cannot begin to compare with the Intense Pulsed Light Lumenis One machine in treating rosacea.

                                Hi Dr. Soldo,
                                Thanks again for agreeing to do the Q and A.
                                What is your preferred treatment of choice (ie Vbeam, KTP-532. Nd:Yag 1064, IPL) for the following symptoms:
                                flushing with burning
                                papules and/or pustules
                                permanent redness

                                I use a combination of IPL (Intense Pulsed Light), KTP 532 laser, a Diode 940 laser, as well as an Nd: Yag 1064 in many patients, in order to address all of the symptoms you name. I also will occasionally use sclerotherapy on resistant vessels.
                                One should not overlook the benefits of LED red light therapy, which many of my patients tell me reduces the inflammation and the flushing associated with rosacea.

                                Dr. Soldo,
                                What do you do for a patient who has been unresponsive to laser or IPL?
                                And, is there a maximum # of treatments where you feel doing any more would not be of benefit or do you have no limit as long as the patient is improving? That is, are there any negative effects over time that could happen with repeated IPL or laser?
                                Thanks again,

                                Again, if strict guidelines are followed and enough IPL’s are performed (? 10, 15, 20 ?) all patients have some improvement. It can be mild to moderate to dramatic.
                                I see many men responding well with fewer treatments than women, maybe because they tend to have thicker skin with more collagen.
                                I do not know what a maximum number of treatments would be. I generally see adequate results with 5- 15 treatments, but have done more in rare cases of some patients with particularly bad rosacea. I am not personally aware of any negative effects from repeated IPL. I have read an article of supposed negative effect (fat loss etc) in a study in Europe, but I don’t know what machine was used in the study.

                                I have seen fat necosis in the face and indentations with other machines, like Thermage, and also IPL-RF combinations (such as Aurora). Although uncommon, I have also seen small skin divots from use of an ND-Yag.

                                But I have never seen these problems with IPL or PDL.I have done many IPL treatments daily for nine years, and have seen none of those effects from the machines I use. One must question things such as
                                1. Equipment used--what was the machine used?
                                2. What was the technique used?
                                3. Who administered the treatment?,etc.
                                Last edited by Melissa W; 28 April 2009, 01:23 AM.