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Thread: had 2nd v-beam today

  1. #11
    Moderator phlika29's Avatar
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    Well I've had pdl induced pupura a number of times recently so I maybe I do. I believe my advice is still good, dont shut yourself away from the world.
    Last edited by phlika29; 22nd January 2009 at 12:51 AM.

  2. #12
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    Default maybe you don't

    again, you know very little about me, you don't know where i've been, so you don't know where i'm coming from.

  3. #13
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    Is purpula v-beam better than if you don't bruise? I had read you get best results when you bruise, but my doc said that it is not necessary with the latest equip. I had two v-beams with him, neither of which really even made me that read...and they didn't help at all. I am wondering if a purpula induced v-beam would be better for diffuse redness?

  4. #14
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    hozer2k,

    I still think the best answer is the link found by man_from_mars.

    http://www.bu.edu/cme/modules/cutane...techNotes.html

    This is a continuing medical education course for doctors about dermatologic lasers. It has several sections. Section II is specifically vascular lasers. It is giving by Dr. Thomas Rohrer, who works at SkinCare Physicians of Chestnut Hill, one of the top dermatological clinics in the country.

    Purpura is just a fancy term for bruising. Bruising comes from broken blood vessels. If the laser breaks the blood vessel, blood spills out, causing bruising. If the laser gently heats the blood vessel, it coagulates, and no blood spills out, no bruising.

    This was the idea behind the newer lasers. If you heat the blood vessel fast, using a common setting of 1.5 milliseconds, all the energy of the laser is delivered in 1.5ms, which heats up the vessel so fast it explodes.

    The newer V-beam lasers allow you to tune the pulse duration, so you can have longer pulse durations (pulse widths), up to 40 milliseconds. The energy is thus delivered to the vessel over a longer time, so the vessel doesn't heat up so fast, and it doesn't explode, thus no bruising.

    While this is the point of the lecture, I've been to some very famous laser doctors, including Dr. Rohrer himself last May, and he still used purpuric settings on me. I honestly don't know what is going on with this new emphasis on no purpura/no bruising. Dr. Rohrer is a very nice guy so it is really confusing. He's one of the nicest doctors I've ever met.

    I currently see another expert on lasers, Dr. Jerome Garden in Chicago, and he uses the same V-Beam Perfecta laser, that theoretically could do 40 millisecond pulses, and he still uses the 1.5ms purpuric setting, just like Dr. Rohrer did.

    My opinion is, you really don't know if you've hit the blood vessel unless you have some sign, which is the bruising. Then you know you've hit something. Without bruising you don't know. Now, I should add a caveat that Dr. Rohrer makes in the lecture about seeing some kind of transient purpura using the non-purpuric settings that lets them know they hit the blood vessel. So maybe this is the future of V-beam.

    But as for now, it seems to me like the experts are still using purpuric settings. I base on this on my experience with Dr. Roher and Dr. Garden, who are two of the most well known experts on lasers for dermatology.

  5. #15
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    Thanks!

    I was unaware of this link and it is very informative. This tends to agree with some studies I have read that shorter wavelengths are recommended for tiny vessels (i.e. diffuse redness). I noticed he mentioned that he treated some spots with purpura still.

    There is also a realistic economic effect that he mentioned that is related to efficacy. If you use a longer duration it seems that you will not get purpura but that you are not as effective. Therefore, you are not likely to get repeat business and perhaps less word of mouth advertisement. HOWEVER, it still seems that for the vessels invisible to the naked eye that purpura treatment *might* be better? He suggests that multiple treatments will mitigate this, but I am a bit skeptical there.

    One thing I did note was that on slides 58/59 he states the texture is "much much improved". I have been hearing this for a long time with IPL, V-beam, etc. but never witnessed it myself....even though they kept saying how much improved the texture was. I look at slides 58/59 and do not really see improvement, but rather different lighting. I sometimes think they don't really have a keen eye to these things. Anyway..just a side issue. Either way, this is very informative. Thanks!

  6. #16
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    oh, what I think he was saying wasn't really economics...but actually if one were skeptical one could interpret it that way.

    my interpretation is that he was saying it's hard to get people to come back and go through purpuric treatments. it's easier to get them to come back if there is no down time. and the best treatment is the one that the patient actually uses.

    so it might be better for the patient since they will actually use the non-bruising treatments, but are too afraid of the bruising treatments to go back. so in the long run it is more effective to do non-bruising because they patient will do those, as opposed to bruising treatments, which s/he won't do.

    then again like you said, maybe there is money in it. probably always is. SkinCare Physicians of Chestnut Hill is NOT cheap. they are a very high end place. you pay to see the best dermatologists in the country...trained at Harvard, Yale, Dartmouth, etc.. I just don't think Dr. Rohrer is greedy. He is really a great guy.

  7. #17
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    Those are some good points. I was not referring to this doctor, but more of the overall evolution and laser manufacturers as well.

    Really my point was not of one being greedy, but rather of efficacy. What I fear is that doctors are not trained to treat at higher wavelengths to avoid purpura, BUT will this be effective as a purpura inducing treatment?

    For patients who just started their treatments and for many average type patients, this may be great. BUT what happens when you get a resistant patient? Does the doc know and SHOULD you then go for a purpura treatment?

    I have read of some people getting good results with purpura treatments and claim that only purpura treatments did them any good. That is why I am particularly curious about this. I have done about 30 IPL over 10 years with some help, but overall I am not satisfied. For me, its better to get it over with than to mess around for the next 20 years. But, I don't know if that is the answer anyway...just getting into it really. I will try to find out what my doc used on me, but it was definately not a purpura treatment and it definately did not help. I guess the real question is if the patient does not see results from a 10ms duration, will not never see a result...or is it possible to go to a 1, 2, or 3ms duration and have a result, even if purpura is induced?

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    hozer2k, I think you are getting the technical jargon mixed up. This isn't a question of V-beam wavelengths. All V-beams use 595nm light.

    Purpuric or non-purpuric comes from two things

    1 fluence = energy = joules/cm2

    2 pulse duration = milliseconds

    really in the end, purpuric is more "effective" in the sense of destroying the blood vessel with certainty, because you are exploding the blood vessel. Without purpura, you are coagulating the blood vessel. It may collapse and be dissolved, it may not, it may re-open, but with purpura, you know for sure it is blown away.

    However, I just want to re-state, what is "effective" is what people will do. If they don't want to do purpuric, then it's 0% effective.

    I think you are right on, though, in that if you have done non-purpuric and don't see any results, then purpuric is the next step.

    man...30 IPL's? do you know that IPL is NOT a laser? It is light of many different wave lengths. V-beam is a laser, which is 1 wavelength, 595nm.
    Last edited by paperbag; 22nd January 2009 at 05:04 AM. Reason: clarity

  9. #19
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    Sorry, I was haste in my writing...but I am very clear that V-beam is a narrow band wavelength and cannot be adjusted. I ended up addressing it later, but what I meant to say was duration and not wavelength.

    This is part of the issue with IPL that I have. It seems less focused and according to the presenter here, the longer wavelengths penetrate deeper. But if you have visible diffuse redness is this really what you want? My doctor said that V-beam is the best thing for my case, but he stopped short of anything other than very slight redness (if any) after treatment.

    I also get the correlation between fluence and duration and how it relates to purpura. And I tend to think, as I have some time, that I may need to try a purpura inducing treatment.

    A few things have held me back:

    1. I am comfortable with IPL and have had "some" results. One problem with my prior treatments was that they used a numbing cream and I have noticed that it constricted vessels. I told them I would prefer not to use it, but they insisted. However, I recently thought about going for more but with someone else. They stated they do not use numbing cream because it can constrict vessels. So it got me immediately thinking this could be a reason for my relatively poor results.

    2. Some physicians are now advocating less energy so as to not aggravate the condition. However, I am not sure if that is really applicable here if you are going to directly destroy the vessels.

    3. Obviously a purpura treatment would suck. I am not sure how I would deal with the downtime to be honest. My thought is to do a small section (1"x1") to see if even had a positive effect. If so, couldn't I just move forward from there?

    Thanks for the help, this has been very informative so far.
    Last edited by hozer2k; 22nd January 2009 at 05:31 AM.

  10. #20
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    Just realized there is a ton of good info dealing with these issues. I am not too knowledgeable about the V-Beam and alot of my info needs to be updated since its years, if not over a decade old...haha. That being said, I don't want to divert this thread any further.

    Best of luck with your healing. It's a rough time and a rough thing to go through. If it makes you feel any better, I noticed you think your problems may be worse or caused by the V-Beam in the first place. I had CO2 laser resurfacing which turned pretty darn good skin (in retrospect), into a red, blotchy, scaly mess. It took me a decade, yes...a damn decade, to get things back to a respectable level. I had a LOT of times where I was very upset with the doctor and my decision. But I have just had to deal with my reality and do my best to make it better. It's gotten better little by little by little until I am fairly happy...but still looking to get back to where I should be if it wasn't for that one decision I made as a young man looking for perfection. I guess that is just what we call life. In hindsight, it has made me stronger in some areas and it is still an interesting challenge....but yeah, it pretty much still sucks! haha. Good luck.
    Last edited by hozer2k; 22nd January 2009 at 05:59 AM.

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