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  1. #1
    Moderator Melissa W's Avatar
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    Default 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.

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    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?

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    Senior Member mattdog323's Avatar
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    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.

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    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
    Kalypso

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    Moderator Melissa W's Avatar
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    Quote Originally Posted by Kalypso View Post
    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
    Kalypso

    Dear Kalypso,
    Thank you for your question. Well, first off, depression secondary to chronic conditions is well recognised but donít give up hope - there may be a treatment that could help.
    Certainly I would respect the opinion of the medics who have had a chance to see you ad provide an opinion based on first hand knowledge. The hormonal issue may be part of the reason why things progressed during pregnancy but it seems like you had the issue before the pregnancy and clearly you have a family history of rosacea (many people do and some people with parents with rosacea donít go on to have it themselves so the family history link isnít always as inevitable as some may assume). I would advise taking the precaution ( the practitioners you have seen so far may have done this already but it might be worth checking) of checking that vasculitis has been excluded
    You may benefit from a range of strategies including:-
    Gently Progressive IPL . I am confident that I can state that none of our patients have never experienced fat loss attributable to IPL treatments delivered at our clinic using treatment settings using our protocols for the Lumenis One IPL.We have delivered over 20,000 treatment shots using our Lumenis One over 5 years and have experienced one tiny overlap blister (which healed within a few days with no ongoing impact) and a couple of slightly singed eyebrow hairs in all that time and with all of those treatments. I have seen at least one patient who has seen us for follow up treatments and who has attributed fat loss and indentations to previous more aggressive treatments with a Nd:YAG laser (treatment delivered elsewhere) and the patient knows that they are welcome to continue to have gentle restorative IPL treatments with us. I always advise a test patch first.
    Nd:YAG
    We have a protocol which may help with the flushing. A test patch would be advisable.
    Pulse Dye Laser
    This may help with the redness. A test patch would be advisable.
    Medication
    A specialist dermatologist would be able to advise if this route might be sensible to try. If you are depressed, antidepressant medication and psychological therapies might offer some benefit Ė your GP should be able to advise you about this.
    Allow time to heal
    Sometimes leaving time to allow healing after a partially successful treatment is a sensible approach. If the condition is progressive then simply waiting without doing anything else is probably not practical. This might give you time to explore what benefit medication and psychological therapies could offer.
    I hope that this advice helps,
    Kind regards,
    Peter
    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.



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    Quote Originally Posted by mattdog323 View Post
    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.
    Dear Matt,
    Thank you for your question. Yes, The highest I go is 28J on single or double or triple pass at 515, 560, 590 or 695
    I advise going very carefully i.e. using extreme caution with 515 at 28J even with those with very light tolerant skin
    No, I havenít taken 640 or 695 above 28J with the lumenis One so the cut off I use is 28J.
    The filter combination I use is 515nm (alone)
    OR 515nm OR 560nm OR 590nm with 615nm AND 695nm
    In my experience, if someone has tolerated a treatment with no prolonged skin reaction (no post-treatment redness lasting more than a few hours at most) then provided that there is no change in the state of the skin e.g. no additional skin exposure / new treatments etc it is usually safe to increase the settings on at least one filter by 2J/cm2. Crusting, however mild, is not a sign that the skin is tolerating the treatment.
    What is often much misunderstood is how to take the settings up safely. I generally apply the filters in multiple passes in ascending order but when increasing the fluence in successive treatments, I generally increase the fluence settings of the higher number filters first.
    I hope that this advice helps,
    Kind regards,
    Peter
    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.

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    Moderator Melissa W's Avatar
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    Quote Originally Posted by dpart View Post
    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?

    Dear Dpart,
    Thank you for your question. Havenít seen it myself Ė it may resolve given time
    Hard to know without examining you Ė even then it might not be possible to say exactly why. Have you spoken to the practitioner who did the procedure?
    Tricky issue will be Ė go for more treatment? Is one side under treated?
    ?Switch strategy Ė I have to say that continuing with the same treatment bearing in mind the previous treatment didnít give you the end result you wanted would not necessarily be advisable. You might want to look at IPL or ND YAG as an alternative but be guided as to continuing with more V Beam by your existing practitioner who may have seen this with their treatments and their laser before.
    I hope that this advice helps,
    Kind regards,
    Peter


    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.

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    Default 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,

    Katie
    Last edited by katieee; 3rd March 2010 at 11:34 AM.

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    Quote Originally Posted by katieee View Post
    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,

    Katie

    Dear Katie,
    Thank you for your question. Pulsed Dye Laser is usually quite effective and Dr Neil Walker is a highly respected laser physician Ė I think you are in excellent hands. Sometimes IPL can work very well following PDL even though it might not be effective until after the PDL has done its initial work. Nd:YAG might also assist with the flushing. I would recommend a test patch with both to help decide.

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    Default 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!

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