V-BEAM Perfecta Laser

This pulsed dye laser is used to treat blood vessels and redness in the skin. This laser targets hemoglobin, which is in the blood, but does not target the normal surrounding skin.

What conditions are treated with the V-beam Perfecta Laser?
◦ Broken blood vessels and capillaries.
◦ Overall redness in rosacea.
◦ Port wine stains (red birth marks).
◦ Venous lakes (varicose vein of the lip).
◦ Red stretch marks.
◦ Red scars.
◦ Stubborn warts.
◦ Bruises.
◦ Cherry angiomas.
◦ Sun damage on the face, neck and chest called ‘Poikiloderma of Civatte’.
◦ Acne, when used with a topical medication called Levulan; see below.

What to expect during your V-beam Perfecta appointment?
◦ You will be given goggles to protect your eyes from the laser light.
◦ The doctor will review the treatment to be performed and look at the areas to be treated.
◦ You will feel a cold and hot sensation, similar to rubber band snapping.
◦ After the treatment, your doctor may apply ice or a calming cream to the area.
◦ Immediately after the treatment, you will be pink in the areas treated; in the case of port wine stain, venous lakes, stretch marks and scars there will be dark bruising which will resolve.

How many treatments might be needed?
◦ The number of treatments will depend on the condition to be treated.
◦ For specific veins or broken blood vessels on the face, usually one to two treatments are recommended.
◦ For overall redness of the face, 3-5 treatments may be recommended, with yearly maintenance thereafter.
◦ In rosacea, you can anticipate a 50-75% improvement.
◦ Port wine stains or blood vessel birthmarks require 5-8 treatments, depending on the size of the lesion and age of the patient.

Who is or isn't a good candidate for the V-beam laser?
◦ The ideal candidate has light skin, and someone who does not have a tan.
◦ Patients with rosacea who are interested in this procedure should have a good skin regimen before and after the procedure to prevent or slow down recurrence.

After-care instructions:
◦ Your skin will be pink or bruised (depending on what was treated) immediately after the treatment.
◦ During the hours after the procedure, your skin may get puffy or swollen; this is normal.
◦ Follow the instructions of your dermatologist.
◦ Mild gentle cleansing and mild moisturizing is helpful.
◦ Daily sunscreen is necessary to prevent a tan while undergoing the treatments.
◦ If your face was treated, sleep with your head elevated on 2-3 pillows to avoid the swelling moving into the eye area.

Risks and side effects:
◦ If you have a history of cold sores, the virus can be reactivated by the laser treatment and the infection can spread throughout the treated area; this could lead to scarring.
◦ Discuss this with your doctor; it may be recommended that you take a preventive dose of an antiviral medication.
◦ Scarring, infection and blistering is VERY rare.
◦ The most common side effect is bruising.

PDT and acne and inflammatory rosacea using the V-beam laser:
◦ The medicated solution Levulan may or may not be applied; when applied patients get more inflammation afterwards, but the clogged pores and pimples clear up much quicker.
◦ We advise 3-4 treatments every 3-4 weeks for the best results (if using Levulan); severe cases may require 5 treatments.
◦ It is common to continue having treatments every 3 months to maintain the improvement.
◦ Depending on the severity of the acne, the dermatologist may use a laser light (V-beam laser) rather than the blue light to penetrate deeper.
◦ This treatment is not covered by insurance for the treatment of acne or rosacea.

Chemical Peels

A chemical peel is a technique used to improve the appearance of fine lines, acne scars, discolorations or other surface changes of the skin on the face, neck or hands, and can be used to reduce breakouts and treat acne During the appointment, you will cleanse your face with a gentle cleanser, and then a chemical solution will be applied to the skin that will first cause it to become red, then tight, and then exfoliate and eventually peel off over the course of 5-10 days. The degree and duration of peeling will vary based on the strength of the peel. The new, regenerated skin is usually smoother and less wrinkled than the old skin, but is temporarily more sensitive to the sun.

The three basic types of chemical peels:
◦ Superficial peel: Alpha-hydroxy acid or another mild acid is used to penetrate only the outer layer of skin to gently exfoliate it. The treatment is used to improve the appearance of mild skin discoloration and rough skin as well as to refresh the face, neck, chest or hands.
◦ Medium peel: Glycolic or trichloroacetic acid is applied to penetrate the outer and middle layers of skin to remove damaged skin cells. The treatment is used to improve age spots, fine lines and wrinkles, freckles and moderate skin discoloration. It also can be used to smooth rough skin and treat some precancerous skin growths.
◦ Deep peel: Tricholoracetic acid or phenol is applied to deeply penetrate the middle layer of skin to remove damaged skin cells. The treatment removes moderate lines, age spots, freckles and shallow scars. Patients will see a dramatic improvement in skin appearance but it will involve more peeling and a longer healing time.

Who is not a candidate for a chemical peel?
◦ Active cold sore or herpes simplex infection on/near the area to be treated.
◦ Nursing or pregnant.
◦ Have taken Accutane in last six months.
◦ Have psoriasis, eczema, dermatitis or rosacea in the treatment area.
◦ Have used Retin-A, Renova, prescription skin care products, products that contain ascorbic acid, bleaching or skin-lightening agents or other acid-based products in the last 48 hours.

Are chemical peels painful?
◦ Chemicals peels sting but do not cause a great deal of pain.
◦ The gentlest peels use alpha-hydroxy, glycolic, salicylic, lactic or fruit acids are also gentle but still may cause stinging, redness, irritation and crusting.
◦ Trichloroacetic acid is a stronger peel and sting/burn more than those the gentler peels.

What are the complications or potential side effects of a chemical peel?
◦ Temporary or permanent change in skin color, particularly for women on birth control pills, who subsequently become pregnant or have a history of brownish facial discoloration.
◦ Scarring.
◦ Reactivation of cold sores that can spread throughout the treated area.

What to expect after a chemical peel?
◦ The day of the peel your skin may be pink.
◦ The next day your skin may feel tight, as if it will crack if you laugh too hard.
◦ In the following days, your skin may flake or peel. The degree of this will depend on the strength of the peel.

After care:
◦ Gentle skin care is recommended during the healing phase.
◦ Avoid exfoliants and retinoid creams.
◦ Gentle cleansers are ideal during this time, with gentle moisturizing.
◦ Sun exposure should be kept at a minimum.
◦ No smoking during the healing phase; this can prolong healing time and cause infection and scarring.
◦ DO NOT PICK the peeling skin; the skin will shed when the new skin is ready.