Lasers, Photoderm, Photofacial, YAG, Epifacial, etc..

Written by on March 10, 2008 with 1 Comment

From: laserdocnyc
Date: Sun, 11 Feb 2001 20:11:54

I have read with great interest many of the messages posted on this wonderful web site.  As a physician and laser specialist, I have treated many patients with Rosacea. For this reason, I understand to some degree what many of the members of this group are experiencing.  I feel an obligation to try to make clear some of the mysteries of laser/pulsed light device treatments.  I am not identifying myself as this is not a solicitation for patients. I will try to explain the lasers and light devices in a simple manner as it is a bit more complicated than what I will describe below.  Please forgive me in advance for this long narrative.

First, lasers are devices that emit a particular singular wavelength of light.  This wavelength will determine a specific target.  With respect to Rosacea, the wavelength should be partial to absorption by haemoglobin ( i.e red blood cells ).  There are many wavelengths of light that meet this criteria.  Many laser systems were developed to capitalize on these absorption points. The pulsed dye lasers which have wavelengths of 577nm (earliest), 585nm (standard for years), and 595nm (newest- includes the Sclerolaser and the V-Beam; the KTP lasers at wavelengths of 532nm ( classically the Versapulse, Aura, or Nd:YAG lasers); and now the longer wavelength Nd:YAG lasers at 1064 nm.  The photolight devices such as Photoderm and Epilight are machines that produce a flash of intense light of many wavelengths.  For this reason they are not considered lasers.  The particular filter ( 515nm,550nm,570nm,590nm,615nm,etc..) will cut off wavelengths of light below the number stated.  [For example, with a 570nm filter wavelengths less than 570nm do not reach the skin.  This prevents unwanted absorption of energy by other targets such as pigment.  With shorter filters, a darker skin individual could blister or burn due to this undesired absorption.]  The main difference between Photoderm and Epilight are the filters.  Epilight was developed as a system for hair removal and uses higher filters to try to concentrate the light energy on pigmented structures above the absorption peaks for blood vessels.  However, one can use the Epilight machine like a photoderm machine by utilizing lower filters.  To be fair, the Epilight is the second generation of the Photoderm but it is very much similar.  A new attachment on these machines is a Nd:YAG laser (1064nm) which has a variable pulse duration (see below) that works best for deep and large blood vessels – specifically leg veins.

Second, beyond the selection of a wavelength or filter, the ability of the laser/light device to work efficiently to destroy vessels also has a lot to do with the duration of laser/light exposure.  This is often measured in millisecond pulses or ms for short.  The optimum pulse duration varies depending on the blood vessel size.  This is where the difficulty in treatment lies.  Rosacea is a complex vascular disorder with vessels of variable sizes.  One laser or light device alone may not meet the needs of the whole process without manipulating pulse duration and energy.

One should not necessarily think that one system, laser or pulsed light device, is better than the other.  Both can be good for any given person.  The main reason that some doctors have only one particular laser or a pulsed light device for treating Rosacea is that these machines cost up to and over $100,000.  The maintenance alone on a machine can be $10,000 – $20,000 a year.  The more important fact about the treatments given is what experience the doctor has with his/her system.  When the photoderm first came out over 5 years ago, nobody really knew what were the best parameters.  There are several parameters to manipulate: filter, fluence (measured in J/cm2 – the energy directed in a given area per second), # of pulses, delay between multiple pulses and very importantly, the pulse durations.  Early on in photoderms history, people were learning what parameters to use.  Now several years later the parameters are better known. 

I have read in these posted messages the varied experiences of many people with both lasers and photoderm units.  These different experiences may be related to the experience of the doctor performing the treatment.  With the rise in desire for cosmetic procedures in the U.S., the number of doctors buying machines without formal training in lasers is skyrocketing.  It should take more than a weekend course to really understand what one is doing with these systems.  A curious fact is that you have to be a physician to buy a laser but not to buy a pulsed light device.  In addition, you don’t have to be a physician to treat someone with these devices.  In fact, in most offices, nurses or technicians are performing these treatments.  You should know who is treating you.  Also, and just as important, one must consider that every person with Rosacea is different and what works well for one may not work for another. I know that people in this support group are trying to get a set of parameters to send around to each other.  Remember, each machine is slightly different and each machine may vary compared to itself over time as the lamps get older.  Speaking as a doctor and a laser specialist, there are constant attempts to produce better systems.  In fact, a new laser is developed almost annually for the treatment of vascular disorders.

One last comment about terminology.  Photoderm and Epilight are intense pulsed light devices.  The terms photofacial, epifacial and fotofacial are not really applying to rosacea directly.  These procedures are treatments with the intense pulse light devices to stimulate collagen growth in the skin and reduce wrinkles.  In the process of doing a treatment, small vessels and some brown spots (lentigines or sun spots) may also be eliminated giving a freshened look to the skin.  Severe Rosacea would best be treated with higher energies and different settings as stated above.

I hope that this message helps you and didn’t confuse the matter too much.  Please pardon any spelling errors as I am writing fairly quickly. Good luck to everyone with their treatments.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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1 Reader Comment

  1. Carole Bram says:

    I am particularly interested in the nd:Yag photofacial. Does this actually stimulate collagen. Is there any damage done to skin?

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