Photoderm: First, Do No Harm

Hello fellow Rosaceans. First let me begin by saying, DON’T LET THIS HAPPEN TO YOU. It is now 3 weeks after my 4th Photoderm tx (or PhotoFacial, as the nurse immediately corrected me when I called to set up my first appt).

Here is a picture, so you can see what I’ve been going through just in the past three weeks, and I’m facing six to nine more months of trauma.

Print it out and take it to your practitioner so they will be as careful as my doctor should have been. Here’s the story, and I’ll warn you now, it will be long and sometimes disgustingly graphic. I apologize for both in advance. When you’ve seen the picture of my chin area, you’ll understand why I need to vent. I need to post this to you, then try to put it out of my mind, and get on with my life. Knowing from experience how a treatment for rosacea can appear very positive in the beginning and then amount to nothing, I had decided to wait until my 5 Photoderm sessions were completed before posting anything to the group, so I could be more objective. Dr.Z came with a good recommendation from someone on this board, and she’s Bitter-trained (I’m in no mood for any more hassle than I’ve already been through, so I will call the doctor who treated me Dr.Z).

I’d already had three treatments in a series of five with Dr.Z. I had considered canceling this appt, as it was the Wednesday before Thanksgiving, and five days later, my husband and I were flying to Italy for our dream trip of a lifetime. But there had been no adverse effects from any of the previous treatments, and my concern was to get all my treatments in before the sometimes heavy snows that blanket the northeast in January. So I drove the three hours from my home in Pennsylvania to my appt.

She took a digital picture, then compared it with the picture taken before my first tx. Not much difference really, maybe a little reduction of telengectasia. (I’d never seen any comparison before, only that day’s digital shot on the camera itself for each of the previous txs.) I know I was disappointed, and asked her if my txs were progressing as she thought they should. She responded that she was going to increase the filter this time, and also do three passes, which she’d never done before. Okay, I figured she knew what she was doing.

During the zaps I was noticing from the beginning that it was hurting more than any other visit. But instead of saying anything, I again figured, she knows what she’s doing. Unlike the other sessions, not once during this session did she ask how it felt; instead she chatted about the weather. I gritted my teeth as she started the third pass on “problem spots”. When she finished the cheeks I should have known I was in trouble, because she said, “Good, the purple marks are what we want.”Remember, this was Photoderm, not pulse-dye laser, which I’d backed out of with my dermatologist because I was afraid my face would not have healed in time for my trip to Italy. But I figured, I can cover purple with makeup, and in five days, it’ll probably be faded to near-nothing.

When she said she was going to do a third pass on the chin, I was already a little worried, because it really hurt, but then so did the cheeks. And I was anxious to see some definite improvement, so again, I said nothing, figuring, she’s the one out there looking at my skin after every zap. If there’s a problem, she’ll stop. She’s done this many times, with many different patients. She must know what she’s doing. In the past three weeks, I can’t tell you many times I’ve regretted this assumption.

After the tx was completed, she said (as she had after every tx) that I may have some blistering; if so, to put some Bacitrin on it. She left the room and her nurse handed me an ice pack. For the first time, I had to ask for a second ice pack, the pain was so great but no pain, no gain, right? After the ice packs, I put on Zinco for my long drive home. My face was redder than I’d ever seen it after a tx, I had purple marks on both my cheeks, and I saw on my chin what looked like a blister. I said to myself, okay, this’ll be fine; one blister’is not so bad.

So I drove home, practicing my Italian, trying to ignore how my face still burned. Then I felt something dripping down my chin, reached up, and asked, what’s this sticky yellow liquid? I’d had burns on my hands before that had blistered, but it was just dawning on me that this might not be as simple as I’d originally thought. I used up several tissues on the drive, noticing that the liquid was now coming from not one, but several areas on the chin.

When I got home and looked in the mirror, I saw that my face was beginning to look as though I’d been in a car accident. It was still as red as immediately after the tx, with purple marks on swollen, numb cheeks. And then there was my chin, swollen, red, and oozing. But every post on Photoderm talked about how both the redness and any swelling went away within the first day or so.

Thursday morning I looked at myself in the mirror and near wept — I was almost unrecognizable. But I had Thanksgiving dinner to prepare for my family, so I piled on makeup and sat with a tissue in my hand, trying to dab inconspicuously at my chin which continued to drip, drip, drip.

The next morning I put in a call to Dr.Z which was picked up by her answering service. When they asked what my message to her was, I said to tell her my chin was a mass of open oozing blisters. She returned my call quickly, but her only advice was use Bacitrin! I told her we were leaving for Italy in two days, and she comforted me by saying the oozing should stop by then, and that she would call back Sunday morning to check on my condition.

By Sunday morning, almost 96 hours after my tx, my chin was still slightly oozing. When Dr.Z called, I asked if I could email her a picture my husband had taken Friday evening. Frankly, I did not believe she was taking my description of my condition seriously. As soon as she got the photo, she called back and said I needed to pick up a prescription and that I should keep my chin bandaged. The prescription was for silver sulfadiaz and the sheet printed out by the pharmacy stated it was used to prevent or treat skin infections in patients with SERIOUS BURNS.
So I went through the entire trip to Italy using this cream, trying to keep a bandage on my chin, which rarely worked; it was always falling off, revealing a huge scab covering most of the left side of my chin. Even perfect strangers asked what had happened to me. Not wanting the attention or to go into long explanations, I simply told anyone who asked that

I had fallen. My poor husband, who never even speaks a harsh word to me, worried that people would think he had beaten me. Yes, the purple bruises did finally fade, about a week afterward; the swelling in my cheeks went down, the numbness gradually faded, and the one blister on my left cheek healed. But the chin, although the scab fell off during my trip, usually while I slept, the area is red and lumpy, requiring three coats of makeup to make it a little less noticeable. It’s now three weeks later and I still look as though I went a round in the ring for the feather-weight title, and lost. But wait, my story doesn’t end here.

My 5th and final Photoderm tx would have been yesterday. I drove the 3 hours to her office, wanting Dr.Z to see her handiwork in person, not just on the computer screen. Her husband, a plastic surgeon, looked at it, and told me I wouldn’t have a scar, but that I have to keep sunscreen on it at all times, and massage the lumpy, dented area for five minutes every night. He gave me a little sheet with these instructions that also included the time frame of three months, and I said to myself, I can handle three months. I said to him, so it’ll be about three months for this to go away completely. He replied, no, more like six to nine months.

Was I angry? Yes. Oh, but there’s so much more. Dr.Z was puzzled. She said, but don’t you remember I asked you over and over if there was any pain? No, I exploded (finally), you never once asked me that during this tx. Then she tells me, as if she’s discovered the cause for all my misery, but you only put the ice on your cheeks, not on your chin. Now, she wasn’t even in the room when I was applying the ice pack, so how the hell would she know what I did? It hurt everywhere, and I had to keep moving it around, so much so, that (as I said previously) I had to ask the nurse for a second pack. She then tells me she had decided to go more aggressive because another rosacean, a male patient, had asked her to do so on his face the previous week, and all he had was one blister which healed up just fine. But I never asked her to do an aggressive tx on my face, and would never have on that 4th tx, with Italy only a few days away. Besides, I’m a 50-year-old female with thinning, delicate skin; I’m sure what works for a male rosacean of unknown age and what works for me will not be the same tx. And here’s the killer: she thinks she should do the 5th tx right now, and she’s showing me pictures of the uses of the Vasculight machine for erasing scars. I’ll only do 2 passes on the chin, not three, she says…

After the pain and trauma I’ve been through the past three weeks, wincing just at the thought of being zapped, I walked out, knowing I would never return to that office. There’s nothing I can do. I have no recourse. I signed my rights away just like the rest of you who’ve begun this treatment. Sure, the scar will probably fade eventually. I can only live in hope the next nine months. As for my 5th session, my husband and I have decided it’s better to eat the financial loss than to ever let her touch my face again. Just think, I paid someone $2200 to first, burn my face, and then, to try to blame me for it!

These words run through my head constantly. Remember them; go to your next Photoderm tx with them: I THOUGHT SHE KNEW WHAT SHE WAS DOING!!!

My best to you all,
Barbara S.,

Fri 15th Dec 2000.
barbaras@pop.paonline.com

Update: Saturday, June 24, 2001

It’s been seven months now since my burning from photoderm. I’ve been getting a lot of questions on my condition lately, so I figured it’s time for an update. My chin is much improved, with only a minor indentation and a slight lumpiness where the blister was.My attitude toward photoderm has not changed: I still believe it is one of the best things that has come onto the scene for rosacea. Don’t let my experience with a bad practitioner scare you out of treatments.As a matter of fact, I’m just starting treatments again myself. Also, just because a doctor is trained by Dr. Bitter Sr doesn’t mean they are well-trained, or even competent. A two-day training course doesn’t make anyone an expert. They need lots of experience with many different types of skin, and some knowledge of rosacea helps. A little compassion on their part doesn’t hurt, either.Recently I’ve had a lot of nose swelling, and have had tissue growth from the beginning of the onset of rosacea, which is rhinophyma. My mother has it, and it’s very disfiguring. When I got Nase’s book there appeared to be only two solutions: either low-dose accutane (I don’t like to take drugs of any sort, unless it’s a medical necessity – my body overreacts), or my old friend, photoderm.In desperation, to avoid taking accutane for possibly the rest of my life, I found a Dr. Bitter Jr-trained photoderm doctor (I understand the son’s approach to treating rosacea with photoderm is much less aggressive than Dr. Bitter Sr) through his web site, www.fotofacial.com. I had one treatment a couple of weeks ago, just on my nose, and have been pleased with the results. The doctor was very reasonable, very careful, and thorough. So I’ve decided to pursue the photoderm for a few more treatments, and hope it arrests the progression of the rhinophyma.The photoderm treatments I had done prior to the burning really did help lessen the redness, and I’m grateful for that; it’s made life just a little easier — I just wish I hadn’t had to go through so much pain and trauma with the chin burning to get those results. But it hasn’t stopped me from getting more treatments, and even considering more full-face treatments as well.

Good luck to all of you out there who are, like me, looking for solutions. Don’t give up the fight. We’ll conquer this soon, I’m positive.

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