Photoderm, FotoFacial Is a Pulsed Light Patient Pleaser, Dr. Patrick Bitter

Written by on August 1, 2008 with 0 Comments

ATHENS — A series of full-face exposures with the PhotoDerm intense pulsed light system is effective for treating rosacea, chronic facial erythema, and minor telangiectasias, with the added benefit of a resurfacing effect, Dr. Patrick Bitter Jr. said at the 20th Congress of the International Society for Dermatologic Surgery.

Skin & Allergy News, 30(10):34, 1999, Erik L. Goldman, New York Bureau, © 1999 International Medical News Group

Dr. Bitter, who pioneered and trade-marked this approach, terms the technique "FotoFacial." He has found it to be a major patient pleaser.

"The name differentiates it from laser ablation or resurfacing, which scare some patients," said the Campbell, Calif., private practitioner.  The technique has a major advantage over laser approaches in that there is usually no visible surface injury, minimal discomfort, and no patient "downtime."

In evaluating the FotoFacial technique, Dr. Bitter has had to rely on patient satisfaction and clinical examination, since there are no clinically useful and reliable objective measures of flushing or rosacea severity.

He reported the results obtained in a series of 30 patients with chronic flushing, rosacea, or telangiectasias who underwent a full course of five treatments.

All of the patients said they had obtained some improvement in their appearance, with 32% reporting that they were "very much improved."

The remainder stated they were "much improved."

Thirty-six percent said they were "extremely satisfied" with the procedure, and none said they were dissatisfied.

Fifty-six percent of the patients with chronic erythema reported a 75% or greater reduction in visible symptoms; the same percentage of rosacea patients said they had a 75% or greater reduction in redness.

Forty-nine percent of the telangiectasia patients had a 75% or greater reduction in visible vessels after treatment with PhotoDerm.

Many patients also saw a marked reduction in pore size, greater skin smoothness, and a reduction in the depth and number of fine wrinkles.  In effect, FotoFacial is a nonlaser resurfacing and rejuvenation procedure.

Histologically, the intense pulsed light generates considerable new collagen formation.

In addition to the indication for erythematous conditions, Dr. Bitter has also found FotoFacial useful for "cleaning up" after laser resurfacing or dermabrasion.

FotoFacial involves five 20-minute treatment sessions, in which the patient’s full face is exposed to the pulsed light source. Dr. Bitter recommends 3-week intervals between sessions.

To obtain optimal results, the instrument settings are very precise. He uses a 550-nm cutoff filter, with a double-pulse setting: The first pulse is 2.4 milliseconds, followed 10 milliseconds later by a second pulse of 2.4-4 milliseconds.

"These are very short pulses and short delay times," he said. Total fluence is in the range of 30-36 J/cm2.

"I know of no other therapy that can improve flushing and rosacea to this degree," he said, noting that histologically, the pulsed light effectively obliterates both small and large surface capillaries.

FotoFacial is extremely safe and well tolerated, he said.

The light exposure does cause a transient darkening of freckles or other highly pigmented features, but this usually resolves within a week.

Roughly half of all patients will experience some mild postexposure swelling, which resolves in 24 hours. A small percentage of patients will have mild scabbing, that resolves in 2-4 days. He has not seen any major adverse effects.

The only significant downside is cost, said Dr. Bitter. The pulsed light technology is quite expensive. A new PhotoDerm intense pulsed light system from ESC Medical Systems in Needham, Mass., costs around $130,000.

In an interview, he said he bills for the FotoFacial as a cosmetic procedure, even though in cases of rosacea or telangiectasias, there is what some people would consider a medical indication.

Although it gives long-lasting results in chronic erythematous conditions, it is not known whether FotoFacial will be a permanent solution, Dr. Bitter said.

The symptoms of rosacea remain improved for at least a year after the last treatment session.

The main advantage of this technique is that from the patient’s position, there is very little burden in terms of time or discomfort.

The sessions seldom take more than 30 minutes, and they do not require anesthesia. Patients can return to work right away; there is no prolonged healing period — as there is with laser resurfacing or dermabrasion — in which they must curtail their social activities.

Dr. Bitter has received payment for serving as a preceptor for ESC Medical Systems.

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

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