PDL - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about PDL or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Pulsed Dye Laser
Overview:
Pulsed dye lasers have been used for many years for vascular birthmarks, angiomas, and enlarged capillaries (telangiectasias), and present an extremely effective, safe, non-scarring treatment. The newest pulsed dye lasers are equipped to prevent bruising, thereby minimizing downtime for most cosmetic treatments. Some birthmarks, however, are still treated with bruising settings.
Expected results:
Removal of unsightly vascular structures and redness.
Pretreatment:
Sunscreen, sun avoidance. In addition, for the treatment of facial blood vessels in rosacea, avoidance of alcohol for 2 weeks prior and 4 weeks after the procedure is recommended.
Post treatment instructions:
Sun avoidance for 3 months. Vigorous use of sunscreens. Avoidance of alcohol for 4 weeks with treatment of facial blood vessels in rosacea. The night following the treatment avoid sleeping face down to minimize swelling.
Time to desired results:
Flat angiomas typically respond to a single treatment. Thick angiomas require more than 1 treatment. Facial veins including those in rosacea as well as leg veins require 2-4 treatments. Birthmarks (strawberry hemangiomas, Port Wine Stains) require many treatments. Treatments can be rendered 4-6 weeks apart.
Duration of desired effects:
Most angiomas will be corrected permanently. In few instances, the body will form new vessels after 5-10 years. Such conditions include rosacea, genetically determined spider veins and blood vessels in certain connective tissue disorders. Port Wine Stains may stay away for life if treated in infancy. Those treated in adulthood may require periodic maintenance treatments.
Contraindications:
History of bleeding or clotting disorder, diabetes, certain auto-immune conditions.
Downtime:
Redness for 1-2 days, swelling for up to seven days, possible bruising for up to fourteen days (treatment of angiomas, birthmarks, and larger facial blood vessels), bruising for up to three months (leg veins).
I have active inflammatory acne that is resolving, but have significant residual erythema (I’m pretty sure it’s PIE); is this something that the pulse dye laser treats? If not, what treatments do you offer for PIE. Mine is really quite significant and I’d like to get it treated ASAP.
Thanks
The pulsed dye laser (PDL) is indeed an excellent treatment for post inflammatory erythema on fair skinned individuals up to Fitzpatrick skin type IV (Mediterranean, light Asian or light African American). IPL might be used instead but in my experience it is not as efficient as the PDL. We use it in Fitzpatrick skin type I-III if PDL is not tolerated. Downtime is significant with PDL, as one might look like a blueberry muffin for 10 days. Most people will need 1-3 treatments to loose the post inflammatory erythema. You may schedule an appointment with one of our dermatologists to be evaluated for appropriateness and we will then coordinate your treatment. Both, the Philadelphia and the Haverford office, provide this treatment.
I live in Williamsport, Pa. I received a profractional Erbium laser facial resurfacing procedure for actinic keratosis. Unfortunately, the procedure was fully ablative. I am now 21 days post-procedure with hyperpigmentation. A well known board certified dermatologist in Connecticut, suggested that PDL should be done sooner rather than later.
I look forward to your reply. 5703603379
Many thanks,
Colleen Fritz
Hyperpigmentation can be treated in several ways. In addition to meticulous sun protection, fading agents, anti-inflammatory topicals and also pulsed dye lasers are used. Fading agents and anti-inflammatory agents are usually first, pulsed dye laser in your circumstances might be considered at 6 weeks post op if pigmentation remains.
Hello,
I had a scar revision on my forehead that had a terrible outcome. It resulted in a raised, bumpy red scar that looks 10 x worse than the original scar. Kenalog injections, dermabrasion, microneedling and profractional laser treatments have minimally changed it. Would PDL help to flatten it? Is it okay to have PDL on an area that’s had all this done to it in the last three years?
Thank you!
PDL might help and your past treatments are not a contraindication if PDL is appropriate. It would be best for you to schedule an appointment to have the area evaluated to determine the best treatment plan.
Do you use 1550 erbium glass laser for acne treatment? There was a randomized, controlled split-face study by Moneib et al. that showed Significant reduction in mean lesion count (p < 0.0001) and sebaceous gland size. I would like to find a provider in the Philadelphia area that uses this laser.
I am aware of most studies published on laser treatment for acne and acne scars, including the above referenced from 2014. We do not routinely use our erbium glass laser for acne treatment because we tend to get better results with combined treatment of long pulsed Nd:YAG with Q-switched laser. We are working with our patients and are open to using treatment protocols that have stayed outside of mainstream. I would be happy to see you in consultation for the treatment described above. Just FYI, we operate a 1540 nm erbium glass laser. Its target is exactly the same as the 1550 nm erbium glass laser.