Hi Dr. Soldo and many thanks for agreeing to do this Q and A.
Do you ever treat the eyelids and if you do how do you protect the eye?
What treatment would you think best for potential early stage rhinophyma?
If rosacea is mild would you recommend starting laser/ IPL treatment early to avoid progression.
I donít often treat eyelids but if I am going to do it I use numbing drops and insert eye shields.
Early stages of rhynophyma react well to IPL plus oral doxycycline (oracea) and I supplement with Nd:Yag for the entire nose each treatment.
Rosacea can never be too mild to treat. My opinion is that every flushing episode generates some new vessels (angiogenesis) so elimination early is desirable.
Is there a different method in treating telangiectasias from steroid induced rosacea vs. a treatment to reduce flushing and overall redness?
Are all telangiectasias treated the same?
-circular spots around outer cheeks and sides towards the ears
-lines around the side of nose and nostrils with some diffuse background redness
Thanks for your support,
There is not a different method that I am aware of. I treat all telangectasias with IPL plus KTP and Diode lasers, but of course the settings vary depending on multiple factors as size, location, skin color, etc. Circular spots, lateral cheeks and pre-auricular (in front of the ear) are hard to treat in my opinion-- but again, all vessels (superficial and deep) require some or all of the modalities mentioned.
Thank you for your time.
I know that Lumenis One is your choice of IPL but what do you think about IPL devices such as Scition BBL, Starlux and Limelight?
Is there a major difference between IPLís manufactured by different brands in terms of the protocols and the device settings that should be used, meaning would you still use the same filters, pulse width, number of passes and other variables with Sciton BBL, Starlux or Limelight?
Let me begin by stating that I have several lasers in my office, and not all are by Lumenis.
Over the years I have used even larger numbers of devices, and to date, the Lumenis One is my first choice for treating the flushing and erythema of rosacea or solar damage. Why?
1. It is the ONLY IPL that allows multiple sequential pulsing, i.e. allowing up to three pulses with one shot, and also allowing the operator to shorten or lengthen both the pulse widths and the pulse delays.
2. It is the ONLY IPL that uses OPT technology, which is the ability to deliver energy evenly throughout each pulse, thus it is safer and more effective on the higher fluences usually needed to treat rosacea.
3. The Lumenis One has multiple depth filters, and can go deeper than other devices.
4. It is the highest powered (2100 watt) IPL on the market, which delivers high peak power and short pulses to better break up the vessels.
5. I can tweak all the parameters independently, and no other device has that unlimited range of variability.
Hi Dr. Soldo,
There are things going around at the moment about IPL and fat loss and skin indentations? Have you ever encountered this before? Is this down to an inexperienced technician or is it case-by-case basis and this potentially might happen to anyone?
As previously mentioned, I have not personally seen any such occurrences. I do admit that anything is possible in medical treatments, but I assume this would be rare.
Hi Dr. Soldo,
My question is about energy levels for IPL that you use on your patients. How do you find the optimum level for person?
The reason I ask is during my treatments using a 3-pass protocol (on Lumenis One) have gone from a range 20-24 J for each pass (24 for the longer wavelength) to recently up to a 28 J for them all. Iím told my skin is very light tolerant. However Iím not noticing any improved benefits. Is it a case of maximum energy for maximum coagulation? (without burning of course)
Again, there is no such thing as normal settings. Every patient varies, and every treatment on the same patient can also vary widely. Excessive settings are not necessarily desirable. I am convinced that more gentle treatments are often more beneficial.
I long ago gave up on trying to beat up on the face and its blood vessels. Itís traumatic to the face to use settings that are too hot, and trauma leads to angiogenesis. I find gentle IPL is often more effective than super-hot treatments, which can lead to excessive flushing and burning post-treatment, and traumatize delicate rosacea skin.