Category Archives: Uncategorized

Photo Dynamic Therapy (PDT)

By | Body Procedures, Facial Procedures, Laser, Uncategorized | No Comments

What is Photodynamic Therapy?
Photodynamic therapy (PDT) is the use of a topical medication (Levulan) activated by intense pulsed light (IPL).   Light converts the Levulan (ALA) into a photo-sensitizing agent, which destroys the targeted sun damaged and precancerous cells (Actinic Keratosis or AKs).   Another positive benefit with PDT is the reduction of pore size since the sebaceous glands are tempered, reducing oil flow and consequent pore blockage.  The use of IPL with levulan also results in targeting of melanin and hemaglobin.  The combination of IPL with Levulan is synergistic resulting in destruction of pre-cancerous cells, reduction in acne causing bacteria and amplifying the benefits of IPL photorejuvenation, for increased cosmetic results.

What can be treated with Photodynamic Therapy?
PDT is typically prescribed to remove actinic keratosis (AKs or pre-cancersous cells) all over the body, but mainly on the head, face, neck, hands and other sun exposed areas.  PDT is also effective for treatment of acne as well as a more aggressive form of IPL photorejuvenation.

Benefits of PDT for Actinic Keratosis
– It has no long-term side effects when used properly.
– It’s less invasive than surgery or cryotherapy.
– It usually takes only a short time and is most often done in-office.
– It can be targeted very precisely.
– PDT can be repeated many times at the same site if needed.
– There’s little or no scarring after the site heals.
– Cosmetic benefits of IPL photorejuvenation are achieved at the same time as AK destruction

Actinic Keratosis (AK) before and after PDT

Levulan for Acne
Levulan has also shown excellent results for the treatment of acne.  IPL with Levulan can be used to treat light to moderately-severe acne and may be suitable for those patients who wish to avoid taking heavy medications to rid their skin of acne.  Mechanisms include reduction of acne causing bacteria,  shutting down the oil glands (sebaceous glands) in the skin, and exfoliation of the skin to unclog pores.  If you have acne that is not responding to medications, or if you are unable to tolerate oral or topical medications for acne, photodynamic therapy with Levulan may be right for you. Combined with a light source, Levulan kills the p.acnes bacteria in your skin, decreases sebum (oil) production and often provides long term improvement of acne.  Results may vary depending on each patient’s unique physiology and lifestyle factors.

Acne before and after PDT

Levulan for general skin rejuvenation
Adding Levulan to an IPL treatment, is somewhat like putting your IPL photorejuvenation on steroids.  The Levulan photo-sensitizes the skin, allowing the IPL energy to be better absorbed by the targeted pigmented and vascular chromophores.  This results in a higher level of correction of freckles, sunspots, skin discoloration, broken blood vessels and redness compared to photorejuvenation alone. Although, Levulan does not penetrate to dermal layers of the skin, the heat and inflammatory response caused by PhotoDynamic Therapy does reach the Papillary dermis.  This heat stimulates the fibroblast to produce collagen.  This combination treatment also benefits enlarged oil glands (sebaceous hyperplasia), enlarged pores and uneven skin tone & texture.


What should I do prior to my PDT treatment?
It is extremely important to protect the treated skin from the sun for a full 4 weeks prior to PDT. This is best accomplished by the use of a quality SPF 30+ sunscreen daily and a hat worn during times of greater exposure to the sun’s rays.   Artificial tanners should be stopped 3 weeks before treatment.  All pre-treatment guidelines for regular IPL treatments should also be followed.  Your face should be washed immediately prior to your appointment to remove any make-ups or creams.

How is the procedure performed?
First your skin is pre-treated with an acetone scrub, to remove oil from the skin’s surface.  Sometimes microdermabrasion is also preformed before the Levulan is applied.  Microdermabrasion will remove dead skin cells and cause blood vessels to dilate, which will result in a more aggressive treatment. After the skin is prepared the Levulan Kerastick is cracked open and applied to the skin. The ALA is left on the skin to incubate, typically for 1 hour.  A longer incubation time can cause more reaction as well as more correction.  Non-facial skin generally tolerates a longer incubation time.  After the Levulan has been on for the determined amount of time, the skin is then treated with IPL to activate the Levulan and provide additional photorejuvenation effects.

What should I do after the PDT treatment?
– Sun protection including quality SPF 30+ sunscreen and a hat are mandatory for at least 48 hours after each treatment.  Avoid direct sunlight to the face even for a minute. Wear sun protection as above even when sitting near a window or in a car.
– Make-up may be put on gently 3-5 days following the procedure unless there is crusting or intense redness.
– Scrubs and facials must be avoided for 1 week after the procedure.
– Retinoids (Retrinal, Retinol, Retin-A, Renova) and glycolic acid products may be restarted after 5 days only if the skin is no longer red, swollen or peeling.
– Light scaling and peeling as well as mild to moderate redness are expected to occur for 2 to 7 days. Any areas of crusting or oozing should be covered at least 3 times per day with Vaseline petroleum jelly or Aquaphor ointment. Notify our office if heavy crusting, intense redness or swelling, or other unwanted side effects occur. Symptomatic relief may be obtained by placing cool tap water compresses on the skin. Compresses made from one cup of cool tap water mixed with one tablespoon of white vinegar may provide additional relief from discomfort if necessary. Advil (ibuprofen) and Tylenol (acetaminophen) can also help alleviate discomfort.
– All post-treatment guidelines for regular IPL treatments should be followed.

Side effects
Redness, swelling, increased warmth and tingling sensations may occur for 1 to 3 days after treatment. Redness and scaling may be present for up to 1 week depending on the degree of sun damage.  Crusting, darkening or lightening of areas of the skin, intense redness and prolonged swelling or stinging may occur.  These generally resolve with proper skin care.  Sun avoidance is absolutely necessary for 48 hours after the procedure.  A quality spf 30+ sunscreen containing titanium and zinc oxide must be worn daily.  Patients must wear a hat to protect the face from sunlight while outside during this 48 hour period as well.  Patients should also stop the use of any topical acne creams and avoid hot showers during this time to allow skin to properly heal.

Will I feel any discomfort during the treatment with the Levulan® PDT system?
Although the Levulan® Photodynamic system has been designed for less patient discomfort, many patients do report some stinging and burning, swelling and temporary reddening. At least 50% of patients experienced significant stinging and burning during the light treatment, usually plateauing in intensity at about 6 minutes.  Almost all patients experienced swelling and temporary reddening immediately following light treatment. This will begin to subside soon after treatment and will be gone in a few weeks. The discomfort usually occurs immediately following treatment, rather than in the weeks following.

How many PDT treatments are required?
Current recommendations suggest 1 to 2 treatments are necessary to achieve results.  Recent data suggests approximately 90% of patients obtain significant improvement from this regimen.  Improvement will last longest with continued use of sunscreens and anti-aging creams such as retinoids (Retrinal, Retinol, Retin-A, Renova).  Maintenance PDT treatments may be required at different intervals ranging from 6 months and up, depending on patient response, aging, exposure to sun and other environmental lifestyle factors.

IPL Photorejuvenation

By | Body Procedures, Facial Procedures, Laser, Uncategorized | No Comments

Rocasea B&A Two IPL Treatments

What are IPL (Intense Pulsed Light) treatments used for?
– Evening out skin tone
– Lightening and removing flat, benign pigmented lesions (freckles, sunspots, age spots and general pigmentation) on the face, neck, chest, hands and other areas of the body
– Lightening and reducing facial vascular lesions, and telangiectasia (spider veins, broken capillaries and red spots ) diffuse redness and rosacea on the face, neck and chest
– Lightening and reducing red scarring, stretch marks, Campbell de Morgans spots or cherry angiomas (red spots of varying size) and Poikiloderma (redness, pigmentation and a spotty look to the neck and/or décolletage)
– Helping to control flushing
– General improvements with uneven and blotchy skin
– IPL treatment also has a lesser effect of improving skin texture & firmness through collagen stimulation and improving pore size by temporarily reducing skin oiliness
– IPL treatments are sometimes beneficial for Acne breakouts, but individual results may vary
– Destruction of pre-cancerous lesions (actinic keratosis) when used in conjunction with Levulan (a light activated topical drug) is described in another blog posting
– Note that the ND:YAG Laser is the preferred treatment modality for moderately sized vascular lesions; however, medical grade IPL is a good choice for small vascular lesions, diffuse redness and general overall skin rejuvenation.  The ND:YAG laser provides a single high power wavelength that is targeted at hemoglobin or melanin, but the IPL device (which is not a laser) provides a broad range of colors, not all targeted.
– IPL is NOT recommended for Melasma.  Melasma is the brown splotchiness on the forehead, cheeks, upper lip, or jaw line that is triggered by hormones and light.  Hormones stimulate the growth of cells (melanocytes) that make brown pigment.  Natural light (and IPL) stimulates the production of even more brown pigment (melanin).  The Clear & Brilliant laser would be an option for treatment of Melasma.

How does the IPL treatment work?
The IPL machine emits high energy bursts of light that is absorbed by hemoglobin (the red blood cells in the blood vessels) or melanin (the brown pigment in freckles and age spots).  The light energy passes through the skin and is absorbed by either hemoglobin or melanin resulting in damage to the vessel wall or fragmentation of melanin pigment. These tiny vessels and the melanin pigment are then absorbed by the body, rendering them less visible.

How many treatments are required?
Treatment of benign pigmented lesions generally require 2-5 treatments performed approximately every month or once all the darkened cells have sloughed off.  Vascular lesions or diffuse redness generally require 2-5 treatments at monthly intervals to achieve the best results. This is so we can progressively destroy the vessels without damaging the surrounding skin.
The number of treatments and subsequent results will depend on the condition and area being treated. You can expect to see some improvement with each treatment, but each individual’s response may be slightly different to each treatment. The more sun damage or redness you have, the more likely you are to require more treatments.  IPL machines that are sold to salons and spas generally have less power than the IPL machines sold to physician’s offices and may require more treatments for similar results.

Is Your Skin Suitable For IPL Treatment?
The table below is used to classify skin according to its melanin (pigment) content and the skin’s reaction to the sun. The lighter the skin type, the more suitable it is for IPL treatment.

Skin Type Classification Colour Indication for IPL  
I  Always burns easily and never tans White Best skin for IPL treatment
II Burns easily and tans minimally White Good skin for IPL treatment
III Sometimes burns and tans gradually White Good skin for IPL treatment
IV Burns minimally and always tans Moderate Acceptable skin for IPL treatment
V+ Rarely burns, naturally dark skin Dark Brown+ Not recommended for IPL treatment

Do I require a consultation before I schedule a treatment?
You must be seen in consultation prior to your first IPL Photorejuvenation treatment.  During your consultation any specific concerns or questions will be addressed.  The cost of consultation will be applied against your first treatment.

What should I do prior to my IPL treatment?
– Please shave the area before your IPL session.
– If you have a history of herpes close to the area being treated, it is recommended that you take antiviral medication before the treatment.
– Avoid self-tanners and unprotected sun exposure 4 weeks prior to treatment.  Use quality SPF 30+ daily on sun-exposed skin that is to be treated.
– If you have a history of hyperpigmentation, you may be prescribed topical agents to apply 4 weeks prior to treatment to prevent any hyperpigmentation.
– You will need to discontinue any medications cause light hypersensitivity  for a week before each treatment, such as antibiotics (minocycline, tetracycline, doxycycline) or Vitamin A compounds (Retin-A/Renova).
– You may be asked to avoid taking aspirin, ibuprofen, or Aleve one week prior to treatment unless medically indicated as these medications can promote bruising.
–  You will be required to discontinue oral isotretinoin (accutane) for 6 months prior to treatment.
– IPL should be avoided if you are pregnant, have a history of seizures, healing problems or keloid formation, severe dermatitis or eczema (within the treatment area), active infections or open wounds in treated area, have a significant systemic illness, have a history of skin cancer or suspicious lesions, are hypersensitive to sunlight, take anticoagulants or medication that alters wound healing, have received gold therapy, or are experiencing cold sores / herpes outbreaks.

What is a typical IPL treatment like?
Prior to treatment, all makeup creams and lotions will be cleaned from the treatment area.  Your therapist will put special goggles over your eyes to protect them from the intense flash of the IPL machine.   A cool gel is then placed on the skin being treated.  The IPL handpiece is gently applied to your skin and pulses of light are administered.  Our equipment also utilizes Zimmer cooling technology for increased comfort and safety.  Test spots are utilized to reduce the risk of complications and optimize results.  You will experience a slight sensation as the light pulses are passed over your skin.  The sensation is usually mild and easily tolerated, but there may be some mild discomfort during the treatment (the first treatment typically has the most “zing”).  As your skin begins to clear, the treatments usually become more comfortable.  At the end of the treatment, the gel is removed and the skin is cleansed with a cloth and moisturizer with sunscreen is applied.  If there is any mild swelling, you may be given a cold pack to apply for five or ten minutes.  Typically you may reapply foundation or concealer immediately after a treatment.  Treatments usually take 30-90 minutes, depending on the size of the treatment area.  Levulan treatments follow a different protocol that is described in another blog post.

What can I expect after the IPL treatment?
Your skin may may have a mild “glow” or light sunburn like sensation lasting for 2 to 5 hours after your treatment.  Your skin will often feel smoother and have a more even tone.  The treated area is generally more sensitive to heat for 2 days following treatment.
– For diffuse redness, generally, the skin looks redder after the treatment then gradually lightens within 1-3 weeks. Makeup can be used right after the treatment, as long as it is applied and removed very gently. Rarely, there is bruising, which can take 1-2 weeks to resolve.
– Contact sports or any other activity that could cause bruising should be avoided.
– After treatment of vascular lesions they will typically either disappear immediately or appear grey or purplish in colour.  Vascular treatments generally require at least 3 treatments for best results.
– For freckles and age spots, the spots generally look darker for 3-7 days. Crusting can occur, which may last up to ten days. The lesions will then begin to clear and will generally be resolving at one month. It can take an average of 3-5 treatments to clear age spots.
– Acne prone skin may sometimes have a breakout after treatment.

Are there side effects from IPL treatment?
The main side effects are mild, temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister.  Do not pick blisters or skin crusting as this may lead to a scar.  Treated pigmented lesions will typically slough off in 2-3 weeks.  Do not shave the treated area if crusting is evident.  Another side effect of IPL treatment is some hair reduction; however, IPL is not as effective as laser hair removal, and more treatments are generally required to achieve similar levels of hair reduction.
Darker patches of pigment on the skin may occur a couple of weeks after treatment (this is not the immediate darkening of pigment we expect when treating pigmentation). This can last from 2 weeks up to 1 year and can be treated with a special lightening cream. You are more at risk of this occurring if you have a darker skin type.
Whiter patches on the skin can occur. This can last 2 weeks up to 1 year, though also has the potential to be permanent. You are more at risk of this occurring if you have a darker skin type.
Higher treatment levels increase treatment effectiveness, but also increase the possibility of adverse effects.  Test spots can aid in finding the optimal treatment settings.

How long will results last?
IPL Photorejuvenation will improve many of the visible signs of aging and sun-damaged skin; however, with the passage of time and with environmental exposure, skin ages as we do.  If you are exposed to a lot of sun and do not use sunscreen, the underlying issues, will return sooner.  However, if you follow a good preventative skin care regime and keep it protected from the sun, your skin will continue to look good.  Quality sunscreen, hats and sunglasses are excellent protection for overall skin health.  Typically, maintenance IPL treatments are recommended every 6-12 months, depending on individual factors.

Rocasea & Thread Veins B&A IPL treatments