detailed report on an 'ideal' photoderm treatment

[Guest guest]

I just had my 3rd photoderm treatment with Dr Zenda -Lat in

Paramus, NJ. Its still too early to discuss improvements from this

treatment (my sense is that it takes 6-10 days to see impact), but I

thought it would be of interest to let others know how she approaches

each treatment because, in my mind, it is a model of how photoderm

treatments should be done. I will say that the first two treatments

have virtually eliminated the burning I would feel essentially every

day around noon.

We start by taking 3 digital photographs from front, left, and right

side, in EXACTLY the same position and lighting as prior photographs.

She then loads them onto her computer, and has some special

software that allows us to bring up two photos side by side to compare

progress from previous treatment. We discuss these quite thoroughly,

and we generally agree on where we see improvement and where we

don't. One of my big complaints about photoderm web sites is the

quality of the before and after photographs: ever notice how the

'after' picture often has a good deal of " flash whitening' that will

make anyone look white as ghost (strangely, one nevers see this in

the

'before' picture ...). Zenda actually studies the previous picture

while looking through her view finder to get the framing as close as

possible. I really respect this thoroughness.

We then induce a flush with topical niacin, which makes me 10x redder

than I've ever been before. The flush kicks in within minutes, and

she took another front-on picture to see where I was the most red -

this is a useful procedure to monitor one's progress: as photoderm

destroys more of the vessels, the niacin produces less and less of a

flush, although I believe even non-rosaceans will experience some

flushing with it.

At Dr Bitter's recommmendation, I have been using a special topical

anesthetic called Betacaine that differs from conventional EMLA in

that it is not supposed to cause vasoconstriction (the dream of every

rosacean, except when you're about to undergo photoderm and you want

to be as red as possible.) However, I did some experiments at home

after tx #2 and convinced myself that application of the Betacaine

was indeed causing blanching. Zenda was most interested in this, so I

put some on my chin and nose only, and we waited 20 minutes for it to

take effect. She then took another round of photos, and indeed I had

lost the niacin flush on the areas treated with Betacaine. I am now

thinking that I will do all future treatments without the Betacaine,

simply becuase I can tolerate the pain and I want to leave no issues

unresolved. Again, I really admire the fact that she was willing to

take the time to hear out my concerns, and tolerate my obsession for

experimentation.

We then moved to the treatment room, where we once again did the

niacin since I my flush was wearing thin. I am very interested in

the operation of the photoderm machine, partly because my PhD is in

nuclear engineering and in prior life, I did computational modelling

of radiation transport. Zenda graciously tolerated all of my

detailed questions concerning impact of various settings, and we

spent at least 10 minutes fiddling with various settings to establish

impact on the 'aggressiveness' scale, switching between Epilight and

photoderm heads. (I felt like a little kid driving his parents car

down the driveway for first time ...). After discussion the

treatment-settings du jure, we did the treatment, with various

crystals and a double pass over some troublesome areas. Again, she

would carefully explain what setting were being used (one's eyes are

covered during the treatment to protect from flash) as we moved

along. Some of the zaps were pretty painful, but its tolerable. The

treatment itself probably lasted 40 minutes or so, using Epilight

with 3-second recharge time, and doing total of 171 pulses.

One thing she did mention is that since she was trained by Bitter Sr,

she is prohibited from releasing the settings. Hence, she did not

give me a printout, but openly discussed at every point what was

being done. (I suspect I could claim patient rights and get the

printout, but its no big deal ...).

We finished the treatment, and she handed me a cold pack to soothe my

face. Had some increased redness, of course, but by time I got home

an hour later, I looked pretty normal.

All told, I was in her office for 2.5 hours (!!), and even spoke to

her husband (and co-practioner) briefly. I must say that I have

never dealt with a physician that takes as much interest in serving

her patients as Zenda has. I can't say now, of course, what will be

the final outcome of my 5 treatments, but I do believe that I am

getting the best possible photoderm experience.

Rick