my photoderm with Dr. Ritchie experience

[Guest guest]

Hey all,

I've been a lurker here for quite some time, and feel this list has

helped me tremendously. This post is my attempt to give something

back.

Let me first say that I'm a 24 year-old male, and live in the suburbs

of Washington, DC. About 5 years ago I did a full course of accutane,

which cured my acne completely, but left me with a redish complexion,

which I never had before. That continued until about a year and a half

ago when it developed into full rosacea. To be fair, it hasn't (yet)

developed into a serious case, and using the scale in Nase's book, I'd

say I'm a 'mild' on a good day, 'moderate' on a bad day. Redness and

flushing, no acne component at all. The redness covered cheeks and

nose only. On an average day, I resembled Nase's picture at the end

of his book (the one with him and his college buddies).

So I went to my family derm, whom I've been going to since a small kid.

All my life I've had dermatitis, ranging from my toes to scalp. So

he looked at my red cheeks, and said I had seb derm. (which was

probably true, but I knew that wasn't what was causing the redness.

For the last several years I've been using a product called

betamethazone, which for me eliminates dermatitis within a few days

of use. It did nothing for my redness). He prescribed tetracycline,

and said to use for 3 months and go back. I did this, and saw

improvement. While on the tetracycline I achieved maybe 30-50%

reduction in redness.

Anyway, long story short, tetracycline gave my bad side effects

eventually, and so did doxycycline (although both did improve my

redness). So on my fourth visit to the derm, he formally diagnosed

me with rosacea. I asked him what a long term treatment might be,

and he said " well we'll just keep trying new antibiotics until we

find one you can take with side effects " . At this point I knew I

needed to try something completely different.

I never took photoderm seriously until I read through Nase's book.

So I knew how important it was to find a practicioner that has

lots of experience with the laser. I was very intrigued by Ann's

description of Dr. Ritchie in Knoxville. $175 per treatment seemed

too good to be true, and plus Knoxville is an 8 hour drive from

Washington, 7 if you drive fast. I exchanged emails with a few

patients recommended by Ann, and that was all the convincing I needed.

Incidentally, Dr. Ritchie has a website (I got it off a pamphlet,

and I haven't seen listed anywhere else, so here it is):

www.laserandveincentre.com

My first appoint was late October, on a friday. Left at 6:30 am, got

there in time for my 3:00 appointment. (although just barely,

construction on the roads in Knoxville held me up quite a bit).

I was taken immediately to the back room, and Dr. Ritchie came in.

He said my rosacea looked very mild (My face happened to look really

good that day, murhpy's law I guess), but said I was very smart for

wanting to " nip it in the bud " for I developed a serious case. I

asked how many treatments he thought it would take, and he said about

3. When I said that seemed low to me, he said that it typically takes

4-6, but he does double treatments (twice as many zaps per treatment

than most doctors who do photoderm). I asked if this would increase

the risk of side effects, and his answer was " no, because I know what

I'm doing. " Seemed like a good enough answer for me. He then

explained that he's been doing this for many years, and knows how to

avoid side effects. I was very worried about side effects, so much

so that I would have had him go easier if it meant reducing side

effects. But I trusted him, so I said nothing.

As for the treatment itself, he did 2 passes, with the 570 and 590.

I didn't get a printout of exactly what he did (duration, delay, etc)

but I do remember the fluence was in the upper 30s. He started out low

and kept increasing it until I became uncomfortable. Each pass was

about several dozen zaps on each cheek, and a dozen or so on the nose.

He did the right cheek and nose, a nurse did the left cheek. The

treatment was very uncomfortable for me, but not because of the pain.

People have described photoderm as feeling like a rubber band snapping,

but I would describe it more as being hit with a mild blowtorch.

Intense light, intense heat, mild sting pain. But most of all it

scares you, because you're blindfolded and feel helpless.

I waited a month and half before the second treatment. This may be

a bit long, but (since it's such a long drive) I really wanted to

see what the effect was before going back. My face was really red

for the next couple days after treatment, but it's what I expected.

Nothing I'd call a side effect. For the next couple weeks, it

alternated between moderate redness and very red. Honestly, I looked

worse. At this point, I wasn't taking any tetracycline, or metrogel.

Just seeing what the photoderm would do. At the 3 week point, my

face settled down, and I was back to where I was (before treatment).

So the net (visible) effect of the first treatment was zero.

Early December I went down again. (construction in Knoxville seemed to

be improving). It's actually a pleasant drive, along I-81 in Virginia.

I was taken back into the back room again, and the nurse put the

lidocaine on, like they did in the first treatment. 10 minutes later

Dr. Ritchie came in. Ritchie struck me as very down-to-business and

got started. He did 3 passes this time, first with the 570, then 590,

then with the 550. Each pass was about 75 zaps. I peeked at the

monitor and noticed the fluence was set at 44. This seemed strong

to me, but since I had no side effects last time, I wasn't worried.

Since I knew what to expect, the treatment was nearly as nerve-racking

as the first time. After he finished with the 550, he said he wanted

to take me to the other room and work on me with the Varia laser,

to help with the telengectasia. (I forgot to mention earlier, that

I have some mild red lines visible in the center of each cheek).

I nervously agreed. I asked if the Varia is associated with side

effects, and he said " no, because I'll go easy on you " . I'm not

sure if that comforted me or not. But he used the laser to do a

blast on the palm of his hand, to demostrate it wasn't that bad.

That actually did comfort me. He did over a dozen blasts on each

cheek. With the Varia there's no light or heat, just a bee sting

sensation. It was quite uncomfortable. Afterwards, the center of

each cheek was a bit swollen, but that went away by the next day.

Again, all this was $175.

The weeks following the second treatment were similar to the first

treatment. At 3 weeks past the second treatment, my face was still

really red. At this point was I was getting discouraged. I

considered not going back for a third treatment (did I mention it is

a long drive?) But the following week my face really cleared up.

For the next 2-3 weeks after that, face looked really good. Still a

little red, but about 50% clearance as compared to before my first

treatment. I'm not going to make a distinction between redness and

flushing, because for me, one always triggers the other.

So, feeling very encouraged, I went down for my third treatment in

mid-January. My appointment was for 3:00, but he didn't take me

until 4:30 because one of his machines had a problem. I didn't mind

sitting in his waiting room (although his bubbly fountain got on my

nerves after a while). When he took me back, he appologized for the

wait, and promptly covered me the ultrasound gel. Again he did 3

passes, 570, 590, and 645. With the 645, I felt heat and light, but

no pain. The passes with the 570 and 590 were quite painful, because

this session he turned up the fluence to 47.5. He said that if I could

stand the treatment at that setting, it would really help. So I got

through it. I asked if he would do the 550 again, and he said no

because he usually only does the 550 once on a patient, as it has

the highest probability of damaging the skin. Anyway, Dr. Ritchie

answered every question I asked, although he didn't usually volunteer

what he was doing until I asked. After these 3 passes, he asked the

nurse to go over my cheeks with the Dornier laser. This was probably

the most pleasant of all the lasers I had gone through. The nurse

said it was a miniature version of the YAG. Each zap felt like a very

mild bee sting, with no light or heat. Again, $175.

So now it's thursday, 6 days after the third treatment and face looks

really good. Better than it's looked in 6 months. The after-effects

of the third treatment seem to have gone away already. Right now

a " bad day " is what I used to call a " good day " . That's all I ever

asked for. In about a month I'll post again, after I see what the

effects are of the third treatment. I'm very optimistic. At the

moment I have no plans to go back for a fourth, but who knows, I'll

see what happens. I'd like to thank everyone on this group,

especially Ann for telling us (me) about Dr. Ritchie.

I'm sure I've left out a few things. If anyone has any questions, let

me know.

-Greg

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