Re: need help with ansers from laser doc...

[Guest guest]

Kajsa,

Geoffrey's book (and its references) are an excellent start. Go to

Medline and do a search for lasers, rosacea, and telangiectasia

(assuming your spelling is better than mine ...). Also, some time

ago, I posted a URL to a special issue of the Journal of Cutaneous

Medicine and Surgery, Volume 2, Supplement 4, June, 1998 which is

devoted to rosacea. In there is an article on " Laser Therapy in the

Management of cea " by Laughlin and Dudley. (BTW, they do not

even

mention photoderm, perhaps for reasons other than it doesn't fit the

'laser' title.)

Also, track down the website for ESC (maker of the photoderm machine)

and read their side of the photoderm / pulsed-dye laser debate.

If I get a chance, I'll try to get these URLs off my office-machine

bookmarks.

Rickl

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation

> > or

> > > > high sebaceous gland activity and not the other

> > way

> > > > around. You can not treat the deeper blood

> > vessels

> > > > that is not visible for the eye. Also that can

> > be

> > > > vessels you might need and you can't treat

> > random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels,

> > that u

> > > > can't treat the one that is not visible for the

> > eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of

> > laser therapy, but

> > from

> > > his comments it appears your physician believes

> > that the primary

> > > cause of rosacea is immune-mediated, not vascular

> > (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories,

> > but neither

> > > satisfactorily explains all we know about rosacea.

> > So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

> >

>

> >

>

> _____________________________________________________

> Gratis e-mail resten av livet på www.yahoo.se/mail

> Busenkelt!

[Guest guest]

Kajsa,

Geoffrey's book (and its references) are an excellent start. Go to

Medline and do a search for lasers, rosacea, and telangiectasia

(assuming your spelling is better than mine ...). Also, some time

ago, I posted a URL to a special issue of the Journal of Cutaneous

Medicine and Surgery, Volume 2, Supplement 4, June, 1998 which is

devoted to rosacea. In there is an article on " Laser Therapy in the

Management of cea " by Laughlin and Dudley. (BTW, they do not

even

mention photoderm, perhaps for reasons other than it doesn't fit the

'laser' title.)

Also, track down the website for ESC (maker of the photoderm machine)

and read their side of the photoderm / pulsed-dye laser debate.

If I get a chance, I'll try to get these URLs off my office-machine

bookmarks.

Rickl

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation

> > or

> > > > high sebaceous gland activity and not the other

> > way

> > > > around. You can not treat the deeper blood

> > vessels

> > > > that is not visible for the eye. Also that can

> > be

> > > > vessels you might need and you can't treat

> > random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels,

> > that u

> > > > can't treat the one that is not visible for the

> > eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of

> > laser therapy, but

> > from

> > > his comments it appears your physician believes

> > that the primary

> > > cause of rosacea is immune-mediated, not vascular

> > (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories,

> > but neither

> > > satisfactorily explains all we know about rosacea.

> > So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

> >

>

> >

>

> _____________________________________________________

> Gratis e-mail resten av livet på www.yahoo.se/mail

> Busenkelt!

[Guest guest]

Kajsa,

Geoffrey's book (and its references) are an excellent start. Go to

Medline and do a search for lasers, rosacea, and telangiectasia

(assuming your spelling is better than mine ...). Also, some time

ago, I posted a URL to a special issue of the Journal of Cutaneous

Medicine and Surgery, Volume 2, Supplement 4, June, 1998 which is

devoted to rosacea. In there is an article on " Laser Therapy in the

Management of cea " by Laughlin and Dudley. (BTW, they do not

even

mention photoderm, perhaps for reasons other than it doesn't fit the

'laser' title.)

Also, track down the website for ESC (maker of the photoderm machine)

and read their side of the photoderm / pulsed-dye laser debate.

If I get a chance, I'll try to get these URLs off my office-machine

bookmarks.

Rickl

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation

> > or

> > > > high sebaceous gland activity and not the other

> > way

> > > > around. You can not treat the deeper blood

> > vessels

> > > > that is not visible for the eye. Also that can

> > be

> > > > vessels you might need and you can't treat

> > random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels,

> > that u

> > > > can't treat the one that is not visible for the

> > eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of

> > laser therapy, but

> > from

> > > his comments it appears your physician believes

> > that the primary

> > > cause of rosacea is immune-mediated, not vascular

> > (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories,

> > but neither

> > > satisfactorily explains all we know about rosacea.

> > So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

> >

>

> >

>

> _____________________________________________________

> Gratis e-mail resten av livet på www.yahoo.se/mail

> Busenkelt!

[Guest guest]

Marjorie,

I really can't comment intelligently on the majority of your

questions given my very limited medical background. I probably should

have said " vessels " rather than " veins " . Some attempts:

> If there's no explosion, then what's happening to these vessels

that

> could even theoretically account for symptomatic improvement?

Bingo, this is the ultimate question. I asked Harvey Jay, and got no

reasonable technical answer. IMHO, there is no such thing as a free

lunch here: if you want the vessels to disappear, then they have to

be exploded. Period. Check out the ESC web site and see if you can

find anything there. Been awhile since I've looked, but Geoffrey does

reference a computer simulation they did supporting their claims for

photoderm vessel elimination.

> Is that what you mean by flushing migration?

Actually, I meant flushing mitigation, not migration. But I believe

you are right, based on what Geoffrey has written, that the vessels

will return after treatment, possibly to a greater extent since,

after all, you are a rosacean, and rosaceans do have enhanced facial

vessel structure (I think) which will ultimately return.

You ask about permanent decreased flushing. I would suggest no one

knows, since there are no publications supporting these claims.

Braverman at Yale, a microcirculation expert, told me he did not

believe that laser (or IPL) treatments could cause observable

reduction in flushing mechanisms. He would be the person I would most

trust to answer your questions, since he is not a laser surgeon, and

hence has no vested interest in the efficacy of these treatments.

Sorry to offer such incomplete answers ...

Rick

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation or

> > > > high sebaceous gland activity and not the other way

> > > > around. You can not treat the deeper blood vessels

> > > > that is not visible for the eye. Also that can be

> > > > vessels you might need and you can't treat random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels, that u

> > > > can't treat the one that is not visible for the eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of laser therapy,

but

> > from

> > > his comments it appears your physician believes that the

primary

> > > cause of rosacea is immune-mediated, not vascular (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories, but neither

> > > satisfactorily explains all we know about rosacea. So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

[Guest guest]

Marjorie,

I really can't comment intelligently on the majority of your

questions given my very limited medical background. I probably should

have said " vessels " rather than " veins " . Some attempts:

> If there's no explosion, then what's happening to these vessels

that

> could even theoretically account for symptomatic improvement?

Bingo, this is the ultimate question. I asked Harvey Jay, and got no

reasonable technical answer. IMHO, there is no such thing as a free

lunch here: if you want the vessels to disappear, then they have to

be exploded. Period. Check out the ESC web site and see if you can

find anything there. Been awhile since I've looked, but Geoffrey does

reference a computer simulation they did supporting their claims for

photoderm vessel elimination.

> Is that what you mean by flushing migration?

Actually, I meant flushing mitigation, not migration. But I believe

you are right, based on what Geoffrey has written, that the vessels

will return after treatment, possibly to a greater extent since,

after all, you are a rosacean, and rosaceans do have enhanced facial

vessel structure (I think) which will ultimately return.

You ask about permanent decreased flushing. I would suggest no one

knows, since there are no publications supporting these claims.

Braverman at Yale, a microcirculation expert, told me he did not

believe that laser (or IPL) treatments could cause observable

reduction in flushing mechanisms. He would be the person I would most

trust to answer your questions, since he is not a laser surgeon, and

hence has no vested interest in the efficacy of these treatments.

Sorry to offer such incomplete answers ...

Rick

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation or

> > > > high sebaceous gland activity and not the other way

> > > > around. You can not treat the deeper blood vessels

> > > > that is not visible for the eye. Also that can be

> > > > vessels you might need and you can't treat random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels, that u

> > > > can't treat the one that is not visible for the eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of laser therapy,

but

> > from

> > > his comments it appears your physician believes that the

primary

> > > cause of rosacea is immune-mediated, not vascular (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories, but neither

> > > satisfactorily explains all we know about rosacea. So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

[Guest guest]

Marjorie,

I really can't comment intelligently on the majority of your

questions given my very limited medical background. I probably should

have said " vessels " rather than " veins " . Some attempts:

> If there's no explosion, then what's happening to these vessels

that

> could even theoretically account for symptomatic improvement?

Bingo, this is the ultimate question. I asked Harvey Jay, and got no

reasonable technical answer. IMHO, there is no such thing as a free

lunch here: if you want the vessels to disappear, then they have to

be exploded. Period. Check out the ESC web site and see if you can

find anything there. Been awhile since I've looked, but Geoffrey does

reference a computer simulation they did supporting their claims for

photoderm vessel elimination.

> Is that what you mean by flushing migration?

Actually, I meant flushing mitigation, not migration. But I believe

you are right, based on what Geoffrey has written, that the vessels

will return after treatment, possibly to a greater extent since,

after all, you are a rosacean, and rosaceans do have enhanced facial

vessel structure (I think) which will ultimately return.

You ask about permanent decreased flushing. I would suggest no one

knows, since there are no publications supporting these claims.

Braverman at Yale, a microcirculation expert, told me he did not

believe that laser (or IPL) treatments could cause observable

reduction in flushing mechanisms. He would be the person I would most

trust to answer your questions, since he is not a laser surgeon, and

hence has no vested interest in the efficacy of these treatments.

Sorry to offer such incomplete answers ...

Rick

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation or

> > > > high sebaceous gland activity and not the other way

> > > > around. You can not treat the deeper blood vessels

> > > > that is not visible for the eye. Also that can be

> > > > vessels you might need and you can't treat random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels, that u

> > > > can't treat the one that is not visible for the eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of laser therapy,

but

> > from

> > > his comments it appears your physician believes that the

primary

> > > cause of rosacea is immune-mediated, not vascular (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories, but neither

> > > satisfactorily explains all we know about rosacea. So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

[Guest guest]

Marjorie,

I really can't comment intelligently on the majority of your

questions given my very limited medical background. I probably should

have said " vessels " rather than " veins " . Some attempts:

> If there's no explosion, then what's happening to these vessels

that

> could even theoretically account for symptomatic improvement?

Bingo, this is the ultimate question. I asked Harvey Jay, and got no

reasonable technical answer. IMHO, there is no such thing as a free

lunch here: if you want the vessels to disappear, then they have to

be exploded. Period. Check out the ESC web site and see if you can

find anything there. Been awhile since I've looked, but Geoffrey does

reference a computer simulation they did supporting their claims for

photoderm vessel elimination.

> Is that what you mean by flushing migration?

Actually, I meant flushing mitigation, not migration. But I believe

you are right, based on what Geoffrey has written, that the vessels

will return after treatment, possibly to a greater extent since,

after all, you are a rosacean, and rosaceans do have enhanced facial

vessel structure (I think) which will ultimately return.

You ask about permanent decreased flushing. I would suggest no one

knows, since there are no publications supporting these claims.

Braverman at Yale, a microcirculation expert, told me he did not

believe that laser (or IPL) treatments could cause observable

reduction in flushing mechanisms. He would be the person I would most

trust to answer your questions, since he is not a laser surgeon, and

hence has no vested interest in the efficacy of these treatments.

Sorry to offer such incomplete answers ...

Rick

> > > > #Laser Doc:

> > > > The vessels are a result of cronic inlfammation or

> > > > high sebaceous gland activity and not the other way

> > > > around. You can not treat the deeper blood vessels

> > > > that is not visible for the eye. Also that can be

> > > > vessels you might need and you can't treat random.

> > > >

> > > > #My questions to the group:

> > > > Is that correct with the deeper blood vessels, that u

> > > > can't treat the one that is not visible for the eye?

> > > > I thought that was the thing Dr Nase did?

> > >

> > > Kajsa, I can't help you with the mechanics of laser therapy,

but

> > from

> > > his comments it appears your physician believes that the

primary

> > > cause of rosacea is immune-mediated, not vascular (as does Dr.

> > Nase).

> > > There is solid reasoning supporting both theories, but neither

> > > satisfactorily explains all we know about rosacea. So the

> > controversy

> > > continues...

> > >

> > > Marjorie

> > >

> > > Marjorie Lazoff, MD

[Guest guest]

I've been wondering about the effect of lasers on vessels also,

in terms of how the vessels respond to the heating. The idea that

the only way to truly eliminate the vessels is to " cook " them seems

correct. However, the idea that the only options are to " explode " a

vessel (I guess boiling the substances inside so they heat enough to

increase pressure on the vessel wall and burst it) and not treat it

at all seems a bit extreme. One would think this is precisely the

point of developing a better laser, to avoid this all-or-nothing

scenario.

I'm certainly not a doctor and have only a limited knowledge of

laser treatment, so I'm only throwing this out here, poor analogy and

all. Can we compare this situation to cooking? Where if you heat

too fast with too much energy something explodes (potato in the

microwave) versus heating it more slowly and consistently (laser

pulses) to effectively " cook " the vessel proteins (a potato in a

conventional oven, perhaps?). This has been my understanding of the

newer lasers like Photoderm and Vbeam. Of course, after heating and

shriveling a vessel more slowly, does it disappear through natural

disposal processes in the body or where does it go?

Any opinions on this line of thought?

[Guest guest]

I've been wondering about the effect of lasers on vessels also,

in terms of how the vessels respond to the heating. The idea that

the only way to truly eliminate the vessels is to " cook " them seems

correct. However, the idea that the only options are to " explode " a

vessel (I guess boiling the substances inside so they heat enough to

increase pressure on the vessel wall and burst it) and not treat it

at all seems a bit extreme. One would think this is precisely the

point of developing a better laser, to avoid this all-or-nothing

scenario.

I'm certainly not a doctor and have only a limited knowledge of

laser treatment, so I'm only throwing this out here, poor analogy and

all. Can we compare this situation to cooking? Where if you heat

too fast with too much energy something explodes (potato in the

microwave) versus heating it more slowly and consistently (laser

pulses) to effectively " cook " the vessel proteins (a potato in a

conventional oven, perhaps?). This has been my understanding of the

newer lasers like Photoderm and Vbeam. Of course, after heating and

shriveling a vessel more slowly, does it disappear through natural

disposal processes in the body or where does it go?

Any opinions on this line of thought?

[Guest guest]

I've been wondering about the effect of lasers on vessels also,

in terms of how the vessels respond to the heating. The idea that

the only way to truly eliminate the vessels is to " cook " them seems

correct. However, the idea that the only options are to " explode " a

vessel (I guess boiling the substances inside so they heat enough to

increase pressure on the vessel wall and burst it) and not treat it

at all seems a bit extreme. One would think this is precisely the

point of developing a better laser, to avoid this all-or-nothing

scenario.

I'm certainly not a doctor and have only a limited knowledge of

laser treatment, so I'm only throwing this out here, poor analogy and

all. Can we compare this situation to cooking? Where if you heat

too fast with too much energy something explodes (potato in the

microwave) versus heating it more slowly and consistently (laser

pulses) to effectively " cook " the vessel proteins (a potato in a

conventional oven, perhaps?). This has been my understanding of the

newer lasers like Photoderm and Vbeam. Of course, after heating and

shriveling a vessel more slowly, does it disappear through natural

disposal processes in the body or where does it go?

Any opinions on this line of thought?

[Guest guest]

I've been wondering about the effect of lasers on vessels also,

in terms of how the vessels respond to the heating. The idea that

the only way to truly eliminate the vessels is to " cook " them seems

correct. However, the idea that the only options are to " explode " a

vessel (I guess boiling the substances inside so they heat enough to

increase pressure on the vessel wall and burst it) and not treat it

at all seems a bit extreme. One would think this is precisely the

point of developing a better laser, to avoid this all-or-nothing

scenario.

I'm certainly not a doctor and have only a limited knowledge of

laser treatment, so I'm only throwing this out here, poor analogy and

all. Can we compare this situation to cooking? Where if you heat

too fast with too much energy something explodes (potato in the

microwave) versus heating it more slowly and consistently (laser

pulses) to effectively " cook " the vessel proteins (a potato in a

conventional oven, perhaps?). This has been my understanding of the

newer lasers like Photoderm and Vbeam. Of course, after heating and

shriveling a vessel more slowly, does it disappear through natural

disposal processes in the body or where does it go?

Any opinions on this line of thought?

[Guest guest]

Hi,

From what I understand with Photoderm / other vascular lasers, the

aim is to heat the blood vessel to the point of coagulation so that

the vessel becomes co-agulated and sealed. Over the next 5 / 7

days, the vessel will become absorbed by the body and clearance will

become visible. This is similar to what happens in Sclerotherapy:

A chemical is injected into the veins which causes the vein to

collapse and become sealed. Over a period of a few days, the body

then absorbs the vein. No " explosion " is necessary.

My own personal experience is that the most successful " zaps " at

treating my superficial redness, within 20-30 seconds of the zap,

*immediate* blanching of the treated area is visible. That small

rectangle where the photoderm crystal zapped becomes pure white.

The area would remain white for around 5 hours after photoderm, them

become pink / red again.

Personally, I think Photoderm is a mixed bag. I believe that the

technology holds *huge* potential but that the majority of operators

are not / cannot become skilled enough in its usage. However, I

*don't* think this is the fault of the operators -- I think it's the

fault of the machine at this stage in its development. I believe

that over time, the machine (and others like it) will be able to

calibrate autmatically to deliver optimum energy to the skin (either

via a feedback mechanism in the delivery head or a laser thermometer

instument which is attached to the head and can meausure the

heating / cooling curve of the skin). I think that because of the

unpredictable results of the machines, the makers have been

reluctant in pushing for more independant trials.

One important thing that we've not been considering in this is

vessel re-growth. After any injury to tissue / blood vessels, the

body releases VEGF which can cause new vessel growth. Before Nase

was injured, he commented a few times (I think this was on the BFS

board) that after any vascular surgery, after the 1st 3-4

treatments, VEGF production (and therefore angiogensis, re-growth

and poor results) is high. After 3-4 treatments, he thought that

VEGF production fell (whether this was a hypothesis or based on

data, published or otherwise, I don't know). This is why Nase was

so keen on the topical NO inhibitors: He hypothesised that used in

conjunction with vascular laser / IPL treatments, they could be made

*significantly* more effective (with little or no re-growth).

Multiple published studies (Ormerod on Psoriasis comes to mind) have

shown that topical NO inhibition *does* reduce VEGF production.

Whether this is safe / practical / etc. after such laser / IPL

treatments is of course an un-answered question.

Rick -- I will contact you privately via email about some pictures

of my photoderm which I can send for you to look at and post your

comments to the group.

.

> Marjorie,

>

> I really can't comment intelligently on the majority of your

> questions given my very limited medical background. I probably

should

> have said " vessels " rather than " veins " . Some attempts:

>

> > If there's no explosion, then what's happening to these vessels

> that

> > could even theoretically account for symptomatic improvement?

>

> Bingo, this is the ultimate question. I asked Harvey Jay, and got

no

> reasonable technical answer. IMHO, there is no such thing as a

free

> lunch here: if you want the vessels to disappear, then they have to

> be exploded. Period. Check out the ESC web site and see if you

can

> find anything there. Been awhile since I've looked, but Geoffrey

does

> reference a computer simulation they did supporting their claims

for

> photoderm vessel elimination.

>

> > Is that what you mean by flushing migration?

[Guest guest]

Hi,

From what I understand with Photoderm / other vascular lasers, the

aim is to heat the blood vessel to the point of coagulation so that

the vessel becomes co-agulated and sealed. Over the next 5 / 7

days, the vessel will become absorbed by the body and clearance will

become visible. This is similar to what happens in Sclerotherapy:

A chemical is injected into the veins which causes the vein to

collapse and become sealed. Over a period of a few days, the body

then absorbs the vein. No " explosion " is necessary.

My own personal experience is that the most successful " zaps " at

treating my superficial redness, within 20-30 seconds of the zap,

*immediate* blanching of the treated area is visible. That small

rectangle where the photoderm crystal zapped becomes pure white.

The area would remain white for around 5 hours after photoderm, them

become pink / red again.

Personally, I think Photoderm is a mixed bag. I believe that the

technology holds *huge* potential but that the majority of operators

are not / cannot become skilled enough in its usage. However, I

*don't* think this is the fault of the operators -- I think it's the

fault of the machine at this stage in its development. I believe

that over time, the machine (and others like it) will be able to

calibrate autmatically to deliver optimum energy to the skin (either

via a feedback mechanism in the delivery head or a laser thermometer

instument which is attached to the head and can meausure the

heating / cooling curve of the skin). I think that because of the

unpredictable results of the machines, the makers have been

reluctant in pushing for more independant trials.

One important thing that we've not been considering in this is

vessel re-growth. After any injury to tissue / blood vessels, the

body releases VEGF which can cause new vessel growth. Before Nase

was injured, he commented a few times (I think this was on the BFS

board) that after any vascular surgery, after the 1st 3-4

treatments, VEGF production (and therefore angiogensis, re-growth

and poor results) is high. After 3-4 treatments, he thought that

VEGF production fell (whether this was a hypothesis or based on

data, published or otherwise, I don't know). This is why Nase was

so keen on the topical NO inhibitors: He hypothesised that used in

conjunction with vascular laser / IPL treatments, they could be made

*significantly* more effective (with little or no re-growth).

Multiple published studies (Ormerod on Psoriasis comes to mind) have

shown that topical NO inhibition *does* reduce VEGF production.

Whether this is safe / practical / etc. after such laser / IPL

treatments is of course an un-answered question.

Rick -- I will contact you privately via email about some pictures

of my photoderm which I can send for you to look at and post your

comments to the group.

.

> Marjorie,

>

> I really can't comment intelligently on the majority of your

> questions given my very limited medical background. I probably

should

> have said " vessels " rather than " veins " . Some attempts:

>

> > If there's no explosion, then what's happening to these vessels

> that

> > could even theoretically account for symptomatic improvement?

>

> Bingo, this is the ultimate question. I asked Harvey Jay, and got

no

> reasonable technical answer. IMHO, there is no such thing as a

free

> lunch here: if you want the vessels to disappear, then they have to

> be exploded. Period. Check out the ESC web site and see if you

can

> find anything there. Been awhile since I've looked, but Geoffrey

does

> reference a computer simulation they did supporting their claims

for

> photoderm vessel elimination.

>

> > Is that what you mean by flushing migration?

[Guest guest]

Hi,

From what I understand with Photoderm / other vascular lasers, the

aim is to heat the blood vessel to the point of coagulation so that

the vessel becomes co-agulated and sealed. Over the next 5 / 7

days, the vessel will become absorbed by the body and clearance will

become visible. This is similar to what happens in Sclerotherapy:

A chemical is injected into the veins which causes the vein to

collapse and become sealed. Over a period of a few days, the body

then absorbs the vein. No " explosion " is necessary.

My own personal experience is that the most successful " zaps " at

treating my superficial redness, within 20-30 seconds of the zap,

*immediate* blanching of the treated area is visible. That small

rectangle where the photoderm crystal zapped becomes pure white.

The area would remain white for around 5 hours after photoderm, them

become pink / red again.

Personally, I think Photoderm is a mixed bag. I believe that the

technology holds *huge* potential but that the majority of operators

are not / cannot become skilled enough in its usage. However, I

*don't* think this is the fault of the operators -- I think it's the

fault of the machine at this stage in its development. I believe

that over time, the machine (and others like it) will be able to

calibrate autmatically to deliver optimum energy to the skin (either

via a feedback mechanism in the delivery head or a laser thermometer

instument which is attached to the head and can meausure the

heating / cooling curve of the skin). I think that because of the

unpredictable results of the machines, the makers have been

reluctant in pushing for more independant trials.

One important thing that we've not been considering in this is

vessel re-growth. After any injury to tissue / blood vessels, the

body releases VEGF which can cause new vessel growth. Before Nase

was injured, he commented a few times (I think this was on the BFS

board) that after any vascular surgery, after the 1st 3-4

treatments, VEGF production (and therefore angiogensis, re-growth

and poor results) is high. After 3-4 treatments, he thought that

VEGF production fell (whether this was a hypothesis or based on

data, published or otherwise, I don't know). This is why Nase was

so keen on the topical NO inhibitors: He hypothesised that used in

conjunction with vascular laser / IPL treatments, they could be made

*significantly* more effective (with little or no re-growth).

Multiple published studies (Ormerod on Psoriasis comes to mind) have

shown that topical NO inhibition *does* reduce VEGF production.

Whether this is safe / practical / etc. after such laser / IPL

treatments is of course an un-answered question.

Rick -- I will contact you privately via email about some pictures

of my photoderm which I can send for you to look at and post your

comments to the group.

.

> Marjorie,

>

> I really can't comment intelligently on the majority of your

> questions given my very limited medical background. I probably

should

> have said " vessels " rather than " veins " . Some attempts:

>

> > If there's no explosion, then what's happening to these vessels

> that

> > could even theoretically account for symptomatic improvement?

>

> Bingo, this is the ultimate question. I asked Harvey Jay, and got

no

> reasonable technical answer. IMHO, there is no such thing as a

free

> lunch here: if you want the vessels to disappear, then they have to

> be exploded. Period. Check out the ESC web site and see if you

can

> find anything there. Been awhile since I've looked, but Geoffrey

does

> reference a computer simulation they did supporting their claims

for

> photoderm vessel elimination.

>

> > Is that what you mean by flushing migration?

[Guest guest]

Hi,

From what I understand with Photoderm / other vascular lasers, the

aim is to heat the blood vessel to the point of coagulation so that

the vessel becomes co-agulated and sealed. Over the next 5 / 7

days, the vessel will become absorbed by the body and clearance will

become visible. This is similar to what happens in Sclerotherapy:

A chemical is injected into the veins which causes the vein to

collapse and become sealed. Over a period of a few days, the body

then absorbs the vein. No " explosion " is necessary.

My own personal experience is that the most successful " zaps " at

treating my superficial redness, within 20-30 seconds of the zap,

*immediate* blanching of the treated area is visible. That small

rectangle where the photoderm crystal zapped becomes pure white.

The area would remain white for around 5 hours after photoderm, them

become pink / red again.

Personally, I think Photoderm is a mixed bag. I believe that the

technology holds *huge* potential but that the majority of operators

are not / cannot become skilled enough in its usage. However, I

*don't* think this is the fault of the operators -- I think it's the

fault of the machine at this stage in its development. I believe

that over time, the machine (and others like it) will be able to

calibrate autmatically to deliver optimum energy to the skin (either

via a feedback mechanism in the delivery head or a laser thermometer

instument which is attached to the head and can meausure the

heating / cooling curve of the skin). I think that because of the

unpredictable results of the machines, the makers have been

reluctant in pushing for more independant trials.

One important thing that we've not been considering in this is

vessel re-growth. After any injury to tissue / blood vessels, the

body releases VEGF which can cause new vessel growth. Before Nase

was injured, he commented a few times (I think this was on the BFS

board) that after any vascular surgery, after the 1st 3-4

treatments, VEGF production (and therefore angiogensis, re-growth

and poor results) is high. After 3-4 treatments, he thought that

VEGF production fell (whether this was a hypothesis or based on

data, published or otherwise, I don't know). This is why Nase was

so keen on the topical NO inhibitors: He hypothesised that used in

conjunction with vascular laser / IPL treatments, they could be made

*significantly* more effective (with little or no re-growth).

Multiple published studies (Ormerod on Psoriasis comes to mind) have

shown that topical NO inhibition *does* reduce VEGF production.

Whether this is safe / practical / etc. after such laser / IPL

treatments is of course an un-answered question.

Rick -- I will contact you privately via email about some pictures

of my photoderm which I can send for you to look at and post your

comments to the group.

.

> Marjorie,

>

> I really can't comment intelligently on the majority of your

> questions given my very limited medical background. I probably

should

> have said " vessels " rather than " veins " . Some attempts:

>

> > If there's no explosion, then what's happening to these vessels

> that

> > could even theoretically account for symptomatic improvement?

>

> Bingo, this is the ultimate question. I asked Harvey Jay, and got

no

> reasonable technical answer. IMHO, there is no such thing as a

free

> lunch here: if you want the vessels to disappear, then they have to

> be exploded. Period. Check out the ESC web site and see if you

can

> find anything there. Been awhile since I've looked, but Geoffrey

does

> reference a computer simulation they did supporting their claims

for

> photoderm vessel elimination.

>

> > Is that what you mean by flushing migration?

[Guest guest]

I think makes some excellent points here. In particular, I

agree that, in principle, advances in the delivery of the photoderm

pulses could dramatically improve the effectiveness of the treatment.

Ironically, the flexability of the photoderm machine (key parameters

are energy deposition (J/cm2), pulse duration, pulse delay, and

cutoff filter) is both its greatest advantage and most significant

drawback: the good news is that it does offer the *experienced*

practitioner the capability to tailor the treatment to the job at

hand; the bad news is that it is very difficult (impossible?) to zoom

in on the optimal settings for each individual. Pulsed-dye has far

fewer parameters, and hence offers more of a one-size-fits-all

approach.

I should mention that my experience with photoderm was somewhat

similar to s: some vessels on the side of my nose would

essentially disappear by the time I left the photoderm room, but

would return within several days to their initial visability. I have

one very small, circular telangiectasia that was specifically targeted

in each of my eight photoderm sessions, and my digital photographs

confirm that it is has not changed in any significant way.

I should say that my cynicism about photoderm is driven more by what

I view as greed and deliberate deception by its current

practitioners. is absolutely right in that the basic photoderm

mechanism may well have enormous potential that (unfortunately) will

take some time to be fully realized.

RIck

> > Marjorie,

> >

> > I really can't comment intelligently on the majority of your

> > questions given my very limited medical background. I probably

> should

> > have said " vessels " rather than " veins " . Some attempts:

> >

> > > If there's no explosion, then what's happening to these vessels

> > that

> > > could even theoretically account for symptomatic improvement?

> >

> > Bingo, this is the ultimate question. I asked Harvey Jay, and

got

> no

> > reasonable technical answer. IMHO, there is no such thing as a

> free

> > lunch here: if you want the vessels to disappear, then they have

to

> > be exploded. Period. Check out the ESC web site and see if you

> can

> > find anything there. Been awhile since I've looked, but Geoffrey

> does

> > reference a computer simulation they did supporting their claims

> for

> > photoderm vessel elimination.

> >

> > > Is that what you mean by flushing migration?

[Guest guest]

I think makes some excellent points here. In particular, I

agree that, in principle, advances in the delivery of the photoderm

pulses could dramatically improve the effectiveness of the treatment.

Ironically, the flexability of the photoderm machine (key parameters

are energy deposition (J/cm2), pulse duration, pulse delay, and

cutoff filter) is both its greatest advantage and most significant

drawback: the good news is that it does offer the *experienced*

practitioner the capability to tailor the treatment to the job at

hand; the bad news is that it is very difficult (impossible?) to zoom

in on the optimal settings for each individual. Pulsed-dye has far

fewer parameters, and hence offers more of a one-size-fits-all

approach.

I should mention that my experience with photoderm was somewhat

similar to s: some vessels on the side of my nose would

essentially disappear by the time I left the photoderm room, but

would return within several days to their initial visability. I have

one very small, circular telangiectasia that was specifically targeted

in each of my eight photoderm sessions, and my digital photographs

confirm that it is has not changed in any significant way.

I should say that my cynicism about photoderm is driven more by what

I view as greed and deliberate deception by its current

practitioners. is absolutely right in that the basic photoderm

mechanism may well have enormous potential that (unfortunately) will

take some time to be fully realized.

RIck

> > Marjorie,

> >

> > I really can't comment intelligently on the majority of your

> > questions given my very limited medical background. I probably

> should

> > have said " vessels " rather than " veins " . Some attempts:

> >

> > > If there's no explosion, then what's happening to these vessels

> > that

> > > could even theoretically account for symptomatic improvement?

> >

> > Bingo, this is the ultimate question. I asked Harvey Jay, and

got

> no

> > reasonable technical answer. IMHO, there is no such thing as a

> free

> > lunch here: if you want the vessels to disappear, then they have

to

> > be exploded. Period. Check out the ESC web site and see if you

> can

> > find anything there. Been awhile since I've looked, but Geoffrey

> does

> > reference a computer simulation they did supporting their claims

> for

> > photoderm vessel elimination.

> >

> > > Is that what you mean by flushing migration?

[Guest guest]

I think makes some excellent points here. In particular, I

agree that, in principle, advances in the delivery of the photoderm

pulses could dramatically improve the effectiveness of the treatment.

Ironically, the flexability of the photoderm machine (key parameters

are energy deposition (J/cm2), pulse duration, pulse delay, and

cutoff filter) is both its greatest advantage and most significant

drawback: the good news is that it does offer the *experienced*

practitioner the capability to tailor the treatment to the job at

hand; the bad news is that it is very difficult (impossible?) to zoom

in on the optimal settings for each individual. Pulsed-dye has far

fewer parameters, and hence offers more of a one-size-fits-all

approach.

I should mention that my experience with photoderm was somewhat

similar to s: some vessels on the side of my nose would

essentially disappear by the time I left the photoderm room, but

would return within several days to their initial visability. I have

one very small, circular telangiectasia that was specifically targeted

in each of my eight photoderm sessions, and my digital photographs

confirm that it is has not changed in any significant way.

I should say that my cynicism about photoderm is driven more by what

I view as greed and deliberate deception by its current

practitioners. is absolutely right in that the basic photoderm

mechanism may well have enormous potential that (unfortunately) will

take some time to be fully realized.

RIck

> > Marjorie,

> >

> > I really can't comment intelligently on the majority of your

> > questions given my very limited medical background. I probably

> should

> > have said " vessels " rather than " veins " . Some attempts:

> >

> > > If there's no explosion, then what's happening to these vessels

> > that

> > > could even theoretically account for symptomatic improvement?

> >

> > Bingo, this is the ultimate question. I asked Harvey Jay, and

got

> no

> > reasonable technical answer. IMHO, there is no such thing as a

> free

> > lunch here: if you want the vessels to disappear, then they have

to

> > be exploded. Period. Check out the ESC web site and see if you

> can

> > find anything there. Been awhile since I've looked, but Geoffrey

> does

> > reference a computer simulation they did supporting their claims

> for

> > photoderm vessel elimination.

> >

> > > Is that what you mean by flushing migration?

[Guest guest]

I think makes some excellent points here. In particular, I

agree that, in principle, advances in the delivery of the photoderm

pulses could dramatically improve the effectiveness of the treatment.

Ironically, the flexability of the photoderm machine (key parameters

are energy deposition (J/cm2), pulse duration, pulse delay, and

cutoff filter) is both its greatest advantage and most significant

drawback: the good news is that it does offer the *experienced*

practitioner the capability to tailor the treatment to the job at

hand; the bad news is that it is very difficult (impossible?) to zoom

in on the optimal settings for each individual. Pulsed-dye has far

fewer parameters, and hence offers more of a one-size-fits-all

approach.

I should mention that my experience with photoderm was somewhat

similar to s: some vessels on the side of my nose would

essentially disappear by the time I left the photoderm room, but

would return within several days to their initial visability. I have

one very small, circular telangiectasia that was specifically targeted

in each of my eight photoderm sessions, and my digital photographs

confirm that it is has not changed in any significant way.

I should say that my cynicism about photoderm is driven more by what

I view as greed and deliberate deception by its current

practitioners. is absolutely right in that the basic photoderm

mechanism may well have enormous potential that (unfortunately) will

take some time to be fully realized.

RIck

> > Marjorie,

> >

> > I really can't comment intelligently on the majority of your

> > questions given my very limited medical background. I probably

> should

> > have said " vessels " rather than " veins " . Some attempts:

> >

> > > If there's no explosion, then what's happening to these vessels

> > that

> > > could even theoretically account for symptomatic improvement?

> >

> > Bingo, this is the ultimate question. I asked Harvey Jay, and

got

> no

> > reasonable technical answer. IMHO, there is no such thing as a

> free

> > lunch here: if you want the vessels to disappear, then they have

to

> > be exploded. Period. Check out the ESC web site and see if you

> can

> > find anything there. Been awhile since I've looked, but Geoffrey

> does

> > reference a computer simulation they did supporting their claims

> for

> > photoderm vessel elimination.

> >

> > > Is that what you mean by flushing migration?

[Guest guest]

Rick, tnx for the tips !

I did a search in Google for " Laser Therapy in the

Management of cea " but all urls " The page cannot

be found " . If u find the url please post.

//Kajsa.

--- rdl000 skrev: > Kajsa,

>

> Geoffrey's book (and its references) are an

> excellent start. Go to

> Medline and do a search for lasers, rosacea, and

> telangiectasia

> (assuming your spelling is better than mine ...).

> Also, some time

> ago, I posted a URL to a special issue of the

> Journal of Cutaneous

> Medicine and Surgery, Volume 2, Supplement 4, June,

> 1998 which is

> devoted to rosacea. In there is an article on

> " Laser Therapy in the

> Management of cea " by Laughlin and Dudley.

> (BTW, they do not

> even

> mention photoderm, perhaps for reasons other than it

> doesn't fit the

> 'laser' title.)

>

> Also, track down the website for ESC (maker of the

> photoderm machine)

> and read their side of the photoderm / pulsed-dye

> laser debate.

>

> If I get a chance, I'll try to get these URLs off my

> office-machine

> bookmarks.

>

> Rickl

_____________________________________________________

Gratis e-mail resten av livet på www.yahoo.se/mail

Busenkelt!

[Guest guest]

Rick, tnx for the tips !

I did a search in Google for " Laser Therapy in the

Management of cea " but all urls " The page cannot

be found " . If u find the url please post.

//Kajsa.

--- rdl000 skrev: > Kajsa,

>

> Geoffrey's book (and its references) are an

> excellent start. Go to

> Medline and do a search for lasers, rosacea, and

> telangiectasia

> (assuming your spelling is better than mine ...).

> Also, some time

> ago, I posted a URL to a special issue of the

> Journal of Cutaneous

> Medicine and Surgery, Volume 2, Supplement 4, June,

> 1998 which is

> devoted to rosacea. In there is an article on

> " Laser Therapy in the

> Management of cea " by Laughlin and Dudley.

> (BTW, they do not

> even

> mention photoderm, perhaps for reasons other than it

> doesn't fit the

> 'laser' title.)

>

> Also, track down the website for ESC (maker of the

> photoderm machine)

> and read their side of the photoderm / pulsed-dye

> laser debate.

>

> If I get a chance, I'll try to get these URLs off my

> office-machine

> bookmarks.

>

> Rickl

_____________________________________________________

Gratis e-mail resten av livet på www.yahoo.se/mail

Busenkelt!

[Guest guest]

Rick, tnx for the tips !

I did a search in Google for " Laser Therapy in the

Management of cea " but all urls " The page cannot

be found " . If u find the url please post.

//Kajsa.

--- rdl000 skrev: > Kajsa,

>

> Geoffrey's book (and its references) are an

> excellent start. Go to

> Medline and do a search for lasers, rosacea, and

> telangiectasia

> (assuming your spelling is better than mine ...).

> Also, some time

> ago, I posted a URL to a special issue of the

> Journal of Cutaneous

> Medicine and Surgery, Volume 2, Supplement 4, June,

> 1998 which is

> devoted to rosacea. In there is an article on

> " Laser Therapy in the

> Management of cea " by Laughlin and Dudley.

> (BTW, they do not

> even

> mention photoderm, perhaps for reasons other than it

> doesn't fit the

> 'laser' title.)

>

> Also, track down the website for ESC (maker of the

> photoderm machine)

> and read their side of the photoderm / pulsed-dye

> laser debate.

>

> If I get a chance, I'll try to get these URLs off my

> office-machine

> bookmarks.

>

> Rickl

_____________________________________________________

Gratis e-mail resten av livet på www.yahoo.se/mail

Busenkelt!

[Guest guest]

Rick, tnx for the tips !

I did a search in Google for " Laser Therapy in the

Management of cea " but all urls " The page cannot

be found " . If u find the url please post.

//Kajsa.

--- rdl000 skrev: > Kajsa,

>

> Geoffrey's book (and its references) are an

> excellent start. Go to

> Medline and do a search for lasers, rosacea, and

> telangiectasia

> (assuming your spelling is better than mine ...).

> Also, some time

> ago, I posted a URL to a special issue of the

> Journal of Cutaneous

> Medicine and Surgery, Volume 2, Supplement 4, June,

> 1998 which is

> devoted to rosacea. In there is an article on

> " Laser Therapy in the

> Management of cea " by Laughlin and Dudley.

> (BTW, they do not

> even

> mention photoderm, perhaps for reasons other than it

> doesn't fit the

> 'laser' title.)

>

> Also, track down the website for ESC (maker of the

> photoderm machine)

> and read their side of the photoderm / pulsed-dye

> laser debate.

>

> If I get a chance, I'll try to get these URLs off my

> office-machine

> bookmarks.

>

> Rickl

_____________________________________________________

Gratis e-mail resten av livet på www.yahoo.se/mail

Busenkelt!

[Guest guest]

When a goggle search lists a url, but then you cannot link to it, use

the " CACHED " link next to the actual url. This is the goggle copy of

the document made at the time it was indexed by the search engine.

tom

> Rick, tnx for the tips !

>

> I did a search in Google for " Laser Therapy in the

> Management of cea " but all urls " The page cannot

> be found " . If u find the url please post.

> //Kajsa.

>

> --- rdl000 <Rdl000@a...> skrev: > Kajsa,

> >

> > Geoffrey's book (and its references) are an

> > excellent start. Go to

> > Medline and do a search for lasers, rosacea, and

> > telangiectasia

> > (assuming your spelling is better than mine ...).

> > Also, some time

> > ago, I posted a URL to a special issue of the

> > Journal of Cutaneous

> > Medicine and Surgery, Volume 2, Supplement 4, June,

> > 1998 which is

> > devoted to rosacea. In there is an article on

> > " Laser Therapy in the

> > Management of cea " by Laughlin and Dudley.

> > (BTW, they do not

> > even

> > mention photoderm, perhaps for reasons other than it

> > doesn't fit the

> > 'laser' title.)

> >

> > Also, track down the website for ESC (maker of the

> > photoderm machine)

> > and read their side of the photoderm / pulsed-dye

> > laser debate.

> >

> > If I get a chance, I'll try to get these URLs off my

> > office-machine

> > bookmarks.

> >

> > Rickl

>

>

> _____________________________________________________

> Gratis e-mail resten av livet på www.yahoo.se/mail

> Busenkelt!

[Guest guest]

When a goggle search lists a url, but then you cannot link to it, use

the " CACHED " link next to the actual url. This is the goggle copy of

the document made at the time it was indexed by the search engine.

tom

> Rick, tnx for the tips !

>

> I did a search in Google for " Laser Therapy in the

> Management of cea " but all urls " The page cannot

> be found " . If u find the url please post.

> //Kajsa.

>

> --- rdl000 <Rdl000@a...> skrev: > Kajsa,

> >

> > Geoffrey's book (and its references) are an

> > excellent start. Go to

> > Medline and do a search for lasers, rosacea, and

> > telangiectasia

> > (assuming your spelling is better than mine ...).

> > Also, some time

> > ago, I posted a URL to a special issue of the

> > Journal of Cutaneous

> > Medicine and Surgery, Volume 2, Supplement 4, June,

> > 1998 which is

> > devoted to rosacea. In there is an article on

> > " Laser Therapy in the

> > Management of cea " by Laughlin and Dudley.

> > (BTW, they do not

> > even

> > mention photoderm, perhaps for reasons other than it

> > doesn't fit the

> > 'laser' title.)

> >

> > Also, track down the website for ESC (maker of the

> > photoderm machine)

> > and read their side of the photoderm / pulsed-dye

> > laser debate.

> >

> > If I get a chance, I'll try to get these URLs off my

> > office-machine

> > bookmarks.

> >

> > Rickl

>

>

> _____________________________________________________

> Gratis e-mail resten av livet på www.yahoo.se/mail

> Busenkelt!