I am one of the fourteen million men and women who suffer from rosacea. Sure, in the grand scheme of life it could be worse. But when you have a condition on your face the entire world can see that flares up, goes into remission, only to come back again, your self-esteem can get a bit beat up to put it mildly.
I have been suffering from rosacea and dilated facial veins, also known as telangiectasia, since my early twenties. I have tried everything under the sun to address it from acupuncture, diet change, and lasers of all types.
Several years ago I was introduced to Eric Bernstein M.D., M.S.E., Director of the Main Line Center for Laser Surgery located in Ardmore, Pennsylvania after being badly burned and scarred by a doctor who I had seen for several years prior without incident. I am not sure how I did not find Dr. Bernstein sooner. But, I am glad that I did. At forty years of age, honestly my skin has never looked better. Sadly, my story of what landed me in his office is one too often heard by Dr. Bernstein and his staff.
What rosacea sufferers need to know is that the responsibility ultimately lies in their hands to do the research in terms of the credentials of who performs the surgery. Unfortunately, without being fulling informed it is impossible to make a solid decision.
Dr. Bernstein, a rosacea sufferer himself, is one of the world's preeminent authorities on sun induced skin damage, laser medicine, laser surgery, and rosacea treatment, and generously shared his thoughts on the condition for those considering laser surgery.
What is Rosacea?
Rosacea is a skin condition characterized by flushing and blushing due to the appearance of veins in sun-exposed areas of the body like the face, neck, chest, and can affect both men and women. The condition typically affects light-skinned individuals in their 20's & 30's, although depending on one's genetic make-up may develop earlier or later in one's life and is often accompanied by acne, general redness and dilated capillaries.
The sun is the major culprit in creating the extra facial veins that result in the flushing of predisposed rosacea sufferers. These extra veins, which don't serve any function, fill up with blood more rapidly then other veins due to stimuli like exercise, coffee, saunas, alcohol, spicy foods, sun exposure and many of the other triggers that can be impossible to avoid. Laser surgery is the only way to destroy these veins, which the body then digests through the healing process.
What kind of credentials should one have to operate and perform laser surgery?
Excellent question, says Dr. Bernstein. Who's behind the laser? I equate this to a driver's license, which is the minimum requirement for someone to drive. But, the license doesn't mean that person is a good driver. My stance is that only medical professionals including doctors, physician assistants and registered nurses should operate facial lasers. And if it is a R.N., that there is on-site supervision so if there is a problem that the doctor can respond quickly and efficiently. On-site supervision means just that. If a laser surgery center claims to have a supervising doctor who is actually based in another state that is not supervision.
Furthermore, just because you are doctor does not mean that you will inherently be a great laser surgeon. I have seen patients badly scarred and burned by doctors. On the flip side, in my office our R.N. performs the laser hair removal. I still meet with every client first and supervise the treatments, but we are always learning from one another.
What type of lasers do you think are the most effective at ridding one of general facial redness and dilated facial veins?
There are two lasers that I find extremely effective for treating both diffuse redness and facial veins. First, the Perfecta Laser by Candela, which is a pulsed-dye laser that is fantastic for removing linear spider veins as well as diffuse redness and also reduces enlarged pores and sagging skin. I had the first Perfecta laser in the country and have published extensively on its use for the treatment of rosacea, spider veins of the lower extremities, port-wine stains, scars, and facial rejuvenation. Second, the Excel-V Laser by Cutera, which is a dual wavelength laser offering versatility to the operator to effectively treat spider veins on the face without damaging the surrounding skin.
Even after a single laser treatment, patients will see a significant improvement although a series of 2-4 treatments are necessary to remove virtually all of the veins to help keep them away for extended periods of time.
Whether people need further treatments once most of the veins have been removed is strictly a function of continued sun-exposure. Since sun exposure is the leading cause for the body to create these unwanted veins the daily use of sunscreen and installing a UV-blocking window film for the car since most sun exposure occurs while we are in our vehicles are crucial for prolonging the need for further laser treatments to maintain improvement.
Are there specific types of lasers that are not appropriate to treat facial veins with?
I don't use IPL lasers for facial veins. In my opinion, IPL is great for removing pigment, but it takes away the good and bad pigment. IPL's are essentially a strobe light with a filter. Since it lets in lots of different wave lengths of light it is much more difficult to predict the outcome versus a laser that incorporates one or two wavelengths. I see more patients come into this office with adverse reactions from IPL treatments then any other laser.
Since there is not a lot of recourse for laser mishaps, what should a patient do when they get a adverse reaction as a result of laser surgery?
Great question. Anyone can get an adverse reaction to laser surgery. We as doctors are always walking a fine line treating patients trying to achieve a great result without causing any damage. The first thing I would do is to call the treating physician right away to discuss your concerns and see what they think. I give my patients my cell phone number, which is unusual, but I make myself available as you know to discuss any concerns right away. If you are not confident with the physician who treated you then you need to find someone that you are comfortable with.
How do you suggest patients find doctors with expertise in laser surgery to treat veins and diffuse redness?
I would suggest that any patient researching a doctor to perform laser surgery check with their friends and family to see which doctors they have had success with or ask both dermatologists and facial plastic surgeons who they would use themselves or recommend. Patients can also call the major manufacturers of the lasers and ask them who their top doctors are in their region.
For more information about Dr. Eric Bernstein, the Main Line Center for Laser Surgery, rosacea and laser surgery visit his website.
All photos courtesy of Dr. Eric Bernstein.