Dear Doc Rokky,

I had demo of the e-matrix done on my hand which left me with the black dot pattern for 5 months after which it did disappear, you might want to try tretinoin 0.05% in a graduated manner to get rid of it.

Hi

Best results you may have if you combine the BBL (560nm or 590nm) with the Nd YAG in the same session.First do it the BBL and then the Nd YAG at a little lower fluence and at pulse width 10-20 msec.

There should be a journal for medical mistakes, with regards to TCA cross technique it sounds nice, but in my hands it has never given a nice result, I have only tried it on three patients but all got a ugly cosmetic result.

I just wanted to share my experince with BBL 560nm for teleangectasia for skin type I-III i start of with 15 J 15 ms 15 c,
look for reaction, then may do a double pass or put on the finesse adaptor and turn up the energy to 18-20J turn down to 10 ms and up to 20 C and it gives the type of punch seen with old pulsed dye lasers, purpura and the vessels usually gone with very few treatments. Good I head to warn and inform the patient if you plan to give the purpura. Dermovat and ice.packs afterwards. If there are sores or crusts I recommend Cicaplast from LRP

For patients with rosacea I always put them on a combination of Finacea and tetracyclines if active rosacea, then perhaps adapalen later.

Does anyone has an experience with Lumenis Deep FX acne scars treatment? Do you think it has better results than ProFractional?
Is it reasonable to do CO2 treatment for acne scars or there is no difference in resurfacing either it is Er;Yag or CO2?

I have experinve with:
Lumenius Ultrapuls Encore and AcuPulse
Sciton ProFractional

And between Sciton vs Lumenis, Sciton is much more advancedm user friendly and versatile.

But to tell you the truth I have better results with the korean laseres Jeisys and Lutronic for acne scar,
I would never waste my money on a expensive Lumenis machine when you can get the same power and precision for 1/3 of the price with korean machines.

I think CO2 is better for acne scars.

Has any one used the skin tyte II or the clearsense . If so what has the experience been like.

Hello Doctors,

I'm Sciton user for one year, i have BBL, STII, Nd:yag and Erbium.beside this we have in the clinic Vbeam and Revlite as well as MGL and Gmax for hairremoval.
We have some experience with Candela Lasers for hairremoval and vascular treatments but not as much with Sciton for vascular treatments also not too much experience with acnee scars. I have a few questions and would appreciate your answers thank you very much, most of my patients are skin type 2-3
1.) vascular lezions: many of the patients treated for veins around the nose tell me that for 1-2 week the veins are gone but after that they reapear some of them not all but still. I think i'm quite agressive as i see the veins closing and sometime darkening: 560 , 23-25 J /10-15 ms /20c - large round addaptor. With the small round addapter i go up to 26-27 J.
Does anyone now the corespondence of J between the spotsizes and the addaptors?
Is the smallest addaptor to small for vascular and doesn't go deep enougth? With the Vbeam i never had this problems seams to get better closure of the vessels in time - maybe i'm not aggressive enougth? With the vbeam i always get some edema, with BBL not. VBeam has 590 nm - should I try 590 filter - what parameters? I know that there are 2 peaks for Hgb absorbtion around 540 and 575 - 560 filter seams to be the best - after 590 the absorbtion drops very fast so 590 filter is not the best. Or should I go for Nd:Yag - ? What parameters?
For a face full of small vessels is 560 , 15/15/15 not to mild? I don't see vessel closure ever after double pass. Should i increase J? Or Temp? I'm afraid to use the big spot because i don't know the J corespondence between large spot and big round addaptor.
Did anyone had a worsening of the vessels? Because i had 2 patients after Bbl and i had to take them to VBeam, i had also one case of worsening after vBeam. Could it be because of blood pressure? Alcohool?
2.) for acnee scars i saw several parameters that are used, i read the whole blog.
Case a.) small scars just a " rougthness " of the skin let's say, is MPL enougth or should i add PRofractional and should i add coag? 1-2-3? 22%? Again all my patients are 2-3 skintype.
B.) for deaper scars profractional is a must, i did max 500-600 microns but no coag, with ok results but not the best, should i always add coag? 1-2-3? And 22% is too much? Should i use 11%? Or double pass of 11%?

Thank you very much appreciate all your work here.
Steve

Hi
1) For the small veins of the face including the corner of the nose just combine the BBL (560nm or 590nm) with the Nd YAG in the same session.First do it the BBL and then the Nd YAG at a little lower fluence (120-140 j/cm2) with a 3mm spot and at pulse width 10-20 msec. You will have a very good result in 1-2 sessions with this way.

2) For small acne scars just a "roughtness" you can use the MLP at 50 μm I think this is OK for patents 1-3.

3) For deep scars use the ProFractional as deep as you go ( 400 - 600 μm) and add coag 2-3 for type 1-2 patients and no coag or type 1 coag for type 3 patients. I think 22% is OK. Tell them to you sunscreen with a high SPF > 30 for at least 2-3 months.

Charry Chavelas
M.D. Dermatologist-Venereologist
M. Aggelou 5
Ioannina
Greece

Thank you very much!

I'm so happy about this forum and look forward to being an active participant in it. I have Scitons NdYag and BBL with ST. I am looking for guidance in treating patchy melasma with PIH in skin type lV.

Dear Dr. Chavelas,

Did you ever had in the beginnings worsening of cuperosis after treating with BBL only?
I just saw another client of mine today with more cuperosis than first time she came to me 1 month ago.
She was treated with 560 nm small addapter 22-24 j 10 ms 20c
Can you explain why some of the patients have this reaction?
I don't understand it.
I'll try treating them with Nd:yag as you said, but i'm trying to explain this phenomena and i can't.

Thank you for your time.

Steve

No actually i have not seen any worsening of cuperosis after treating with only the BBL. But i have seen patients that they have not a very good result after just one BBL treatment and i had to combine with the Nd YAG as i told you before. Maybe your patient was in this category and the worsening was a physical process of an unsuccessful treatment. Another exlpanation is that maybe there was a small burning after the session that could deteriorate your patient.Which Fitz type had been your patient ?

Thank you dr. Chavelas , skintype 3 was the patient.
I'll add the Nd:Yag. We have the Reveal from Canfield and we can monitor every little change, and i saw it was worse.
And it was not just one patient, several, especially those with little vessels, difuse redness is working very nice.
Do you think that undertreating can cause worsening? With 560nm 15j, 15 ms, 15c - double pass i don't see always closure of the vessels.
Do you always see the closure of the vessels when doing a BBL 560 ? Maybe i'm just affecting a little bit the vessel wall and not a fully closure, and because of that the vessel will be more dilatated after the treatment.
This is the only explanation i have.

Thank you again for sharing this information with me.

Steve
BBL is very good for small facial veins with red colour not purple. For the larger veins with deep red or purple colour it is necessary to combine with the Nd YAG 1064, first BBL then Nd YAG. Another option you have if you use only the BBL is to change to the 590nm which goes deeper and so you can treat the larger and deeper facial veins with deep red colour. Of course the undertreating can cause the worsening of the situation.

Thank you very much!

I have a question regarding treating acne scars. I have been using my Sciton Joule for one year now and just love it, and my patients love the results. My biggest challenge has been improving acne scars. I have been doing pro fractional and have gone as deep as 400 microns without coag and have not had much improvement at all. I have read that some folks are going as deep as 755 microns to get results. Can that depth be tolerated with BLT alone? Is there a much higher risk at depths >400? Such as scaring, PIH etc. I would like to at least make an improvement in the acne scars in my patients. I appreciate your insight and expertise.

I am interested in information on treating Poikiloderma (suggested treatment settings, treatment plan, post care, etc) from anyone who has treated this condition with Sciton. The patient is male, skin type III with his entire neck affected. Thanks so much!

Hi

Poikiloderma is a difficult condition but for sure you can treat it with the BBL. Try as starting parameters treating with BBL (560nm ) (13-14 J/cm2 , 10-15msec , 22 C) and rise up your fluence in the next sessions after 1 month. You must do 2-3 sessions to see a very good result on your patient.

I have been treating telengestacia with 2 general passes 515 filter 10-12j/10/15 and spot treating 515 20/20/20. I have a pt with very stubborn red spots due an autoimmune disease. We test spotted before treating, and the spots on the outer edges of her face cleared nicely but the spots in the middle of the face are very stubborn. Last night I had the idea to spot treat 515 20/20/20 and then followed the rest of the acnes protocol suggested in the manual using the 560 15/200/15 followed by the 590 15/200/15. the 590 seemed to be showing some good results during the treatment, but as mentioned that's not what I usually treat reds with. Do you have any other setting suggestions for the 590 in this case?