Exchanging Clinical Information and Treatment Protocols about Intense Pulsed Light. Sciton. Palomar. Cutera and others.

Does anyone use their IPL for dark circles under the eyes which is caused by pigment and vacular issues? We have the Sciton BBL and we are trying it for this indication. Do you use any type of eye protection or do you just have your patient close their eyes. What settings have you found to be helpful: wavelength, pulse duration, etc?

I always have pts wear eye protection. It is the appearance of safety that matters. Wavelength depends on what your chromophore is. Follow the BBL safe starts and increase as you feel comfortable.

When working in this area I often use the 11mm circular spot. I will even do multiple passes. I often will treat the vasculature first then the pigment on a second pass with a different filter.

LH, what filters are you using?

Most of my patients are Fitz I to III. I tend to use the 515 for most but if I have the redhead in I will use the 420 for pigment. For the facial veins I am using the 560.

Be cautious until you get a feel for your system as you can see redness and blistering occur over the next 24 hours. You will learn how far you can push it.

Type 3-4 skin with hyperpigmentation 3d post procedure with IPL. Plan to treat with HQ for 1-3 months. First time seeing this complication. What are yor experiences/advice?

09.12 | RD

BBL is a very good IPL with filters.For PWS I am using first BBL (590nm filter,10-12 J/cm,15-20msec) and then 1064nm 3spot,130-160 J/cm,10msec).The clinical endpoint is darkening of PWS.

12.13 | Charry

Charry,

How soon after the BBL do you do the 1064? Does it have to be within seconds or minutes (the blood which has been converted leaves the vessels and is replaced by new blood). Do you ever do a Laser Genesis type treatment with the 1064? 5 mm, 0.3 ms, 10 Hz, 12-15 j/cm2 - passing handpiece 2 cm above the skin with 5000 - 10,000 pulses (end point redness).

Jee,

I tend to start with the 1064 and go after the deeper vessels and then the finer more superficial vessels with the BBL. I may treat only with the 1064 for the first few treatments especially if they have the deeper larger vessels. Once you get a significant amount of these then you can go after the fine vessels with the BBL.

You can treat both on the same day but I treat it like treating leg veins. You need to get the supply to the small veins. If you treat only the fine superficial veins the underlying larger veins will just make the fine stuff reappear much sooner.

So my feeling is get the deep stuff then the fine vascular netting.

I have tried Genesis for PWS but feel it is useless. I have never seen benefit from it and I have done multiple treatments on at least 5 to 6 patients for free. Even the patients did not feel it was beneficial.

I tend to start with the BBL and after a few seconds i am using the 1064 but NOT with the Genesis type treatment.I agree with the LH that is type is useless in treating the PWS but is useful in treating the rosacea patients.

I currently have Sciton’s BBL. We’re charging $500 per tx last year when we first opened. Now we’re lucky to charge $250 per tx if purchased in the package of 4 txs.

Can some one recommend an inexpensive but safe IPL device to tx freckles and pigmented legions? We don’t need to do much hair removal at all.

For epidermal pigmented lesions, the IPL is a good device to use. The Sciton BBL works very well. Use the 515 nm filter in skin types 1-3. For Asian Skin you would want to use the 590 nm filter and longer pulse durations (ie. > 20 ms).

JL,

Why would you want to get a cheaper IPL? You already have one of the best on the market. You basically have no consumables so $250/tx is not that bad. You are only going to increase your costs by adding a "cheaper" IPL.

Photofacials only take a few minutes with the large head on the BBL. If I were you I would keep the same price but decrease the package to 3 treatments. Now you are at $333/tx and the patient is still paying the same over all. You should have very nice results in 2 to 3 treatments with the BBL.

I agree with JEE on the settings.

Theoretical Question.

I am doing Rosacea and I am using your recommended settings 14 - 20 j; 20 ms; 20 degrees, 560 filter.

This is my question. Since the Pulse Dye Laser uses a short pulse duration (down to 0.4 ms), why don't we use 15 ms or 10 ms pulse duration for redness and vascular with our BBL?

What is the best pulse duration for Rosacea, for diffuse redness and for discrete veins?

JEE,

I do usually use 10 to 15 msec and then I will also often go to 25 degrees cooling. I agree the shorter pulse widths seem to work better.

How effective is the BBL for treating reds? The palomar rep is insisting the BBL is underpowered and it underperforms compared to his machine. Also, he states the hair removal on the BBL is inadequate. I like the idea of filters but want to make sure this IPL platform is as good as starlux 500

Question: How do you tell a Sales Rep is lying?
Answer: His or Her lips are moving!

BBL is not underpowered. It uses half the mj because its Spectral Output is much better than Palomar. Ask Palomar how you are to treat darker patients with pigment if they don't have a 590 fliter. They will give you some BS, but don't believe them. Dan, it is tough to get the truth when shopping for a laser. The best place to find the truth in on blogs like this. Also ask the Sciton Rep about Reds and being underpowered. Also go to www.geocities.com/foxydog1064 to see the IPL Dog & Lemon Guide. Very useful information.

JEE

If you want to use short pulse width why you are not using the 590 filter for Rosacea?You can safely decrease the pulse width up to 10-15msec especially in 1-3 type patients.

Charry

I'm lookling to purchase the profile with BBL, scanning erbium and profractional xc. I know what the erbium can do. I'm just not completely sure for all of the reds. For the typical rosecea patient, if there is one, with mouth and nasal eryhtema and vessels, is the BBL an outstanding IPL? Would I regret my choice? I treat mostly 1,2,3's and a few 4 and 5's, assuming the 5 would be hispanic or asian.
Also,Is the machine safe to use on 4 and 5's. I know it's user dependent, but have you had difficulties with these skin types?
What are the limitations of the BBL for hair in these same 1-3++ skin types?
Sorry for all of the questions.

Dan,

The Palomar rep does not know what they are talking about. My BBL can give 34 joules at 15msec and the most I have ever used is 21J at 15 msec. That is on fitz 1 and 2. I have never needed more energy than that.

I have had both the Palomar and the Sciton in my clinic prior to purchasing and the Sciton out performed the Palomar. No IPL works well on larger facial vessels at least in my experience. I use the 1064 for the larger vessels and then the BBL for the finer vessels and flushing. I have had my BBL for about 18 months and have not regretted the purchase even once.

I tend to use my 1064 for my darker hair and darker skin individuals and a combination of the BBL and 1064 for the lighter patients. I usually will try one or the other systems and look for response. If they did not respond I may switch to the other system. I have seen nice results on many patients with the BBl for hair removal.

We own two Scitons and both have BBL. I would agree with LH that the Palomar rep. simply doesn't know what he is talking about. We use it for most of the veins and vasculature on the face and it works great. The problem with these reps. is that they have never used the lasers they claim don't work. They only know what their company tells them and that is usually misinformed too. Don't listen to them. We also use the BBL for hair removal and the results are good there as well.

How much slower is the single head scanner than the dual head for full ablation using coag and for profract xc with say 500 microns, level 3 coag, and density 11% for a full face?
Do the patients notice more discomfort or is it just a convenience and time issue?

Lastly, what shouls an additional year of warranty cost? The rep tried to get it down in price and quoted me only 2 years warranty?

Thankk you.

Sal LaForgia

I think that the best treatment for these white atrophic (Striae-like) scars is a combination of an ablative procedure such as a microdermabration or even better an ablative laser + the SkinTyte.With this treatment combination you could get a very good result for these scars.

My Alma Harmony did not come with a treatment template. Is there a way to make my own and if so what type of material is safe to use with the 540 and 570 hand pieces?

@ Stech, 540 is for Vascular and pigmented lesions.
570 is for Skin rejuvenation.

Try doing more passes rather than higher power per treatment will get you a better result.
I do usually 3-4 passes per treatment.
first two passes I tend to use lower pulse width, third and forth I do higher pulse width.
You will get a good result 7-10 days later.
For forehead and the very edge of the cheek, I lower the power to avoid " zebra straps.