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

[Guest guest]

> #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]

> #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]

> #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]

> #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]

Hi,

I agree completely with both points made by the Laser Doc.

Laser therapy (as well as photoderm) works because visible light (e.g

585 nm for pulsed dye laser) is absorbed by the hemoglobin in the

telangiectasia, causing the vein to literally explode in the case of

pulsed dye, producing the infamous bruising. (This was first

published in Science in 1983). Photoderm heats it more slowly,

thereby avoiding the rapid heating and explosion that occurs with

pulsed dye. If you're in a bad mood about photoderm (many know that

I am in such a state perpetually), then it can be argued that it

cannot be effective since pulse width and delay are chosen to AVOID

significant overheating. A couple of people on this board have

commented that the best results they got with photoderm have been

where some mild bruising occured (Beth mentioned this to me

after her successful photoderm series.)

I also agree that destroying the veins you cannot see is to be

avoided (even if were possible), because you risk depriving the skin

of need nutrients. (I really know very little about this - my

comments are based on those of Irwin Braverman at Yale Med via some

private correspondence). This is why I am somewhat cynical (as is Dr

Braverman) of the claims that photoderm significantly reduces facial

flushing. Of course, as I have noted before, no evidence of flushing

mitigation have been published (to my knowledge).

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]

Hi,

I agree completely with both points made by the Laser Doc.

Laser therapy (as well as photoderm) works because visible light (e.g

585 nm for pulsed dye laser) is absorbed by the hemoglobin in the

telangiectasia, causing the vein to literally explode in the case of

pulsed dye, producing the infamous bruising. (This was first

published in Science in 1983). Photoderm heats it more slowly,

thereby avoiding the rapid heating and explosion that occurs with

pulsed dye. If you're in a bad mood about photoderm (many know that

I am in such a state perpetually), then it can be argued that it

cannot be effective since pulse width and delay are chosen to AVOID

significant overheating. A couple of people on this board have

commented that the best results they got with photoderm have been

where some mild bruising occured (Beth mentioned this to me

after her successful photoderm series.)

I also agree that destroying the veins you cannot see is to be

avoided (even if were possible), because you risk depriving the skin

of need nutrients. (I really know very little about this - my

comments are based on those of Irwin Braverman at Yale Med via some

private correspondence). This is why I am somewhat cynical (as is Dr

Braverman) of the claims that photoderm significantly reduces facial

flushing. Of course, as I have noted before, no evidence of flushing

mitigation have been published (to my knowledge).

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]

Hi,

I agree completely with both points made by the Laser Doc.

Laser therapy (as well as photoderm) works because visible light (e.g

585 nm for pulsed dye laser) is absorbed by the hemoglobin in the

telangiectasia, causing the vein to literally explode in the case of

pulsed dye, producing the infamous bruising. (This was first

published in Science in 1983). Photoderm heats it more slowly,

thereby avoiding the rapid heating and explosion that occurs with

pulsed dye. If you're in a bad mood about photoderm (many know that

I am in such a state perpetually), then it can be argued that it

cannot be effective since pulse width and delay are chosen to AVOID

significant overheating. A couple of people on this board have

commented that the best results they got with photoderm have been

where some mild bruising occured (Beth mentioned this to me

after her successful photoderm series.)

I also agree that destroying the veins you cannot see is to be

avoided (even if were possible), because you risk depriving the skin

of need nutrients. (I really know very little about this - my

comments are based on those of Irwin Braverman at Yale Med via some

private correspondence). This is why I am somewhat cynical (as is Dr

Braverman) of the claims that photoderm significantly reduces facial

flushing. Of course, as I have noted before, no evidence of flushing

mitigation have been published (to my knowledge).

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]

Hi,

I agree completely with both points made by the Laser Doc.

Laser therapy (as well as photoderm) works because visible light (e.g

585 nm for pulsed dye laser) is absorbed by the hemoglobin in the

telangiectasia, causing the vein to literally explode in the case of

pulsed dye, producing the infamous bruising. (This was first

published in Science in 1983). Photoderm heats it more slowly,

thereby avoiding the rapid heating and explosion that occurs with

pulsed dye. If you're in a bad mood about photoderm (many know that

I am in such a state perpetually), then it can be argued that it

cannot be effective since pulse width and delay are chosen to AVOID

significant overheating. A couple of people on this board have

commented that the best results they got with photoderm have been

where some mild bruising occured (Beth mentioned this to me

after her successful photoderm series.)

I also agree that destroying the veins you cannot see is to be

avoided (even if were possible), because you risk depriving the skin

of need nutrients. (I really know very little about this - my

comments are based on those of Irwin Braverman at Yale Med via some

private correspondence). This is why I am somewhat cynical (as is Dr

Braverman) of the claims that photoderm significantly reduces facial

flushing. Of course, as I have noted before, no evidence of flushing

mitigation have been published (to my knowledge).

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]

Hi Rick !!

tnx for replaying and explain things. I belive I must

buy a laser book to educate myself a bit =) Do u or

anyone else in the group a good " easy " book which

explain laser ? please post!!

//Kajsa.

--- rdl000 skrev: > Hi,

>

> I agree completely with both points made by the

> Laser Doc.

>

> Laser therapy (as well as photoderm) works because

> visible light (e.g

> 585 nm for pulsed dye laser) is absorbed by the

> hemoglobin in the

> telangiectasia, causing the vein to literally

> explode in the case of

> pulsed dye, producing the infamous bruising. (This

> was first

> published in Science in 1983). Photoderm heats it

> more slowly,

> thereby avoiding the rapid heating and explosion

> that occurs with

> pulsed dye. If you're in a bad mood about photoderm

> (many know that

> I am in such a state perpetually), then it can be

> argued that it

> cannot be effective since pulse width and delay are

> chosen to AVOID

> significant overheating. A couple of people on this

> board have

> commented that the best results they got with

> photoderm have been

> where some mild bruising occured (Beth

> mentioned this to me

> after her successful photoderm series.)

>

> I also agree that destroying the veins you cannot

> see is to be

> avoided (even if were possible), because you risk

> depriving the skin

> of need nutrients. (I really know very little about

> this - my

> comments are based on those of Irwin Braverman at

> Yale Med via some

> private correspondence). This is why I am somewhat

> cynical (as is Dr

> Braverman) of the claims that photoderm

> significantly reduces facial

> flushing. Of course, as I have noted before, no

> evidence of flushing

> mitigation have been published (to my knowledge).

>

> 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

>

>

_____________________________________________________

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

Busenkelt!

[Guest guest]

Hi Rick !!

tnx for replaying and explain things. I belive I must

buy a laser book to educate myself a bit =) Do u or

anyone else in the group a good " easy " book which

explain laser ? please post!!

//Kajsa.

--- rdl000 skrev: > Hi,

>

> I agree completely with both points made by the

> Laser Doc.

>

> Laser therapy (as well as photoderm) works because

> visible light (e.g

> 585 nm for pulsed dye laser) is absorbed by the

> hemoglobin in the

> telangiectasia, causing the vein to literally

> explode in the case of

> pulsed dye, producing the infamous bruising. (This

> was first

> published in Science in 1983). Photoderm heats it

> more slowly,

> thereby avoiding the rapid heating and explosion

> that occurs with

> pulsed dye. If you're in a bad mood about photoderm

> (many know that

> I am in such a state perpetually), then it can be

> argued that it

> cannot be effective since pulse width and delay are

> chosen to AVOID

> significant overheating. A couple of people on this

> board have

> commented that the best results they got with

> photoderm have been

> where some mild bruising occured (Beth

> mentioned this to me

> after her successful photoderm series.)

>

> I also agree that destroying the veins you cannot

> see is to be

> avoided (even if were possible), because you risk

> depriving the skin

> of need nutrients. (I really know very little about

> this - my

> comments are based on those of Irwin Braverman at

> Yale Med via some

> private correspondence). This is why I am somewhat

> cynical (as is Dr

> Braverman) of the claims that photoderm

> significantly reduces facial

> flushing. Of course, as I have noted before, no

> evidence of flushing

> mitigation have been published (to my knowledge).

>

> 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

>

>

_____________________________________________________

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

Busenkelt!

[Guest guest]

Hi Rick !!

tnx for replaying and explain things. I belive I must

buy a laser book to educate myself a bit =) Do u or

anyone else in the group a good " easy " book which

explain laser ? please post!!

//Kajsa.

--- rdl000 skrev: > Hi,

>

> I agree completely with both points made by the

> Laser Doc.

>

> Laser therapy (as well as photoderm) works because

> visible light (e.g

> 585 nm for pulsed dye laser) is absorbed by the

> hemoglobin in the

> telangiectasia, causing the vein to literally

> explode in the case of

> pulsed dye, producing the infamous bruising. (This

> was first

> published in Science in 1983). Photoderm heats it

> more slowly,

> thereby avoiding the rapid heating and explosion

> that occurs with

> pulsed dye. If you're in a bad mood about photoderm

> (many know that

> I am in such a state perpetually), then it can be

> argued that it

> cannot be effective since pulse width and delay are

> chosen to AVOID

> significant overheating. A couple of people on this

> board have

> commented that the best results they got with

> photoderm have been

> where some mild bruising occured (Beth

> mentioned this to me

> after her successful photoderm series.)

>

> I also agree that destroying the veins you cannot

> see is to be

> avoided (even if were possible), because you risk

> depriving the skin

> of need nutrients. (I really know very little about

> this - my

> comments are based on those of Irwin Braverman at

> Yale Med via some

> private correspondence). This is why I am somewhat

> cynical (as is Dr

> Braverman) of the claims that photoderm

> significantly reduces facial

> flushing. Of course, as I have noted before, no

> evidence of flushing

> mitigation have been published (to my knowledge).

>

> 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

>

>

_____________________________________________________

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

Busenkelt!

[Guest guest]

Hi Rick !!

tnx for replaying and explain things. I belive I must

buy a laser book to educate myself a bit =) Do u or

anyone else in the group a good " easy " book which

explain laser ? please post!!

//Kajsa.

--- rdl000 skrev: > Hi,

>

> I agree completely with both points made by the

> Laser Doc.

>

> Laser therapy (as well as photoderm) works because

> visible light (e.g

> 585 nm for pulsed dye laser) is absorbed by the

> hemoglobin in the

> telangiectasia, causing the vein to literally

> explode in the case of

> pulsed dye, producing the infamous bruising. (This

> was first

> published in Science in 1983). Photoderm heats it

> more slowly,

> thereby avoiding the rapid heating and explosion

> that occurs with

> pulsed dye. If you're in a bad mood about photoderm

> (many know that

> I am in such a state perpetually), then it can be

> argued that it

> cannot be effective since pulse width and delay are

> chosen to AVOID

> significant overheating. A couple of people on this

> board have

> commented that the best results they got with

> photoderm have been

> where some mild bruising occured (Beth

> mentioned this to me

> after her successful photoderm series.)

>

> I also agree that destroying the veins you cannot

> see is to be

> avoided (even if were possible), because you risk

> depriving the skin

> of need nutrients. (I really know very little about

> this - my

> comments are based on those of Irwin Braverman at

> Yale Med via some

> private correspondence). This is why I am somewhat

> cynical (as is Dr

> Braverman) of the claims that photoderm

> significantly reduces facial

> flushing. Of course, as I have noted before, no

> evidence of flushing

> mitigation have been published (to my knowledge).

>

> 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

>

>

_____________________________________________________

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

Busenkelt!

[Guest guest]

Finally, I understand! So exploding vessels is the key to eliminating

telangiectasias. That explains all the bruising I've been hearing

about, and why it's so successful. Do you know if the vein's

explosion is secondary to the red cells exploding, or is there

another mechanism?

With respect to photoderm, the target vessels are those that still

actively dilate -- these are presumably arteries, not veins, right?

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

could even theoretically account for symptomatic improvement?

My understanding is that the most superficial vessels are located

just under the epidermis which receives its nutrients, oxygen, and

other essentials. Zapping these vessels to destruction should deprive

the epidermis above it its source of blood. But the destruction of

these vessels should activate angiogenesis of surrounding vessels, to

provide alternate routes to blood flow and returning blood flow (and

symptoms) to pre-treatment status. Is that what you mean by flushing

migration?

Seems to me the goal would be to zap the whole face so that the

number of superficial vessels are decreased proportionally across the

face, or to zap local vessels to uniformly restrict blood flow while

allowing sufficient nutrition to the epidermis -- enough to decrease

flushing but not enough to starve the overlying epidermis and hence

activate angiogenesis. Would either of these result in permanent

decreased flushing?

In the non-photoderm treated face, are superficial vessels

consistently the cause of flushing? In photoderm-treated faces, are

deeper and deeper vessels engaged once the more superficial vessels

are treated, or do those superficial vessels grow back if the deeper

vessels feeding into them are not treated at the same time?

A million more questions. Thanks so much for sharing your knowledge.

Marjorie

Marjorie Lazoff, MD

> > > #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]

Finally, I understand! So exploding vessels is the key to eliminating

telangiectasias. That explains all the bruising I've been hearing

about, and why it's so successful. Do you know if the vein's

explosion is secondary to the red cells exploding, or is there

another mechanism?

With respect to photoderm, the target vessels are those that still

actively dilate -- these are presumably arteries, not veins, right?

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

could even theoretically account for symptomatic improvement?

My understanding is that the most superficial vessels are located

just under the epidermis which receives its nutrients, oxygen, and

other essentials. Zapping these vessels to destruction should deprive

the epidermis above it its source of blood. But the destruction of

these vessels should activate angiogenesis of surrounding vessels, to

provide alternate routes to blood flow and returning blood flow (and

symptoms) to pre-treatment status. Is that what you mean by flushing

migration?

Seems to me the goal would be to zap the whole face so that the

number of superficial vessels are decreased proportionally across the

face, or to zap local vessels to uniformly restrict blood flow while

allowing sufficient nutrition to the epidermis -- enough to decrease

flushing but not enough to starve the overlying epidermis and hence

activate angiogenesis. Would either of these result in permanent

decreased flushing?

In the non-photoderm treated face, are superficial vessels

consistently the cause of flushing? In photoderm-treated faces, are

deeper and deeper vessels engaged once the more superficial vessels

are treated, or do those superficial vessels grow back if the deeper

vessels feeding into them are not treated at the same time?

A million more questions. Thanks so much for sharing your knowledge.

Marjorie

Marjorie Lazoff, MD

> > > #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]

Finally, I understand! So exploding vessels is the key to eliminating

telangiectasias. That explains all the bruising I've been hearing

about, and why it's so successful. Do you know if the vein's

explosion is secondary to the red cells exploding, or is there

another mechanism?

With respect to photoderm, the target vessels are those that still

actively dilate -- these are presumably arteries, not veins, right?

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

could even theoretically account for symptomatic improvement?

My understanding is that the most superficial vessels are located

just under the epidermis which receives its nutrients, oxygen, and

other essentials. Zapping these vessels to destruction should deprive

the epidermis above it its source of blood. But the destruction of

these vessels should activate angiogenesis of surrounding vessels, to

provide alternate routes to blood flow and returning blood flow (and

symptoms) to pre-treatment status. Is that what you mean by flushing

migration?

Seems to me the goal would be to zap the whole face so that the

number of superficial vessels are decreased proportionally across the

face, or to zap local vessels to uniformly restrict blood flow while

allowing sufficient nutrition to the epidermis -- enough to decrease

flushing but not enough to starve the overlying epidermis and hence

activate angiogenesis. Would either of these result in permanent

decreased flushing?

In the non-photoderm treated face, are superficial vessels

consistently the cause of flushing? In photoderm-treated faces, are

deeper and deeper vessels engaged once the more superficial vessels

are treated, or do those superficial vessels grow back if the deeper

vessels feeding into them are not treated at the same time?

A million more questions. Thanks so much for sharing your knowledge.

Marjorie

Marjorie Lazoff, MD

> > > #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]

Finally, I understand! So exploding vessels is the key to eliminating

telangiectasias. That explains all the bruising I've been hearing

about, and why it's so successful. Do you know if the vein's

explosion is secondary to the red cells exploding, or is there

another mechanism?

With respect to photoderm, the target vessels are those that still

actively dilate -- these are presumably arteries, not veins, right?

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

could even theoretically account for symptomatic improvement?

My understanding is that the most superficial vessels are located

just under the epidermis which receives its nutrients, oxygen, and

other essentials. Zapping these vessels to destruction should deprive

the epidermis above it its source of blood. But the destruction of

these vessels should activate angiogenesis of surrounding vessels, to

provide alternate routes to blood flow and returning blood flow (and

symptoms) to pre-treatment status. Is that what you mean by flushing

migration?

Seems to me the goal would be to zap the whole face so that the

number of superficial vessels are decreased proportionally across the

face, or to zap local vessels to uniformly restrict blood flow while

allowing sufficient nutrition to the epidermis -- enough to decrease

flushing but not enough to starve the overlying epidermis and hence

activate angiogenesis. Would either of these result in permanent

decreased flushing?

In the non-photoderm treated face, are superficial vessels

consistently the cause of flushing? In photoderm-treated faces, are

deeper and deeper vessels engaged once the more superficial vessels

are treated, or do those superficial vessels grow back if the deeper

vessels feeding into them are not treated at the same time?

A million more questions. Thanks so much for sharing your knowledge.

Marjorie

Marjorie Lazoff, MD

> > > #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]

Hi Rick

What is your opinion on Vbeam? in terms of redness reduction, flush

reduction, smooth skin, inflamation, etc

it's so hard trying to get a straight answer from a doctor who is

trying to sell you something (never ask a barber if you need a

haircut <g>).

thanks

tom

> > > #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]

Hi Rick

What is your opinion on Vbeam? in terms of redness reduction, flush

reduction, smooth skin, inflamation, etc

it's so hard trying to get a straight answer from a doctor who is

trying to sell you something (never ask a barber if you need a

haircut <g>).

thanks

tom

> > > #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]

Hi Rick

What is your opinion on Vbeam? in terms of redness reduction, flush

reduction, smooth skin, inflamation, etc

it's so hard trying to get a straight answer from a doctor who is

trying to sell you something (never ask a barber if you need a

haircut <g>).

thanks

tom

> > > #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]

Hi Rick

What is your opinion on Vbeam? in terms of redness reduction, flush

reduction, smooth skin, inflamation, etc

it's so hard trying to get a straight answer from a doctor who is

trying to sell you something (never ask a barber if you need a

haircut <g>).

thanks

tom

> > > #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]

Tom,

(on this board) is the resident proponent of V-Beam, having had

a successful experience with it. Off hand, she is the only one who

comes to mind as having done it and been satisfied.

Proponents of V-beam argue that it is the optimal tradeoff between

pulsed-dye laser and photoderm: they claim it produces the clearance

of pulsed-dye with the minimal side effects of photoderm. It is a

laser, but it has a cooling device that causes immediate localized

cooling of the dermis immediately prior to the pulse, thereby

minimizing the bruising. My understanding is that one can still get

pulsed-dye-like bruising if the practitioner is more aggressive with

less induced cooling.

Photoderm advocates suggest that the cooling mechanism of V-beam

causes the vessel to constrict, thereby making it difficult for the

laser light to " seek " out the problematic vessels. This is why they

advocate inducing a flush (via topical niacin) prior to treatment.

Pulsed-dye advocates will tell you that the best way (albeit with

bruising) is simply nail the vessels with sufficient energy to

explode the vessel walls with no way around the accompanying purpura.

Who's right (you ask ...?)? FWIW, a good friend of my wife has (to

my mind) totally trivial telangiectasia on her face. She badgered me

for my advice, and I told her that if she was willing to take 10 days

of downtime, go ahead and do pulsed dye because I do believe it is the

most effective treatment for persistent, visible vessels (as opposed

to transient erythema). Several people here have seen Ross Levy in

Mt Kisco, NY, so I suggested him. She went, got zapped, and came away

very disappointed, noting that he had refused to show her any before

and after pictures. Her experience further confuses me, so while I

do have a modest understanding of what is going on, I have no

absolute, carved-in-stone advice to offer, other than my often-stated

skepticism of claims by photoderm advocates.

In my work, we have a saying that when you have a hammer, everything

looks like a nail (i.e. if you have a favorite way of solving a

problem, you apply it to every new problem no matter how ill-fitted

it is ...). Laser and IPL advocates are pretty much the same way:

they all have their favorite hammers that they are more than happy to

apply to anything that ails your face (erythema, sun damage, flushing,

telangiectasia, you name it ...).

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]

Tom,

(on this board) is the resident proponent of V-Beam, having had

a successful experience with it. Off hand, she is the only one who

comes to mind as having done it and been satisfied.

Proponents of V-beam argue that it is the optimal tradeoff between

pulsed-dye laser and photoderm: they claim it produces the clearance

of pulsed-dye with the minimal side effects of photoderm. It is a

laser, but it has a cooling device that causes immediate localized

cooling of the dermis immediately prior to the pulse, thereby

minimizing the bruising. My understanding is that one can still get

pulsed-dye-like bruising if the practitioner is more aggressive with

less induced cooling.

Photoderm advocates suggest that the cooling mechanism of V-beam

causes the vessel to constrict, thereby making it difficult for the

laser light to " seek " out the problematic vessels. This is why they

advocate inducing a flush (via topical niacin) prior to treatment.

Pulsed-dye advocates will tell you that the best way (albeit with

bruising) is simply nail the vessels with sufficient energy to

explode the vessel walls with no way around the accompanying purpura.

Who's right (you ask ...?)? FWIW, a good friend of my wife has (to

my mind) totally trivial telangiectasia on her face. She badgered me

for my advice, and I told her that if she was willing to take 10 days

of downtime, go ahead and do pulsed dye because I do believe it is the

most effective treatment for persistent, visible vessels (as opposed

to transient erythema). Several people here have seen Ross Levy in

Mt Kisco, NY, so I suggested him. She went, got zapped, and came away

very disappointed, noting that he had refused to show her any before

and after pictures. Her experience further confuses me, so while I

do have a modest understanding of what is going on, I have no

absolute, carved-in-stone advice to offer, other than my often-stated

skepticism of claims by photoderm advocates.

In my work, we have a saying that when you have a hammer, everything

looks like a nail (i.e. if you have a favorite way of solving a

problem, you apply it to every new problem no matter how ill-fitted

it is ...). Laser and IPL advocates are pretty much the same way:

they all have their favorite hammers that they are more than happy to

apply to anything that ails your face (erythema, sun damage, flushing,

telangiectasia, you name it ...).

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]

Tom,

(on this board) is the resident proponent of V-Beam, having had

a successful experience with it. Off hand, she is the only one who

comes to mind as having done it and been satisfied.

Proponents of V-beam argue that it is the optimal tradeoff between

pulsed-dye laser and photoderm: they claim it produces the clearance

of pulsed-dye with the minimal side effects of photoderm. It is a

laser, but it has a cooling device that causes immediate localized

cooling of the dermis immediately prior to the pulse, thereby

minimizing the bruising. My understanding is that one can still get

pulsed-dye-like bruising if the practitioner is more aggressive with

less induced cooling.

Photoderm advocates suggest that the cooling mechanism of V-beam

causes the vessel to constrict, thereby making it difficult for the

laser light to " seek " out the problematic vessels. This is why they

advocate inducing a flush (via topical niacin) prior to treatment.

Pulsed-dye advocates will tell you that the best way (albeit with

bruising) is simply nail the vessels with sufficient energy to

explode the vessel walls with no way around the accompanying purpura.

Who's right (you ask ...?)? FWIW, a good friend of my wife has (to

my mind) totally trivial telangiectasia on her face. She badgered me

for my advice, and I told her that if she was willing to take 10 days

of downtime, go ahead and do pulsed dye because I do believe it is the

most effective treatment for persistent, visible vessels (as opposed

to transient erythema). Several people here have seen Ross Levy in

Mt Kisco, NY, so I suggested him. She went, got zapped, and came away

very disappointed, noting that he had refused to show her any before

and after pictures. Her experience further confuses me, so while I

do have a modest understanding of what is going on, I have no

absolute, carved-in-stone advice to offer, other than my often-stated

skepticism of claims by photoderm advocates.

In my work, we have a saying that when you have a hammer, everything

looks like a nail (i.e. if you have a favorite way of solving a

problem, you apply it to every new problem no matter how ill-fitted

it is ...). Laser and IPL advocates are pretty much the same way:

they all have their favorite hammers that they are more than happy to

apply to anything that ails your face (erythema, sun damage, flushing,

telangiectasia, you name it ...).

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]

Tom,

(on this board) is the resident proponent of V-Beam, having had

a successful experience with it. Off hand, she is the only one who

comes to mind as having done it and been satisfied.

Proponents of V-beam argue that it is the optimal tradeoff between

pulsed-dye laser and photoderm: they claim it produces the clearance

of pulsed-dye with the minimal side effects of photoderm. It is a

laser, but it has a cooling device that causes immediate localized

cooling of the dermis immediately prior to the pulse, thereby

minimizing the bruising. My understanding is that one can still get

pulsed-dye-like bruising if the practitioner is more aggressive with

less induced cooling.

Photoderm advocates suggest that the cooling mechanism of V-beam

causes the vessel to constrict, thereby making it difficult for the

laser light to " seek " out the problematic vessels. This is why they

advocate inducing a flush (via topical niacin) prior to treatment.

Pulsed-dye advocates will tell you that the best way (albeit with

bruising) is simply nail the vessels with sufficient energy to

explode the vessel walls with no way around the accompanying purpura.

Who's right (you ask ...?)? FWIW, a good friend of my wife has (to

my mind) totally trivial telangiectasia on her face. She badgered me

for my advice, and I told her that if she was willing to take 10 days

of downtime, go ahead and do pulsed dye because I do believe it is the

most effective treatment for persistent, visible vessels (as opposed

to transient erythema). Several people here have seen Ross Levy in

Mt Kisco, NY, so I suggested him. She went, got zapped, and came away

very disappointed, noting that he had refused to show her any before

and after pictures. Her experience further confuses me, so while I

do have a modest understanding of what is going on, I have no

absolute, carved-in-stone advice to offer, other than my often-stated

skepticism of claims by photoderm advocates.

In my work, we have a saying that when you have a hammer, everything

looks like a nail (i.e. if you have a favorite way of solving a

problem, you apply it to every new problem no matter how ill-fitted

it is ...). Laser and IPL advocates are pretty much the same way:

they all have their favorite hammers that they are more than happy to

apply to anything that ails your face (erythema, sun damage, flushing,

telangiectasia, you name it ...).

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]

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!