What is a pulsed dye laser?
Pulsed dye lasers (PDL) deliver an intense burst of light into selectively targeted areas of the skin. The light is absorbed by specific blood vessels or melanin pigmented areas in the epidermis, depending on the condition being treated. Factors such as the age, colour and type of lesions, as well as the location on the body, all determine whether lesions can be removed.
What can be treated with a pulsed dye laser?
- redness of the face and neck
- telangiectasia (broken vessels)
- spider naevi
- age spots and freckles
- early scars and red stretch marks
- early changes of sun-induced ageing
- port wine stains
Your doctor will establish the appropriate parameters for your treatment. The full therapy may then be completed by the doctor or by a vascular laser nurse.
What does the treatment involve?
Your doctor will ensure you are as comfortable as possible; most patients lie down, depending upon the area being treated. Both the patient and staff will be wearing protective eyewear. When treatment begins, the laser will be calibrated and the parameters will be set, based on the specific condition being treated.
Treatment parameters are set in consultation with the patient. Standard settings typically produce redness and swelling, resembling a bad sunburn, which will last several days. More aggressive levels, sometimes used to treat marked rosacea or similar conditions, may result in spotty bruising.
Treatment for conditions such as port wine stains usually results in the whole area appearing bruised following treatment.
Rarely, before treatment is carried out, small areas may be tested at different settings to determine the suitable power. The area is typically evaluated 1 to 2 months after testing to determine the most appropriate parameters to use.
Does it hurt?
No anaesthetic is required, but most patients describe the effect as like the stinging sensation of a hot elastic band flicked onto the skin. The skin being treated is additionally protected by Candela’s dynamic cooling method, DCD, which delivers a cooling mist onto the skin before the laser pulse is emitted. This cooling mist increases comfort during treatment, as well as protecting the skin, to minimise side-effects. In addition, further cooling devices can be used which fan refrigerated air across the skin. Icy water compresses are frequently applied during treatment, and this too provides for increased comfort. Inhalational anaesthesia can be used if the above measures are not adequate. However, it is only a small minority of patients who would require this step. Your dermatologist will recommend the best options during consultation.
Is PDL treatment safe?
Yes. In fact, the treatment is so safe that it has been successfully used since the 1980s for the treatment of port wine stain birthmarks in infants and young children. During treatment, the outer layer of skin (epidermis) is protected by dynamic cooling (DCD), which sprays a cooling mist onto the target skin.
Are the results of pulsed dye laser treatment permanent?
Permanency of results depends on many factors, such as the condition being treated, and the lifestyle of the patient. Conditions such as spider naevi and facial blood vessels will typically clear with therapy. Other conditions, such as rosacea and port wine stains (which are typically caused by ‘internal factors’), do gradually tend to recur.
However, excellent improvement is seen for years following successful therapy.
How soon will I see the results of my treatment?
The results of laser therapy are very dependent on the condition that is being treated and the number of treatments required for clearance. Treatments are also dependent upon the energy used to treat the condition. Most patients will note improvement within the first 6 to 8 weeks following treatment.
How many treatments will I require?
PDL therapy is dependent upon the underlying condition. Patients with redness and telangiectasia (blood vessels) will typically require an average of 2 to 3 treatments. Patients with port wine stains usually require many treatments (an average of six or so) to lighten port wine stains. Facial port wine stains typically do best, whilst more distal areas, such as the hands and lower limbs, typically do relatively poorly.
What are the side-effects of treatment?
It is normal for patients to experience redness and swelling in the treated area immediately following treatment. This will usually go away over the next few days. As previously described, some bruising (purpura) is not uncommon with more aggressive energy levels, and is to be expected in the treatment of conditions such as port wine stains.
Such bruising fades, as does any bruise, usually over a week or so, with more intense therapies sometimes taking longer.
Following treatment, cold packs are used to help decrease swelling and to help with discomfort. It may be wise to have someone drive you home following treatment, so that you can continue to apply cold compresses. Sleeping on an extra pillow at night can be beneficial to help decrease swelling around the eyes.
Permanent side-effects of pulsed dye laser therapy are rare. Scarring is described; it is typically focal and resembles a chicken-pox scar. The risk is in the order of 1 in 1,000 patients.
Some degree of difference between treated and untreated areas is not uncommon. Patients presenting with rosacea, but who also have background sun-induced redness, may wish to consider treatment to the whole ‘unit’ of the skin, such as the cheek, or even whole-face therapy if this seems to be indicated.
Bruising of the skin quite commonly produces some brown staining of the skin, due to deposition of iron pigments. This usually fades over two months or so. Use of sunscreen and sun avoidance helps to decrease this risk and hastens the absorption of the pigment.
Crusting, scabbing and blistering may occur at high energy levels. Such crusting can be treated with a heavy moisturiser, or even a coating of Vaseline, and settles over one week. Secondary infection is a very rare side-effect of pulsed dye laser therapy.
Are there any special precautions I need to take before or after treatment?
It is recommended to avoid sun exposure before and throughout treatment to maximise results. A sunscreen of SPF30+ should be worn daily during this time.
Ice-packs are useful to help decrease swelling and discomfort.
It is important that you do not attempt to remove any crust. Just apply moisturiser or Vaseline to the areas until such crusts separate naturally.
Is pulsed dye laser covered by Medicare/health insurance?
Medicare rebates are available for patients with port wine stains. They are also available for patients who have evident redness or telangiectases of the head and neck. Such changes have to be visible ‘from three metres away’. There is no rebate available for blood vessels or other acquired conditions (e.g. scars) that are not on the head and neck.
Health funds do not provide cover for pulsed dye laser therapy, as such treatment is not typically performed in hospital or within a day-care centre.