IPL: An Expensive Way to Age Your Face at Least 10 Years - New England
I have rosacea, acne and very oily skin, with some...
The next day, I woke up to a very dark red area on that cheek that was large, looked slightly depressed, and did not look like any bruise I had ever seen. I also had a lot of red marks all over my face, and some darkening brownish areas. Over the next 3 days, the red area just got darker and redder, which I did not expect, and the brown areas appeared to be doing the "coffee ground" thing, which I did expect.
Day 3 I sent some selfies to the doc, and was told the red area was because the heat had burst a blood vessel, and I was seeing the pooled blood, not to worry, it should fade, and the doc noticed a brown area in my pics that was bubbling up. Doc said to keep that area moist w/ vaseline at all times, which I did, religiously. I basically did not sleep, thinking the red blob might be permanent, and thinking I would be scarred for life. Applying mu went from a 10 minute task to a 30 minute art project every day.
BY day 5, the red area started to fade in the middle, and I could see in the blob darker areas that looked like tiny dark red depressed lines about a 1/4" long in random patterns. I also started to see tiny depressions and similar red depressed lines in random areas all over my face, pinhole depressions like very large pores, and weird crinkles and depressed areas that looked like squiggly lines. In short, as the swelling faded, the texture of my skin looked worse and worse. Then the bubbled brown spot peeled off and left a pink area that, given my tendency to PIH, ended up turning into another PIH spot, despite constant vaseline and spf50.
As for the broken caps, some that had seemed to disappear immediately seemed to return or grow back within about 14 days, and those that looked redder and more prominent after the tx never faded. So, the red veiny look just got worse. I also started breaking out because all the retinA and acne tx's barely keep my acne under control, and babying my face, using vaseline, etc. caused breakouts that in turn caused new PIH spots, defeating the purpose of the tx.
Then, on day 9, the real kicker: on a warm afternoon, I noticed tiny red dots on my face coming through my makeup in about 4 spots, mostly cheek area. I thought it was an errant dot of lipstick pigment, or maybe tiny spots of red lint. Light red, not dark. I wiped, and it was liquid. It appeared to be blood from a superficial wound, but coming out of my skin from no visible opening or cut that I could see. WTH????? I have gotten this every day since day 9, sometimes one spot, sometimes 4-5 or so. It seems to occur only in the afternoon when my face get warm from sun, hot drinks, etc. I had been prone to flushing, like many rosaceans, and I had disclosed this to the doc before the IPL. This symptom is really freaking me out, because I see no mention of it anywhere on the internet.
At a 14 day f/u visit, I told the doctor about all of my symptoms, including the weird red blood dots starting day 9. The doc said there should not be any pinpoint bleeding at day 9 or 14, and could not explain that. I did not have any of the red dots at the time of the appt to show the doc, either- it was an early morning appt,, and every time this has happened, it's been late afternoon. Doc Also said that the IPL could not cause depressions and holes because the energies used do not target the skin structures in that manner and only hit pigment or vascular structures.
Well, I really wish I had done extensive research before having this procedure. I later found medical texts online stating (and showing) that depressed areas, pinhole scars, and "atrophic" scars CAN result from IPL, usually from "insufficient cooling." Then I found a study intended for medical providers where the authors tested a large number of IPL machines, all unnnamed, and found variations as much as +/- 20% from the manufacturers' specifications, in EVERY PARAMETER measured - fluence, pulse rate, temperature, wavelength, etc. And this was after calibration. Well if you have variation that wide, you are going to sometimes get wrong wavelength, "insufficient cooling," etc that can all result in adverse results, even when the operator is good and uses the correct settings. In my mind, machines that cannot remain w/in the correct settings are inherently dangerous.
Then, to top it all off, I found a paper by some reseachers that found an increase in lipid peroxidase levels, which is a marker for ageing/oxidative stress, in IPL treated skin that was 6 TIMES HIGHER than what you'd get w/ UV radiation. Another reseacher wrote a paper proposing that topical antioxidants after IPL tx might help reduce the oxidative stress. If I had know that, I would have been applying antioxidants immediately after the tx!
I really wish someone had told me about the risks of variation in these machines, the risks of atrophy and depression marks, and the need for antioxidant tx immediately after IPL. My skin basically looks at least 10 years older now - it is still oily, yet has this wrinkled, pitted texture, as if I've been using nothing but alcohol and benzoyl peroxide on it for a month straight, and the only thing that helps, and even then only temporarily and not 100%, is a heavy, water-retaining cream like Cerave Cream in a tub, applied very thickly morning and night. Mind you, I have such oily skin, I never used or needed moisturizer before the IPL. My skin looked generally smooth and mostly wrinkle free, with little to no wrinkling. Now my skin has what looks like superficial wrinkling like what you'd get from severe dehydration on top of small pit and line depressions. My PIH is not really improved and in some areas looks worse. My broken caps look worse. The dark red blob on my cheek has faded, but I have a cluster of broken caps there and some shallow pits clustered in that area. Can I cover this all up w/ heavy cream, good primer and mu? Almost, and it's quite a job.
My skin looks like I have big pores (I did have large pores in the nose/cheek area, but now they look much bigger, and I have what looks like large pores in areas I never had them before), and now instead of a very young looking 40's, I look I'd say early-mid 50's.
I also got a bad rosacea flare after the tx, with a few inflamed pustules surrounded by new, tiny red bod vessels. Rosaceans w/ this type of rosacea know what I mean. It seems as if the IPL aggravated the rosacea intead of improved it, and gave the effects of a few years' worth of bad flares in about 20 minutes. As if I'd been a pizza maker working in front of an 800 degree pizza oven for a few years.
I really wish I had checked realself and done more research before having this done. I had some laser hair removal about 10 years ago, and it was a breeze w/ no adverse effects. IPL / BBL is advertised and promoted as gentler than lasers, "no downtime," etc., so I assumed the experience would be similar to or even less risky than the hair removal. Intead, there was a lot of downtime, I see worsening of my skin, and instead of being able to wear less mu, I now must wear more, and my skincare regimen is more complicated and time consuming. When I hear "scars" I never thought of depressions that have no scar-like appearance - just dents and depressions. They look like I was hit in the face with tiny hammers, and instead of popping back out, they more or less stayed. say more or less because someties they look somewhat improved, and sometimes they look very pronounced. It's bizarre. I have started taking a bunch of antioxidant supplements, am using topical antioxidants like Replenix Power of three cream mixed w/ retinA, and am using Cerave cream as well to keep the skin very hydrated. I can only hope that things will improve with time and care, and now, after seeing some photos of people with bad burns from IPL, I realize things could have been much worse, and I am thankful that the pits and depressions are fairly shallow and I have only one small burn mark.
I am going to see how things look after another month or so, and I am considering making an adverse event report to the FDA. I am very concerned about the accuracy and reliability of these machines, and the long-term adverse effects. I think this is something the FDA should examine. I realize some people get great results from IPL. I was not one of them. I would advise extreme caution, especially if you have rosacea that involves very bad reactions to heat, and are prone to flares from heat, sun, etc. I wish I had known more - I would have either skipped the procedure entirely, or insisted that the operator use much more cooling than usual, and only do one pass per tx. But I relied on the expertise of the Dr. , and even such precautions probably would not have prevented adverse effects caused by any variations from machine settings, as that study on machine variation found. This was a reputable office, with patients coming and going and a lot of them getting the IPL tx, and I did not see/hear any dissatisfied patients or anyone looking like they had a bad result.
I can't recommend IPL, and doctors, please be very cautious and educate yourselves more on adverse effects and how to prevent and treat them. Might be a good idea to get some education from sources independent from the IPL machine makers - listen to your patients and examine them closely before and after. I am now thinking that like some other drug and product debacles we've seen, medicine will only acknowledge some adverse IPL effects and possibly unknown contraindications many years from now, after thousands have already been injured. I suspect I may be looking for treatments down the road to correct the effects I am seeing now. I really hope that medicine is able to come up with some solutions.
Correction to the size of the random, red lines in the red blob: should be 1/8" long not 1/4"
Warning: Long term Use of Tretinoin Topicals May be a Contraindication for IPL
I had disclosed longterm RetinA use before the IPL, had stopped the RetinA 14 days before the IPL, the bleeding started 9 days after the IPL, and I did not restart RetinA until 14 days after the procedure, when I was given the go-ahead to resume. So, given this chronology, it does not seem that short term immediate use of the RetinA could cause the bleeding.
The only logical interpretation of this information is that long-term use of RetinA thins the skin to the point where IPL can more easily cause injury to the thinned skin. If that is the case, then I'm not sure how stopping the RetinA now will help, although I'll try it, despite my concern about more acne flares, leading to more PIH, thereby defeating one of the initial purposes of the IPL.
If this is theory is true, then RetinA use may be a CONTRAINDICATION TO IPL, and people should be warned to not undergo IPL tx if they are long-term RetinA users. To my knowledge, there are no current warnings on this. If the skin had not been thinned by RetinA, the IPL would not have had adverse effect (under this theory). Anyone else out there use RetinA for years and have a bad effect from IPL? How about a good effect after years of RetinA use?
IPL CAN cause broken capillaries, contrary to some Doctor Answers on this forum
It is common knowledge that excessive heat can cause broken capillaries. It is also stated in numerous medical texts on IPL that excessive heat from various causes during the IPL can cause adverse effects. There are also calculations on heat, fluence, thermal relaxation time of the blood vessel being treated - it is not hard to conclude from all this that if any settings or machine outputs are not a correct match for the size and location of the bood vessel being treated, you could easily get broken/ burst/enlarged vessels.
I just had an appt w/ a derm and upo reviewing my situation and photos she commented that knowing what can go wrong had kept her from getting her own blood vessels zapped- her thought being, is what I have worse than a possible bad outcome? She emphasized that she was not against cosmetic procedures, she just was very aware that what you can end up with can, in too many instances for her comfort, be worse than what you had to begin with, and to think twice if what you have to begin with is not all that bad.
Settings used in my tx
Fitzpatrick Type II
515 filter, no adapter, 14 j, pw20, cool 20
560 flter w/ snap on adapter, 18j, cool 25
No pulse width was noted for the 560 filter. I am wondering also if I am really a Fitzpatrick II. I went online and took the American Skin Cancer society's test and came out as just over the line into Fitzpatrick Type III. I don't know if that makes a difference. Also, while I look pretty light (light eyes), I have some family members who have brown eyes, dark brown hair, and look like they could pass for American Indian. Don't know if that makes a difference.
The Dr. was personable and approachable and responded very promptly to emails and calls after the procedure. The Dr. did not avoid addressing my concerns, and seems to scheduling appropriate follow-up visits (14 days post and another one after another month). However the Dr. could not explain the depressions and pinpoint bleeding long after the tx.