Should I go with PDL or BBL?

Question

I am looking to correct diffuse redness (not rosacea) and some small broken red capillaries in my mid cheeks, I do not have pigment or dark spots.The centers that offered both treatments recommended either PDL or PDL/KTP combo. The center that didn’t offer PDL told me PDL is “outdated” technology and BBL is the way to go for better skin and redness reduction, and they kind of put down PDL a lot saying it was old technology and not as good. Advice please!!! Thank you!!!

William Groff, DO · Answer

I have seen great success treating rosacea symptoms like flushing using one of the newer pulse dye lasers, the Vbeam. This laser is designed to target the redness in the skin, reducing the discoloration while leaving surrounding skin and tissue intact. There do tend to be more side effects with the Vbeam, because it is a stronger device than the BBL. However, the results also tend to be better. I encourage you to work with a very experienced, board-certified dermatologist to ensure your procedure is as safe and successful as possible. Keep in mind that rosacea is chronic, which means the focus is on managing the symptoms and not “curing” the condition.

Raffy Karamanoukian, MD, FACS · Answer

Vbeam laser is an excellent modality for patients who have rosacea, blushing of the skin, facial and body telangiectasia, spider veins, redness, post surgical redness, and skin flushing. It is a safe procedure that can be used at varying depths to help treat micro blood vessels in the skin. We also use it in our office for facial skin inflammation, keloids, and hypertrophic scarring. It is an important part of scar therapy. Vbeam can be combined with chemical peels and other lasers, but experience with the treatment is essential. The Vbeam laser does not affect deeper tissue. Schedule a consultation with an expert in Vbeam and you will find it to be an excellent modality for many skin types. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Rebecca Fitzgerald, MD · Answer

PDL (pulsed dye laser) has been around for a very long time (since 1983) and it's the still the most effective procedure for reducing redness that is beyond the minimal.As noted from other responses, a pulsed dye laser (we use Vbeam) does have a stronger side effect since it's a stronger treatment. Lasers use concentrated light to target a certain color - in this case the red of blood in the vessel. The Vbeam also has the ability to reduce brownish discoloration. To get a full understanding of Vbeam, and vascular lasers in general, this video with the inventor of Vbeam and some of the top laser experts is an excellent resource. Video: Advantages of VbeamBBL is not a laser, and has no downtime to speak of. It's a gentler procedure and is based on the use of filtered broadband light. You can think of it as upper level photofacial. Your personal description of the issues of concern would indicate the use of BBL, but in all fairness, you would need to see a dermatologist to make the best determination. There are many options for reducing facial discoloration and improving the appearance of your skin.

Jason Emer, MD · Answer

The best treatments for capillary issues are vascular lasers such as PDL, Excel V, Aerolase, Venus Versa IPL, Laser Genesis or Yellow laser. The settings are determined on a per case basis, so it is best to consult with an expert to determine what will work best for you. We often combine vascular lasers with non-ablative fractional lasers such as Clear + Brilliant or Venus Viva for better results. I would suggest seeing a cosmetic dermatologist for a formal evaluation. Best, Dr. Emer.

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  There is a fundamental difference between those two treatments - pulsed dye laser is a true laser with one wavelength that specifically targets the blood vessels and hemoglobin in them, and the BBL is "Broad Beam Light" that is less specific and has several wavelengths coming out of the opening of the handpiece.  Both can be effective for redness but the vascular laser tends to have longer lasting results and is probably better for the small capillaries and spider veins.  BBL can do fine with overall redness and light brown pigment, so it depends on the skill and experience of your laser specialist.  I would definitely research their experience and see their own before and after photos.   Some places might not be able to afford a pulsed dye laser unless they were a valid dermatology clinic that treats serious issues like port wine stains.  Most spas do fine with BBL or IPL and don't need the more advanced technology of a vascular laser.  Best of luck.

Thomas D. Griffin Jr., MD · Answer

Thank you for your question. As a strong supporter of BBL technology, it’s not a fair comparison to a true vascular laser like KTP or PDL. If your goals are simply to remove broken capillaries or reduce redness, PDL is the answer. That being said, it comes with a cost. PDL often causes swelling and can induce bruising whereas BBL really doesn’t. Routine treatments with BBL has long term anti aging effects that PDL has not shown. It is for this reason that I often do both treatments in the plan for my patients. If redness is the goal, I treat initially with a 585 laser once or twice and finish the treatment with BBL. hope this helps.