Bruising Necessary to Achieve Results from V Beam for Rosacea?

I had a vbeam treatment done this week and the doctor advised me that it is not necessary to bruise the skin in order to clear redness and broken vessels caused by rosacea. Just wondering if that is true? I have read some information that bruising helps.

Doctor Answers 7

Bruising doesn't cause results, it is evidence that results have been achieved.

With respect to my Dermatological colleagues who have answered this already, we need a little science here. The V-beam laser is a type of pulsed dye laser (long pulse) designed to treat vascular lesions such as port wine stains or the skin vessels of rosacea. Pulsed dye lasers work by emitting laser energy at a 585nm (yellow) wavelength that happens to correspond to an absorption peak of oxyhemoglobin. This means that this color of laser energy is preferentially absorbed by oxygenated blood, which of course is what is in our blood vessels (even veins). The V-beam laser is one kind of pulsed dye laser that operates at or near this same wavelength and has selectable shutter durations and power settings.

Blood vessel abnormalities such as port wine stains are actually capillary malformations, or abnormal dilations of capillaries close to the surface of the skin. The color of the port wine stain (pink to salmon-red to purple) relates to the flow rates (and subsequent absorption of the oxygen bound to the hemoglobin molecules) within these tiny vessels. Rosacea is a skin condition characterized by sebaceous hyperplasia, skin thickening, dilated vessels, and often certain kinds of intra-follicular bacteria.

Same dilated surface capillaries, different cause. Same treatment (as far as the vessels are concerned).

Neither condition has "broken" vessels, and in fact this is a lay term that is incorrect medically, but often used by physicians because that is the terminology patients use. These vessels are (more) visible because they are dilated, not "broken."

To destroy these dilated vessels enough energy needs to be absorbed by the vessel to do one of two things, preferably without damaging the normal skin structures. 

  1. The vessel absorbs enough energy to actually burst, releasing a blush of blood (the bruise) which demonstrates the capillaries in that laser spot received adequate energy to be destroyed. The pulse of energy is timed so that the laser shuts off so fast, heat damage is minimized to other tissues. This combination of proper energy for a specific duration is dependent on vessel diameter, and is termed the thermal relaxation time. Of course, depth of vessel is also important, but these laser wavelengths penetrate only about a millimeter or so before all the energy is absorbed, especially by a port wine stain or the dilated capillaries of rosacea. The bruise takes about two weeks to go away, just like a black eye.
  2. The vessel heats up more slowly and the vessel spasms and the blood is actually constricted away from the vessel. This occurs when the energy is applied slowly, rather than in the half of a thousandth of a second that the pulsed dye laser beam duration is. The vessel (hopefully) heals shut permanently.

A V-beam laser is a long-pulse pulsed dye laser, with shutter durations which can be twice to as much as 20 times the shutter duration (1-10 milliseconds) of the "standard" pulsed dye laser (450 microsecond shutter duration). Typically, this will be enough energy to cause a bruise (bursting) of only a few of the capillaries in a port wine stain or rosacea blush, since usually these energies cause the vessels to heat up and spasm rather than burst. So, a bruise is not necessary, but if it occurs, it always signifies that at least some of the offending vessels have been properly damaged and will now be gone! The V-beam laser can cause enough thermal damage to blister and scar skin, so proper energy selection is important.

Depending on the size (diameter) and flow rates of the vascular lesion to be treated, V-beam is more nonspecific than the short-duration pulsed dye laser, which is specifically designed to treat the type and diameter of the vessels in port-wine capillary malformations. BTW, pulsed dye laser treatment of larger vascular lesions such as venous malformations or hemangiomas is generally not effective, since the target size of the vessel is too large for the energy and pulse duration of this laser. V-beam treatment may be more effective, or other recommendations need be considered. (Outside the scope of this discussion.)

So, bruising DOESN'T "help." It is simply a sign that the capillaries that you want destroyed burst and can be considered "gone." The absence of bruising doesn't mean that the treatment was ineffective, but it COULD mean that. It's all in the energy, the vessel size, the depth and flow rates of the vessels, and therefore the skill and experience of the doctor choosing the laser type, settings, etc. It's not about laser brand names!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

V-Beam for Redness and Rosacea

Most doctors now agree that bruising is not necessary to get good results with the V-beam laser.  It is not necessary, but sometimes it helps.  The bruising settings on the laser are sometimes better at getting rid of stubborn broken vessels (vessels as opposed to redness). Some studies even show that for redness, it is more effective to NOT bruise (and instead stack pulses or do multiple passes with the laser at settings that do not bruise.)

So the answer is that you do not usually need bruising to get good results.  The V-beam is often a series of 4 or 5 treatments.  So I often start with settings that do not leave bruises for the first few treatements, and only increase the settings to "bruising" levels if necessary for stubborn areas during the last few treatments.

Todd Minars, MD
Miami Dermatologist
3.7 out of 5 stars 6 reviews

No bruising necessary

The V Beam laser is a laser that treats red veins and broken blood vessels as well as red cherry spots, and red birthmarks (hemangiomas, port wine stains).  I use the V Beam laser for rosacea patients with great results. Bruising is not necessary to achieve results for broken blood vessels and redness on the face due to rosacea, however this is a side effect that could happen with the laser treatments.  My patients have some slight redness and possibly swelling for 24-48 hours immediately following treatment.  Usually a series of 3 treatments are needed to achieve desired results.

Mandy Lynn Warthan, MD
Dallas Dermatologist
5.0 out of 5 stars 1 review

V-Beam is great because it is effective without bruising

The old pulsed dye laser would leave everyone bruised.  The newer Candela V-Beam lasers are equally effective.  What is amazing about the newer technology is that you do not need to bruise someone to have superior results.  Your rosacea can be treated effectively without bruising the skin.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Bruising not necessary with VBeam

When used to treat birthmarks like portwine stains, bruising may be helpful and I typically use settings that do bruise. When treating rosacea or telangiectasias (enlarged blood vessels), bruising is not mandatory though may occur as a side effect. I typically try to use settings that have low chance of bruising and most patients are happy with blood vessel reduction after 2 or 3 treatments.

Daniel Berg, MD
Seattle Dermatologic Surgeon
4.0 out of 5 stars 4 reviews

Bruising after v-beam - not necessary

It's not necessary to have bruising to get a response from v-beam. Most patients develop redness after the procedure. Bruising can be diminished by icing the area right away. 

Gary Goldenberg, MD
New York Dermatologist

Bruising Not Needed for Laser and Rosacea

Bruising is not required to treat the redness associated with rosacea with a VBeam however typically areas that bruise respond more quickly and efficiently. 

Kavita Mariwalla, MD
New York Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.