Why Didn't my Pulsed Dye Laser Treatment (For Blood Vessels) Work the First Time?

Question

I was told in the consultation that mine was not a severe case and that she could remove most all of the blood vessels from my cheeks and chin, as well as lighten a little patch of the "mask of pregnancy" in the initial treatment, with the possibility of needing a second treatment for a touch up. After the swelling and redness went away, I still have all of the vessels on my chin and nose, all of the mask of pregnancy, and more than half of the vessels on my cheeks. What could have happened?

Rebecca Fitzgerald, MD · Answer

Pulsed dye laser goes after red color and that's why it's used for vessels in the skin. The laser creates a certain level of heat that begins a coagulation process in the target vessels. It is a "process" and seldom does one session clear an area.

	To make the treatment tolerable (and safe) the energy levels have to be kept in a certain range so that you do not have skin burns or severe bruising. The tradeoff is that you then need multiple sessions to get the veins to clear while not risking burns.From a safety standpoint is actually better to under-treat than over-treat.

	As to getting rid of brown, there are systems with dual technology that can be used for getting rid of red and brown, but laser for melasma (aka pregnancy mask) is indeed a little trickier and often other treatments will manage it better.

	Sun protection will be helpful for both issues.

Michael Contreras, MD · Answer

I'm glad you asked this question because it brings up a number of important points.  Pulsed dye laser (PDL) is very effective for facial vessels, but it often takes at least 2-3 treatments for maximal improvement.  Many factors need to be considered when treating facial vessels and pigment including the following:

	Different sized vessels (e.g. small red, larger purple) respond best to different settings.  It can take more than one treatment to target vessels of different caliber.  It is sometimes a matter of trial and error to figure out the settings that will work best for a particular patient.

	Bruising settings are generally more effective than non-bruising settings with PDL.  Of course, this means 7-10 days of prominent bruises.

	Pigmentation generally does not respond as well to PDL as it does to intense pulsed light (IPL).  Melasma, in particular, tends to be very resistant to laser, and it is most responsive to a bleaching cream (hydroquinone, tretinoin) in combination with rigorous sun protection.

	I suggest that you discuss these points with your dermatologist and consider scheduling another treatment when you have enough downtime to accept some bruising.

Ritu Saini, MD - Account Suspended · Answer

The pulsed dye laser is very effective at treating generalized redness, such as from rosacea, and broken blood vessels.  However, how well the treatment works often depends on how aggressive the treatment was.  The new generation of pulsed dye lasers allows us to treat more conservatively so that the patient does not leaved bruised (at sub purpuric settings).  The downside to this is more treatments are often needed.  The upside is less downtime for the patient.  I would discuss your expectations and whether you can tolerate more or less downtime with your provider.  Lasers for melasma are not always effective and can result in a worsening of the hyperpigmentation.  The pulsed dye laser is not really the treatment of choice for melasma.  There are other options such as topicals and chemical peel regimens that may be more suitable for you.

Why Didn't my Pulsed Dye Laser Treatment (For Blood Vessels) Work the First Time?

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Why Didn't my Pulsed Dye Laser Treatment (For Blood Vessels) Work the First Time?

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Everything you need to know about Pulsed Dye Laser

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