When treating scars with Pulsed Dye Laser, I expect to see some bruising but this can happen in varying degrees. When performing the treatment, your Plastic Surgeon should be able to see the vessels react to the light. Depending on the amount of vascularity and treatment settings used, this reaction may fade to a red within a few seconds and not stay a bruised color. This having been your first treatment, your doctor is still getting to know how your skin responds. Everyone is very different and settings may have to be adjusted. I always prepare my patients for a series of treatments, whether it is for a red scar, Rosacea, or birth marks. Best of luck!
Most dermatologists and plastics would take things easy with the first treatment- this is because we use this as a 'test dose' to see how your skin reacts and how much downtime ensures. We can easily give prupura or bruising by decreasing the pulse duration and or increasing the fluence.
I ALWAYS tell patients that 3-4 treatments are needed for optimal outcomes, and the first treatment is ALWAYS conservative. Once patients are comfortable with the treatment and know what to expect, I decrease the pulse duration and push up the power- this results in bruising, and better outcomes. You are indeed correct that prupura or bruising is the desired outcome, however you are exception to the rule as you are well versed in this desired end result. Not everyone is as well read as yourself.
If you are comfortable with bruising- go for it..... this will improve your scar. Tell your specialist that you know what to expect and they will use the optimal parameters.
All the best,
Dr Davin S. Lim
Laser and cosmetic dermatologist
The V-Beam is the gold standard for redness and rosacea. The old pulsed dye lasers left everyone bruised. The benefit of the newer lasers is that you can accomplish the same results with little or no bruising.
It usually takes several treatments to get the best results.
There are a number of settings on this laser which determine whether you will experience bruising. There was a recent paper in the Derm Surgery Journal which proved that the results with the use of a non-bruising parameter were just as good as those using a bruising parameter. I would wait 4 weeks to judge your results: don't base it on whether you experienced bruising.
Not everyone gets bruising after a pulsed dye laser treatment. Factors such as skin type, type of lesion treated and the laser settings can all influence whether bruising occurs or not. I would wait a month or two and see how the redness looks. It is possible that your treatment was fine, even without bruising. Sometimes treatments need to be repeated to get the best result.