I have rosacea, acne and very oily skin, with some but not a lot of broken blood vessels, a fair amount of PIH, and several areas of hyperpigmentation that are light brown. I am late 40's but have few lines and have always been complemented on looking a good 10 or so years younger than I am. I decided to do some maintenance, as I was nearing 50, and thought, it would be nice to use less makeup to cover the minor PIH, broken caps, pigmentation, etc. I had one treatment of IPL using a Sciton BBL, 2 passes, one w/ the vascular lesion filter and one w/ the pigment lesion (515 and 560 filters). A plastic surgeon experienced in many cosmetic procedures performed the tx. The machine looked new, there was an inspection sticker dated 2 months earlier on it, and the surgeon's certificate of proficiency in that machine's operation was on the wall. I found the treatment quite painful, like a million hot rubber bands being snapped on my face. I almost couldn't stand it. At the end of the procedure, my face was red and covered in red marks and welts. I had to go back to work, so I waited a few minutes, then applied makeup (I'm really good w/ foundation). and went to work. The dr. said I might have bruising on one area on my upper cheek, on the bony part under the eye, where the vascular tx had been used. The dr. said to use only gentle cleansers, like cetaphil, and no retinA or any acne txs. My face felt warm afterward, but not hot. I did not have any pain afterward.
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.
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.
