Rosacea and Vascular Lesions

Rosacea/Telangiectasias and Vascular Lesions Treatment in Ottawa

What is rosacea?

Rosacea is a chronic skin condition that causes redness in the face. It’s a common skin condition that begins as continuous blushing or flushing, and visible blood vessels can be seen on your face. It may also produce small, pus-filled bumps. These symptoms may appear for weeks to months at a time and then disappear for a while. Rosacea can be mistaken for acne, other skin problems or natural ruddiness. Rosacea can appear in different ways. 

Here are some of the examples:

• Thickening of the skin on the nose, ears or chin 
• Inflamed, red bumps, papules and pustules (pimples) on the cheeks, chin or forehead
• Visible, tiny blood vessels
• Rough, dry, scaly skin that can often sting and/or burn

How do you treat rosacea?

There are two components of redness to treat. The big visible telangiectasias (red or blue veins and capillaries visible around the nose and on the cheeks), and general redness. 

At Inovo Medical, we treat your rosacea with the excel V+ (Cutera), a dedicated vascular laser. It treats both components of redness: the visible telangiectasias and the general redness.

We can treat your blood vessels with the 2 wavelengths required for optimal results (1064 and 532). The 532 nm (KTP) wavelength is absorbed strongly by haemoglobin at the surface: fine facial vessels, broken capillaries and diffuse redness. The 1064 nm (Nd:YAG) wavelength penetrates deeper, for larger or bluer vessels, and it is the safer choice for medium-to-deep skin tones. Contact cooling protects the surface of the skin at each pulse.

We also own the Fotona SP Dynamis Pro, an excellent long-pulsed Nd:YAG laser: 1064 nm is a genuine vascular wavelength, and the device still earns its place in the clinic. We bought the excel V+ anyway: for vascular work, we wanted the best tool for that one job, not simply a very good one. 

How does rosacea treatment work?

The laser targets the blood vessels that cause the redness associated with rosacea by delivering laser energy to the haemoglobin in the blood. The blood in these tiny vessels heat, coagulate and collapse. When the red zones are large and wide, we use the same laser at a lower setting and run multiple passes over the areas being targeted. Visible blood vessels will either disappear or their collagen will increase and they will become invisible.

Can I treat my rosacea with Intense Pulsed Light (IPL) therapy?

We treat rosacea with a laser, not with IPL, and the reason is the way the clinic is built: each problem we treat gets a device built for that problem, and when that device is a laser, a wavelength chosen for that target. What we avoid is a single light source used to do a little of everything. We treat blood vessels with the excel V+, which selects between its two vascular wavelengths: 532 nm for fine vessels at the surface, 1064 nm for deeper or bluer ones. We treat brown spots and tattoo ink with a picolaser, the Fotona StarWalker, where what matters is not only the wavelength but a pulse short enough to break up pigment. And we leave resurfacing to a device built for resurfacing, our Opus RF plasma.

IPL is not a laser. It is a broad-band lamp: it releases a wide range of light at once, roughly 500 to 1200 nm, narrowed by a filter but never reduced to a single wavelength. The problem is not the label; it is the spread: the energy is shared between several targets instead of being aimed at one. On a single distinct vessel, that spread is what shows: the light covers the whole area instead of concentrating on the one vessel we are trying to close. A little of everything at once, and nothing in particular.

One of those targets is your own pigment. Melanin absorbs the same light as the blood inside a vessel, so part of the energy stops at the surface of the skin instead of reaching the vessel. That can leave marks behind: spots, or areas lighter or darker than the skin around them. The risk is highest on tanned skin and on darker skin tones, where there is more pigment at the surface to absorb the light.

That also matters for the vessel itself. If part of the energy stops at the surface, a vessel can be heated without being closed, and a vessel that is only partly heated fills again once it cools: the redness returns, sometimes with a pigment mark now sitting on top of it. Rosacea is a chronic condition: it comes back with time whatever we use, our laser included, and touch-ups are part of the plan. What we want to avoid is a session that leaves a new mark behind while the vessel is still there.

That is why we treat a vessel here with a laser that emits a single wavelength at a time, 532 nm or 1064 nm, chosen for the blood inside that vessel and set for your skin tone. One problem, one device built for it. 

How would you treat rosacea with textural issues?

Often, rosacea will lead to other types of damages, such as dilated pores, enlarged nose (bulbing) and scarring. This can be remediated using the Alma Medical’s Opus RF device. The device uses the RF two ways.

• It creates plasma over the skin to resurface it.
• Remodelling and production of collagen and elastin leads to skin tightening and smoothing.

Because the Opus RF is not a laser and is pigment independent, it involves less risks of hyperpigmentation and can be safely performed on every skin type. Being as strong as a CO2 laser, but with minimal downtime and complications, this device combines the best of both worlds to produce optimal results. It’s the best option for resurfacing!

What about other laser options?

For resurfacing, fractionated options such as Fraxel (or the erbium fractionated mode of our own Fotona SP Dynamis Pro) involve a significant amount of downtime with less results. Additionally, individuals with darker skin are at risk of post-inflammatory hyperpigmentation. We value our patients’ time and money, which is why we choose the OPUS RF Plasma.

Are there other ways to help with my rosacea?

We suggest the use of Nizoral shampoo 2-3 times per week and leaving it on your head and face for 5 minutes. A prescribed topical medication can also be prescribed to aid in the treatment process. With every treatment, it starts and stops with you! 

Remember, rosacea is a chronic condition. While we can markedly reduce the visible redness, it tends to slowly come back. Touch ups are recommended but time frames between each session may vary per each person’s condition. Make sure to read about rosacea triggers and blushing to prevent an exacerbation of symptoms following a  treatment!

Benign Vascular Lesion Removal

We use the same excel V+ laser and the same process to remove the following:

• Small varicose veins on legs under 5 mm (click for page). 
• Cherry angiomas, hemangiomas, spider angiomas 
• Other vascular lesions

Hemangioma removal

Spider vein removal