I just had my 3rd photoderm treatment with Dr Zenda Garcia-Lat in Paramus, NJ.
Its still too early to discuss improvements from this treatment (my sense is
that it takes 6-10 days to see impact), but I thought it would be of interest
to let others know how she approaches each treatment because, in my mind, it is
a model of how photoderm treatments should be done. I will say that the first
two treatments have virtually eliminated the burning I would feel essentially
every day around noon.
We start by taking 3 digital photographs from front, left, and right side, in
EXACTLY the same position and lighting as prior photographs. She then loads
them onto her computer, and has some special software that allows us to bring
up two photos side by side to compare progress from previous treatment. We
discuss these quite thoroughly, and we generally agree on where we see
improvement and where we don't. One of my big complaints about photoderm web
sites is the quality of the before and after photographs: ever notice how the
'after' picture often has a good deal of "flash whitening' that will make
anyone look white as ghost (strangely, one nevers see this in the 'before'
picture ...). Zenda actually studies the previous picture while looking
through her view finder to get the framing as close as possible. I really
respect this thoroughness.
We then induce a flush with topical niacin, which makes me 10x redder than I've
ever been before. The flush kicks in within minutes, and she took another
front-on picture to see where I was the most red - this is a useful procedure
to monitor one's progress: as photoderm destroys more of the vessels, the
niacin produces less and less of a flush, although I believe even non-rosaceans
will experience some flushing with it.
At Dr Bitter's recommmendation, I have been using a special topical anesthetic
called Betacaine that differs from conventional EMLA in that it is not supposed
to cause vasoconstriction (the dream of every rosacean, except when you're
about to undergo photoderm and you want to be as red as possible.) However, I
did some experiments at home after tx #2 and convinced myself that application
of the Betacaine was indeed causing blanching. Zenda was most interested in
this, so I put some on my chin and nose only, and we waited 20 minutes for it
to take effect. She then took another round of photos, and indeed I had lost
the niacin flush on the areas treated with Betacaine. I am now thinking that I
will do all future treatments without the Betacaine, simply becuase I can
tolerate the pain and I want to leave no issues unresolved. Again, I really
admire the fact that she was willing to take the time to hear out my concerns,
and tolerate my obsession for experimentation.
We then moved to the treatment room, where we once again did the niacin since I
my flush was wearing thin. I am very interested in the operation of the
photoderm machine, partly because my PhD is in nuclear engineering and in prior
life, I did computational modelling of radiation transport. Zenda graciously
tolerated all of my detailed questions concerning impact of various settings,
and we spent at least 10 minutes fiddling with various settings to establish
impact on the 'aggressiveness' scale, switching between Epilight and photoderm
heads. (I felt like a little kid driving his parents car down the driveway for
first time ...). After discussion the treatment-settings du jure, we did the
treatment, with various crystals and a double pass over some troublesome areas.
Again, she would carefully explain what setting were being used (one's eyes are
covered during the treatment to protect from flash) as we moved along. Some of
the zaps were pretty painful, but its tolerable. The treatment itself probably
lasted 40 minutes or so, using Epilight with 3-second recharge time, and doing
total of 171 pulses.
One thing she did mention is that since she was trained by Bitter Sr, she is
prohibited from releasing the settings. Hence, she did not give me a printout,
but openly discussed at every point what was being done. (I suspect I could
claim patient rights and get the printout, but its no big deal ...).
We finished the treatment, and she handed me a cold pack to soothe my face.
Had some increased redness, of course, but by time I got home an hour later, I
looked pretty normal.
All told, I was in her office for 2.5 hours (!!), and even spoke to her husband
(and co-practioner) briefly. I must say that I have never dealt with a
physician that takes as much interest in serving her patients as Zenda has. I
can't say now, of course, what will be the final outcome of my 5 treatments,
but I do believe that I am getting the best possible photoderm experience.
Rick