Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

I am in my mid-twenties and have been suffering from severe ocular rosacea that has not responded to any treatment. On top of that, I have corneal nerve damage resulting in disabling corneal pain. I need to wear a prosthetic device for the corneal pain, but the ocular rosacea is keeping me from using the prosthesis. So it is crucial for me to treat the ocular rosacea.

There is a new treatment for ocular rosacea and meibomian gland dysfunction, utilizing IPL. This procedure is done by an ophthalmologist, not a dermatologist.

The ophthalmologist that developed this treatment uses the Dermamed International Quadra Q4 Diamond Series. I am not sure what exact setting my doctor does for me, but generally speaking, it is set at the acne treatment platform for fitzpatrick skin type 1, as well as the vascular platform. The fluence is set from 8 to 12 J/cm^2 with a pulse width of 20 to 30 milliseconds depending on the skin's response. Treatment is a double pass from ear to ear. The idea is that the IPL closes up the telangiactasia that is bringing inflammatory particles to the meibomian glands on the eyelid margin.

Every patient needs a different number of treatments, ranging from 2 - 12 treatments, spaced 4 weeks apart. After that, maintenance treatments are needed every 3-12 months for the rest of your life.

For me, I have had 5 treatments so far, with minimal improvement and so I forsee a few more in the future. I am also Asian, so to decrease the chance of hypopigmentation, my doctor uses a setting that is slightly lower than his other patients.

I have heard about fat loss and skin damage (indentations, hollowness, etc) resulting from IPL. Is this machine and the settings that my doc uses safe for the skin? How likely can this machine cause skin damage, compared to other IPL machines? How "strong" of a setting/machine is this compared to other IPLs? Also, how many treatments are TOO much? My doc is very confident in the safety of this treatment, but his is not a derm/plastic surgeon, and no studies have been done on long term treatment.

Here is a link about the treatment if you need more info:
http://www.toyosclinic.com/media/docs/t ... ndrome.pdf


Thank you for your time and commitment to being open about safety and possible side effects of laser treatments!

hi,
honestly, i do not know the answer to your question. this is something you must speak with your physician about. i wish i could be of greater help in this matter.
best,
sml

Hi Dr. Lam,

Thank you for your quick reply!

I have asked my ophthalmologist about fat loss/skin damage from general IPL and he said he has never heard of it happening before in the history of IPL ......but then again he is not a derm or plastic surgeon.

But I am under the assumption that you are one of the few docs that have seen patients who have experienced skin abnormalities that is possibly due to IPL. And you have commented that "stronger intensity" IPL machines are more likely to cause this.

So I am guess some more general questions would be:
1. Have you ever heard of the Dermamed International Quadra Q4 Diamond Series causing skin damage/fat loss to patients before (regardless of what it was used for)?
2. And more generally, do you happen to know if this particular type of IPL machine is "stronger intensity" or not, compared to other machines? Is this a machine that you use?
3. And in all your years of experience, for your patients, generally speaking, how many IPLs is the limit before you decide its too much?

My questions are more general IPL questions; they not specifically pertaining to my treatment.

Thank you again!

again i wish i could be of greater help but i have limited experience with the complication you are speaking of. you really should ask a cosmetic dermatologist that question. i would be guessing here and i make it a point not to offer guesses but educated responses.
best,
sml

Dr. Lam,

I am disappointed you do not have an opinion for this gentleman.
Given the advertisements on you website for the extensive amount of procedures your practice performs and your experience I would have anticipated some general comments which would not have been "guesses" and should not have medical-legal implications.
As an ophthalmologist, I certainly have concerns about the uncommon complications that can occur from IPL treatment. Dry eye is a huge problem for our profession and I hope Dr. Toyos' procedure is successful. However, for me, that will mean performing the procedure and dealing with possible complications.

hi,
i am sorry that you are disappointed. i only know what i know and i know what i don't. i go to 10 meetings a year and i truly try to keep up with information but can't even though i specialize in one area of the face. this is why i rely on my colleagues: dermatologists and oculoplastic surgeons to help me fill in gaps of my own knowledge.

also, sorry, i had to delete part of your post. this forum is intended to have people ask me questions and not for members to dispense their own medical opinions or advice. hope that is ok with you.
best,
sml

Dr. Lam,

I do not mind at all.
Hopefully we can both find definitive answers at some point regarding this subject.
Half the fun of practicing medicine is that it continuously changes for us.

All the best!

yes, i am constantly striving every day to learn more and to be better.
much respect,
s.