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Blistering during Smoothbeam... How to prevent

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#1 SkinRN

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Posted 31 January 2004 - 08:41 AM

Hi everyone... I have been reading alot of posts about blistering during Smoothbeam and I just have to comment here. I own a Laser Center and use the Smoothbeam, as well as the VBeam and Gentlelase. There are many factors that go into finding the right setting for the Smoothbeam. First of all, the tech should be performing test spots with every treatment and look for the correct tissue response. If they don't know what they are looking for and don't understand the skin and how it functions then they will be clueless in what the response is. Be aware that a doctor in many states can train even the janitor or secretary to do laser treatments. You don't need any special qualifications to run these machines in some states. Every state has their own rules for who can do this.

The settings that you are all mentioning are the joules that we use "12,13,14". What is even MORE important when discussing the problem of blistering is the cooling spray setting. It has to be adjusted when the joules are adjusted. It is pretty simple... For 12 you use 30, for 13 you use 35, and for 14 it is 40. This is of course an average. BUT.. if a tech has the joules to 13 and the spray on say 25 or 30, you can blister. If you go up on the joules you go up on the spray. If there is too much spray then you will likely hyperpigment. If the laser guide isn't TOUCHING your face you are really risking pigmentation as the cryogen can go under the guide and cause harm.

I just spent all day this past Monday with a Derm in his office doing Smoothbeam and VBeam treatments. He is one of the doctors whose name is on the paper that was submitted to the FDA for acne. So he knows what he is doing. He pretty much always uses these settings::

Skin Type I and II: 14 and 40 (joules and spray)
III: 13 and 35
IV: 12 and 30
V and VI: 10 or 11 and 20/25

He doesn't have problems with blistering and bad outcomes because he looks for the right response before blindly proceeding.

I also use these higher settings when at all possible to improve outcomes. I have never (knock on wood) had a bad outcome, except in a 17 year old boy who didn't wear sunscreen and went in the sun for 8 hours one day despite warnings NOT to do this. He is hyperpigmented and we are treating it with a steroid cream and hydroquinone. But nobody has EVER blistered.

With acne scarring and the pictures that are posted on the Smoothbeam website and other doctor's sites I want you to realize that those settings were at 14 and 40 for ALL of them. I realize that this is a HIGH and PAINFUL setting. We don't use Emla or Elamax (now called LMX). It is only 4 or 5% lidocaine and in my experience NOT strong enough. We get ours formulated for us by a pharmacy and it is 10% Lidocaine, 10% Tetracaine and 4% Prilocaine. MUCH stronger and alot more effective. There is no reason a doctor can't get this for his office. All he needs to do is get a formulating pharmacy to do it. We use Hollis Pharmacy in Nashville TN. The pharmacist's name is John Hollis. He will ship anywhere in the US. All your doc needs to do is fax a Rx for this laser cream!

I really hope this helps give you some knowledge about who to go to and questions to ask. I got this info from Candela and the doctor who did the research on this laser. It WILL work when used properly. Hugs to all!

#2 OursFan

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Posted 31 January 2004 - 09:19 AM

Thank you so much for sharing this information with us. This proves to me that SmoothBeam is technique dependent and that we should have someone do it that is properly trained and experienced.
~ Tamara

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#3 Anna

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Posted 31 January 2004 - 12:42 PM

SkinRN,

Thanks so much for posting! I am sure you have saved a lot of people's skin with the information you provided. I wish I lived closer! I would feel extremely comfortable in your hands.

Again, thank you and please stop in again!

Anna
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#4 GoldRex

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Posted 31 January 2004 - 03:22 PM

SkinRN, how much do you typically charge for a package of Smoothbeam treatments? Thanks!

#5 Guest_ObiWontonKenoli_*

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Posted 31 January 2004 - 04:45 PM

Skin RN thanks for posting this important info.

I do have very similar scars like the guy on Candela's pic (my temples look like that on both sides). I have a pretty big 1/2 inch in diameter rolling scars on my right cheek also that I'd like to get rid off. My skin tone also similar to the (Asian) guy on the website

Here's what I have done so far:

First Treatment: about 720 zaps at setting 12 (no hyperpigmentation).

Second Treatment: about 650 zaps at setting 13/14 combined (lots of hyperpigmentation but they're now back to normal already).

Third treatment (couple weeks ago). setting 13 for 350 zaps. Reason why the zap count is low because the practitioner said she didn't want to zap the same area twice (like she did on my first two treatments).

Am I going to see any improvements at all with what I'm doing? I was planning on doing 4-5 treatments, and after finishing my 3rd I don't see much improvements on my face, except for the compliments from the people at the treatment center. Not that i don't trust them, but I just want to get an unbiased opinion.

I hope I'm not spending my money without any good cause.

I also post this hear instead of PMing you because I hope your answers can also help out others in the similar situation.

Thanks for your time.

#6 SkinRN

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Posted 31 January 2004 - 08:12 PM

ObiWonton... these settings are probably fine for you. I wouldn't change anything. I would give it another try. Are you using any other methods to help it along? I combine microdermabrasion with the Diamond Peel wand (particle free system) and use that along with Smoothbeam to improve results.

Gold Rex.. I charge $1900 for a series of 6.

Anna.. thank you. I am in SC, where are you?

#7 LoveGreenSmoothies

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Posted 31 January 2004 - 08:47 PM

Thanks SkinRN,

You confirmed what I had suspected. It makes me mad untrained, inexperienced people allow people to think they're in capable hands.

I would trust you to perform it as well. Wish you were closer sad.gif
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#8 Anna

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Posted 31 January 2004 - 09:10 PM

SkinRN,

I'm in very green but rainy Seattle! I hear South Carolina is beautiful though. I have a friend whose mom was a former Miss North Carolina!

Have a great day!

Anna
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#9 plateaukid

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Posted 31 January 2004 - 10:41 PM

SkinRn,
Thanks for all this detailed info. I now have a better understanding of how Smoothbeam works. Now I feel a little bit better about the whole thing.

#10 stillhere

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Posted 31 January 2004 - 10:56 PM

I just had a smoothbeam Monday, got one good sized blister by my nose. Not very big really but bigger than the tiny ones I got on my first treatment which were maybe 3 mm in length and almost like little lines. I'm unsure why it happened. The tech was reluctant to even go to a level 12 on my skin. I'm not asian or hispanic but have just a very slight tinge of olive in my skin. I normally wear a very light to slightly medium makeup which matches my skin perfectly. I'm uncertain the category my skin type is but I wish I could have had higher settings. This was my last one of a series of 4. Do most people start on a lower setting and then go up? This was what was suggested to me. I must say It seems my skin is responding to this level 12 much more than the level 11 in my 3 previous treatments. Even after a week, It may be my imagination, but it seems to have really tightened up my skin and made a few scars seem less obvious. I suppose it could be an accumulation of all 4 treatments. :-k

#11 SkinRN

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Posted 01 February 2004 - 07:36 AM

tryingtoimprove- some people start on lower setttings and then go up. On a Skin type I or II I might start at 13 or even 13.5 (the newer software allows us to increase by 0.5 joules). I would look for the response. Then I MIGHT go to 14. It is a clinical decision I make after assessing the response. Again, we are looking for significant erythema (redness) on the skin. If you see the epidermal sliding sign or Nikolski sign (where the skin slides over the top of itself when you push on it laterally) then you know you are too high and you need to back off.

I am surpised you got blisters at 11 and 12. I am guessing the cooling spray was too low for you and that caused it... not the joules amount.

emmanuel ... This is upsetting to me as well, believe me. In general these lasers are very safe. However it isn't fair to charge someone for a full charge and then give substandard service because the tech isn't intelligent or experienced enough to go to a high enough setting.

Here is a link to our website if anyone is interested. I can't take credit for it other than the text and colors... I just had a really good designer. I own this along with my MD spouse and I LOVE what I am doing now. I am also a licensed ethetician and do many of these treatments myself! Beats hospital work any day! It is a joy and privledge to help people attain the skin they have always wanted!

#12 fromchicago

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Posted 01 February 2004 - 12:23 PM

6 for $1900 ?!?!?

Don't you find that you be way too expensive? Especially for south carolina?

I mean, I thought if you get get all 6, there should be a deal.

320/treatment isnt exactly a deal.

#13 SkinRN

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Posted 01 February 2004 - 02:24 PM

I think the prices are more motivated by how saturated the market is, as well as the level of service that you get. South Carolina is always the last to get with new technology (or at least it seems). The other 2 places in the state charge $400-450 per treatment, without any "packages"... so my prices, for the area are actually very good. This equipment isn't exactly cheap..... not to mention the $75,000 a year malpractice insurance costs, $7500 per year umbrella insurance, rent, salaries, cost of goods sold, utilities....etc. Actually we are just breaking even at this point. Do I want to make money? Of course I do.. that is the American way. I started the business on a credit card and a dream and I sacrificed alot of good years putting my husband through medical school to get to this point. So no, I don't think our prices are too high. Espeically when you consider the option of Accutane... which isn't too cheap either. Add up the side effects, out of pocket lab costs, doctor visits, out of pocket drug costs. We don't even charge for follow up visits, consultations, or doctor visits. We have alot of people on Obagi and we don't even charge our patients for a "doctor fee". Considering that the derms here charge people $75 to walk in the door for 10 minutes, we are pretty fair, and our patients love us because we spend an enormous amount of time with them. We allow for an hour PER PATIENT for the treatment time so that NOBODY ever feels rushed or hurried. We (the RNs and the MD) personally CALL each and every one of our patients after the treatments to follow up and check on them. How many other MD's do that ? We are available to our patients 24 hours a day, 7 days a week via cell phone.... So if there are after-hour needs, our patients can reach us. So what we give is alot more than just a quick laser treatment. We don't treat our patients like numbers. I think that you have to consider every aspect of a medical practice before deciding if they charge too much. The Derm in a big city who charges $400-450 per treatment has a "tech" there that gave one of my patients (who came to us after she went to them for 2) a "full face" treatment with 100 pulses on level 10. She got ZERO results(no doubt).... I did a full face treatment with over 500 pulses at level 13.5 and she had great results for acne after one visit. This lady feels extremely ripped off my this practice and I can see why. I think that we do an outstanding job servicing the community and our patients do too. We are booked 4 weeks in advance and we have people now coming to US from those bigger cities. They have gone to other practices and dealt with the total lack of caring for long enough. They tell us that we are a breath of fresh air... and I hope that never changes. If it is does I will quit.

#14 animegirle

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Posted 01 February 2004 - 04:43 PM

I have had problems with breakouts post Smoothbeam, as well as some of the others on this board. Do you see this in your experience?

#15 SkinRN

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Posted 01 February 2004 - 06:25 PM

Yes and this is totally normal and necessary as the keratin that has built up within the deeper layers of your skin will be purged out through the follicle. Your doctor should have expalined that to you.

I had this area on both of my cheeks that was "thickened". It never would really come up to a head, but it was always there.... bugged me too! About 3 days after my first Smoothbeam they all came up and out. They were little hard pieces of sebum that would've still been there without Smoothbeam. Now my cheeks are totally smoootthh. After a few treatments this normally stops.

#16 animegirle

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Posted 01 February 2004 - 07:01 PM

Thank you for the answer. How many treatments have you had? Did you have scars or were you just using this as a "skin treatment"?

#17 SkinRN

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Posted 01 February 2004 - 07:08 PM

animegirle.. I looked at your pics.. you are a really pretty girl! We all have our levels of comfort with our skin, but yours really is nice! I have seen so much worse. But I realize that for you , it is an issue.

I struggled with acne myself for years after my kids were born 6 years ago. It all started then... severe cystic acne that really really got me down. I have always tired to look my best and I felt so very frustrated! A year ago exactly, the local Derm wanted to put me on Accutane. But for personal reasons I felt it wasn't a good choice for me. [-( That was when I started seeking alternative treatments. :-k When I finally got my own skin cleared up it gave me the confidence I needed to open my own Medical day Spa. I had always been interested in going back to Esthetics school, but my own skin problems always prevented me from following that dream. I felt that nobody would really listen to an esthetician who had terrible skin herself! Now I don't even wear makeup except for a little eyeliner and mascara and lip gloss! biggrin.gif/ I never thought that would be possible. I always take out my own before and after pictures to show my clients that I REALLY DO understand how they feel! So now I am on a mission to give others that confidence to follow their dreams and become the people that God intended them to be! Best wishes in your journey!

#18 SkinRN

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Posted 01 February 2004 - 07:13 PM

I had post-inflammatory hyperpigmentation after breakouts.. not really pitting scars. I lucked out there. I cleared that up with Obagi and the Vitalize Peel from Skin Medica. (Also something you can only get through a doctor's office.I initially did this through a Facial Plastic Surgery practice. The Esthetician there was the one who encouraged me to go back to school.) Both my sister and brother had to take Accutane and had some scars left over. Unfortunately they both live across the country from me so I can't treat them.

#19 SkinRN

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Posted 01 February 2004 - 07:16 PM

animegirle.. I forgot to say... I have had 4 treatments myself, and 2 VBeams. That along with about 8-10 Vitalize Peels over the last year, and Obagi for 3 months now. I have also done a Timeless Peel from Cosmedix line... I like those alot too... deeper than the Vitalize and great for hyperpigmentation. It was a constant struggle for me, even after I finished school , until I did Smoothbeam. It was the BOMB for me personally.

#20 GoldRex

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Posted 02 February 2004 - 01:20 AM

SkinRN, I'm very interested in picking up a package of 6 treatments through your spa. Those 6 are generally at the 14 joules setting?

Also, I'm on tazorac .1% gel right now, which has made a marked difference in the texture of my healthy skin, and now, closing in on two months since I first started, it is killing my acne completely. I'm immeasurably pleased by this, and plan on staying with tazorac for as long as possible.

However, if I stay on tazorac while I have my treatments with you, how long would you say I should refrain from using it before the treatment? Perhaps a week? I'd like to contact you off the forum with questions, and actually set up a date, and I'd like to do this stoon...

I'd probably fly into Dulles, because of family in the area, and then drive down to Florence. I live in Chicago.

Thanks in advance.