Harvey H. Jay, M.D.
45 East 62nd. St., New York, NY 10065
Tel: 212-755-2237 * Fax: 212-755-3359
APRIL 15, 1997
A Leg Up on Ugly Veins
Pulsating light targets bulges and birthmarks
By Deena Yellin
IT USED TO BE that Dulce Roppenecker couldn't stand the sight of her own legs. The entrepreneur and mother suffered from unattractive and painful varicose veins caused by a combination of pregnancy and heredity. She avoided the beach and eschewed miniskirts and shorts lest anyone catch a glimpse of the purplish bulges winding up her legs.
"I didn't want to see the ugly veins," says the resident of Mount Tremper in upstate New York. "I was even embarrassed to show them to my husband." She tried sclerotherapy, a procedure in which a chemical is injected into the veins to decrease the protrusions, but was not satisfied with the outcome. "It was painful, and the results weren't great," she says. Then, last year, she saw a news segment on television about PhotoDerm, a new, computerized procedure that uses pulses of light to destroy unsightly veins and skin lesions. Dr. Harvey Jay, an Assistant Professor of Dermatology at the New York Hospital-Cornell Medical Center, was interviewed on the program and said the technique is noninvasive and does not require anesthesia or injections.
As an energetic businesswoman who is on her feet all day and goes flamenco dancing at night, Roppenecker didn't want a treatment that would require a long recuperation. Jay assured her that after the PhotoDerm procedure, she would be able to dance out of the office.
He was right. "It wasn't painful at all," she says. "Afterwards, I felt no discomfort." She was even happier about the results; smoother, healthier looking legs. "I can really see the difference," she says, noting that the bulging veins have faded away. "Now I can go to the beach and show off my legs."
The PhotoDerm VL is a small, hand-held machine that emits pulses of intense light to selectively damage or destroy abnormal veins or tissue. Invented in 1991 by an Israeli physicist and distributed by ESC Medical Systems in Haifa, it has been used by physicians in Europe for the past four years and in America for the past two.
"It's like a laser, but it's more flexible," says Hillel Bachrach, President of ESC. The advantage of flexibility is that physicians can adjust the wavelengths of light, energy levels and other variables to heat the blood vessels without damaging the surrounding skin, he says.
The PhotoDerm treatment can be conducted in the doctor's office in anywhere from one to five sessions of about 20 minutes each, depending on the severity and density of the area being treated.
At each pulse, the patient feels a mild pin-prick sensation. Typically, there is a reddening of the skin, which disappears in about two days. After the treatment there are no restrictions on a patient’s activity, except for exposure to the sun. Side effects may include local swelling or reddening, which goes away within a few days. In rare instances there may be transitory blistering or burning. Longer-lasting side effects may include temporary changes in skin color, which, in some instances, last up to a few months.
At Jay’s Manhattan office, a patient with severe spider veins on her legs is perched on the examining table. Jay squirts clear gel over the area to be treated, slips on a pair of protective eyeglasses to avoid the harsh rays of light and aims the head of the PhotoDerm machine at a portion of the spider veins on her leg. The machine buzzes and emits a quick lightninglike flash. He examines the vein, which is now turning from purple to red.
This is clearing away nicely,” he tells the patient reassuringly. He repeats this process several times during the 15 minute session. The patient will have to come back for about three more treatments to cover both legs, he says.
Dr. David Goldberg, the chief of Dermatologic Surgery at New Jersey Medical School, the director of the Skin Laser Center of New Jersey and the President of the American Society for Laser Medicine and Surgery, has been using PhotoDerm for several years on patients with varicose and spider veins end is pleased with its performance.
"I have no other technique that works this well on spider veins," he says. PhotoDerm is the first machine of its kind that allows physicians to custom-tailor the treatment according to the patient's skin color, skin type and vein size, he points out. This prevents the surrounding area from being harmed.
If used properly, this machine can be used for a wide range of treatments, he says. The pulsed-light therapy can also remove birthmarks, brown spots, tattoos, scars, sun damage, hemangiomas, stretch marks and unwanted hair painlessly and with minimal side effects, says Jay.
In clinical trials on port-wine stains, 75 percent of the stains achieved clearness of 75 to 100 percent with- in three treatments. Other types of lesions, such as hemangiomas and scars, had similar results.
Mary Gormely, a retired waitress from Manhattan whose hands used to be covered with brown "age" spots, recently had them removed with PhotoDerm. "I think it's fantastic," she says. "It doesn't hurt at all and after a few weeks, the spots were gone. It worked well for me."
Paula Riegel, 61, a learning consultant in New Jersey, recently had hair on her face removed with Epilight. "I did electrolysis before that, but it became very tedious for me to go all the time," she says. After just two Epilight treatments, the hair was gone. "It was very mild," she says. "I didn't have any bad reaction. I'd recommend it for sure."
Insurance coverage for the procedures varies according to the carrier and the nature of the medical problems. For example, while treatments of a cosmetic nature are usually not covered, treatment for such conditions as port-wine stains are.
The procedure can be costly. Jay's office charges $300 for a first treatment and, depending on how many additional treatments are necessary, up to $600. He said the average cost is $600.
Despite the apparent success of the procedure, some doctors have questioned the effectiveness of PhotoDerm, because in some cases it leaves the skin discolored or causes blistering. The critics note that there are other more established methods of treating problem veins such as sclerotherapy, and because some patients have experienced side effects from the intense-light treatment, which has not been used in medicine before, why not stick to the tried and true remedies.
But the study ESC submitted to the FDA last year to obtain marketing approval concluded that PhotoDerm cleared up blemishes in a large percentage of cases and had few side effects.
Jay, who has treated more than 1,500 patients with PhotoDerm, says his patients report a high degree of satisfaction with the technique.
I have seen no side effects whatsoever in over ninety-nine percent of my patients, he says. But he cautions that PhotoDerm only works well for those who know how to use it properly. If you target an area you don’t want to target, you get a side effect, so you have o know what you’re doing,” he says, noting that the settings must be adjusted on a patient-by-patient basis.
Like any physician’s tool, The efficiency of the instrument depends on the skill of the physician using it.”
Goldberg agrees, adding You can’t just turn it on and press the button to get good results.
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